October 27, 2015 CBCC Conference Call

Community-Based Collaborative Care Working Group Meeting

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Attendees

	Member Name		x	Member Name		x	Member Name
x	Johnathan ColemanCBCC Co-Chair		x	Suzanne Gonzales-Webb CBCC Co-Chair			Jim Kretz CBCC Co-Chair
.	Max Walker CBCC Co-Chair		x	Mike Davis Security Co-Chair		x	John Moehrke Security Co-Chair
x	Kathleen Connor		.	Ken Salyards CBCC Interim Co-Chair			Lori Simon CBCC Interim Co-Chair
x	Diana Proud-Madruga		x	Rick Grow			Harry Rhodes
	Serafina Versaggi		x	Ioana Singureanu		x	[mailto: Glen Marshall]
	Steve Eichner		.	Steve Daviss		.	Wende Baker
x	Neelima Chennamaraja		x	Lee Wise		.	Mike Lardiere
.	Reed Gelzer		.	Marlowe Greenberg			Chris Clark, WV
.	Paul Knapp		.	Matt Peeling			Brian Newton
.	William Kinsley			Lisa Nelson		.	Amanda Nash
x	Russell McDonell			Susan Litton			David Bergman
.	Linda Bailey-Woods		.	Debbie Bucci			Chirag Bhatt
	Oliver Lawless			Keith Boone			Lori McNeil Tolley
.	Mohammed Jafari		.	Peter Fiaspa, Columbia University			Gary Dickinson

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Agenda

1. (05 min) Roll Call, Approve Meeting Minutes from October 20, 2015 CBCC Conference Call
2. Consent Directive Recirculation to NIB VOTE
3. Comments on ONC Draft Interoperability Standards Advisory- Kathleen
   • e-mail sent to listserve (see also attached: 2016-Interoperability)
4. (05 min) Patient Friendly Language for Consumer User Interfaces - (Standing Agenda Item) - Update
5. (05 min) HL7_CDAR2_DPROV_IG_DSTU10-22-2015.pdf - (Standing Agenda Item) - Update
6. Draft CBCC and Security WG harmonization proposals for review
7. (05 min) Behavioral Health Domain Analysis Model (HL7 BH DAM) Update
   • Unique Ballot ID: V3_DAM_BH_R2_I1_2015SEP, HL7 Version 3 Domain Analysis Model: Behavioral Health Record, Release 2 (Project Insight ID: 1174)
8. FHIR Meeting Timeslot
9. (10 min) PASS Access Control Services Conceptual Model - (Standing agenda item) update (Diana)
10. (10 min) Joint EHR, Security, Privacy Vocabulary Alignment - (Standing agenda item) update (Diana/Mike)

Meeting Minutes (DRAFT)

Approval of Meeting Minutes for October 20

Objections: none, Abstentions: none, Motion Passed: 11

Consent Directive Recirculation to NIB

Recommend

• submit previous NIB (no change in scope)
• update as needed as going through approval processes (ballot announcement)
• tentative: refresh interested parties (add patient choice project in ONC as interested party)

MOTION: Submit previous NIB with reason why we are re-balloting as per Lynn's e-mail unable to complete recirculation in time (Johnathan/Ioana)

Objections: none, Abstentions: none, Motion Passes (11)

Lynn will need to submit NIB on the HL7 side; Ioana will assist NIB completion

Comments on ONC Draft Interoperability Standards Advisory

• Clarify as re-balloting on Consent Directive ballot
• add R1, R2 for BH DAM

MOTION: (Kathleen/Glen); Send (document name: ) with the two changes to PAC to go forward to the executive committee

Objections: none, Abstentions: 1 (Johnathan), Motion Passes (10)

Draft CBCC and Security WG harmonization proposals for review on Tuesday’s CBCC and Security WG calls

Submitted proposals are attached along with the Summary shown below. (Kathleen to walk participants through)

Technical review of these initial proposals and input from the workgroups will be used to create the final proposals, which are due 11/08.

Draft Nov 2015 Harmonization proposals.docx – Summary for posting to Oct 27 CBCC and Security wiki agenda]

http://www.hl7.org/events/harmonization/

VALUE SET: ActConsentDirectiveType

Description:

ActConsentDirective and ActConsentType codes are used to specify the type of Consent Directive or Consent Type to which, for example, a Consent Act conforms, to which a Security Observation (Security Label) refers to, or to which a Privacy or Security Act refers. V:ActConsentDirectiveType is the union of v:ActConsentDirective [2.16.840.1.113883.1.11.20425] and v:ActConsentType [2.16.840.1.113883.1.11.19897].

Supported Code Systems: ActCode (2.16.840.1.113883.5.4)

Contains 2 children of type unionWithContent

Bound to Domains:

ActConsentDirectiveType and ActConsentType (CWE) in R1 (Representative Realm)

The combined ActConsentDirectiveType Value Set value set would include the following codes:

ABSTRACT CONCEPT: _ActConsentDirective [abstract term] Description: Definition: Specifies the type of consent directive indicated by an ActClassPolicy e.g., a 3rd party authorization to disclose or consent for a substitute decision maker (SDM) or a notice of privacy policy.

Usage Note: ActConsentDirective codes are used to specify the type of Consent Directive to which a Consent Directive Act conforms.

LEAF CONCEPT: EMRGONLY (emergency only) Description: This general consent directive specifically limits disclosure of health information for purpose of emergency treatment. Additional parameters may further limit the disclosure to specific users, roles, duration, types of information, and impose uses obligations.

Definition: Opt-in to disclosure of health information for emergency only consent directive.

LEAF CONCEPT: NOPP (notice of privacy practices) Description: Acknowledgement of custodian notice of privacy practices. Usage Notes: This type of consent directive acknowledges a custodian's notice of privacy practices including its permitted collection, access, use and disclosure of health information to users and for purposes of use specified.

LEAF CONCEPT: OPTIN (opt-in) Description: This general consent directive permits disclosure of health information. Additional parameter may limit authorized users, purpose of use, user obligations, duration, or information types permitted to be disclosed, and impose uses obligations.

Definition: Opt-in to disclosure of health information consent directive.

LEAF CONCEPT: OPTOUT (op-out) Description: This general consent directive prohibits disclosure of health information. Additional parameters may permit access to some information types by certain users, roles, purposes of use, durations and impose user obligations.

Definition: Opt-out of disclosure of health information consent directive.

ABSTRACT CONCEPT: _ActConsentType [abstract term] Description:

Definition: The type of consent directive, e.g., to consent or dissent to collect, access, or use in specific ways within an EHRS or for health information exchange; or to disclose health information for purposes such as research.

LEAF CONCEPT: ICOL (information collection) Description:

Definition: Consent to have healthcare information collected in an electronic health record. This entails that the information may be used in analysis, modified, updated.

LEAF CONCEPT: IDSCL (information disclosure) Description:

Definition: Consent to have collected healthcare information disclosed.

SPECIALIZABLE CONCEPT: INFA (information access) Description:

Definition: Consent to access healthcare information.

LEAF CONCEPT: INFAO (access only) Description:

Definition: Consent to access or "read" only, which entails that the information is not to be copied, screen printed, saved, emailed, stored, re-disclosed or altered in any way. This level ensures that data which is masked or to which access is restricted will not be.

Example: Opened and then emailed or screen printed for use outside of the consent directive purpose.

LEAF CONCEPT: 'IRDSCL (information redisclosure) Description:

Definition: Information re-disclosed without the patient's consent.

SPECIALIZABLE CONCEPT: RESEARCH (research information access) Description: Definition: Consent to have healthcare information in an electronic health record accessed for research purposes.

LEAF CONCEPT: RSDID (de-identified information access) Description:

Definition: Consent to have de-identified healthcare information in an electronic health record that is accessed for research purposes, but without consent to re-identify the information under any circumstance.

LEAF CONCEPT: RSREID (re-identifiable information access) Description:

Definition: Consent to have de-identified healthcare information in an electronic health record that is accessed for research purposes re-identified under specific circumstances outlined in the consent.

Example: Where there is a need to inform the subject of potential health issues.

MOTION: (Kathleen/Johnathan) Accept and approve for submission to final harmonization

Discussion:

John M - are these described with enough detail, where an organization can create RBAC rules? The OPT-OUT is complete, we have had problems with the concepts, with need to describe what limits authorized users meant. (Comment) Not saying we shouldn't go forward, but we may need to further refine

• these are the codes on the consent directive, a high level characterization as to what kind of consent they are looking at vs. the type of the procedure. There is further elaboration regarding service (BPPC?) where you can be very specific (i.e., further information of the author, etc.)
• just channeling the concern when people have attempted to use - at a high level it's fine, but between organizations the argument needs to be determined

Objections: none; Abstentions: none; Motion passes: 11

FHIR Consent Profile Timeslot

• Doodle Poll sent out by John
  • two slots had most choices....that also have Kathleen and Johnathan in attendance
    • Tuesday at 4:00 Central Time
    • Wednesday at 5:00 Central Time (6 ET)

MOTION: (JohnM/Ioana) Propose Wednesday at 5:00 Central time (6 ET) for FHIR Consent Profile meeting

Abstentions: none; Objections: none; Motion Passes: 11

• Meetings will start at this time slot TOMORROW, Wednesday 10/28
• CBCC Chair required (Johnathan/Suzanne as CBCC co-chair will be available to chair); we will use Johnathan's GoToMeeting, Suzanne to set up HL7 call

BH DAM

• Received several good reviews from SMEs
• Ioana reported that David Tao voted negatively. One of this comments addressed the issue of using SNOMED CT vs. DSM and if there are walkthroughs from DSM to SNOMED.
  • According to Ioana, there are walkthroughs from SNOMED to ICD-9 and ICD-10. She questioned if it makes sense to encode information in SNOMED as encoding in DSM is the status quo in Behavioral Health right now.
  • Ioana followed up with David via email.
  • She also submitted a request to withdraw the negative comments from FDA because CBCC resolved them at the WGM in Atlanta.

PASS Access Control

• in process of reconciling the ballot comments
• VA, DoD comments remaining
• comments from Lorraine Doo were not related to the PASS AC ballot

Vocabulary Alignment

Today's meeting covered definitions for

• Update and Append
• Merge properties
• Attach / Link
• Correct

• Updated version of the Visio diagram (sent as PDF); sent to meeting attendee list

Meeting adjourned at 1159 PDT --Suzannegw (talk) 14:59, 27 October 2015 (EDT)