Rad TF CDS-OAT pending updates?

[Dan Konigsbach]

The IHE Radiology Technical Framework Supplement –Clinical Decision Support Order. Appropriateness Tracking (CDS-OAT) is currently at Rev. 1.5 - Trial Implementation.

Are there publicly available drafts/discussions/documents regarding anticipated changes for when CDS-OAT goes to Final Text?

[Kinson Ho]

Hi Dan,

In the regular process, a trial implementation can be promoted to final text after it has been tested at several Connectathons and there is no major outstanding CPs. CDS-OAT has not been tested at several times at Connectathon yet, especially with the most recent updated content specification. So currently it is not pending for final text.

Having said that, we understand that this profile is focus on a very specific area and some vendors may not implement profiles that are not yet finalized. I will put in the agenda in the upcoming April meeting to discuss CDS-OAT and whether we should accelerate final text of this profile and how.

Please let us know if there are any comments that we should consider.

Thanks,

Kinson

On Mon, Mar 30, 2020 at 11:59 AM Dan Konigsbach <dkoni...@gmail.com> wrote:

The IHE Radiology Technical Framework Supplement –Clinical Decision Support Order. Appropriateness Tracking (CDS-OAT) is currently at Rev. 1.5 - Trial Implementation.

Are there publicly available drafts/discussions/documents regarding anticipated changes for when CDS-OAT goes to Final Text?

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[KOdo...@mru.medical.canon]

Hi Dan,

 

Just to add to Kinsons comments, the intention of Trial Implementation is that no breaking changes will be made when going to Final Text unless a significant issue is found during trial implementation.  So TI should be stable enough to do product work. 

 

Best Regards,

  Kevin

 

Kevin O’Donnell

Sr. R&D Manager - Connectivity, Standards & Integration

Canon Medical Research USA, Inc.

www.research.us.medical.canon

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[Dan Konigsbach]

Hi Kevin and Kinson,

 

Thank you very much for your responses.  I hope all of you are managing to stay safe and healthy.

 

Mostly, I want to check my understanding and assumptions about CDS-OAT National Extensions for IHE United States, and thought perhaps the Final Text might have examples and possibly additional explanations.

 

Some of the assumptions that I am hoping to verify:

 

* The CMS-issued AUC Code goes into OBX-8.1 if a Clinical Decision Support Mechanism was consulted  ("ME", "MF", "MG") and into OBX-8.32.1 if not ("MA", "MB", MC", "MD", "MH", "QQ")?

 

* The CMS-issued G-Code to identify a Clinical Decision Support Mechanism goes into OBX-15.1?

 

* The corresponding coding system in OBX-8.3 or OBX-32.3 and in OBX-15.3 is "HPC"?

 

Other questions I had:

 

* I could benefit from more insights into "branch number" (OBX-13) and Appropriate Use Criteria (OBX-17), and into the two cases described for MSH-21.3.

 

* Since the CMS-issued AUC Codes are CPT/HCPCS modifiers, would it be expected, incorrect, or optional to also include it in Procedure Code Modifier (OBR-45, FT1-26)?

 

If you know of any additional resources I should be researching, I'd be delighted to know.

 

Thank you again and stay safe,

Dan

[Dan Konigsbach]

Hi Kinson!

I'm definitely struggling with AUC OBX-5 Observation Value and OBX-32 Observation Value Absent Reason.  Both of these are CWE, and a naive interpretation might be to use the CMS HCPCS modifiers.  But Epic, in their documentation, and RBMA, in a presentation, show that they are populating OBX-5 with Y/N/NA.  No problem - that's an easy mapping.

But, I haven't found anything suggesting codes for OBX-32 Observation Value Absent Reason.  Should OBX-32 use the CMS HCPCS modifiers, even if OBX-5 Observation Identifier doesn't?  Is there another set of recommended codes for OBX-32 in a document I've overlooked?

Anyway, if you are going to bring up CDS-OAT for more review, could I suggest making these explicit in the National Extensions for IHE United States?

Most of all, stay safe, and thank you VERY much,

Dan

[Kinson Ho]

Hi Dan,

I am really sorry for the late reply.

I think I know where the problem is. Reading HL7 v2.9 OBX segment, OBX-5 has variable type. However, in CDS-OAT, it defines OBX-5 to use CWE which requires a coded value. This is more desirable from the profiling perspective as each deployment can choose its required value set. In HL7 v2.9, OBX-32 is defined as CWE, so it should be a coded value.

I agree with you that what value set should be used in OBX-5 and OBX-32 should be defined in the National Extension for US if there is not a common well known value set used.

To your earlier questions:

* The CMS-issued AUC Code goes into OBX-8.1 if a Clinical Decision Support Mechanism was consulted  ("ME", "MF", "MG") and into OBX-8.32.1 if not ("MA", "MB", MC", "MD", "MH", "QQ")?

 

[Kinson] During the development of the revised CDS-OAT, it was leaning towards using the HCPCS codes that CMS will provide, but I believe the codes was not ready at that time. Recommend to have a decision among the stakeholders and  we can then document that as a national extension.

* The CMS-issued G-Code to identify a Clinical Decision Support Mechanism goes into OBX-15.1?

[Kinson] Yes, this is my understanding. Recommend to have a decision among the stakeholders and we can then document that as a national extension.

 

* The corresponding coding system in OBX-8.3 or OBX-32.3 and in OBX-15.3 is "HPC"?

[Kinson] That's correct.

* I could benefit from more insights into "branch number" (OBX-13) and Appropriate Use Criteria (OBX-17), and into the two cases described for MSH-21.3.

[Kinson] There was a discussion whether this is necessary to communicate for AUCs. At that time, the group did not believe this is necessary, but the information was not finalized yet by CMS. So it was left there.  Recommend to have a decision among the stakeholders and we can then document that as a national extension if needed, or removed it if it is decided to be not necessary.

 

* Since the CMS-issued AUC Codes are CPT/HCPCS modifiers, would it be expected, incorrect, or optional to also include it in Procedure Code Modifier (OBR-45, FT1-26)?

[Kinson] I don't recall we had a discussion about this during the development of the revised CDS-OAT.  Recommend to have a decision among the stakeholders and we can then document that as a national extension if necessary.

Hope this help.

Stay safe and healthy.

Kinson

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