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January 2012 WGM San Antonio

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PC San Antonio WGM 2012 Jan

PC Monday Jan 16 2012

PC Monday Q1

Present: Stephen Chu (chairing the meeting), Wlliam Goossen, Michael Tan, Susan Matney, Hugh Leslie, David Rowed, Kai Haitmann, Adel Ghlamallah, Rajan RAI, Meredith Lewis, Jennifer Sisto, Michael van der Zel, Ray Simkus, Kevin Coonan.

Action items Q1:

  1. Short introduction of members present in the meeting.
  2. Agenda setting for the week: The agenda was changed. Move to accept the changed agenda v05. 1st Kevin, 2nd Susan vote: 0 opposed, 0 abstain, 13 in favor. This file has been mailed via PC HL7 mailing list.
  3. Tooling Micheal van der Zel is our official toolsmith. He asks if PC has requirements for tooling. He will collect these and summarize.
  4. Plan for D-MIM / 3 R-MIM ballots
    • Motion to accept the D-MIM and any combination of Patient Care ‘Care Provision’ R-MIM topic artifacts for ballot content (referral, acceptance, query, and care record) to move to ballot. 1st William 2nd Kevin: vote: 0 no , 0 abstain, 12 in favor. Do we need an out of cycle meeting to arrange this? Nictiz is willing to organize this in February 2012.
      • Action item for Michael Tan.
  5. WG Mission and Charter on website review
    • The mission and charter was briefly reviewed.
      • Motion to leave the existing PC mission and charter as it currently is. 1st William, 2nd Hugh, vote 0 against, 0 abstain, 12 in favor.
  6. 3 year Workplan 2012-2014: 3 year workplan to be discussed and re-approved
    • The spreadsheet with the PC project was reviewed. Some items have finished, and will be removed. Others are ongoing priorities such as D-MIM and R-MIMs for Care Transfer Topic (refer and promise) Care Record Query Topic, and Care Record Topic.
      • Motion to accept the changes in Excel workplan 2012 version 0.88. Moved: 1st William 2nd Kai, votes: 0 against, 1 abstain, 12 in favor.
    • Business Plan PC: handled as part of the 3 year workplan.
    • Planning of conference phone calls and other work plans: due to time deferred to meeting on Wednesday.
    • PC planning of work items and meetings for next WGM: due to time deferred to meeting on Wednesday.

PC Monday Q2

Present: Stephen Chu, Wlliam Goossen (chairing the meeting), Michael Tan, Ray Simkus, Hugh Leslie, David Rowed, Kai Haitmann, Meredith Lewis, Robert Dunlop, J.D. Baker.

Walk through and discussion of Patient Care wiki on Care Provision

What are the core R-MIMs?

1. Care Record 2. Care Transfer (Referral and Promise, 2 R-MIMS altogether) 3. Query of patient record contents relevant to the referral

The topic Query of referral status – early work has been done - does get no further development.

Use of template – can be in form of R-MIM or clinical content as xml; application of constraints to HL7 domain models, CSP, etc; and for creation of validation artefacts.

Confusions on template still exist in HL7 at large. Need to find a “standardized” way how to express template and use them in CDA, Care Record, etc – need to work with Structure Document WG on this issue.

Need also to consider moving away from representing templates as graphic notations and consider use of some form of constraint language (and constraint statements) to express templates. Also need to move away from the entry points for each artifact in D-MIM. Need to look for a better way and harmonize with templates.

Ballot materials – beneficial to add information pertinent to different target audience view points, e.g. clinician, modellers, implementers. Each view point also needs to consider the level of abstraction

Kai to review section on “template” and update contents where necessary

Issue of cascading changes when made in one artefacts need to flow through to other forms of artefacts. Model driven tools to support such changes are lacking.

Motion 1:

Accept that each patient care template shall have a template ID according to HL7 methodology and this identifier shall be used for every expression of the same template in different formats including MIF, R-MIM, xml, uml, xmi, etc

Kevin (move), Ray (second)

0 against, 1 abstain, 9 support


Motion 2:

Patient care shall adopt a single approach to template ID generation, and Patient Care shall prescribe the use of template ID.root and template ID.extension for all patient care templates

Tabled for further discussion in another session.

Storyboard – copy and paste from current ballot materials

PC Monday Q3

Meeting was cancelled. Individual PC members have worked on the ballot D-MIM work preparations.

PC Monday Q4. O&O Hosting PC

Care Provision D-MIM was updated with inclusion of the statement collector choice box between the Care Provision and Clinical Statement CMET allowing simplifying R-MIMs that use this. Pertinent information act relationship from care provision to statement collector en component from statement collector to clinical statement.

Care Record D-MIM was updated to replace the care statement with the clinical statement CMET. The structure on D-MIM with Statement Collector needs to be modeled on Care Record The CareEvent CMET has been removed in favor for the Act Class itself. DMIM model is updated, needs correction of choice-box. Care Record needs the choicebox completed and the CareEventClass needs to have all the attributes from the CMET ActClass.

Three kinds of templates for PC D-MIM: Kai identified three types of templates we need in PC for the D-MIM and R-MIMs. 1. Root level templates (care provision class) that constrain a whole message (composition of the message) and reside in the care provision class 2. Structural templates, that allows the CMETs, 3. Clinical Statement Level template that applies to the clinical statement choice box which allows entry-level template levels.

Criterion: have one solution that allows referring to (long) lists of templates, without having to redo the D-MIM every time when a new template is created.

Action item: changes on care record to be done in a similar manner for the request and the promise R-MIMs.

Action item: continue to model this and discuss in PC meeting later this week and have motions to approve.

PC Tuesday 17th Jan 2012

PC Tuesday Q1 Present: Michael Tan, David Rowed, Susan Matney, Stephen Chu (chairing), Ray Simkus, Hugh Leslie, Nicholas Oughtibridge, Kevin Coonan, Elaine Ayres, William Goossen (scribe). Nicholas Oughtibridge gave an overview of the work on ISO 13940 Contsys and the content of this standard. It covers the description of health care works, and actors and processes in it. His presentations and weblinks will be provided. The draft standard could be made available to HL7 PC due to the linkage through the JIC work where Contsys was added recently. Several items seem to overlap with PC materials. But it does not seem a perfect match. Discussion to accept Contsys as DAM for PC lead to conclusion it is too early, but it needs to be considered as candidate. This can follow up on earlier gap analysis and adaptation, such as the concern tracker being similar to health issue thread.

The page is the main Wikipedia, not a separate site http://en.wikipedia.org/wiki/CONTSYS

The web site of the model is at http://www.datadictionary.nhs.uk/contsys


Motion: "That patient care considers the ISO/CEN 13940 standard Contsys as a candidate for the overall Domain Analysis Model (DAM) for the Care Provision Domain, both standards focusing on continuity of care, acknowledging that there have been joint sessions to explore the overlap and differences, and that a gap analysis is required to detect remaining conceptual differences that need to be taken into account during subsequent ballots to follow."  


Motion moved by Ray Simkus 2nd by William: votes 0 against, 1 abstain, 8 in favor.

William presented the results of the modeling with O&O of Monday: Care Provision D-MIM RM000000 version 800.3 statement collector introduced between Care Provision Act and Clinical Statement. This to ease up models downstreams and to allow any collection of clinical statements be linked to the care provision. Care Record R-MIM update to include the clinical statement collector, To include the same statement collector and to have the CareEvent change from CMET to full class because it is only one Act Class.

Motion to tentatively accept these current D-MIM and R-MIM Care Record as changed in the joint PC and O&O meeting versions as the ones to working towards normative ballot in May 2012 (so ready by March). Pending a resolution of the following action items: - ongoing harmonization work with PA on encounter (Kevin and Irma Jongeneel). - class type List versus Container (Kevin).

moved by William 2nd by Michael Tan, 0 against, 0 abstain, 10 in favor.


PC Tuesday Q2 Present: Michael Tan, Susan Matney, William Goossen (no motions due to too limited number participants).

Report back on the question on list versus container: Jean Duteau said that container is just for documents. ActList is the proper act class for creating lists. However, Jean suggested to remove the choicebox and the category act and just have the ActList class with 0..* relationship to CP and CS.

Hence DM 000000 version 800.4 created where the StatementCollector choice box is removed in favor of the Modeling Facilitator’s advice to replace that with the StatementCollectorActList class.

RM002000 Referral changed to version 800.1 - Replaced Care Statement CMET with SupportingClinicalStatement CMET - Replaced StatementCollector CMET with StatementCollectorActList class after advice from MnM on Jan 17, 2012 - Replaced ConditionTrackingEvent local CMET with ConcernTracking local CMET

RM003000 Promise not changed, because no needed but updated to version 800.1

REPC_RM004000UV CareRecord changed to version 800.1 - Replaced Care Statement CMET with SupportingClinicalStatement CMET - Replaced StatementCollector CMET with StatementCollectorActList class after advice from MnM on Jan 17, 2012 - Replaced PatientCareProvisionEvent CMET with PatientCareProvisionEvent Act Class

PC Tuesday Q3

Kai Heitmann, Michael Tan, Ray Simkus, JD Baker, William Goossen (quorum just).

Review of ballot preparation of D-MIM and R-MIMs:

1. Models are done now.

2. R-MIMs 2000, 3000 and 4000: storyboards and dynamics do not need to change. Walkthrough should reflect the updates in the model and need to change for this.

3. Query topic: no change needed at all to move to normative ballot.

4. Looked at intro, explanatory sections: no changes.

5. Interactions overview: chapter 14 of NE 2010. Pertaining to D-MIM and RM002000, 3000 and 4000 can be kept without change.

6. Change requests 000 to 033 and 043 and 044 for CP reviewed. No impact on current Ballot plan, some will affect future ballots. Except for 044: sequence number added to Reason relationship to Clinical Statement.

Motion Michael: To accept this as the current work for the ballot. Kai, 2nd 4 in favor, 0 abstain, 0 against.

PC Tuesday Q4 - Joint PS, SD (SD hosting)

See SD minutes.

PC Jan 18 Wednesday

Q1 Joint with CIC, PHER, CBCC

Presentations of different groups:

CIC update Anita Walden. Emergency services DAM passed, DAM EMS, EMS CDA, all passed Cardiovascular project, ballot reconciled. Plan to expand scope to cardiac imaging. Data elements are defined. CIC is working on trauma project and schizofrenia, which is an FDA priority area. FDG data standards plan list priorities. DAMs will be licenced at no costs (HL7 Board decision). Next steps would be to include terminology bindings. CIC is also working on clinician outreach. There will be a joint meeting with CDISC

CBCC Suzanne: update brief. Current ballot of Behavioral Health was passed, with few negatives. Ongoing work includes terminology binding. Material is implemented in Australia. Security and Privacy DAM is underway.

PHER, John: several projects are ongoing. Immunization DAM is ongoing. Cross paradigm interoperability implementation guide for immunization. This uses 3 HL7 implementations CDA, Message and Services. It will follow SAIF guidance. Vital Records: Death message in v 2.5 has been balotted and other topics like fetal death are balloted in similar way, and now also use of CDA. Friday Q1 and Q2 discussion of PHER on this multi paradigm approach. OMG and IMG are involved. It is hosted by SOA. SDWG is sponsoring this.


PC update D-MIM and R-MIMs / wiki with documentation What will go in ballot can be followed on the wiki. The major changes include removal of Care Statement in favor of Supporting Clinical Statement CMET. The walkthrough for D-MIM Care Provision and RMIM referral, promise and Care Record will be updated to reflect this. Other changes include improved modeling since 2005, such as no CMET for a one class item (Care Entity, StatementCollector, and updating to newest RIM version, datatypes R2 and so on.

PC also discussed using COntsys as DAM. Gap analysis needs to be done.

Emergency Care: Kevin Coonan Update EHR S FM R2, revised profile will be updated. DEEDS specifications of data elements for emergency are currently updated.

PC will request ISO for a copy of Contsys to carry out gap analysis.

Q on next WGM meeting in Vancouver: Wednesday Q3 joint on DAM and DCM style guides Q1 continue, unless discussion with EHR leads to a change.

Wednesday Q2. EHR Hosting Patient Care.

Updates given on projects. Please refer to EHR minutes for details. Decided to keep the Wednesday Q1 joint session.

PC Wednesday Q3. Workplanning

Present: Rajan Rai, Meredith Lewis, Hugh Leslie (chairing), Stephen Chu, William Goossen, Adel Ghlamallah. Mark Shafarman entered after the motions where passed.

PA and PC harmonization:

Motion 1: to accept the PA request that PA and PC have joint responsibility for the Care Provision D-MIM, accepting that harmonization is effective this way and that after normative ballot passes, further changes can only be made in joint WG groups meetings. Moved by William, 2nd by Stephen. Against 0 , abstain 0 , in favor 5. Motion passes.

Motion 2: to accept changes to the PC D-MIM as determined through the harmonization process between PC and PA and that subsequently are to be accepted by both WG using the DMP. Notes to motion 2: Current identified changes include the addition of location, responsible organization, means of transportation to the PCPR Act. Others will follow. Moved #2: William, 2nd Stephen. Against 0, abstain 0, in favor 5.

Action: Irma and Kevin to complete the gap analysis and to submit this to PA and PC. PC to organize a conf call to identify if there are issues with the changes request from PA on the CP D-MIM. Plan conf calls for these PA change requests with issues for CP D-MIM PC plan Doodle vote on the PA change request for CP D-MIM without issues.

PC Wednesday Q4. Allergy/Intolerance/Adverse Reaction Topic Sub-Group

Present: Elaine Ayres, Andre Boudreau(by phone), Stephen Chu, Margaret Dittloff, Adel Ghlamuallah, Maggie Gilligan, Kai Heitmann, Wendy Huang, Tom de Jong, Hugh Leslie, Russell Leftwich (by Phone), Masaharu Obayashi, Carolyn Silzle (by phone), John Snyder, Michael Tan

Minutes – Minutes of the January 3rd conference call were not reviewed. Add to next meeting agenda.

DSTU Extension (Elaine)

Current DSTU will expire in June 2012 therefore the plan is to extend the DSTU. A draft extension document developed with help of Don Lloyd. The document as written was reviewed with the group. ACTION ITEM - Motion: to approve the extension of the DSTU x 2 years Margaret; Tom moved. Voting: 0 against; 0 abstain; 11 support, motion carried The completed document will be forwarded to the Domain Expert representative of the Steering Division.

Scope Statement (Elaine) Scope statement – the wording was reviewed with the group. Margaret noted that if the purpose of the scope statement is to propose a DAM, the intended ballot should be informative rather than DSTU. Co-sponsors: proposed are; Patient Safety, Pharmacy, Clinical Decision Support, Structured Documents, Clinical Statement, EHR, O & O (pending review and acceptance by each group) Facilitators: Wendy Huang + Cecil – Vocab; Michael Tan – publishing; Jean Duteau + Lorraine Constable – data models. Cecil to recommend correct HL7 nomenclature to be used for “project scope” section. Dependence – seek recommendations from other co-sponsor groups for model and project dependencies

Motion: to approve this project scope statement as written and pending inputs from Cecil on correct terms for Section 4a (Project Scope) and 4b (project need) Move: Stephen Second: Andre Vote: 0 against, 0 abstain; 13 in support

Review of Allergy and Intolerance Models reviewed by the work group Quick update delegates/attendees on international allergy/intolerance/adverse reaction models: HL7 Patient Care VA Canada Australian Intermountain Health (including discussion on “failed therapy”)

Review of DAM elements: (Andre suggested the order of these elements). Introduction and history Storyboards and use cases Statement of requirements Glossary Activity & states Common data elements RMIM (current and proposed) Acronyms References

Elaine then did a brief review of existing use cases / storyboards.

Suggested use cases: 1. Observed reaction/condition (allergy or intolerance) [no distinction of allergy/intolerance from informatics perspective] a. Medications b. Food c. Environmental d. Devices e. Latex f. Biologicals 2. A reported reaction 3. A reported condition 4. Creating and maintaining a list of reactions/conditions 5. Sharing a list within one provider organisation 6. Sharing a list between provider organisations 7. Active vs inactive items on the list 8. Query of EHR for conditions/reactions 9. Include use cases to identify severity (related to the symptoms) and criticality (related to the condition) 10. Include a use case to define preferences and the notion of failed therapy

The group needs to review and refine the use cases and then use as a starting point for the DAM.

Changes to the Canadian Allergy Model Revised Canadian allergy/intolerance and adverse reaction hierarchy presented by Andre. A more complete presentation will be provided at the next conference call.

Conference calls: Every two weeks on Thursdays 5-6pm (EST) First call: 2 February

PC Jan 19 Thursday

PC Thursday Q1. Care Plan

Present: Andre Boudreau, Laura Heermann Langford,Stephen Chu,Carolyn Silzle, Susan Campbell, Margaret Dittloff, William Goossen, Maggie Gilligan, Gordon Raup, Elaine Ayres, Hugh Leslie, Thomson Kuhn, Michael Tan, Susan Matney, Ken Rubin, Mark Shaferman

Ken Rubin – SOA update on scheduling SOA – initiating collaboration with domains Defining services to enabling business To explore how SAO and scheduling can be used in care coordination – how to manage resources including care team SOA = black box approach – user asks for something and something comes back, what happens to make something come back is the business of services There are protocols for, e.g. how to ask for medication details, and what are returned are medication information Question for care services: what are the protocols, how do we ask the services what do we get in return Collaborative model – to offer the value of services Question – care plan is at stage of planning and is technology agnostic, how does services fit in? Answer – need to work with domains to define how business services/processes work for them  and how do services support care team coordination and scheduling Mark Shafarman – V3 already has scheduling and should be considered in care plan modelling discussions Care plan implementation can consider using ACT + mood codes + ActRelationships Suggestion – Ken Rubin to present to care plan group SOA and its values to care plan in a conference call after the WGM Andre – will follow up with Ken after the group has completed the SBs and requirements

Perinatology CP SB Walkthrough of the SB The document is on the wiki Comments are invited Discussion to be pursued at the next regular meeting

Status of storyboards: Acute Condition - draft 1 nearly complete Home Care - under external review Chronic Conditions - Reviewed. Third draft completed. Pediatric Allergy/Immunization - Reviewed. Second draft of both. Perinatology - Reviewed. Second draft. Stay Healthy/ health promotion. - Draft 1 nearly completed

Suggestion from William – WRT HDF processes: good to follow But do not use glossary Capture data definitions/metadata as data element specification William to send standard examples of data element specification to the group Work plan discussed as per work plan excel file contents: Itemised deliverable components, need to work on and agree on deliverable dates Target DAM ballot date: possible September 2012 To be discussed and confirmed in next conf calls Feb 1 Good storyboards will make the mapping and modelling of process flows a lot easier

PC Thursday Q2. Joint Templates, SD

Present: Hugh Leslie (Chair), R. Rai, Adel Ghlamallah, Jason Murphy, Philip Wilford, Ben Flessner, David Sundaram, THomson Kuhn, Margaret Ditloff, Elaine Ayres, John Toberts, Mark Shafarman, Kai Heitmann, Gaby Jewell, Vin Sekar, Sarah Gaunt, David Sundaram, Marahara Chiyashi, Shawn Meyers, Bob Dolin, Maggie Gilligan, Rik Smithies

Template “representation” at D-MIM/R-MIM level

Kai Heitmann explained that Patient Care wanted a D-MIM and R-MIM “entry point” for templates, i.e. where templates apply. After discussion in the group it was decided to have three kinds of templates (message level, substructure level and clinical statement level) and the only indication at model level that now is needed would be to indicate the associated classes that carries the respective template ids, e.g. the Care Provision class carries templates of kind “message level”. Mark Shafarman volunteered to bring that issue forward to MnM.

Motion: Template WG will ask MnM to provide mechanisms at any model level for example DMIM, RMIM and Templates, to indicate Template IDs and Template Categories for the purpose of managing the proliferation of models and to add the semantics of Template categories to creation of model instances. Moved: Kai H; Second Mark S; Neg 0, Abstain 0, For 20

New Templates ITS

Mark Shafarman introduced the brand-new project statement (compiled this morning) to create an ITS for templates. It can be seen as the successor of the former Templates DSTU Release 1. The Project Statement was further refined in the group. Bob Dolin said that this project should not have dependencies with the Project “Business Requirements for Templates Registries” as they have different timelines. It was discussed that the ITS for templates is aiming on a canonical representation for templates for persistent storage that can also be used for the exchange of templates between systems. One of the first steps would be to do an analysis of existing “template tools” as there are different approaches developed and used meanwhile. The Project Scope Statement will be further developed Friday morning and brought to TSC's attention as soon as possible.

Development of new templates

Bob Dolin suggested the development of new templates (in addition to those found in the Consolidated CDA guide) as a collaboration between Structured Documents andPatient Care aiming on the representation of patient’s cognitive functions. This would complete the set of the existing templates mostly dealing with patient’s functional abilities.

A Project scope statement will be crafted by Bob Dolin and William Goossen.

PC Thursday Q3. Clinical Statement

Joint w/O&O, SD, PHER - see clinical statement minutes CS January 2012 WGM Minutes

PC Thursday Q4. Clinical Statement

Joint w/O&O, SD, PHER - see clinical statement minutes CS January 2012 WGM Minutes

PC Jan 20 Friday

PC Friday Q1. Templates hosting

See Templates minutes.