Community Based Health Services
CBHS SIG ran an information session to enable people not experienced with/ knowledgeable of HL7 to gain an insight into the organization and its processes. This was specifically designed to cater for people who are going to work on 3 projects based in the Aged Care setting, however was attended by many other people who found this a very helpful exercise. It now being considered that this be an annual event.
CBHS took the Collaborative Care Messages (CCM), as proposed for V2.7 to the Patient Care TC. The TC formally endorsed CBHS to move the CCM towards Ballot. Patient Care will conduct the Ballot on behalf of CBHS.
A competency framework is being developed as a precursor for development of learning objectives, curriculum and accreditation processes. A plan has been prepared to develop a professionally-produced e learning package at an introductory level on the topic “What is HL7”. It will be freely available and widely distributed. The Board is being approached to provide funding for this.
A Glossary has been developed for the EHR System Functional Specification, and international input is specifically requested to ensure its widespread applicability.
- Draft Conformance Clauses and a “How To Guide” for developing conformance criteria for the EHR-S DSTU have been balloted at the Committee level. Some confusion in scope was evident – ie what should be in the functional model vs profiles (granularity)
- EHR TC sub-groups/work items:
- Certification – the US certification agenda, led by the Certification Commission for Healthcare Information Technology (CCHIT) has seen groups set up in the US to look at functionality, security, interoperability, and certification processes. The US certification priorities are ambulatory EHRs (Year 1), then acute inpatient EHRs (Year 2) and broad health information exchange services (Year 3).
- Personal Health Records (PHRs) – the PHR functional model was derived from the EHR-S functional model in 2003, with 64 functions, as opposed to 130. Subsequent activities have included describing what constitutes a PHR; environmental scanning to see what products are currently available and how they fit this scope; and upgrading the PHR functional model on the basis of this work. Conformance criteria will then be developed. Whether this ends up as an EHR profile or a distinct but related model will need to be determined. A critical issue is that PHRs and EHRs will need to be able to interoperate, but they re currently being geared to different markets – consumers vs providers.
- Harmonization – profiles developed by disparate groups require harmonization to be consistent within the HL7 EHR realm, let alone with other HL7 activities. Outcomes to date include the Glossary (see above)
- Long term care – the Long-Term Care Group is trying to develop a long term care profile, but at this stage the group of stakeholders is quite disparate and finding it difficult to consolidate an agenda.
- Paediatric profile (joint with Paediatrics SIG) – a profile is under development.
- Reconciliation of ballot comments - there are 3043 line items to be resolved, and the process was initiated. It is proposed to finalise this work by the end of February.
- Conformance – every function is associated with a set of conformance criteria, which form the basis for determining if the function has been implemented. The overall approach taken is to keep the functional model at a high level, since it has to satisfy a wide range of contexts, and provide the overall range of conformance criteria; and have the profiles translate this into specific contexts, in which product offerings will be assessed against the criteria. There was extensive and at times heated discussion concerning the extent to which the draft standard can mandate specific functions given the breadth of settings to which it will apply while still meeting the intent of a standard, which is to encourage consistency. Accordingly, an approach was taken to include a “conditional mandatory” criterion, in which the condition is mandatory in those settings/circumstances where a specified condition (eg jurisdiction specific legislation) exists
- The EHR Interoperability project has 3 areas of work:
- compilation/analysis of relevant definitions and concepts. A first draft is ready, will shortly be posted to the HL7 list, is being prepared for publication and will be presented at HIMSS in February
- Defining EHR interoperability. The base definition of interoperability adopted by the (US) National Alliance for Health IT (NAHIT) being built upon.
- Developing the interoperability model (specifying characteristics of an EHR record that ensure its interoperability, referenced to HL7 artifacts) and building conformance criteria. The current draft has 101 functions, of which about 30 comprise a minimum function set. It will have the same approach as the functional model – an model and profiles. ISO 21089 (Trusted End to End Info Flows) is a key reference. Public comment on this was from early December 2005 to early January 2006, and input was limited.
- The Emergency Department (ED) SIG has made substantial progress on a functional profile for EDs, strongly led by practicing clinicians (apparently with some international participation. The aim is to ballot this by December 2006.
A proposed HL7 format has been developed and is being trialed for exchange of genetic family history data between applications that use family history data for care provision (including cancer assessment and prevention programs). A demonstration was given of profile collection software used at Massachusetts General Hospital feeding clinical information to a predictive analysis system used in University of Texas.
There was considerable discussion of associated issues including privacy and consent (particularly in relation to other family members), whether genetic data should be allowed to be embedded in the messages without being further encoded as RIM classes and how constraints might be specified and used with genetic data.
(May 2006) The v2-v3 mapping project will be discussed. Committee is looking for ideas on how to engage better. Purpose this week is to gather concerns/issues, crucial blocks that implementers can deliberate on. Low participation to date in Project Registry.
(Jan2006) An online register captures details of contacts, projects, work products – this is being redeveloped.
INM (formerly known as CQ)
INM has its first out-of-cycle meeting prior to the May2006 WGM. Some festering issues related to MCCI (wrappers) and the ATS were discussed, as well as the overlap between the work of the SOA SIG and that of INM. With over 30 attendees it was well attended. The Batch Wrapper was redfined to be a minimalistic grouper for transmission purposes only, which will have an impact on the MCCI material.
INM had two documents open for ballot: Removable Media ("v3 on CD"), and Shared Messages. Ballot reconciliation has started for both ballots. During the WGM we were able to reconcile the last few open line-items of the Sept2005 Webservices ballot and the May2005 ATS and MCCI ballots.
MnM took on an action item to redefine the dynamic model into something that looks like the Interaction Pattern concept. If adopted, this will have a serious impact on the various wrappers.
For the first time ever, INM presented a [Breakfast Briefing] - a meeting to make the co-chairs of other committees aware of some of the modelling pitfalls related to INM's artefacts. This was well received (although attended by a select group); it will be repeated during the next WGM.
In general the WGM went smoothly - again there was no reliable internet in the meeting rooms. INM has accepted a motion to bring amotion to the TSC to address the issue during future WGMs. We were however prepared for this situation, so the synchronization with the action item list on the Wiki went much smoother than during the last WGM.
The meeting was able to agree a structure (effectively an archetype) for Microbiology acceptable to all participants including US, UK, Canada and Australia. Critical to development of this acceptance was a form of diagramming the structure.
- Many minor issues with v3 Pathology were resolved so that v3 Pathology should now be ready for ready for the April ballot.
- A group is starting to work on v3 representations of Histology. They will initially base this work on the existing Pathology structures.
Patient Care TC
Considerable discussion has taken place in Patient Care regarding how to handle particular realm requirements within the domain (& normative) standard. The recommendation from the International Affiliates Meeting was that these should be included in an appendix and tools should be developed to act as filters. There seems to be Substantial work is likely to be required before this is fully resolved
Patient Care has completed the disposition of comments from the V3 Care Provision September ballot. Plans are to publish Ballot Comment that is reasonably stable and should have a good chance of passing DSTU status in May. The upcoming ballot contains new material in 2 areas:
- Major revisions in the storyboards, annex and walkthruh of the D-MIM. The walkthruh will be discussed in portions to make it manageable. Possibly there will be a minor change in the D-MIM itself to refer to the proper Patient CMET (universal) and other Universal CMETS, but this has already been decided upon as ballot reconciliation work last time. It therefore will be for review.
- Major changes in the R-MIM for allergy, intolerances and adverse reactions based on ballot comment of last september ballot. This would also require decisions on the condition and condition node class on the R-MIM level. In addition further working out of a problem list and of 'smal' single observation messages from Canada. Only the items that are sufficiently ready will indeed go in the March ballot.
Discussions with parties interested in producing a CEN 13606 based EHR Extract in HL7 V3 have resulted in the resurrection and refinement of a prototype model with the intent to support the complete EHR Extract structure and include the Clinical Statement Acts at the Entry level of the model.
The comittee will set up informal working conference calls for particular subjects such as order sets and care planning. These will facilitate ongoing work, will probably not go into the March ballot, unless a proposal or workitem can be introduced as informative only. This kind of work will have the potential to be discussed at next May WGM and then perhaps go into formal ballot in the cycle thereafter.
Realm localization – the HL7 Publishing Committee has agreed to host localized material, either for ballot or as realm specific standards. Parameters for holding and accessing realm standards on the HL7 publishing databases are currently being developed.
The services group is very active and is developing 4 specifications (record location and access services, common terminology services, entity identification services and decision support services). An infrastructure group is working on how these are specified (methodology, templates etc). The aim is to ballot the entity identification services in the May 2006 ballot cycle; record location and access and common terminology services in the September 2006 cycle; and the decision support services in January 2007. These will also be taken through the Object Management Group (OMG) processes, as these are collaborative projects. A workshop will be held in the UK on 31 January 2006 to look at this agenda in relation to the NHS program (see HL7 UK site). There is also a degree of informal collaboration and cross representation with the OASIS group.
Structured Documents (CDA)
The Structured Documents TC is developing a Conformance Profile for a Continuity of Care Document (CCD), which is a Clinical Document Architecture (CDA) representation of the ANSI Continuity of Care Record (CCR). This work builds on the HL7 Care Record Summary implementation guides and the IHE cross-enterprise document sharing (XDS) Medical Summary profile by specifying additional sections with CDA Level-3 structured data. Sections currently being profiled include Lab Results, Allergies and Conditions.
Since the last HL7 Working Group meetings, the HL7 Templates SIG has been looking in detail at CEN and openEHR archetypes. Unofficially, there seems a high degree of consensus that they could be adopted as templates subject to relatively small clarification/extensions. There was substantial discussion and a sentiment that 80-90% of the representations of clinical concepts for EHRs can be generic, while the remaining effort is in specifying the technical artifacts required for their instantiation in HL7, CEN, openEHR, etc. It was agreed to continue the comparison of archetypes and templates and begin to articulate the generic versus the technically specific components within the Templates SIG; and to refer questions of how the generic components could be governed to an ISO Planning meeting to be conducted later in the week. This group should also consider archetype/template registries.
- Templates continue to be difficult topic for Modeling & Methodology TC and Templates SIG. Limited progress had been made on the prototype HL7 Query and Constraint Language prototype that was endorsed to be explored in the recent Constraints meeting in Alexandria. It even seem that there was some suggestion that perhaps HL7 should look at existing constraint language such as OWL and ADL and that different languages may be required for different purposes. It was agreed that there need to be some implementation experience using these languages for specifying template constraints.
- While a constraint language for HL7 seems distant, there is a need to represent the clinical knowledge of concept representation that needs to be shared and referenced by other published materials such as the CCD. The need for a process of registering and retrieving concept representations has been identified even if structured natural language assertions in word documents is used until a constraint language is agreed. This would also provide a human readable form of these concepts for consensus building, which could also be represented using various machine readable technologies. This would ensure the policy and infrastructure is in place when the technology is ready.
- The SIG agreed to use PC Storyboards to test template models. A repository of this work is to be established
- Parties interested in producing a CEN 13606 based EHR Extract in HL7 V3 have resurrected discussions, with Dipak Kalra (UK) presenting the CEN EN 13606 standard, supported by Heath Frankel’s elaboration of a prototype 13606 R-MIM including Clinical Statement Acts at the Entry level. This work was generally well received as a potential contribution to harmonization, subject to completion of the model.