MnM Minutes WGM 201401 San Antonio

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Sunday Jan. 19 Q3

Attendees

Beebe, Calvin (Mayo Clinic)

Beeler Jr, George (Woody) (Beeler Consulting LLC)

Duteau, Jean (Duteau Design Inc)

Duteau, Katherine (Duteau Design Inc)

Jeong, Dongil (IHIS Research Center in Kyungpook National University)

Kreisler, Austin (Leidos, Inc.)

Lee, DoYoun (IHIS Research Center in Kyungpook National University)

Loyd, Patrick (ICode Solutions)

McKenzie, Lloyd (Gordon Point Informatics (HL7 Canada))

Smithies, Rik (NProgram Ltd)

Song, Joon Hyun (IHIS Research Center in Kyungpook National University)

Agenda

• Review of Hot Topics
• Review of Agenda Sessions
• New Motions

Review of Hot Topics

• No new hot topics have been brought up since the last WGM
• Rik raised the issue of how to populate IVL_TS. M&M does not normally provide instance implementation guidance. That perhaps could be something that AID (formerly RIMBAA) does.
• Structured Documents are looking into a refresh of the CDA model which may raise some Hot Topic discussion.
• The BlockedContextConduction hot topic might be one that CDA will need. It was discussed that this is a technical issue - context conduction is working, but the attribute is defined in the RIM incorrectly.
• Action: Jean will take on bringing the existing hot topics to the mailing list with an eye towards closing as many as we can.
• The UDI Task Force will have a recommendation coming forward which might result in a Pattern Harmonization discussion. Not at this WGM but in May.
• Remove the Monday Q1 Hot Topics session

Review of Agenda Sessions

• No FHIR core team present at Tue Q3 so probably no need for that session
• No meeting on Thursday Q2
• Discussion of FHIR as a work group since M&M may not be meeting other than jointly or as FHIR work. M&M should be model-based methodology workgroup which means that FHIR should remain part of M&M
• Tue Q2 activities were covered in this session (see below). Tue Q1 is also dropped due to no need of discussion.

Core Principles Ballot

• FDA and Siemens have not withdrawn their votes
• MOTION: Hold a recirculation ballot to override the three negative votes. Woody/Austin 10-0-0

RIM Ballot

• MOTION: Ballot Next RIM Release in September 2014 ONLY rather than in both May and September because in last 3 cycles we have needed only one cycle and should always finish in September. Katherine/Patrick 10-0-0

Wednesday Jan. 22 Q1 - Hosting Joint with Vocabulary and FHIR

Attendees

Beeler Jr, George (Woody) (Beeler Consulting LLC)

Couderc, Carmela (Siemens Healthcare)

Daoust, Norman (Daoust Associates)

de Moel, Ed (Hawaii Resource Group)

Fillmore, Chris (Systems Made Simple)

Fine, Steven (Cerner Corporation)

Geimer, Rick (Lantana Consulting Group)

Grain, Heather (Standards Australia, eHealth Education)

Haddorff, Rick (Mayo Clinic)

Hamm, Russell (Lantana Consulting Group)

Hendler, Peter (Kaiser Permanente)

Hirai, Masaaki (HL7 Japan Voter #2 - Nihon Kohden Corp, Eng. Oper.)

Huang, Wendy (Canada Health Infoway Inc.)

James, Julie (Blue Wave Informatics)

Klein, William Ted (Klein Consulting, Inc.)

Mandel, Josh (Boston Children's Hospital)

McKenzie, Lloyd (Gordon Point Informatics (HL7 Canada))

Parimi, Sailaja (Cerner Corporation)

Parker, Craig (Intermountain Healthcare)

Smithies, Rik (NProgram Ltd)

Takasaka, Sadamu (HL7 Japan)

Ting, Jeffrey (Systems Made Simple, Inc.)

Warden, Robert (HL7 - UK)

Agenda

Value Set Definition Project

Ted Klein provided an introduction to this project which is tracked on the wiki as Value Set Definition Standard Project. Initiated a year ago to consolidate and standardize the structure and content of a Value Set definition wherever used in HL7 specifications. Also relates to US and other realm activities around value set definition.

Reviewed progress in last 12 months, and the draft documents being maintained collaboratively in Google Docs from the Wiki. Klein provided an overview of the 48 elements that are likely to be part of "definition" of a Value Set.

Switched to discussion of the beginnings of a draft and future plans. Current plan is to work through the Jan-May cycle with the goal of a Normative ballot in the May2014 Ballot. The specification is a "Logical" model or representation. Core principles contains the conceptual model for this, and things like the MIF become the physical implementations of this logical model.

Motion: Klein moved to state that this document be approved for the intent to ballot in the May Ballot Cycle. Klein/Lyle 21-0-1

Wednesday Jan. 22 Q2 - Hosting Joint with Vocabulary and FHIR

Attendees

Beeler Jr, George (Woody) (Beeler Consulting LLC)

Couderc, Carmela (Siemens Healthcare)

Daoust, Norman (Daoust Associates)

de Moel, Ed (Hawaii Resource Group)

Fillmore, Chris (Systems Made Simple)

Fine, Steven (Cerner Corporation)

Geimer, Rick (Lantana Consulting Group)

Grain, Heather (Standards Australia, eHealth Education)

Haddorff, Rick (Mayo Clinic)

Hamm, Russell (Lantana Consulting Group)

Hendler, Peter (Kaiser Permanente)

Hirai, Masaaki (HL7 Japan Voter #2 - Nihon Kohden Corp, Eng. Oper.)

Huang, Wendy (Canada Health Infoway Inc.)

James, Julie (Blue Wave Informatics)

Klein, William Ted (Klein Consulting, Inc.)

Mandel, Josh (Boston Children's Hospital)

McKenzie, Lloyd (Gordon Point Informatics (HL7 Canada))

Parimi, Sailaja (Cerner Corporation)

Parker, Craig (Intermountain Healthcare)

Smithies, Rik (NProgram Ltd)

Takasaka, Sadamu (HL7 Japan)

Ting, Jeffrey (Systems Made Simple, Inc.)

Warden, Robert (HL7 - UK)

Agenda

FHIR & Vocabulary

McKenzie undertook a discussion of the proposed FHIR "Namespace" Resource, with a view to consideration of a registry of such resources might subsume the requirements of the current HL7 OID Registry. Agreed on steps to search out additional data requirements imposed for ISO OID registries, and to undertake a transform that could convert OIDs registered here and expressed via FHIR into the format needed to exchange content with coordinated OID registries being developed internationally.

Agree should map the FHIR resource spec to the ISO interchange requirements.

Discussion of FHIR QA

McKenzie noted that a FHIR QA activity was underway with "criteria" being developed for documentation in MnM and subsequent adoption by FHIR Governance Board.

Thursday Jan. 23 Q1

Attendees

Arndt, Brad (Cerner)

Beeler Jr, George (Woody) (Beeler Consulting LLC)

Donnelly, Michael (Epic)

Edidin, Howard (Edidin Group, Inc.)

Hirai, Masaaki (HL7 Japan Voter #2 - Nihon Kohden Corp, Eng. Oper.)

Jeong, Dongil (IHIS Research Center in Kyungpook National University)

Lee, DoYoun (IHIS Research Center in Kyungpook National University)

Lynch, Cecil (Accenture)

McKenzie, Lloyd (Gordon Point Informatics (HL7 Canada))

Moldeklev, Elisabeth (Helse Vest IKT)

Reppen, Bertil (Apertura)

Sandvik, Steinar (Helse Vest IKT AS)

Smithies, Rik (NProgram Ltd)

Song, Joon Hyun (IHIS Research Center in Kyungpook National University)

Swegel, Chuck (GE)

Tanji, Natsuki (HL7 Japan Voter #9)

Walker, D. Mead (Mead Walker Consulting)

Wefring, Marius (Helse Vest IKT AS)

Agenda

FHIR Methodology

McKenzie introduced the FHIR Methodology "Questions" on the FHIR Wiki. He noted that the focus today was to identify "quality measures" or checkpoints to manage. Process is to collect "issues" then turn those into a set of "rules" that become part of the methodology and can be tested for QA. Details of the discussions follow:

Automated

1. make sure examples validate
2. make sure there aren’t “hanging” examples in the source that aren’t part of the spec
3. Ensure that all external linkages within the specification use permalinks
4. Generate a “reverse map” for v2 (and v3??) that provides a list of v2 segments & fields with mappings into the corresponding FHIR resource elements

Manual

1. Resource introductions should identify a broad set of example contexts in which they might be used. (Should be minimum of 3, as many as 8-10).
2. Create a mapping from the EHR Functional Profile to identify the primary resource(s) and/or specification sections that relate to satisfying that EHR function
3. Examples must exist for every example context identified in the resource introduction and must, between them, show the use of every data element in the resource definition. Examples should include a mixture of “simple” and fully fleshed out “complex” scenarios.
4. Examples should be clinically valid and include comments explaining what they’re representing where this isn’t obvious from the instance
5. Create a complete mapping of one or two existing v2 messages?
6. Coded values should draw from external code systems as much as possible. If defining a CodeableConcept, FHIR-specific codes must only be used when no external code systems apply (and should be verified for 80% if this occurs). Preference is to use international code systems (SNOMED, LOINC, UCUM, ICD, etc.) where possible. National code systems may be used when international codes don’t apply/exist (e.g. manufactured drug codes). When using national code systems, draw from different countries (i.e. not just U.S.)
7. Value sets should be “representative” whenever possible. I.e. The value set should be useable in production systems, at least as a reasonable starting point. (Though in some cases, might be limited to a specific country.)
8. Where FHIR defines its own codes, every code must have a formal definition that follows best practices (i.e. isn’t tautological)
9. All data elements must have definitions that follow best practices (non-tautological, include examples, provide additional guidance beyond the name and short description). Definitions should not document constraints that can be conveyed by invariants
10. Constraints and minimum repetitions must not prevent “narrative only” resources and must allow for broad use of the resource (summary and anonymized reporting, scenarios of partial availability, etc.)
11. Names of elements within the same “family” should be consistent unless business convention dictates otherwise.
12. Data elements within the same “family” should be ordered in the same way (e.g. medications, interventions, orders, etc.) Data elements should in general be ordered in a “sensible” way – related elements together, more important elements towards the top, “big” elements (those that take a lot of space in instances) towards the bottom.
13. If constraining to the “code” data type, ensure that the set of available codes will work in all possible business scenarios, particularly if the element is minOccurs = 1. Also ensure all codes are mutually exclusive

Thursday Jan. 19 Evening - Facilitator's Roundtable

Attendees

Jean Duteau (M&M, PC), Woody Beeler (M&M), Mead Walker (RCRIM), Melva Peters (Education), Julie James (Pharmacy, RCRIM), Hugh Glover (Pharmacy), Ted Klein (Vocabulary), Alexander Henket (Patient Admin), Wendy Huang (Patient Admin), Lorraine Constable (O&O, ArB), Andy Stechishin (AID, Tooling, Publishing), Rob Hausam (Vocabulary, O&O), Calvin Beebe (SD), Lloyd McKenzie (M&M, FHIR), Dale Nelson (ITS), Abdul-Malik Shakir (M&M, CIC)

Agenda

• Schedule 2014 Harmonization
• Project to Define a HL7 Facilitator
• Facilitators' Reports
• Other Business

Schedule 2014 Harmonization

• First Trimester -

  Harmonization: March 12-13-14, 2014 (Wednesday thru Friday)

  Initial deadline: February 9, 2014, 11:59PM

  Technical Review: On or about February 13, 2014

  Final deadline: March 2, 2014, 11:59PM

• Second Trimester -

  Harmonization: July 22-25, 2014 (Tuesday thru Friday)

  Initial RIM ballot for RIM R7 opens 8 days after the end of this meeting and must include all RIM changes approved at this meeting.

  Initial deadline: June 22, 2014, 11:59PM

  Technical Review: On or about June 26, 2014

  Final deadline: July 13, 2014, 11:59PM

• Third Trimester -

  Harmonization: November 18-21, 2014 (Tuesday thru Friday)

  First two days overlap AMIA fall meeting

  Initial deadline: October 19, 2014, 11:59PM

  Technical Review: On or about October 23, 2014

  Final deadline: November 9, 2014, 11:59PM

Plan "Project" to Review and Define the Role of "Facilitator" in HL7

Considerations arise from discussions in the Foundation and Technology Steering Division meeting on Monday evening this week. In brief, there are numerous "kinds" of Facilitator in HL7 today. These individuals:

• fulfill a variety of roles that require a variety of technical knowledge;
• must have sound communication ability;
• must be able to act as a liaison between two or more Work Groups; and
• have never existed in "sufficient" numbers.

Questions to be considered include:

• Should each different technical requirement (modeling, vocabulary, publishing, etc.) have a "named Kind" of facilitator (like "Project Facilitator"), or could a list of capabilities for each Facilitator suffice?
• Should Facilitators be "qualified" and, if so, how?
• Is there a need for a "community" (perhaps a Work Group) for Facilitators, or might the "Roundtable" suffice?

Related Information

For reference, Heather Grain has provided a File:Facilitator Training Outline V0.2.docx from Vocabulary

MnM definitions about Modeling Facilitation on Wiki

Facilitators' Reports

Patient Care

• Patient Preferences passed ballot and will be published along with a new version of the Allergy DAM

M&M

• Two projects dealing with Negation Indicators (Update Core Principles #6.6, Implementation Guide)
• Recirculation ballot of Core Principles
• RIM will only be balloted in the Fall rather than in Spring and Fall

RCRIM

• Annotated ECG Implementation Guide will be getting a new version
• Harmonization Proposal to "fix" ControlVariable
• New workgroup will be created to support BRIDG

Pharmacy

• Working on CDA issues that are Pharmacy-focused and will create CDA templates and FHIR examples

Vocabulary

• Working on dealing with "out-of-control" vocabularies and making good progress
  • Working on creating a single Vocabulary repository that combines V2, V3, and CDA
  • Significant enhancement to the value set definition
• CTS2 is complete and is getting ready for publishing

Patient Administration

• Scheduling is back in scope
• Encounter and Personnel Management will be in Normative 2014
• Encounter DMIM is in Care Provision but PA wants to reference it for their RMIMs
• Interested in use of SKMT for use as the source of definitions in models

Orders & Observations

• May have a harmonization proposal around Susceptability
• May publish Common Product Model

Structured Documents

• CDA R3 may be possibly cancelled but would be replaced with a CDA R2.1
  • Rather than a whole new step, it might be an incremental step with a RIM refresh

FHIR

• looking for additional resources, additional profiles
• asking the workgroups to define CCDA R1.1 profiles
• providing tooling and training around the creation of profiles
• defining quality metrics for the next DSTU
• FHIR publishes its DSTU next week

CIC

• EMS Implementation Guide DSTU finished testing - will be moving it forward to normative
• Trauma Implementation Guide DSTU passed ballot and will be publishing soon
• MAX Project has developed a criteria for project completion

Other Business

CDA 2.1

• The impetus behind updating to CDAv3 was lost as FHIR came along
• A refresh was deemed useful
• Discussion ensued about vocabulary that arose from the various Implementation Guides that have been balloted
• There is a concern with the source of truth of vocabulary value sets as expressed in CDA IGuides