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2017-06-14 SGB Conference Call

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HL7 SGB Minutes


Date: 2017-06-14
Time: 10:00 AM Eastern
Facilitator Paul/Calvin Note taker(s) Anne
Attendee Name

x Calvin Beebe
x Lorraine Constable
x Russ Hamm
x Tony Julian
x Paul Knapp
x Austin Kreisler
x Wayne Kubick
Mary Kay McDaniel
Ken McCaslin
x Rik Smithies
x Guests: AbdulMalik Shakir, Lisa Nelson, Holly Chevalier, Serafina Versaggi, Lloyd McKenzie
Quorum: Chair + 4


  • Agenda review
  • Approve Minutes of 2017-05-31_SGB_Conference_Call
  • Action Items
    • Wayne will forward info from Grahame on variance from normal balloting/publishing process
    • Paul to find principles document and write precept on mixed ballot content
    • Austin to update mission and charter boilerplate
    • Anne to gather all principles and precepts and publish on Wiki by mid-June
    • Tony to find vitality assessment slide deck
    • SGB to join ARB on 2017-06-06
    • Paul to draft a precept on state machine alignment
    • Anne to invite MnM/InM//Structured Docs cochairs to 2017-06-14 call to discuss state machine alignment
    • Anne to respond (copying Austin/Paul) to David Pyke re: SPIA email
  • Discussion Topics
    • State Mahine Alignment with MnM/InM/Structured Docs co-chairs
    • Revisit our current precepts and add who our precepts apply to and how they are to be implemented
    • Review PIC document on balloting best practices
  • Parking Lot
    • Review Publishing M&C updates regarding dual roles
    • Write/post precept on vitality assessment
    • Next steps on Substantivity (from ARB)
    • How do we deal with making sure that WGs involve those whose content domain they’re touching? (CIMI and Pharmacy and Lab models)
    • Review Mission and Charter
    • PSS approval process: managing unresponsive parties - propose new precept to TSC
    • Handling situations where two documents come out of one project
    • FHIR Product Director Position Description: we should 1) review further and draft feedback, then 2) map back the description to the role of FGB
    • Drafting Shared Product Management Responsibilities
    • Vocabulary precepts
    • General precepts
      • Precept around training WGs in CDA methodology and management principles
    • Levels of standards
    • Separation of concerns
    • Ownership of content
    • ISM
    • Ask methodology groups to define how the definition of substantive change applies to their product family; management groups must then operationalize


  • Agenda review
  • Approve Minutes of 2017-05-31_SGB_Conference_Call
    • MOTION to approve: Rik/Austin
    • VOTE: Lorraine abstains; remaining in favor
  • Action Items
    • Wayne will forward info from Grahame on variance from normal balloting/publishing process
      • Discussed on Monday; Grahame wrote something up that Wayne will forward
      • ACTION: Anne to add document review to next week's agenda
    • Paul to find principles document and write precept on mixed ballot content
      • Add to next week
    • Austin to update mission and charter boilerplate
      • Add to next week
    • Anne to gather all principles and precepts and publish on Wiki by mid-June
      • Precepts complete. Look at adding any principles.
    • Tony to find vitality assessment slide deck
      • Add to next week
    • SGB to join ARB on 2017-06-06
    • Paul to draft a precept on state machine alignment
      • Add to next week
    • Anne to invite MnM/InM//Structured Docs cochairs to 2017-06-14 call to discuss state machine alignment
      • Complete
    • Anne to respond (copying Austin/Paul) to David Pyke re: SPIA email
      • Complete
  • Discussion Topics
    • CIMI product family
      • CIMI has a meeting tomorrow. They're planning to look over/discuss the note that TSC send regarding forming a product family. Lorraine will attend to assist with the conversation. Paul will go as well.
    • State Machine Alignment with MnM/InM/Structured Docs co-chairs
      • Review of current status of the issue: Austin state that Structured Docs looked at some mappings from a FHIR resource to a RIM based standard; came to the conclusion that there may be no right status attribute. Lisa: The poster child is the mapping between Concerns and Condition. Lorraine: This came up in OO and we came up with two state models - business and clinical. What are the governance questions that are bringing it to this body?
      • Paul: What precepts or guidance do we need to have so committees address this kind of situation. At this point we're trying to bring people together to get input on the situation and guide the establishment of precepts if any are required. Lorraine: This is primarily a methodology question.
      • Austin: The governance question is do we need to mandate that methodology has to address this cross-family consistency problem? Lorraine: A business concept should be reflected similarly across the product family; not sure about record status/act status.
      • Lisa: The information is doing what the information does regardless of product family representation. The act status workflow is the same regardless of how its viewed. Tony: In V2 the record is a point in time; as far as an ADT message carrying a status, it's carrying a status of the business but no status of the message itself except that it's active. AMS: When we take Encounter, in V2 we have admit which makes it active and discharge that makes it inactive. The term status is used for both business and clinical so maybe they should be differentiated. Paul: Need to propose a method to address the situation of the differences. In V3 we put act status on everything.
      • Lloyd arrives. Paul describes the issue. Status codes in FHIR are being compared to business status or act status in CDA and V3. In a few of the FHIR resources, there is no equivalent status or status had been used differently. SGB is looking at what we need to do from a precept standpoint, so we're trying to get input from methodology. Condition, for example - in V3 there's an act status and a business or clinical status, but the FHIR resource has a field called status that maps to clinical status, but no act status equivalent.
      • Lloyd: The position that FHIR takes is that we're driven by what do software systems typically expose, and the WG would be saying that most systems don't have a notion of act status when it comes to healthcare conditions. Few have a notion of draft vs. active vs. completed when it comes to diagnosis. If you have a strong need for it you can have an extension to convey that. Paul: Yes, but we should be able to explain that.
      • Lisa: But it is used in CDA and there's no spot to put it in FHIR. Lloyd: You can put anything you want in FHIR using extensions. If most systems in the world do this, then we can put in a change request and add it in to the core spec. If it's not done by most of the world, then we can do a standard extension.
      • Paul: So we should look at the issues of consistency of naming such that we don't have confusion with status meaning different things in terms of business and clinical. Lloyd: We try to be consistent in naming the cross resources, but don't enforce the consistency when it would increase implementer confusion. We don't name things based on what V2 or V3 implementers would be familiar with. Would not want to have a rule that says we must use status to always mean business status or record status because there is the potential for circumstances where that would increase confusion.
      • Paul: I think we should strongly try to work towards consistency on core concepts because it's not helpful or safe to use the same term to refer to different things, or to require people to read the definition of the field.
      • Lloyd: There's the name, the short definition, the long definition, and the value set. We have a wide variety of value sets for state. We do not use a consistent state machine for all resources. We do have patterns for act-based states that we look for alignment to; but not all resources will expose all states even there. The priority remains intuitiveness to the implementer; but if we can achieve that and be consistent across resources, we strive to do that.
      • AMS: It might be enough to say that we recognize there are two different state machines for business and record. How can we add metadata to it?
      • Lloyd: FHIR doesn't necessarily create a split. In the publication there is a table with codes and their V2 and V3 equivalents. It is also in ConceptMap. In the excel spreadsheets we have a column including the V2 and V3 for a lot of the status codes; the intention is that we'll do it for all.
      • Lisa: You still have to get the value set mapped to the right spot. Paul: It's possible within family methodology to confound concepts. Where there is no way to represent a concept, there's an element missing, and the question is how to get that element in.
        • ACTION: Paul will go in and find the concept maps
        • ACTION: Need to take a look at everything in CDA to find out if the missing concepts can be represented in FHIR
        • ACTION: Need proposals to create the elements or to use a consistent extension to ensure translation mechanism to capture the information
      • Discussion over how this encourages people to do things differently. Wayne: Need to have clear definitions and descriptions. Ultimate goal is to be consistent where it makes sense across all product families, and perhaps we need to issue guidelines or a checklist regarding consistency when you add a new concept or attribute.
      • Paul: From a safety perspective, we should move toward consistent naming.
      • Wayne: SGB and FGB should look at this together.
      • Calvin: When FHIR was set forward, it was a green field strategy; and yet mappability from one family to another is desirable. But don't we have a conflict between those perspectives? Are we going to set up a rule or guidance? Wayne: It wasn't a totally green field, but it was what can we do that would be more implementable? Need to look at where we can possibly converge where possible. Lorraine: Business concepts are business concepts regardless of the paradigm. Paul: So is the status of the record.
      • Paul asks guests to come next week as well and reflect on the notion of if people are going from your family and going to another family, what is the guidance that we need to make available to people, and how to we make it available to them? Serafina: We will see different product families being used within the same organization, and semantic interoperability needs to be clear.

Meeting Outcomes

Next Meeting/Preliminary Agenda Items

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