Orders & Observations WG

Welcome Welcome to the Orders & Observations Work Group Wiki Site. On these pages we will manage notes and discussions in progress to support the development of V2 and V3 materials by the Orders & Observations Work Group which includes Laboratory. Leadership Co-Chair: Hans Buitendijk; 610-219-2087, hans.buitendijk@cerner.com Co-Chair: Patrick Loyd; +1-602-366-0346, patrick.e.loyd@gmail.com Co-Chair: Lorraine Constable; 780-951-4853, lorraine@constable.ca Co-Chair: Robert Hausam MD; 801-949-1556, rrhausam@gmail.com Co-Chair: Ken McCaslin; +1.610.650.6692 ,h.kenneth.mccaslin@accenturefederal.com Co-Chair: Riki Merrick; +1 916-216-0052, rikimerrick@gmail.com Co-Chair: JD Nolen MD, PhD, MSPH; 816-983-6098, jlnolen@cmh.edu Co-Chair: David Burgess; , burgessd@labcorp.com Project Fac: Hans Buitendijk Publishing Fac: Patrick Loyd / Lorraine Constable Vocab Fac: Robert Hausam MnM Fac: Patrick Loyd Conference Calls and Minutes Dates: Weekly on Thursdays starting January 29, 2009 Time: 13:00 - 14:30 EST Phone Number: +1 (770) 657 9270 Participant Passcode: 398652 Link to OO WG minutes on hl7.org Mission The mission of the Orders and Observation work group is to define information exchange capabilities to support the order/scheduling and clinical event management/reporting requirements between the stakeholders in the healthcare organization regarding patients, non-patients, people, other species, or inanimate objects. These information exchanges are not limited to intra-organizational transactions, but may cross organizational boundaries. These information exchanges may involve messages, documents, services, and other HL7 constructs. Approach The Orders and Observations work group is current developing v3 messaging artifacts based on the conceptual model depicted below. Charter The basic charter of the Orders and Observation work group is to continue to support the ongoing development of Version 2.x and ensuring that equivalent functionality is present in HL7 Version 3.0. Work Products and Contributions to HL7 Processes The Orders and Observations work group plans on creating and maintaining artifacts in the following areas: - Version 2.x, chapters 4, 4a, 7, 13, 17, and parts of chapter 8 General orders and results Lab test orders and results Lab Automation Specimen management Bloodbank Radiology orders and results Medication prescriptions, management, and administration Dietary orders Supply Logistics Healthcare devices orders and observations Clinical Trials Product Experience It should be noted that many of these areas of information exchange overlap with other HL7 work groups. Since Orders and Observations has responsibility for ongoing maintenance of 2.x standards in these areas and many of the overlapping work groups work solely on V3, this overlap will continue and will require formal coordination with various work groups. When delineating responsibilities with other work groups, the Orders and Observation work group focuses on ensuring general/composite order/scheduling and observation/clinical event information exchange capabilities are: available across the various work groups involved in orders/scheduling and observations/clinical events consistent within domains and across versions. Version 2.x implementation guides related to the above chapters. Responsible for patterns, messages, documents, services, templates, and implementation guides for: Version 3.0 Orders Domain Including template contributions to Version 3.0 Scheduling Version 3.0 Clinical Event Domain (Observations) Version 3.0 Laboratory Domain Version 3.0 Specimen Domain Version 3.0 Blood, Tissue and Organ Domain Version 3.0 Common Product Model Version 3.0 Materials Management Formal Relationships with Other HL7 Groups The Orders and Observations work group has formal relationships with the following HL7 groups, in many cases as a result of V2.x and V3 content overlaps. Anatomic Pathology Clinical Genomics Clinical Statement Healthcare Devices Imaging Integration Patient Administration Patient Care Patient Safety Pharmacy RCRIM Structured Documents Structure and Semantic Design steering division Formal Relationships with Groups Outside of HL7 The Orders and Observations work group does not have any formal relationships with groups outside of HL7 at this time.

O&O Wiki Content O&O Home Laboratory Ballot Status OO Projects Orders Domain Composite Order Laboratory Order Observations Domain Observation Request Common Observation Other OO on FHIR FHIR Workflow discussion OO Dynamic Model Version 2 OO Change Requests OO WGM Agendas + + + News + + + 08-May-09 OO Change Request page added 03-Feb-09 OO wiki pages updated 29-Jan-09 Lab WG has dissolved and merged with OO 12-May-06 Welcome to the new O&O wiki page!

Scope

The initial scope of this committee is to migrate the contents of Chapters 4 and 7 from Version 2.3 to

Version 3.0. To that end the committee will define the respective models as described in the Message

Development Framework. While the primary focus for Version 3.0 is to encompass Version 2.3 capabilities, the committee will not exclude new material. In this context, for example, the committee encourages current users of the standard to submit z-segments for inclusion in Version 3.0 The primary focus post Version 3.0 is to aggressively expand the richness of the model with new material.

Throughout the modeling and message definition, the committee will encounter overlap with other subject areas. Order messages do not only contain the request for a service, but more and more require supporting information such as financial/insurance information, diagnostic context, consent or waiver information, and other clinical context.

During the initial definition of Version 3.0 it will be critical to remain involved in HL7 efforts that focus on migration strategies from Version 2.3 to Version 3.0. While the Implementation Guide will function as the main catalyst to provide migration strategy alternatives/suggestions, the committee feels it is important to contribute as necessary.

Potential overlaps exists for problem lists with Patient Care, clinical trial registrations with ADT, scheduling with Inter-Enterprise, medical record data with Medical Records.

The scope does not include topics such as the inventory aspects, and work orders.

Scope Examples

An order is a request for material or services, usually for a specific patient. An observation is a clinical statement or series of statements about a subject, usually a patient. These orders and observations may not need to be associated with patients who are people. Non-patient or non-people patient orders and observations are included in the scope. The following types of orders and observations have been or will be considered:

• Orders - medications from the pharmacy, clinical observations (e.g., vitals, I&Os) for the nursing service, tests in the laboratory, dietary orders, radiology tests/treatments, linens from housekeeping, central supply, lab tests for animals, cultures from counter tops, etc.
• Observation - clinical laboratory results, imaging studies, EKG pulmonary function studies, measures of patient status and condition, vital signs, intake and output, history & physical, surgery reports, outcomes, severity and/or frequency of symptoms, drug allergies, physician and nursing history, physicals, progress notes, operative notes, etc.