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January 2013 WGM Phoenix

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Patient Care Phoenix WGM 2013 Jan

PC Monday Jan 14 2013

PC Monday Q1


Stephen Chu, Nehta, Australia

Jon Farmer, Thrasys, USA,

Kim Nolen, Pfizer, USA,

Iona Thraen VAMC / Apelon, USA

Christine Knotts First Databank, USA,

Michael van der Zel, Results4Care , NL, /

William Goossen, Results4Care, NL,

Michael Tan, Nictiz, Nictiz, NL

Susan Matney 3M, USA,

Enrique Meneses, Careflow solutions, USA,

Elaine Ayres, NIH, USA,

Stephen chairs and opens the meeting. The minutes of last WGM are accepted (no comments came in). First item: Stephen puts a motion to appoint two interim co-chairs for PCWG in order to carry out part of the work. This will be accompanied with asking Ian Townend and Klaus Veil about how they see their position. William has announced that he might step down.

Discussion on tasks and projects

0 against

0 abstains

10 in favor.

Due to absence of Klaus Veil, Ian Townend, Hugh Leslie, and Kevin Coonan, and the preparations to step down of William, PC faces that again there is insufficient leadership and decides to appoint 2 interim co-chairs and to prepare for their elections in May 2013.

Michael Tan volunteers as co-chair ad interim and will take up concern as topic.

William motion, Iona seconds.

0 against

1 abstain (Michael Tan).

9 in favor.

Congratulations to Michael from the whole team.

Other individuals are asked to express interest.

Stephen moves that we accept the minutes of last meeting.

William makes an exception for one Quarter that still needs to be added. Given that, the remainder of the minutes are moved for approval.

Motion William to accept the minutes Jon seconding.

0 abstain

0 against

10 in favor.

Question from tooling: how will patient care handle versioning of templates? This is a work item of templates, structured docs and PC. Kai Heitmann is representing the PC position in this, based on implementation work in care record messages in the Netherlands.

The agenda is talked through and the work plan is clear.

For May meeting, it can be more or less a copy from this, since both Allergy and Assessment scales need to reballot.

PC Monday Q2


Stephen Chu, Nehta, Australia (

David Rowed, OpenEHR, Au

Thomson Kuhn, ACP, USA, (

Rik Smithies, HL7 UK, (

Jon Farmer, Thrasys, USA, (

Iona Thraen VAMC / Apelon, USA (

Christine Knotts First Databank, USA, (

William Goossen, Results4Care, NL, (

Michael Tan, Nictiz, Nictiz, NL (

Susan Matney 3M, USA, (

Enrique Meneses, Careflow solutions, USA, (

Gordon Raup, (

Adel Ghlamallah HL7 Canada, (

Helen Drijfhout HL7 NL, (

David Hay, Orion Healthcare (no mail provided)

Ewout Kramer, Furore the Netherlands, (

Tom de Jong, HL7 NL

Hugh Glover, HL7 UK.

Peter Handler, Kaiser Permanente, US.

Joint with FIHR

Topic to be discussed: “Problem”

Ballot Reconciliation is currently taking place and Ewout Kramer presents the FHIR ballot results on this.

Ewout Kramer is presenting the FHIR problem model, and goes through several ballot comments.

Those parts for PC are addressed only this quarter. Workgroup members comments and Resolutions voted on include:

  • Change the description: it is circular
  • Change the cardinality of Supporting information to 0..*
  • Change Location to 0..*
  • Add a 0..1 reference from Problem to Encounter, where the link means "encounter during which the problem was first asserted"
  • Add a 0..1 attribute "asserter" which references the provider/agent/patient
  • Rename dateFound to dateAsserted, because this date is relative to the asserter.
  • Add a 1..1 attribute "subject" which references the patient
  • We do not expect the search to calculate the onset date from the onset age and let this turn up in the search results when search on date.
  • We do not add treating provider nor applicable treatments to Problem. This should be handled through concern tracking, care planning and provision, which are resources yet to be defined.
  • If a stage assessment is applicable, this is indeed done using an agreed upon assessment scale, however it is unclear whether the commenter meant this. Since the AssessmentScale resource does not yet exist, we will defer this discussion and accept Any for now.

Add to ballot sheet:

  • Age is questionable, you might well need a range of Age or even (in practice) a text like "in their teens". => new ballot comment.
  • Todo: discuss the applicability of assessing stages

He uses the Excel spreadsheet for the ballot reconciliation.

Diagrams will become proper UML models.

Williams moves to accept the comments, Rick Smithies seconds.


3 abstains

0 against

14 In favor

There is a discussion about the yes or no use a link of problem to encounter. There are different use cases. Decision made is to include a link, but allow to not use it.

Motion to include by Peter

2nd by David


1 abstain

0 against

18 in favor.

Onset. Can be data or age. Can system translate this to date? Do we need it, there are valid use cases. Can we do it this way, or are we mixing age and date up. The latter is not disputed.

Will be split up into date and age.

Ewout moves, William seconds

0 Abstain

0 Against

18 in favor

We do not ad treating provider nor applicable treatments to the problem.

Motion Rik and 2nd Ewout.

1 abstain

0 against

17 in favor

Motion carries

Assessment comment moved by Ewout and 2nd by Rik.

1 abstain

17 in favor

0 against

(1) PC agrees with the proposal that the Patient Administration Work Group will take the lead in developing the Encounter Resource for the FHIR project. Patient care to nominate leadership and representative persons to work with PA and FHIR on development of Encounter resource. The nominees will need to participate in the Encounter resource development conference calls (weekly) and provide inputs/comments where necessary. Who this will be, will be discussed later this week.

(2) Patient care will take primary responsibility in development of allergy/intolerance/adverse reaction and care plan resources and submit them to FHIR for balloting. These resources will be developed following completion of the DAM ballot for both topics.

PC Monday Q3


Elaine Ayer

Stephen Chu (scribe)

Jon Farmer

Meya Achdiat (Australia)

Maree Ferguson (Australia)

Christina Knotts (FDB)

Susan Matney (3M)

Jean Duteau (Canada)

Adel Ghlamullah (CHI, Canada)

Jamie Cash (AN)

Crystal Wolfe (AN)

Tom de Jong (HL7 NL)

Russell Leftwich (Tennessee)

Michael Tan (NICTIZ, NL)

William Goossen

Monday Q3 - Dedicated to "Allergy/Intolerance" DAM Ballot reconciliation

Elaine gave a brief background on the project:

Re-evaluate the existing DSTU, with worldwide tour of available models around the world

Decided to drop the DSTU in favour of developing a DAM as inputs to further work on the DSTU

DAM submitted for informative ballot in January 2013 ballot cycle

Procedure/Process for dealing with comment disposition:


To deal with typo comments in block - Motion by Jean

Seconded by Russ


14 in favour; 0 - abstain; 0 - objection

Motion carried

Action item: project team to deal with typo comments in block

Negative Major resolution:

Details: see disposition documentation captured on ballot spreadsheet

PC Monday Q4


Stephen Chu

William Goossen

Elaine Ayres

Others: see O&O minutes

Topic discussed:

Allergy/Intolerance and Adverse Reaction project - updates (progress since Baltimore meeting)

Care Plan project - updates (collaboration with SOA and progress since Baltimore meeting)

Stephen sought advice from OO on mapping of Dispenser and Dispensing Organisation details to HL7 v2.4 pharmacy message standards. OO advised to use PRT segment for Dispenser and Dispensing Organisation details in HL7 v2.4 pharmacy messages. While PRT segment is not available till v2.7, OO advised that it would be possible to use PRT segment in earlier versions (e.g. v.2.4) as early adopter.

Other details: see O&O minutes

PC Monday Q5


Stephen Chu

Russ Leftwich

Laura Heermann Langford

Jon Farmer

Enrique Menses

Gordon Raup (

Jon povided a brief background/history on works done by OMG on CMMN (case management modelling notation)

This was followed by walk through the OMG CMMN

Questions raised on the meaning and intended uses of each CMMN constructs and how they are used in health care, especially in care plan


to provide OMG with complex use cases, e.g. DM, rheumatoid arthritis, for OMG to review and evaluate the suitability of CMMN for care plan modelling

to further review and consider how some of the CMMN constructs and operations can be used in Care Plan model and Care Coordination Services definition

PC Tuesday Jan 15 2013

PC Tuesday Q1


Michael Tan (

Susan Matney (

Holly Miller (

Crystal Wolfe (

William Goossen (

Jamie Cash (

Maree Feguson (

Steve Davis (

Ellen Tovves (

Andrew Norton (

John Walsh (

Elaine Ayres (

Terri Monk (

Martin Hurrell (

• On the agenda of Q1 is reviewing the ballot outcome of Assessment Scales.

• Technically we have an overall positive result on the votes. We have a quorum and there were 28 positive votes. The threshold for a positive result is 24 votes.

• Question: which assessment scales are selected for the ballot? William explains that the ballot explains how an assessment scale is modeled and the scores mentioned are examples.

• Propriety scores are often now allowed to be published.

• Elaine would prefer to explain the difference between assessment and screening. The name of the topic will be changed to assessment/screening tools. Add some screening tools ( from malnutrition) to illustrate the possibility of this topic.

• William has no objection to add new examples of scales.

• To add a new scale you need an ID for the scale ( LOINC, SNOMED), not for the terminology used in the scale.

• The system logic is not part of the explanation of the ballot.

• The scales /screening are used in the clinical statement box, ( for example) with an organizer with various assessment scales.

• Five examples from mental care will be sent and added. Action Steve Daviss

• Second comment from Daniel is to reference LOINC appropriately. Action Susan Matney .

• Storyboards and diagrams are missing. The storyboard are placed elsewhere in the Care Provision material. We will link to these storyboard. Action Michael Tan

• The RMIM is using R1 and should use datatypes R2. Action Jean Duteau. • Virginia comments that HMD information is missing. We do not know what Virginia Lorenzi means. Action William Goossen.

• Question on the cardinality of author and patient. The cardinality is currently set to zero to many. The cardinality should always be a minimum of 1 to many for subject and author. The model should be adjusted. Action Jean Duteau.

• Kevin is complaining on the German text. They are not typo’s but umlauts. They will be corrected. Action Michael Tan

• According to Kevin the use of ICD 10 in assessment scales is not clear. ICD 10 will be removed. Action Michael Tan

• Kevin suggests that only universal models should be mentioned in the ballot and that the German examples should only be mentioned in the German realm. We will keep International examples. Action Michael Tan

• Kevin objects to name Clinical Statement Pattern. It should be changed into Clinical Statement. Action Michael Tan

• Classcode with a capital letters should be changed to lower case. Action Michael Tan

• Wrong use of Derivationcode. Derivation expression the means to arrive at the total score. This text has to be changed. Action Michael Tan. • Duplicates will be removed. Action Michael Tan.

• The Class, Mood where there is a match with observationEvent should be explained more better. Action Kevin Coonan.

• The RMIM is screwed up according to Kevin. We do not understand why. This comment is regarded as not persuasive.

Motion from Susan Matney to accept all the comments on the 5 spreadsheets of the ballot review. Second from Elaine. 0 against, 0 abstain, 9 in favor. The changes to be made are not substantive, (only editing). We can regard the ballot as accepted.

PC Tuesday Q2

Patient Care – Joint with Anesthesia


Michael Tan

Susan Matney

Jay Lyle

Enrique Meneses

William Goossen

Jon Farmer

Maree Feguson

Patient care reviewed the status of the different materials in the ballot and identified work for future WGMs and projects.

See pictures:

Ongoing work


R-MIM Transfer - ready

Query - ready

Care Record - ready

Clinical Statement – done

Allergy R-MIM, DAM (September) work in progress

Care Plan R-MIM, DAM (September) work in progress, in planning phase

Assessment Scale R-MIM All changes are non-substantive

Pressure Ulcer DAM will be published in the next couple weeks (Jay Lyle)

This work is under control.

To Do

1. Remove care statement - done

2. Remove old observation assessment scale (2007) - done

3. Observation Vital Signs R-MIM– work with anesthesia and devices

  • Needs updated
  • Harmonize with GAS and devices

4. Concern topic (will use ISO 13940 Contsys as the standard), get to NHS work through wikipedia

  • List
  • Tracking
  • Statement collector
  • Health Concern Topic (Michael Tan)
    • Statement collector
    • Concern
    • Concern Tracker
    • Clinical Document Topic – needs to be removed, in Sept. 2009 ballot material.
  • Canadian Work – discussed in 9/2010 and in 2011. Need to know the plan for these items. Removed from ballot and no longer working on. Canada has been encouraged to develop new project scope statements to work on the following items.
    • Professional services
    • Care Composition

5. Detailed Clinical Models

  • Vital Signs – new project scope statement.
  • Braden – William has formally requested permission to use.
    • Susan to check LOINC copyright for use within DCM.

6. Ballot edits

  • Remove “Ballot Clean-up for Jan. 2010”
  • “Notes to readers” will be number one and the first and second paragraph will be removed. Keep third, fourth and fifth paragraphs.
  • “Guidance for balloters” can be removed. Graphic “Care Provision Domain Relationships” needs to be updated.
  • Keep Acknowledgements
  • Changes from previous release: remove
  • Known issues and planned changes – keep.

7. Care Provision Section – keep. Revisit after contsys review.

  • Explanation and guidance topic – remove.
  • D-MIM storyboards – topic four, replace current graphics with the correct ones.

PC Tuesday Q3


William Goossen,

Michael Tan,

Enrique Meneses and

Peter Hendler.

William Goossen gave a short tutorial on Detailed Clinical Modeling, the status of them in HL7, the work of CIMI, the status of the ISO DTS 13972 on DCMs, existing tooling and projects in the Netherlands

PC Tuesday Q4


Elaine Ayres (

Amy Light (

Christina Knotts (

Jean Duteau (

Rob McCure (

Shelly Spiro (

Scott Robinson

Russell Leftwich (

• Continuation of ballot reconciliation of the DAM for allergies.

• The notes and action of each comment on the ballot comment spreadsheet is written down in the overall ballot comment sheet of the DAM by Elaine Ayres.

• Rob McLure is in search of standards and value sets for allergies for the purpose of CCD and meaningful use. The current stage in Patient Care however is still analyzing the domain on conceptual level. You will not find any specific value sets at this stage.

• Jean Duteau does mention that the model of the DAM is still in line with the removed DSTU model of allergies from 2009.

PC Tuesday Q5 and Q6


Laura Heermann Langford - Intermountain Healthcare -

Stephen Chu - NEHTA

Jon Farmer - Thrasys

Enrique Menses

Rosemary Kennedy - NQF

Ann Wrightson - HL7 UK -

Gordon Raup - Datuit -

John Sheridan - Ehds -

Juliet Rubini - NQF - jrubini@qualityforum .org

FHIM Model Discussion

Looked at the FHIM Care Plan Model.

Looked at the HL7 Care Plan Initiative Model

• Suggestion made to compare/contrast to contsys ---

• Kevin’s contribution/model is more tied to V3 and the care provision model.

• Discussion re: the linkages of the proposed action, implemented action to the goal.

• Need to add a line to link the health goal with the proposed intervention (proposed action).

• Need to address the issue of nesting plans of care…Think CABG surgery… a plan of care could have many plans of care…..

• Need to look at the role of the steward to the brown care plan box as well as the red plan of care box.

• Need to add the little line from the brown care plan box back to the brown care plan box.


• Moved Stephen: the Care Plan project team to identify 5 or 6 care plan classes for working with the FHIR core team to develop very high level FHIR care plan resources, which will be reviewed by this project team before submitting for FHIR ballot (time line: by June 2013). FHIR liaison person for PCWG is David Hay

Seconded by Laura.

o Discussion: some concern this would affect the CCS project proposal- but determined this would be a good way to get some feedback on the model.

Jon and Enrique volunteered to work with FHIR cor team to develop the identified care plan resources.

o Vote: no objections, 3 abstentions, 5 approvals. Motion carries.

Glossary items Role: Caregiver – is it defined? Does it include Medical Home etc ?



FHIM: need to do the analysis of what that model would contribute to the HL7 model and make recommendations.

And vice versa – need to also make recommendations to the FHIM what should be incorporated into this Care Plan Model

HealthConcern - Goal - Plan Action (proposed and implemented)

• The likages between goals, interventions, outcomes are not the same. Would recommend an optional link between goal and intervention. Also recommend a link between goal and health concerns. (these need to be optional to many relationships both way 0……* and *…….0)

• Need to review the interventions on the FHIM model to address planned and implemented interventions. )(difference here)

• Need to put more detail in the goals section of the HL7 model.

• Suggest FHIM looks at the review of the goals, the proposed interventions, the care preferences, and barriers.

• Do the have the concept of the “steward” in the roles?

Kevin’s contribution

• To be discussed at another out-of-session meeting (likely to be Wednesday lunch)

PC Wednesday Jan 16 2013

PC Wednesday Q1


William Goossen - Results4Care, NL, ( chair and scribe)

Mark Shafarman (

Crystal Wolfe - Abbott Nutrition (

Jamie Cash - Abbott Nutrition (

Laura Heermann - Intermountain (

Russel Leftwich - TN (

Rebecca Wilgus - DCRI (

Dianne Reeves - NCI (

Anita Walden - Duke (

Ed Hammond - Duke (William.hammond@duke.edu_

Rob Savage - PHER

Xxx deYoung Oasis

CIC. DIM to DAM work for EMS (Emergency Medical Services).

Cardiac Domain Analysis Model, working on multi modality modeling and other aspects. 250 data elements are going to be brought to ballot.

MAX tool for export and export content from EA to excel and other formats. Requirements are published, but not yet gaining much responses, so will be done again.

CIC is sponsoring this with tooling. It is in particular important for the requirements in spreadsheet put in EA. Other work on the DAM is ongoing.

PSS for trauma registry CDA with progressive timeline.

Project for Schizofrenia. FDA project towards submissions. Meeting with RCRIM about the models.

Perhaps use a different modeling approach. FDA would like to see the DAMs to look consistent. Make them more consistent. Today Q4 and Thursday Q2 and Q3.

Would mindmapping be useful?

Discussion on the tools.

PHER update on the joint project with OASIS aiming at transforms between OASIS and HL7.

V2 and v3 version.

Questions are raised about how to interest vendors to implement it.

Testing and connectathons are very helpful too to attract a vendor.

Would cooperation with IHE and NIMSIS be helpful?

Rob moves the motion to accept the PSS for this as PC co-sponsoring this project.

Laura seconds


11 for, 0 against 0 abstentions.

Emergency Care DAM is close to ballot. There are some travel restrictions so not everybody can be here.

EHR Functional Profile is going to be updated. And a DAM will use that.

Mark Shafarman will send the PowerPoint he presented during the Q1 meeting.

PC Wednesday Q2

Joint meeting with EHR WG (hosting PCWG)


From PCWG:

Stephen Chu

Elaine Ayre

Laura Heermann - Intermountain (laura.heermann@imail.org_

Russel Leftwich - TN (

William Goossen

Others - see EHR WG attendance record

PCWG updates to EHR WG

Update by Stephen on Care Plan project - progresses since Baltimore meeting

Update by Elaine on Allergy/Intolerance and Adverse Reaction project - progresses since Baltimore meeting and first informative ballot result on Allergy/Intolerance and Adverse Reaction DAM

Presentations generated significant interests and support from those present at meeting.

Details - refer to EHR meeting minutes

PC Wednesday Q3


Stephen Chu

Elaine Ayres

Maree Ferguson

Christina Knotts

Jamie Cash

Crystal Wolfe

Russell Leftwich

Jay Lyle

Mark Shafarman

Allergy/Intolerance ballot reconciliation - continued

Ballot comment disposition details - see documentation in Ballot comment spreadsheet

Discussions on ballot comments identified a number of issues in the Allergy/Intolerance class diagram

Examples of issues:

"Adverse sensitivity to substance" has two subclasses:

"Allergy" and "Intolerance"

But there is no "Allergy/Intolerance" subclass for cases where differentiation between allergy and intolerance is clinically not possible

It is unclear whether "Adverse Reaction" is a collector class for linking "Manifestation" (signs and symptoms), or "adverse reaction" is for representing the signs and symptoms; and "manifestation" for representing the date/time of the adverse reaction.

It is also considered to be undesirable to call out "severity" which should be an attribute that defines signs and symptoms of reactions

It is agreed that the class diagram will need to be reviewed further and clean up before the next ballot

PC Wednesday Q4


Stephen Chu

Elaine Ayres

Jon Farmer

Maree Ferguson

Rob McClure

Christina Knotts

Rob Hauram

Amy Light

Jay Lyle

Russell Leftwich

Crystal Wolfe

Jamie Cash

Update of work progress since Baltimore meeting

Update on January 2013 informative ballot reconciliation progress

FHIR: Stephen reported on FHIR core team plan to develop Allergy/Intolerance and Adverse Reaction FHIR resources for ballot before September 2013

FHIR liaison person for PCWG (David Hay) indicated that FHIR core team would develop strawman FHIR resources in collaboration with PCWG.

Allergy/Intolerance project team will be providing domain knowledge inputs and review of draft work. The draft resources will need to be approved by PCWG before submitted for ballot.

Motion: Stephen moved that PCWG/Allergy and Intolerance project team to accept contribution from FHIR core team and to participate in FHIR development, review and approval

Second: Elaine


10 in favour;

0 abstain;

0 objection

Motion carried

Forward planning - works needed to be done to prepare for next DAM informative ballot and conference calls

It was agreed to continue with fortnightly conference call:

Wednesday 5:00 to 6:30pm US Eastern Time

First call to commence: 30 January

See the following MS Word file for additional details:

PC Thursday Jan 17 2013

PC Thursday Q1


Stephen Chu

Laura Heermann Langford

Enrique Meneses

Jon Farmer

Russ Leftwich

Elaine Ayers

Iona Threan

Gordon Raup

Vince McCauley

William Goossen

Andy Bond

Floyd Eisenberg

Patty Craig

Amy Light

Maree Ferguson

Cheng Jian

Ken Rubin

Zoran Milosevic

Joint meeting - PCWG and SOA

Update on Care Plan project was presented - progress since Baltimore meeting:

Care Plan structure conceptual model: significant progress achieved through use case analysis and fortnightly review and improvement. Model is maturing

Further meetings during this week: Monday Q5 and Tuesday Q5, Q6 and Wednesday lunch quarter - further enhance conceptual model with harmonization analysis on FHIM care plan module and inputs from Kevin Coonan.

See slide deck for details:

Further development of care plan structure will be required. This will include review of previous patient care works on care plan and order set; and investigate bringing relevant components of previous work into new care plan structure.

Discussions over relationships between health concern, goals and interventions

Agreed that relationships between concern, goals and interventions can be overly complex - especially involving many-many relationships between goals and interventions.

While it is important to define and represent the relationships, the complexity of many-many relationships may not be implementable at current technology capabilities and they may also be over burdening clinicians. It was suggested that these relationships would defined as optional and implemented optionally.

Detailed discussions over how allergy/intolerance and adverse reactions are represented and implemented in Care Plan – will bring in works done by Allergy/Intolerance project

It was suggested analysis of how the "contra-indication" and "risks" care plan constructs/classes could be used to implement "allergy/Intolerance" and "adverse reaction".

Care Coordination Services – it may be desirable to develop a functional model for services coordination

The following topics were also discussed:

  • the need to decouple the collaboration processes from the implementation (organisation specific workflows) of care plan
  • the need to define role-based functions which follows/guided by organisation policies
  • how organisation policy that defines scope of practice of individual (e.g. care providers) to be enacted – need to define structural attributes of each role class
  • the need to connect with quality group for inputs on Care Plan.

The Quality Group was invited to participate in the Care Plan project fortnightly conference calls.

Patient Care WG Specific matter:

Motion: Patient care WG accepts inputs from Kevin Coonan in relation to criterion on assessment scale (comment 16 on ballot comment sheet)

William motion/second Stephen

Voting: Abstain 13, for:6, object:0

Motion carried

PC Thursday Q2

Joint meeting: PCWG, Template, Structured Document (PCWG hosting)


Stephen Chu

Elaine Ayres

Vinayak Kulkarni (Siemens)

Diana Behling (Iatric)

Ken Salyards (SAMHSA, HHS)

Masaaki Hirai

Sadamn Takasaka (HL7 Japan)

Lisa Nelson

Iona Thraen

Brett Maronard (River Rock)

Christina Knotts (FDB)

Gordon Raup

Amy Light

Maree Ferguson

Jay Lyle

Jim Kretz

Stuart Nelson

Mark Shafarman

Kai Heitmann

Adel Ghlamallah (Infoway Canada)

Sarah Gaunt

Rick Geiner

Russell Leftwich

William Goossen

Carmela Conderk

Lisa Brooks Taylor (AHIMA)

Lauran Heermann

Marisol Navas (VA)

Michael Tan (NICTIZ, NL)

Vin Sekar (Australia)

Bob Dolin

Tessa von Stign (NICTIZ, NL)

Update from Template - Template Versioning and Relationships

Update given by Kai Heitmann, covering the following topics/areas: governance, template design, registry vs repository, template versioning (ID, date, status).

Lengthy discussions on criteria for determining a new version of template and parent-child relationship between templates. Deterministic criteria include governance group, purposes and value set bindings. The issues/implication of adoption, adaptation, replacement, backward compatibility between new and old versions and equivalency were also extensively discussed.

Also discussed were whether Detailed Clinical Models (DCM) are templates:

It was suggested that DCM would be considered as templates. There is the need to work on transform mechanism to transform DCM to other formalism, e.g. HL7 templates. And HL7 templates can be linked (as metadata – with derived from relationship) back to the DCM. Registry can store and return for the metadata in response to queries. Metadata can also be kept in repository.

It was suggested that DCM and templates should be linked by identifiers.

Motion: (by William Goossen): to include “derived from” relationship to the template relationship

Second: Bob Dolin


In favour: 30; Opposed: 0; Abstained: 0

Motion carried.

See the following side deck for more details:

Update from Template - Template ITS

Short update by Mark Shafarman on Template ITS

See the following side deck contents for details:

Update from Template - HingX

Update by Mark Shafarman on HingX - summary as follows:

Implementation guide subgroup of publishing work group – not limiting to CDA

  • HingX is Open Health Tools project initially sponsored by Rockefeller foundation – initially known as HEART
  • Provides global resource registry (for registration of health related ICT resources globally) with relationships between resources
  • Reference repository
  • Participating in project – HL7 piloting a limiting number of projects: including tooling; publishing; template; SOA, etc. It could potentially be a repository of all HL7 artefacts
  • HingeX website:
  • test actual artefact registrations with several WG projects
  • Implementation guide sub-committee
    • Develop cookie cutter for CDA implementation guide
    • Would also like this developed for patient care
  • Currently Seeking feedback on need for enhancement of APIs

See the following side decks for more details:

Update from Structured Document/CDA

Acknowledge the need to better understand relationship between constraints on templates implementation guides and adoption, adaptation before implementation.

A C-CDA support task force has been established with goals to support prioritization of MU2 data element requirements and to development clear guidelines (based on best practices)to improve consistency in CDA implementations/adoptions.

See slide deck posted by SDWG on this project for more details:

Update from Patient Care - Allergy/Intolerance & Adverse Reaction Project and MU2 Medication Allergy value set business

History and update by Elaine Eyre:

  • MU2 defined use of Rx Norm as code set for reporting allergies (medication)
  • Scope and value sets are too limited. Issues identified in a slide deck prepared by George Robinson and James Shalaby with proposed solutions.
  • Other groups including Patient Care raised concerns and initiated a number of conference calls with participation by George and Jim.
  • Subsequent to the conference calls a white paper was developed by George and Jim, with recommendation on scope and value set to meet MU3 timeline (5 February 2013)
    • It is unclear what the status of this white paper is in at the time of Phoenix meeting.
  • Patient Care allergy project team with inputs from George and Jim also submitted comments/feedback (via HL7) to MU3 requirements on allergy reporting.

Comments by Bob Dolin:

eMeasure Group with inputs from George and Jim has described the problems/issues in the form of Statement of Problems.

Developed "intensional" value set definition and identified a list of value set affected:

  • Medication value sets
    • RxNorm Term Types: SCDF, SBDF, SCDG, SBDG, SCD, SBD, GPCK, BPCK
    • Future: NDFRT Therapeutic Intent (e.g. to exclude “alka seltzer” from antithrombotics)
  • Allergy/Intolerenance value sets
    • RxNorm Term Types: BN, IN, MIN, PIN

Definitions are pending sign off by NLM, HL7 Patient Care and HL7 Pharmacy

Next Step:

  • Measure steward review of revised value sets 9Feedback by January 21st (send to; Offline discussions (if necessary)]
  • Seek approval of recommendations on Feb 5, 2013 eMIG
  • Implement recommendations for April eMeasure update cycle

Update from Patient Care - Care Plan Project

Update by Lauran Heermann

The Care Plan DAM development continues with plan for informative ballot in May.

Questions: what other ballots were coming through SD from the LCC related to CP.

There appears to be discussions on the LCC calls about a ballot for the IMPACT data set and for an implementation guide on CDA with Care Plan components.

Follow up discussions with SDWG: The structured docs group indicated neither of those (IMPACT data set and CDA IG including Care Plan components) are targeted for ballot in May and that they are fully aware of needing to work closely with Patient Care when it comes to any ballots related to care plan

PC Thursday Q3

Joint meeting: CS, Patient Care, OO


Stephen Chu

William Goossen

Others: see attendance list - CS meeting minutes

Meeting minutes details - referred to CS meeting minutes for details

Clinical Statement January 2013 ballot reconciliation

CS balloted for DSTU twice with change requests (from other Work Groups, e.g. PCWG, Pharmacy) being incorporated

January 2013 ballot is on updated CS based on change requests

Currently getting last cycle of change request done, then will aim for normative

Disposition of ballot comments: see CS ballot reconciliation spreadsheet


CS in discussion with Tooling to develop tools to compare models, e.g. get two models into OWL and conduct comparisons – need to write up requirements

SBADM Act – CS harmonization

CS and Pharmacy conducted attribute by attribute analysis of CS model and pharmacy models Model-by-model comparison is always difficult task

Alignment change requirement spreadsheet posted to OO list on 9 January:

Disposition of Pharmacy change requests: see CS wiki on Clinical Statement Change Requests:

PC Thursday Q4

Joint meeting: CS and PCWG (CS hosting)


See CS meeting notes for attendance record

Meeting minutes - see CS meeting minutes for details

- End of PCWG Phoenix January 2013 Meeting Minutes -