July 18, 2011 RM-ES Work Group Meeting

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Here are the notes from today’s RM-ES meeting:

Attended By: Michelle, Gary, Barbara, Kim, Serafina, Reed, Beth, Kathleen


1. S&I Initiative – Electronic Submission for Medical Documentation (esMD) Update (Michelle and Reed)

Notes: Michelle updated the group on a discussion with the esMD workgroup from CMS, ONC and Accenture regarding digital signatures. Reed is on the tiger team that is doing design work and standards support. Last week’s discussion was on digital signatures. The group was considering requiring a digital signature and certificate. Michelle offered the RM-ES workgroup for input on the record integrity issues that relate to identity, metadata, authorship, signature, etc. The implementation guide that we have been discussing will be very useful to advance record integrity issues for use cases like esMD. There is a fraud component that the workgroup wanted another CMS group to explore. This may also relate to the Unintended Consequence work that Barbara is participating in. esMD wiki: http://wiki.siframework.org/esMD+Profile+Definition

2. Evidentiary Medical Record Project Update (Serafina and Beth)

Notes: Serafina updated the RM-ES group on the current status of the ballot document. Getting information out to ballot will help gather more comprehensive information and feedback on core RM-ES issues and getting others at HL7 engaged.

ACTION: look at a proposal for ballot structure/content at next Monday’s meeting.

3. Lifecycle Model - CDA – RM-ES Crosswalk Analysis

1. The HIT standards committee and esMD projects would potentially be interested in the crosswalk as there is discussions that CDA meets the legal record issues. The crosswalk helps to identify the consistency across the three as well as the gaps particularly with the providence of the record.

2. The crosswalk has been discussed with Calvin Beebe (co-chair Structured Docs), but may not have been addressed with the full committee.

3. A summary may be beneficial to share the issues identified that need to be addressed. This would also be useful for HIT standards committee and esMD.

4. ACTION: Reed will draft a summary that highlights gaps and will update Calvin on the latest developments related to the use of CDA for initiatives like esMD.

4. Review draft IN.2 and reconciliation document (Gary)

Notes: Gary presented the outline for information infrastructure.

1. IN.1 Security – is being reviewed with John Moerke, HL7 Security WG

2. IN.2.1 Record Lifecycle

- Should Legal Hold be a life cycle event

3. IN.2.2 Record Lifespan

- Should IN.8 Archive be moved into Lifespan section

4. IN.12.1.1 Record Audit Triggers

- Develop the metadata for security and system metadata and the conformance criteria for the logs and log management including accounting for disclosure.


5. Next steps for Accounting for Disclosures - how to initiate new work into the evolving FMR2? (will address with audit logs and in S.2.2 Health Record Output)