CIMI WGM Agenda January 2017

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Agenda

Day Time   Room Event Host Joining Chair/Lead Scribe
Sunday
January 15
AM Q1 Chula Vista Administration and Planning     Stan Galen
Q2 Chula Vista "Cram Session:" FHIM-CIMI-FHIR, CDS/CQI Requirements, SOLOR/Condition/Observation issues, CQL implications     Galen/Richard  
PM  
Q3 Chula Vista "Cram Session:" FHIM-CIMI-FHIR, CDS/CQI Requirements, SOLOR/Condition/Observation issues, CQL implications Galen/Richard  
Q4 Chula Vista "Cram Session:" FHIM-CIMI-FHIR, CDS/CQI Requirements, SOLOR/Condition/Observation issues, CQL implications Galen/Claude  
Day Time   Room Event Host Joining Chair/Lead Scribe
Monday
January 16
AM Q1 Chula Vista Ballot Reconcilliation Stan tbd
Q2 Chula Vista Ballot Reconcilliation     Stan tbd
PM Q3 Chula Vista Semantic alignment with terminology model binding Stan/Jay tbd
Q4 Chula Vista CIMI FHIR profile governance and coordination across groups
  • coordination across HL7 working Groups
  • coordination across international initiatives
Stan tbd
Day Time   Room Event Host Joining Chair/Lead Scribe
Tuesday
January 17
AM Q1 Rio Grande Ctr @ Patient Care (skin breakdown) Patient Care (Pt Care) n/a
Q2 Blanco FHIM Coordination   Harold/Galen tbd
PM lunch Blanco Lunch with FHIR: CIMI FHIR profile governance & coordination across groups FHIR-I Galen Jay
Q3 Blanco Ballot Reconcilliation tbd tbd
Q4 Rio Grande Ctr @ Patient Care (negation) Patient Care (Pt Care) n/a
Day Time   Room Event Host Joining Chair/Lead Scribe
Wednesday
January 18
AM Q1 Rio Grande West @ CQI CQI (CQI) n/a
Q2 Nueces @ CIC: Next steps for integrating the Data Elements into CIMI models; How to support DE->FHIR project CIC (CIC) n/a
PM Q3 Regency East #1 Reference Model: review any proposed reference model changes Claude Jay
Q4 Rio Grande West @ CDS CDS (CDS) n/a
Day Time   Room Event Host Joining Chair/Lead Scribe
Thursday
January 19
AM Q1 Blanco Conditions and Observations Richard Richard/Jay
Q2 Blanco Recap of Integration of Information Models and Tools PSS efforts Steve tbd
PM Q3 Rio Grande Ctr @ Vocabulary Vocabulary (Vocabulary) n/a
Q4 Blanco Ballot planning tbd tbd
Day Time   Room Event Host Joining Chair/Lead Scribe
Friday
January 20
AM Q1 NOT MEETING  
Q2   NOT MEETING        
PM Q3   NOT MEETING        
Q4   NOT MEETING        

Sunday Q1

Attendees: Allen, Kurt; Coyle, Joey; Esmond, Richard; Gustafson, Greg; Huff, Stan; Hufnagel, Steve; Langford, Patrick; Lyle, Jay; Matney, Susan; Mulrooney, Galen; Nanjo, Claude; Shin, Soo-Yong; van der Zel, Michael; Vernon, Annette

Sunday Q2

Attendees: Allen, Kurt; Coyle, Joey; Esmond, Richard; Gustafson, Greg; Huff, Stan; Hufnagel, Steve; Karlsson, Daniel; Langford, Patrick; Lyle, Jay; Matney, Susan; Mulrooney, Galen; Nanjo, Claude; Shin, Soo-Yong; van der Zel, Michael

Sunday Q3

Attendees: Aassve, Oyvind; Allen, Kurt; Bray, Bruce; Coyle, Joey; Esmond, Richard; Heerman, Laura; Huff, Stan; Hufnagel, Steve; Karlsson, Daniel; Langford, Patrick; Lyle, Jay; Matney, Susan; Muir, Sean; Mulrooney, Galen; Nanjo, Claude; Shin, Soo-Yong; van der Zel, Michael

Sunday Q4

Attendees: Allen, Kurt; Bray, Bruce; Coyle, Joey; Esmond, Richard; Heale, Bret; Huff, Stan; Hufnagel, Steve; Karlsson, Daniel; Langford, Patrick; Lyle, Jay; Matney, Susan; Muir, Sean; Mulrooney, Galen; Nanjo, Claude; Rhodes, Bryn; van der Zel, Michael


Monday Q1

Attendees: Allen, Kurt; Booth, David; Chennamaraja, Neelima; Chute, Chris; Coyle, Joey; Esmond, Richard; Heale, Bret; Huff, Stan; Hufnagel, Steve; Langford, Patrick; Matney, Susan; Mulrooney, Galen; Nanjo, Claude; Solbrig, Harold; van der Zel, Michael; Versaggi, Serafina

Monday Q2

Attendees: Allen, Kurt; Booth, David; Chennamaraja, Neelima; Chute, Chris; Coyle, Joey; Esmond, Richard; Goossen, William; Heale, Bret; Hoang, Catherine; Huff, Stan; Hufnagel, Steve; Langford, Patrick; Luensman, Genny; Matney, Susan; Mulrooney, Galen; Nanjo, Claude; Solbrig, Harold; Versaggi, Serafina

Monday Q3

Attendees: Allen, Kurt; Booth, David; Chute, Chris; Coyle, Joey; Esmond, Richard; Hirai, Masaaki; Huff, Stan; Hufnagel, Steve; Jordan, Peter; Karlsson, Daniel; Konishi, Yukinori; Kramer, Mark; Langford, Patrick; Lyle, Jay; Matney, Susan; Mulrooney, Galen; Nanjo, Claude; van der Zel, Michael; Versaggi, Serafina

Jay presented slides developing several questions concerning CIMI semantics and how to test them.

  • CIMI will support Assertion pattern, but it needs to be convertible to the Evaluation pattern. For this to happen, we need “Observable” concepts available for each “Finding.”
  • Criteria for distinguishing which pattern is "preferred":
    • Assertions are about the whole patient; evaluations are about characteristics
    • Prefer Evaluation where possible
    • Assertions are about categories
    • If the evaluation expression has a value of "present," use assertion
    • We will create a table of examples to illustrate the distinction between Assertion and Evaluation.
  • Note: CIMI is about building models with unambiguous meaning. Deriving computable expressions is a good thing, but it should not impede the primary work. We will, however, use computable expressions to test the hypothesis of unambiguous meaning.
  • Open question: Where is the binding reference that a recipient needs to assign an attribute to a property? In a CIMI archetype library? In a Template library? We can create model bindings in archetypes, but SCT Templates would support inter-element constraints; e.g., if finding pre-coordinates finding site, finding site cannot conflict. Do we want to specify the binding in two places, or specify once and let the other inherit?
  • “Don’t do negation in terminology” means don’t precoordinated negation. We have no problem explicitly stating “Absence.”
  • Issue: SNOMED negation classification doesn’t work the way clinicians are going to want it to work.

Monday Q4

Attendees: Allen, Kurt; Booth, David; Bray, Bruce; Coyle, Joey; Huff, Stan; Hufnagel, Steve; Langford, Patrick; Lyle, Jay; Matney, Susan; Mulrooney, Galen; Parker, Craig; van der Zel, Michael

Tuesday Q1

Tuesday Q2

Attendees: Allen, Kurt; Coyle, Joey; Huff, Stan; Hufnagel, Steve; Kramer, Mark; Langford, Patrick; Matney, Susan; Morford, Dan; Mulrooney, Galen; Nanjo, Claude; Versaggi, Serafina

Tuesday Lunch

  • Attendees: Allen, Kurt; Coyle, Joey; Greive, Grahame; Hufnagel, Steve; Kramer, Mark; Langford, Patrick; Lyle, Jay; Mandel, Joshua; Matney, Susan; Mulrooney, Galen; Nanjo, Claude; Parker, David; van der Zel, Michael
  • Chair: Galen Mulrooney
  • Scribe: Jay Lyle
  1. CIMI status
  2. Areas where FHIR needs DCMs
    1. Labs are pretty mature
    2. Patient observations, patient entered data, human mediated exams, data from devices, wearable devices, PHRs
    3. FHIR is a spec and a community.
  3. Plan for coordinating profile development
    1. Standardize registries; financial impact.
    2. Argonauts higher level: DAF, not LOINC
    3. FHIR leads by example.
    4. HL7 HSPC meeting with societies. CMS – council of medical societies. They should own the specification.
    5. Unification projects by dint of different lifecycles become a primary driver of variety.
  4. Should we just use FHIR?
    1. See reasons from Monday meeting

Tuesday Q3

Attendees: Allen, Kurt; Coyle, Joey; Hufnagel, Steve; Langford, Patrick; Matney, Susan; Mulrooney, Galen; Nanjo, Claude; Parker, Craig; van der Zel, Michael

Tuesday Q4

Wednesday Q1

Wednesday Q2

Wednesday Q3

Attendees: Allen, Kurt; Coyle, Joey; Hufnagel, Steve; Matney, Susan; Mulrooney, Galen; Parker, Craig; Takasaka, Sadamu; van der Zel, Michael; van Dyke, Pat

Wednesday Q4

Thursday Q1

Attendees: Allen, Kurt; Coyle, Joey; Esmond, Richard; Huff, Stan; Hufnagel, Steve; Konishi, Yukinori; Kramer, Mark; Langford, Patrick; Lyle, Jay; Matney, Susan; Nanjo, Claude; van der Zel, Michael; Zheng, Shuai


SNOMED CT Finding concept seems appropriate to the Assertion model. This is a finding in the patient. We do, however, make presence, timing, and subject explicit, as in the SNOMED CT Situation model.

  • Key = Assertion; Value = Diabetes (finding)

This corresponds to Situation; subject = patient, context = present; associated finding = diabetes.

SNOMED CT Observable concept (or LOINC codes) seems appropriate to the Evaluation model. This is the evaluation of a property in the patient.

  • Key = Blood Type (Observable); Value = B negative

Observable: do we need a specific range, or can an Observable have two (pulse rate, pulse strength)

  • Wave form: frequency, amplitude, shape. Are these three observables? We think so.
  • Wound: many observables. Type may be baked into the assertion. All the rest are Observables.

The question is not what the fact “is,” but how do we represent it?

How to decide which pattern is preferred (for a case):

  • Characteristic vs whole patient.
  • Category. (e.g., drug injector question)
  • Can we use Queries to differentiate.
  • Table of examples & edge cases.
  • If answer is Boolean or Present/Absent

[case: absent risk. Multiple context values or precoordinated; or other approach]

Note: use “evaluation result” to distinguish from the act of evaluation.

We want a single representation that can be reliably used for both cases.

EvaluationResultto Finding is easy:

  • Finding of blood type of B negative.
  • Systolic Blood Pressure is 131 (unlikely but unambiguous)

Assertion to EvaluationResultcan be harder

In order to logically transmute Finding of Diabetes into an evaluation, not only do we need a corresponding Observable concept, but the Finding concept or Observable concept needs to be defined in terms of the other. Another question: can we negate loss of consciousness within a present head injury? The situation model only has one site for Finding Context. These have to be separate Situation using the current model; their relationship lives in CIMI, not the ontology.

PenRad using CliniThink, which uses attribute chaining rather than role groups, apparently successfully.

EvaluationResult has Method; how do you do that in Assertion? Assertion has [property]; how do you represent that in an EvaluationResult?

Thursday Q2

Attendees: Allen, Kurt; Coyle, Joey; Esmond, Richard; Huff, Stan; Hufnagel, Steve; Kramer, Mark; Langford, Patrick; Matney, Susan; Nanjo, Claude; van der Zel, Michael

Thursday Q3

Thursday Q4

Attending: Harold Solbrig, Jay Lyle, Claude Nanjo, Ken Kawamoto, Michael Van Der Zel, Steve Hufnagel, Patrick Langford, Galen Mulrooney; Susan Matney, Stan Huff, Joey Coyle, AMS Shakir Chair: Galen Mulrooney; Scribe: Jay Lyle


Goals for May Ballot:

  1. Modeling. #1 priority. [Claude, Galen]
    1. BMM: Reference model including pilot content
    2. ADL: top level archetypes including pilot content
    3. FHIM generation: #4 priority [Galen]
  2. Pilots
    1. Skin Wound Assessment: content is #1 [Jay, Susan]
      1. Expression #1 [Jay]
      2. Quality measure #2 [Claude, Ken]
    2. Zika measure #3
    3. Pediatric Bilirubin Management CDS #2 (Ken)
    4. Immunization Management #3 (Steve with Gary Dickinson, EHR WG)
    5. Refine PROCEDURE and CONTEXT based on Pilots #3
    6. US Core / QI Core / CIMI Archetype integration #1 [Claude]
    7. Family Planning Annual Report (FPAR) – HSPC pilot with ACOG #?
    8. Device interfaces MDEpiNet. #3 (Julia)
  3. Tooling
    1. FHIR conversion (2e) #2
    2. Code generation – Java classes to represent the CIMI models #3
    3. Authoring
      1. Visualize #2 [Patrick]
      2. Version management/governance #3
      3. STAMP #4
    4. Repository (e.g., Simplifier) #2
      1. Visualization #3 [Michael]
      2. Get requirements to Furore #1 [Claude]
    5. libraries to manipulate BMM/ADL #0 [Claude]
    6. Documentation [Patrick, Editor]
      1. Overview/marketing pitch [Stan, Jay, Claude. Steve, Nona, Ask Laura.]
      2. Practitioners' Guide, for clinicians, Analysts and non-CIMI SMEs. [Steve, Nona]
      3. Style guide [Susan, Jay, Steve]
      4. Architecture guide [Claude]
      5. Refine CIMI Process Definition for CIC #3 [Steve, Claude, Jay, Galen]
      6. Content uptake & governance process [Jay]
      7. Generation tool [Michael]
    7. Terminology
      1. Author: SOLOR / TermWorks – get access #1 [Keith/Susan]
      2. Publishing #2

Work plan

  • 3/26 pub date
    • 3/1 full content draft
    • 3/10 content done
    • 3/14 docs done: to Patrick for editing

Action Items*

  • Glossary: resurrect the Mayo one.
  • Assertion/Evaluation Example Table to be in style guide [Stan]

San Antonio HL7 Workgroup unresolved-topics:

  • FHIR Management Group requested justification for CIMI PSS being Universal Realm; where, the bulk of our work appears US centric (SNOMED, LOINC, RxNorm (SOLOR) in particular).
  • Requirements and tactical plan for May Ballot content
  • Requirements and strategic Plan for how CIMI tooling can improve (make consistent) and integrate with current FHIR web-based tooling
  • Requirements and strategic Plan for Streamline process to produce FHIR Profiles and Extensions
    • E.g., Is there an expedited UML tool path to FHIR Structure Definitions, as recommended by Michael van der Zel; where, tooling can also produce ADL.
    • Requirements and strategic Plans for CIMI Clinical Knowledge Manager (CKM) before we create stovepipe solutions


The Vocab group has several threads of ongoing work that intersects with CIMI in critical ways. [Richard Esmond]

  • Terminology & ValueSet Publishing
  • Terminology Binding
  • ValueSet Expansion