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Wednesday, February 25, 2015

Catching Up from Paris

Between driving through storms, reaching my vacation spot, getting over more storms there, and then heading off to Paris for IHE meetings, I've not spent any time here too long, so I'm overdue.

IHE PCC has been looking this week at Workflow, Remote Reading for Radiology, CDS for Radiology and our newly christened accompanying component call Guideline Appropriate Ordering (GAO).  We've also looked at Remote Patient Monitoring, which is simply Continua's framework recast as an IHE profile, and what is now known as Clinical Mapping (CMAP).

GAO is looking at different ways to integrate the ordering process with clinical decision support in a lightweight way.  One proposal is to use RFD with a CDA document, the other, is to develop a FHIR service endpoint which accepts the proposed order, some clinical and demographic data, and responds with a classification of the proposed order (in guideline, not in guideline, no guideline available), and possible alternatives, along with an "authorization".  This is principally to support the requirement that certain imaging orders be accompanied by an evaluation of appropriateness of the order by 2017, or no payment will be provided.  However, we can see already how this can be applied to the Order Placer and Order Fillers in Laboratory, Pharmacy, Cardiology and other profiles from other domains.  It can also support prior authorization, and a few other possibilities.

The CMAP profile will likely use FHIR's ConceptMap resource and the $translate operation it provides to map from IEEE to LOINC (using the Device Mapping option), or SNOMED CT to ICD-10 (using the Billing Option).

I've got way too many balls in the air, this year, as I'm basically working on every topic.  Somehow I thought my "retirement" as PCC Cochair would be easy.  I just dropped the IR and rearranged the remaining letters to become coach.

The BPMN work went through a brief review of standards in the early part of the week.  Admittedly I did a small amount of market research before settling on BMPN, and got called on it.  Mostly I relied on the opinions of other experts I highly trusted not to steer me wrong.  Fortunately, I came prepared with a good deal more for this meeting, and we did rightly (I think), settle on the standard with the greatest Market awareness (2-3 times more than its closest competitor), if not penetration in the Healthcare space.  So, it's still based on BPMN, which is good.  The other thing we did was look at whether we wanted to make this a profile.  We decided against it on two counts: The DSUP CP 613 being processed by ITI addresses one of our issues.  Secondly, the other reason would be to get actors to use BPMN, and we want to make sure we get the BPMN right.

In other activities, we came very close to resolving our long-standing PCC-0 issue, the missing Document Sharing transaction (which we will call PCC-1).  I have a few more edits to make to that CP and we'll be ready to send it out for broad review.  Lastly, we have some actor cleanup to do.  We discovered we had 26 different actor names in PCC, and we figured out how to clean a lot of that up by updating workflow profiles.

The newly proposed common names for workflow participants are:
Service Requester
Service Dispatcher
Service Scheduler
Service Performer
Workflow Monitor
Workflow Manager

Only a couple of workflow actors don't merit one of these names, so they have one-off actor names which may also be renamed to be more reusable [BTW: The difference between the Service Dispatcher and the Service Scheduler is that the latter needs to look at a resource calendar, the former does not].

So, the week is rapidly coming to a close, and I'll have more to report tomorrow night.