HL7 Immunization User Group Monthly Meeting October 10, 2019 2:00 - PowerPoint PPT Presentation

HL7 Immunization User Group Monthly Meeting October 10, 2019 2:00 PM ET

Agenda  Welcome  Poll: Which perspective do you primarily identify yourself with?  Updates  SISC Update  HL7 Workgroup Meeting  Presentation  Lessons Learned Exploring Analysis of HL7 Log Data  HL7 FAQ

SISC Update Mary Woinarowicz

HL7 Work Group Meeting Nathan Bunker

HL7 Work Group Meeting • Work Group Meeting • WGM schedule • Meets three times a year locations • Jan 2019 – San Antonio TX in the US and world • May 2019 – Montreal Canada • Allows work groups to meet face- • Sep 2019 – Atlanta GA to-face to create/update standards • Feb 2020 – Sydney Australia • Tutorials offered concurrently • May 2020 – San Antonio TX • September meeting includes half- • Sep 2020 – Baltimore MD day plenary presentation • IIS community attends FHIR • FHIR Connectathon Connectathon? • Jan 2021 – Henderson NV • Held two days before every WGM • May 2021 – New Orleans LA

FHIR Connectathon • FHIR is the center of all HL7 activities • Record attendance at both the connectathon and meeting • Many new attendees, a lot of new energy • 400+ attendees at the Connectathon, divided into 40 subject tracks

Immunization Decision Support Ballot • First FHIR standard from IIS community • Official HL7 Public Health work group project for past two years • Ballot #1 completed Jan 2018 • Ballot #2 completed Sep 2019 • Hoping to resolve ballot comments and publish by end of year • Interest group meets every Friday at 11 am ET • https://confluence.hl7.org/display/PHWG/Imm+CDS+FHIR+IG+Project+Calls • Join the group to help create and give input to standard • Motions are brought to Public Health for formal decisions

Scenario #1: EHR queries IIS

What is the scope of the guide? • In Scope • Communication between • IIS (or perhaps other health systems, such as EHR), and • Engine that provides evaluation and forecast for immunizations • To replace current proprietary web service interfaces with common standard • Out of Scope • How the results are calculated by the engine • How the results might be displayed to an end user • How the results might be used to support other IIS functions

What is in scope for ballot #2? • In Scope • Standard childhood, adolescent and adult schedules • Out of Scope • Special conditions that impact forecast • Will be considered for future implementation guides

Ballot Results • 46 Affirmative Votes • 5 Negative Votes • 16 Comments • 1 Duplicate • 3 Negative

Ballot Comments • Consider returning a reference to the guideline used to make the recommendation • Add support for risk conditions and other patient specific attributes • Return additional data in the operation response • Supporting data version • Version of CDS engine itself • Use CDS Hooks • Why not use CDS Hooks? Please document gaps. • How should we handle bad input?

Ballot Comments • Add Immunization evaluation to example • Consider condensing two of the use cases • Use SNOMED instead of CVX • Specifying immunity • Recommendation given for values for Reason codes • Higher priority should be given to the transfer of data from non-IIS systems • Not clear on what this comment means in context of this ballot

HL7 FAQ CDC-AIRA Technical Assistance Team

Primary Language • What values should IIS accept/allow for language and how should this affect reporting or reminder notifications? • HL7 perspective: • Optional field, no expectation that EHRs will support or populate • If supported, EHR should follow PHINVADS table here: • https://phinvads.cdc.gov/vads/ViewValueSet.action?id=43D34BBC-617F-DD11-B38D- 00188B398520 • IIS should expect any of the languages in this set (486 values!) • IIS does not have to store all of these codes or use them • If IIS does not support or recognize the primary language • IIS should still process the rest of the message normally

Primary Language • MIROW Reminder Recall guide • See page 57 • https://repository.immregistries.org/files/resources/5835adc2dc122/mirow_reminder_r ecall_in_iis_full_guide.pdf • IIS should record language • Reminder/Recall notifications should be in preferred language • Indicates a threshold for language support when a certain number of the population speaks that language

Disagreement of NDC and CVX • Both CVX and NDC can be transmitted in RXA-5 • CE data type allows two representations of the same concept • One concept may be more specific (NDC is more specific than CVX) • Receiver may read one or both of the values • IIS should support both CVX and NDC • CVX support is required by the IG • NDC support is needed to support certified systems • What if the codes don’t agree? • Understanding the correct code is critical for IIS

Disagreement of NDC and CVX • Two resources that might help: • https://repository.immregistries.org/resource/iis-functional-guide/ • https://repository.immregistries.org/resource/iis-data-quality-practices-to- monitor-and-evaluate-data-at-rest/ • Ideal solution • IIS should recognize conflicts between values • IIS may return an error or warning about situation • IIS decides on what data should or should not be stored • IIS should have data quality process to engage with submitter and resolve

NIST Tool Warnings • Will generate warnings for messages • Even for NIST example messages! • Warnings indicates: • Areas that the tool cannot verify that will require additional testing to ensure conformance • Especially for RE fields • Warnings are expected: • Test messages sent by EHR systems • Production data from submitters https://hl7v2-iz-r1.5-testing.nist.gov/iztool/#/cf

Disease with Presumed Immunity & OBX-14 • When sending history of Varicella infection • OBX|1|CE|59784-9^Disease with presumed immunity ^LN|1|38907003^HISTORY OF VARICELLA INFECTION^SCT||||||F|||20090412<CR> • What do you send in OBX-14 Date/Time of Observation? • Recent SISC decision: • “If the appropriate value is not known, OBX-14 should remain empty – it is an RE field and is not required in every message instance” • But what if only YYYYMM is known? • Option 1: Send OBX-14 as blank • Option 2: Send only YYYYMM in OBX-14 • This is a conformance violation but should not prevent message from being processed

Lessons learned exploring advanced analysis of HL7 log data Kevin Snow Steve Murchie Envision Technology Partners AIRA National Meeting 2019

Disclaimer • While Envision is an IIS software vendor, this presentation is about the process of discovery. • Analytics products discussed and/or demonstrated herein are generally available to the public. • Approach presupposes availability of a variety of log data. Your mileage may vary.

Four years ago…

Some technology background • Traditionally, large-scale data analysis has required significant preparation of the data prior to investigation • Optimize performance for complex queries • Data warehouse or data mart most common elements • Helps to know what questions might be asked • New technologies permitting much more free-form analysis • “Big data” tools

A need arises • Meet Kevin

Scenario 1 • Using Elastic to quickly answer random questions about HL7 activity https://www.elastic.co/ Demo

Scenario 2 • Using Power BI to assess HL7 performance and diagnose system issues https://powerbi.microsoft.com Demo

Conclusions • Large number of options available • Powerful, inexpensive (at least to get started) • No one tool serves all needs • Different users, different problems • Logging should be first class citizen

Backup

What we’ve seen so far… • Pros • Cons

More features…

Next Meeting November 14, 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!