LRI+Public+Health+WG+Meeting+Minutes+2011-06-08

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 * Date:** 06/08/11
 * Name**: LRI – Public Health Workgroup Meeting 7

Agenda/Objectives:

 * **Topic** || **Time Allotted** ||
 * Review of Public Health Reportable Lab Results Abbreviated Use Case || 4:00-4:35 ||
 * Review of Dataset Considerations/Required (R, RE, C, CE) Data Elements from ELR Guide & ELR Usage Codes || 4:35-4:50 ||
 * Review of FTF Meeting Agenda || 4:50-4:55 ||
 * Wrap Up || 4:55-5:00 ||

Attendees:
__Workgroup Attendees:__ Natalie Menser, Nikolay Lipskiy, Cindy Vinion, Sara Imholte, John Ritter, Rita Altamore (WA DOH), Ken Gerlach, Kathy Walsh, Dave Shevlin, John Stinn, virginia sturmfels, nam nguyen, Smriti Singal, kosta makrodimitris, Cheryl Liu, Bob Yencha, Xiaohui Zhang, Andrea Pitkus, Freida Hall, Sri Koka, Kate Hamilton

__Panelist Attendees:__ Riki Merrick, Merideth Vida, Ed Larsen, Erik Pupo, Jitin Asnaani

**Action Items:**

 * **Action Item** || **Status / Next Steps** || **Lead** || **Contributors** || **Due Date** ||
 * Finalize document based on changes that were made during the 6/8 workgroup meeting || In Progress || Support Leads || n/a || 6/10/11 ||
 * Review documentation posted to wiki for FTF meeting. || In Progress || Support Leads || n/a || 6/14/11 ||

Abbreviated Use Case Review:
//Trigger Table:// //Activity Diagram:// //Base Flow:// //Functional Requirements://
 * Key Discussion Points:**
 * Introduction:**
 * Many of the participants were not sure why the word “inpatient” was included in the phrase, “In order to adhere to the requirements for Public Health Laboratory Reporting as by inpatient electronic health record systems…”
 * Support leads reiterated the point that the group is not pre-empting or trying to address any future problems for public health reporting. We are simply trying to state the requirements as they apply to meeting the Meaningful Use requirements for sending reportable labs to a PH agency.
 * The overall decision after a round robin was to keep the statement general and not try to make it specific to Meaningful Use Stage 1 requirements.
 * The clause, “by inpatient electronic health record systems” was deleted
 * Scenario:**
 * The word “Agency” was changed to “System” in order to add clarity.
 * A major discussion revolved around the inclusion of both an EHR and an LIS system as being responsible for sending reportable lab results to the Electronic Public Health System.
 * Everything has to come from a certified EHR environment. Because many LISs have modules that provide certified EHR functionalities, perhaps we should leave both in the document so that we are aligned with Meaningful Use.
 * Some districts order all orderables reported while with other tests only if the results cross a certain threshold they are reported.
 * Support leads noted that at this point, a clear decision was not made choosing one over the other.
 * This use case is directed specifically for MU EHR Technology but the underlying guide can be used in a broader sense. If this is added to the beginning of the scope it might be better than in the triggers sections.
 * The group agreed with adding a scope statement/section to address this point.
 * No comments
 * The word “Sent” in row three as an input for the public health agency was deleted.
 * Informational Interchange Requirements
 * The group decided to add the word “Action” as titles for columns two and four. The Use Case Simplification is working on a template for this section.
 * The phrase “Information Interchange Requirements” is something that the UC Simplification group has decided should be used as they have spent time figuring out how everyone will be gathering and recording requirements.
 * Initially, the group had decided to add the LIS reference to the “Initiating system”; however, in the end it was determined that the parenthetical statement in the following sentence, “Electronic Health Record System (or LIS that performs certified EHR technology functions)” will be added to the Actors and Roles table and then the reference wouldn’t have to be repeated throughout the document.


 * __Review of Dataset Considerations/Required (R, RE, C, CE) Data Elements from ELR Guide & ELR Usage Codes:__**
 * The phrase, “jurisdictional boundaries” is used to indicate the differences in reporting requirements between federal and smaller divisions. This phrase will be used throughout this document whenever this distinction needs to be made.
 * Message Content Requirements:
 * This section was used to identify and compare the elements in the ELR guide to those that were pulled out of the Use Case. These are the ones that the group would be proposing for inclusion in the IG analysis.
 * Message contents requirement format is the same as it is on the IG analysis.
 * When these data elements were chosen, usage code detail was addressed using RE and C. Group suggested it might be helpful to identify how this was selection was conducted.
 * Message content requirements were pulled from the spreadsheet Riki put together that listed out the required elements from the ELR guide.
 * A large part of the discussion revolved around adding state specific data elements. Some participants felt that it was necessary to include them because at times there are specific questions that they have to ask in order to report to the state.
 * Group determined that going state specific could get very complicated. Those entry questions don’t have a specific field within the HL7 message and so they would need specific LOINC codes. They should be defined somewhere but it might be out of the scope of the recommendation we would give to the IG analysis group
 * Minimum required data elements you have to have in your system. The following note was added to clarify this: “//Note: The NIST data elements[[file:///C:/Users/smriti.singal/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.Outlook/4N6U9S5U/ONC_LRI_Public Health Workgroup_Meeting Summary_060811_FINAL.docx#_ftn1|**[1]**]] are included as part of ELR guide and therefore part of the message content requirements listed in table 6.//”
 * ELR task force is trying to put together a knowledge base where you can query for certain criteria for a state, but it’s in the requirement development stage at this point in time.


 * __Resolution(s):__**
 * “by inpatient electronic health record systems” was deleted from the Introduction.
 * The following Scope statement was added to this abbreviated Use Case: “The Use Case is directed at addressing the requirements for Meaningful Use for certified EHR technology, for the sending of laboratory results from the EHR to the Public Health Agency. The underlying guide does not intend to replace or exclude other requirements for reporting to Public Health.”
 * “(or LIS that performs certified EHR technology functions)” was added to the Actors and Roles table
 * “Note: This includes tribal, local, state and federal (jurisdictional boundaries) public health agencies.” Was added under the Actors and Roles Table
 * “An EHR system is responsible for sending reportable lab results to the Electronic Public Health System” is the specific precondition in the trigger table
 * The word, “sent” was deleted from the Input in step 3 of the Base Flow
 * “Note: The NIST data elements[[file:///C:/Users/smriti.singal/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.Outlook/4N6U9S5U/ONC_LRI_Public Health Workgroup_Meeting Summary_060811_FINAL.docx#_ftn2|[2]]] are included as part of ELR guide and therefore part of the message content requirements listed in table 6” was added as a note below the dataset considerations table with the associated footnote.


 * __Verbal Consensus:__**
 * A round robin was conducted during the call and each of the workgroup members voted “Yes” to the Abbreviated Use Case being finalized and utilized as the formal recommendation to the Harmonization Workgroup for consideration when they do their analysis to make sure all the requirements for PH are included.
 * The majority of the group voted yes and verbal consensus was reached.


 * __Wrap-Up / Next Steps:__**
 * The goal is to extend this Use Case as part of the long term approach. It would be great to have a list of data elements and what they are required to do.
 * The Public Health Lab Results Workgroup will meet on Wednesday afternoon next week for during the Face to Face meeting.

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