HL7 Immunization User Group Monthly Meeting May 9, 2019 2:00 PM ET
Agenda Welcome Poll: Which perspective do you primarily identify yourself with? Updates National Meeting Updates HL7 Workgroup Meeting Update Discussion SISC Guidance Document Review
National Meeting Reminders Tracy Little
HL7 Workgroup Update Nathan Bunker
HL7 Workgroup Update • HL7 WGM and FHIR Connectathon • May 2019 – Montreal • Sep 2019 – Atlanta • Feb 2020 – Sydney • May 2020 – San Antonio • Sep 2020 – Baltimore • FHIR Dev Days • Jun 2019 - Seattle
HL7 Workgroup Update • HL7 Improvements • All new work is being done in FHIR • Older standards (HL7 v2 / HL7 v3 / CDA) are still be supported • Standards development process is being improved: • Work group documents now in confluence: https://confluence.hl7.org/ • Project Scope Statements (PSS) are now being moved online • Major push to improve Implementation Guide publishing for FHIR • Grahame Grieve is leading this effort https://onfhir.hl7.org/author/grahamegrieve/ • US government is going to fund improvements in this area • Zulip is being used for day-to-day work in FHIR and other standards • Deadlines for PSS and ballots are being lengthened
HL7 Workgroup Update • Ballot comments for CDS Immunization FHIR service • Dispositions approved by Public Health • Getting ready to publish the guide for the next ballot
SISC Guidance Document Review Nathan Bunker
SISC Guidance Document Review • Current Guidance • HL7 ACK Messages • HL7 RSP Messages • Lot Number Guidance for UoU/ UoS • LOINC Codes • Preferred/Contraindicated Vaccines
HL7 Ack Messages • https://repository.immregistries.org/resource/guidance-for-hl7- acknowledgement-messages-to-support-interoperability/ • In Scope • MSA-1 and ERR-4 • Out of Scope • Other MSA or ERR fields
HL7 ACK Messages • What does “error” or “exception” mean? Could refer to… • General concept of an error as in something unexpected, unwanted, or wrong. • Error (ERR) segment • Severity code of Error (E). • Acknowledgement Code of Application Error (AE)
HL7 ACK Messages • ERR-4 Severity
HL7 ACK Messages • IIS determines value for ERR-4 • IIS practice and policy • Jurisdiction policy and law • Data quality requirements • HL7 conformance issues
HL7 ACK Messages
HL7 ACK Messages
HL7 ACK Messages
HL7 ACK Messages • Correction and Resubmission • ACK can not indicate which parts of message were accepted • If some of the message was not accepted • Submitter should fix and resubmit all information • Receiver should merge any duplicate information
HL7 RSP Guidance • https://repository.immregistries.org/resource/guidance-for-hl7-rsp- messages-to-support-interoperability/ • In Scope • MSA-1, QAK-2, and ERR-4 • Out of Scope • Other important RSP fields • Caveats • ACK Guidance also applies, especially to values in ERR-4 • Only one ERR segment can be returned, IIS must pick salient error
HL7 RSP Guidance • Three potential outcomes of a query: • Message is rejected • query is not constructed properly, or unable to process • Error occurs in processing • unable to complete search • Query is successfully processed • with or without a match
HL7 RSP Guidance • Setting MSA-1 and ERR-4
HL7 RSP Guidance • Setting QAK-2
Lot Number Guidance for UoU/ UoS • https://repository.immregistries.org/resource/guidance-on-unit-of- sale-unit-of-use-lot-numbers/ • Two potential lot number for every vaccine: • Unit of Sale: The vaccine as sold • Unit of Use: The vaccine inside the sold container that is used • Results of 2016 query to VFC manufactures: • GSK, MedImmune, Merck, Pfizer, Protein Science, Sanofi, Seqirus • Documented patterns of lot numbers used
Lot Number Guidance for UoU/ UoS • Document has these tables; • List of all vaccines know to have different UoU/UoS lot numbers • Assume all others have matching UoU/UoS lot numbers • Estimate of the number of vaccines with different UofS/UoU based on VTrcksS orders in 2015 and 2016 • Manufacturers not included in request for information
Lot Number Guidance for UoU/ UoS • Example from the guidance:
Lot Number Guidance for UoU/ UoS • Do you know of any discrepancies or have other information? • Share information with IISinfo@cdc.org
LOINC Codes • https://repository.immregistries.org/resource/guidance-on-detailed- message-structure-and-the-use-of-specific-loinc-codes/ • In Scope • Order Segment Groups • LOINC in r1.5 • New LOINC defined since but can be messaged in a r1.5 message • Out of Scope • Local codes
LOINC Codes • Different flavors of Order Segment Groups • Immunization Event • Immunization Event (Contraindicated) • Immunization Event (Refused) • Immunization Event with Evaluation • Forecast • Patient Observations
LOINC Codes • Structure of Update (VXU) Z33 messages • Usually has at least one Immunization Event • May have Patient Observation • Order of OBX’s is not defined • Related OBX’s need to be linked by OBX-4 SubId • Not expecting • Immunization Event with Evaluation • Forecast
LOINC Codes
LOINC Codes • Structure of Complete Immunization History (RSP) Z32 • For each immunization history include one of these; • Immunization Event Order • Immunization Event with Evaluation • May include Forecast • If so, should include Immunization Event with Evaluation • Each set of vaccine forecasts has same OBX-4 SubId • All sets are put together in one Forecast (under one ORC/RXA) • May contain • Immunization Event (Refused) • Immunization Event (Contraindicated)
LOINC Codes • Structure of Complete Immunization History (RSP) Z42 • For each immunization history must be; • Immunization Event with Evaluation • May include Forecast • Each set of vaccine forecasts has same OBX-4 SubId • All sets are put together in one Forecast (under one ORC/RXA) • May contain • Immunization Event (Refused) • Immunization Event (Contraindicated)
Preferred/Contraindicated Vaccines • Current specification allows for indicating: • Vaccine group that is recommended • But some IIS want to indicate more specific guidance: • Preferred vaccine (more specific than vaccine group) • Contraindicated vaccine (specific vaccine that must not be given) • A new code will be assigned • A new OBX can then be added to forecast set • Will be permissible under current release 1.5 • Not yet finalized, waiting for LOINC from Regenstrief
Next Meeting June 13, 2019 2:00 pm ET / 11:00 am PT
More Information • Web Links • Subscribe to immunization group http://www.hl7.org/participate/UserGroups.cfm?UserGroup=Immunization • Public User Group Wiki http://www.hl7.org/special/committees/iug/index.cfm • Private User Group Wiki http://iugwiki.hl7.org/ • HL7 Press Release http://www.hl7.org/documentcenter/public_temp_F760602A-1C23-BA17- 0C0D326E635471F9/pressreleases/HL7_PRESS_20140402.pdf • AIRA Press Release http://www.immregistries.org/events/2014/04/10/hl7-immunization-user-group
Contact Information If you have any questions or comments: Kim Salisbury-Keith Kim.SalisburyKeith@health.ri.gov Nathan Bunker nbunker@immregistries.org Kevin Snow ksnow@envisiontechnology.com Danny Wise Danny.Wise@allscripts.com Thank you!
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