October 30, 2012 CBCC Conference Call

Community-Based Collaborative Care Working Group Meeting

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Attendees

• Daniel Crough
• Mike Davis
• Suzanne Gonzales-Webb CBCC Co-chair
• Adrianne James
• Richard Thoreson CBCC Co-chair
• Serafina Versaggi

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Agenda

1. (05 min) Roll Cal, Approve Minutes & Accept Agenda
2. (05 min) HL7 Harmonization proposal update (Administrative Gender)
3. (10 min) DSTU CDA IG - Update
4. (25 min) Announcements & Report Out
5. (15 min) Behavioral Health Summary project - next steps

Meeting Minutes

Harmonization Proposal Update (AdministrativeGender)

The V3 AdministrativeGender harmonization proposal will be formally withdrawn from the November 2012 ballot cycle on Tuesday, November 6. It will be the first item on the agenda that day (schedule and call coordinates to be announced shortly).

DSTU CDA R2 Implementation Guide for Privacy Consent Directives

• A request to extend the current DSTU until October 2013 and to inform ANSI of intent to go Normative in May 2013 is underway. Once it has officially been extended by ANSI, we will report back to the group.
• Mike indicates that there are a few changes that the Security WG would like to introduce to the standard. CBCC and Security will work together to incorporate these items into the May ballot to reflect lessons learned during the pilot presentation given at the HL7 Baltimore WGM under the auspices of the ONC S&I DS4P pilot implementation project

Announcements & Report Out

Mike Davis reports that the Security WG submitted two new NIBs (notice of intent to ballot) for the January cycle.

1. Security & Privacy Ontology
2. Health Care Classification Scheme

The Security & Privacy Ontology project is one that is being revived after being placed on hold pending resources.

• CBCC will want to continue to participate in the development of the ontology, which will take place on the Security WG calls (see additional announcement below)

Both projects involve significant changes to vocabulary and Kathleen Connor has been spearheading these activities.

The Health Care classification scheme was balloted as Informative in September and significant feedback from that ballot has contributed to this iteration (DSTU).

• This project supports the enforcement of patient privacy protection/preferences and is an extension of the ONC S&I Framework DS4P initiative but also involves the CDA R2 IG for Consent Directives which needs to be revised to account for the ability to supply security labels to artifacts.
• The mechanism is to use observations as the key to applying security labels (see diagram)

Mike said that as he was developing the diagram of the architecture reflecting the pilot demonstration he had an epiphany moment when he noted the clear distinction between Data Tagging of a particular item that appears in health records - the identification of clinical facts such as a particular laboratory test (order and result) is associated with HIV (the data tag) and Security Labeling.

• Clinical facts (which are the data tags) are not 'colored' by judgement or subjectivity.
• Security Labeling, on the other hand is a well known, long understood and standards-based security process that is based upon a security risk assessment. This is a subjective evaluation of the perceived harm from the exposure and is driven by law (e.g., Title 38, 42 CFR Part II, patient preferences, etc).
  • The process takes a clinical fact and evaluates it against the subjective rules assigned by the risk assessment and results in a Security Label. This essentially means that the 'clinical facts' are "colored" - by the process that evaluates the clinical fact against the requirements (local/organizational policy, patient/client privacy preferences, jurisdictional laws and regulations, etc.) - with a "Security Label". (Mike please verify that I have accurately reflected the process)

With respect to collaboration, Richard asked where SHARP fits into the picture.

• SHARP attended only one Security QG meeting. Mike would like to clarify the relationship with them. Suggest inviting them back to the Security calls, add CBCC representation and determine the working relationship going forward if one is to exist
• The SHARP effort has presented a draft proposal for LOINC codes to support the identification of 'clinical facts'. See Proposed use of LOINC document ontology codes for data segmentation - draft for additional information

Mike has also been looking at protocols for sending and receiving obligations and promises between organizations (vendor-neutral communication). OASIS has a new standard OASIS Advanced Message Queuing Protocol (AMQP) Version 1.0, which is a very flexible standard to communicate in a variety of ways, synchronous, asynchronous, between organizations that don't share common protocols. This enables a policy decision point to be executed in the cloud.

• Richard reports that FEI surfaced a new open-source identity service WS02 version 3.2 that looks promising. It was suggested that a connection be made between this new identity service, the Kantara work, and the work Mike is currently involved with related to User Managed Access(UMA).
  • The understanding is that Kantara has a specification for an architecture but requires an implementation. That specification was almost fully implemented in the pilot demonstration at the HL7 Baltimore WGM.

For those who are not yet aware, Mike announced that the Security WG has changed it's meeting time to Tuesdays at 5:00 PM Eastern to encourage participation from the Australian and German co-chairs.

Behavioral Health Summary - Next Steps

1. Organize work around Behavioral Health Summary Implementation Guide enhancements
   • Chunk into "products"
   • Identify a "starter-set" of core interoperability vocabulary that is intended to be shared across entities. Supports the re-use of data
     • Criminal Justice
     • Homelessness
     • Schools
     • Vocational Training
     • Foster Care/Child Care agencies

Action Items

1. All: Please join the Security Work Group calls - Tuesday 5 PM Eastern
2. CBCC team: Chunk work into deliverables for the May ballot cycle
3. Ask Kathleen to provide brief overview of the Health Care Classification Scheme and Security & Privacy Ontology projects (proposed for 11/13 meeting)

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Meeting adjourned at 1:00 PM Eastern. No significant motions or decisions were made Back to CBCC Main Page