2010-04-29 Call Minutes

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HL7 Ambulatory Oncology Functional Profile Meeting

Meeting Logistics

Date/Time: Thursday, April 29, 2010 / 1:00 PM – 2:30 PM EST

Location: Phone: 1- 770-657-9270; Passcode: 510269

Attendees

• Helen Stevens (co-chair)
• John Ritter (EHR WG Co-chair)
• Christine Bester
• Dr. John Ellerton
• Dr. Peter Harrison
• Cliff Thompson
• Sandy Thames

Minutes

1. Welcome and Introductions
   • Round table introductions because Sandy was new to the group.
   • Sandy is with the CDC National Program of Cancer Registries. The following is extracted from the email she sent to the group by way of introduction:
     • I’m a Public Health Advisor working on several informatics activities within the Centers for Disease Control and Prevention’s National Program of Cancer Registries (CDC NPCR). I recently became aware of the HL7 EHR-S Ambulatory Oncology Functional Profile work and am very interested in participating/collaborating on this project. Your workgroups have done a great job in developing this document. After an initial review of the document, I was glad to see that reporting to tumor registries was mentioned in section 7.15, but I feel that it is not fully described. I believe that CDC NPCR could provide your group with the public health expertise needed to expand the profile to include additional requirements for reporting to public health cancer registries.
     • The CDC NPCR had originally planned to develop an EHR-S Functional Profile for Reporting to Public Health Cancer Registries, but would rather explore the possibility of integrating the public health cancer registry needs into the HL7 EHR-S Ambulatory Oncology Functional Profile. CDC NPCR will provide formal comments on the document through the HL7 process. However, I feel that we could provide more assistance to the group if we were able to participate in the workgroup activities. Could you please let me know the best way for CDC NPCR to contribute to the development of the Ambulatory Oncology Functional Profile and EMR-S Oncology module? Does the HL7 EHR Workgroup and HL7 Clinical Genomics Workgroup plan to work with the Healthcare Information and Management Systems Society (HIMSS) Integrating the Healthcare Enterprise (IHE) to test and demonstrate the EHR-S Ambulatory Oncology Module?
     • Background information on the CDC NPCR and specific cancer informatics activities that we are working on is provided below.
       • The CDC NPCR is congressionally-mandated by PL 102-515 to fund state cancer registries (currently funds 45 states, District of Columbia, Puerto Rico, and the Pacific Island jurisdictions) to implement population-based cancer registry surveillance systems to collect and report all cancer diagnoses to the federal level for the purposes of research and producing national statistics on cancer.
       • Through the work of the NPCR-Advancing E-cancer Reporting and Registry Operations (NPCR-AERRO) project, we have developed some best practices, guidelines, and recommendations for an ideal cancer surveillance informatics infrastructure that takes advantage of emerging health information technology and national and international standards. NPCR-AERRO uses a collaborative framework to construct a comprehensive model to demonstrate the potential of electronic cancer registry reporting and automated registration to the cancer community and other partners. NPCR-AERRO has been working to coordinate standards with partners at IHE, the EHR vendor community, and cancer registry community (state cancer registries, North American Association of Central Cancer Registries, etc.).
       • For more information on NPCR0-AERRO activities, please visit the project website at www.cdc.gov/cancer/npcr/informatics/aerro.
     • CDC NPCR staff have been working within IHE to develop interoperability profiles for reporting anatomic pathology and physician office data to state cancer registries. Existing HITSP and IHE constructs are used to support the collection and reporting of standardized health information on all cancer patients to state cancer registries.
     • The NPCR-AERRO project has formed a Clinic/Physician Office Workgroup that includes participants from the cancer registry community, EMR vendors, standard setting organizations, etc. to define the content that state cancer registries need to receive from physician office EMRs and the feasibility of reporting these data from physician EMRs to state cancer registries. We would like to invite members of your group to participate on our Clinic/Physician Office Workgroup. Please let me know if you are interested in participating.
   • Sandy was welcomed to the group and we had a brief discussion regarding the objectives and alignment of her work with the AO-FP. It was agreed that there is strong alignment and the NPCR input would be a valuable contribution.
2. Agenda review and approval
   • Agenda approved as published.
3. Approval of minutes from previous calls: April 8th and April 15th
   • Minutes approved as published.
4. Review Actions from previous meeting(s)
5. Ballot Support Question/Answer Session
   1. Sandy raised some questions regarding the level of public health input that would be appropriate for the AO-FP and there was a discussion on how we could incorporate further storyboards and narratives into the existing works.
      • John suggested that we could add an appendix or separate document if we wanted to include storyboards and narratives that were too long to include inline in the overview document.
      • It was agreed that having additional narratives is helpful in explaining the context behind the requirements and conformance criteria.
   2. John Ritter reported that we currently have 83 members signed up for our ballot pool!!!! This is excellent and exceeds expectations (at least Helen's!). The pool contains a good mix of interests including government, vendors, corporations and internationals.
   3. Helen reminded everyone to make sure they are signed up before the deadline and that they notify contacts as appropriate.
   4. Helen reminded everyone that as this is a ballot for comment - we are accepting comments in any form including in-line revision markers and comments and comments from non-HL7 members.
6. Document Review Session
   1. Direct Care 1.0 Functions
      • We completed review of DC.1.1.3.1.3 (Capture Referral Request) - comments and changes are in the document which has been posted to wiki.
      • Some “patient-handling” requirements are often met in a Practice Management System, but those same requirements occur in a traditional EHR system. For example, consider the reception of a referral. Is a referral best received in a PMS, an EHR-S, or both???? To be specific, ARRA mandates that systems need to be certified regarding their ability to receive referrals. But what is actually certified: the EHR-S, the PMS, or both???
        Thus, as Peter Harrison pointed out, a vendor who attempts to build and certify an EHR-S – and relies on the PMS to do certain things (for example, receive referrals), must certify EVERY possible PMS referral-reception-module. This is onerous.
        Therefore, we must clarify the “system of systems” concept that was proposed in 2003 for the EHR-S FM. That is, is an EHR-S actually a composite of multiple EHR systems, or is it a composite of various EHR functionality (regardless of where that functionality lives – even in a non-EHR system)??
      • ACTION: John Ritter to take question regarding scope of EHR system to the EHR WG for discussion as this is not specific to AO.
7. Other business
   • none
8. Agenda items for next meeting (May 6th):
   • this will be the last meeting before the HL7 WGM.
   1. Direct Care 1.0 Functions
      • Starting at DC.1.1.3.2 (Capture Patient-Originated Data)
9. Meeting adjourned at 2:32pm EST.