20170117 US Realm SC WGM

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US Realm Steering Committee Call Agenda/Minutes

Location: Blanco

Date: 2017-01-17
Time: 7:00 AM
Co-Chairs Ed/Brett Note taker(s) Anne
Attendee / Name
x Calvin Beebe Keith Boone x Hans Buitendijk
Lorraine Constable x Johnathan Coleman x Ed Hammond
x Tony Julian Paul Knapp x Austin Kreisler
x Brett Marquard x Ken McCaslin x Nancy Orvis
Brian Pech x Wayne Kubick Mark Roche
Sandra Stuart . Pat Van Dyke x Anne Wizauer
x Danielle Friend x Eric Haas x Jenni Syed
x Steve Posnak . David Susanto x Craig Parker
x Christol Green x Angelique Cortez x Josh Mandel
Visitor/ Name
x Floyd Eisenberg x Grahame Grieve x Angelique Cortez
x Josh Mandel
no quorum definition



  • Agenda review
  • Discussion Topics:
    • Scope of US core
    • Review list of US realm IGs that we should track
    • Principles for developing US realm FHIR IGs
    • Next meeting date?


  • Called to order at 7:00 AM Central
  • Discussion Topics:
  • Definitions of US Realm vs. US Core
    • Viewed Brett's powerpoint
    • US Realm: Includes all us realm guides and specifications with requirements or constraints that specifically address US needs. Responsible for US specific requirements across the product families.
    • Scope of US core Implementation Guide
      • The FHIR US core IG is a set of profiles every EHR FHIR server must support. The IG provides the data elements, extensions, and terminology to implement the ONC 2015 Edition Common Clinical Data Set and Argonaut requirements.
      • Is it broader than this?
        • Steve suggests changing that it’s a set of profiles every US FHIR based server must start with.
        • Floyd: Currently it is only the common clinical data set…how would people get something else in there? People would like to see other things in US core.
        • Johnathan: The term US core feels like a catalog of specifications that are important to the US. It doesn’t matter what we call it as long as we communicate it clearly. Discussion over whether the focus should be on FHIR.
        • Johnathan: If the intention is to have a set of specs or profiles which every implementation must support, then the term US core feels like it applies to the container, not to one specification defining something very specific. If it is more like a catalog, things can be added.
        • Hans: Core has the opportunity to be wider than CCDS; however, CCDS must be supported. CCDS should be step one or a first component. Should be recognized or not restricted to.
        • Danielle: We need to decide where we need to go next.
        • Ed: We need to change the definition to be more open.
        • Josh: Are we talking about what goes into a guide, or how we label a guide?
        • Ed: We’re talking about both. We want to make sure that the label we use is broad enough to contain the ultimate activities.
      • Scope of US Core: As it grows, how does it grow? Who curates it? A new work group, an existing work group, a US realm subgroup in coordination with specific workgroups?
        • Hans: The challenge is that the resources that are part of US core are currently being managed all over. Discussion over most appropriate option.
        • Grahame: Key question is who owns the authority to change US realm specifications? If this group has the authority to do so, it can choose any of those options. Question is, who’s got the authority? This group has the authority, so it’s a tactical decision on where to do the work.
        • Ed doesn’t want the work itself to be done in this committee; this group should curate.
        • Hans: If we really look at it as a series of projects, we don’t need new governance. We own it.
        • Grahame: If the committee owns the content, the committee is responsible for the content. Technical work would be delegated out.
        • Steve: Three processes around the curation aspect – 1) If there is ongoing work that should be part of the US core container, this group would take on that conversation and 2) When there’s a lot of work going on or getting started and should be a candidate for US core, and 3) When additional work is being proposed that would leverage things that we listed in the US core list, we expect them to start with that. Don’t start work outside of US core in that situation – should be used as a starting point.
        • Ed: Summary - US core is a concept, not an entity, and it is owned by US realm. We can write this up and share with the group.
        • Johnathan: The challenge is fitting this in to the HL7 processes.
        • Nancy: US Core as a concept makes sense because it may look different in two years.
        • Josh: It may need a version number.
        • Johnathan: Would like to see a draft of documenting the processes for adding to US core.
          • ACTION: Ed and Brett will get together to draft the concept and the process.
        • Floyd: There is some urgency to help people understand how to go forward. Need to nail down definition and then process. Hans: We need to make sure the outside world can understand and identify what US core is. There’s a distinction between the CCDS and US core and we need to define that.
    • Review list of US realm IGs that we should track
      • ACTION: Anne to post Dave’s spreadsheet of US realm IGs
    • Principles for developing US realm FHIR IGs
      • Topic for us to think about in the future.
      • Johnathan: First bullet would be “start with US core.” Then we identify who does the work.
      • Discussion over approval process.
      • Floyd states there’s no guidance on universal projects going into US core.
      • Steve: Is US Core the purpose agnostic set of resources?
      • Johnathan: We need a roadmap. Not every US realm FHIR spec is appropriate for US core. Hans: There must be continuity – this will be a learning curve.
      • Brett: The US realm extension process that we crafted should in some way be similar to what we come up with for core.
        • ACTION: Will have initial proposal 2017-01-31
    • Next meeting date?
      • Cancel 2017-01-24 meeting. On 2017-01-31 we will approve the US Core definition.
  • Adjourned at 7:52 am Central

Meeting Outcomes

  • Ed and Brett will get together to draft the definition of US core as well as the process for additions to US core.
  • Anne to post Dave’s spreadsheet of US realm IGs
  • Review formal definition of US core on next call

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