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II WGM Agenda September 2017

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Imaging Integration WG Agenda - HL7 WGM 09/2017 San Diego


Day Quarter Event Room Notes
Sunday 10th Q1 9:00am No meeting
Q2 11:00am No meeting
Q3 1:45pm No meeting
Q4 3:30pm No meeting
Monday 11th Q1 9:00am No meeting
Q2 11:0am No meeting
Q3 1:45pm No meeting
Q4 3:30pm FHIR Infrastructure hosting II Aventine D Hosted by FHIR-I
Tuesday 12th Q1 9:00am II/WG-20: General Admin
  • Opening
  1. Call to order, introductions, welcome
  2. Review & approval of the Agenda
  3. Minutes of the previous meeting
  4. Antitrust rules
  • General Administration
    • Review PBS Metrics
    • Review Workgroup Health Metrics
    • Update of all Project Deadlines
    • Review items for 3 year plan - Project Index
    • Review project for STU4 activities
      • Project submission deadline Oct 10
    • Discuss project submission for RadReport / FHIR Profile mapping
    • Co-chair election
  • FHIR-based application sync
    • discussion led by Isaac Vetter (Epic)
Q2 11:00am II/WG-20: General Admin
  • Finish administration topics from previous quarter
  • Discuss DICOM Part 20 project status and updates
  • Use of media in FHIR
Q3 1:45pm HSI

II/WG-20: FHIR Topics

  • Review Release4 Ballot Prep activities
  • Tasks requested by FHIR-I
  • HL7-DICOM mappings (i.e., Patient, Practitioner)
HSI - ???

II/WG-20 - Palmero

Q4 3:30pm II/WG-20: FHIR Topics
  • Continue FHIR topics
  • MHD-I discussion
  • DICOM thumbnails
  • Discuss retirement of ImagingManifest
Wednesday 13th Q1 9:00am II/WG-20 Palmero
Q2 11:00am Orders and Observations hosting II Studio Suite 310
Q3 1:45pm II/WG-20
  • Review FHIR-I discussion topics for the afternoon
  • WG-06 update
  • Book fall t-cons and January Schedule
Q4 3:30pm II/WG-20 hosting FHIR Infrastructure
  • Workflow update
  • Use of FHIR Media versus Attachment and other means
Thursday 14th Q1 9:00am Structured Docs hosting II Aventine E
Q2 11:00am II/WG-20 joint teleconference with WG-6 Palmero
Q3 1:45pm II/WG-20 Palmero
Q4 3:30pm No meeting
Friday 15th Q1 9:00am No meeting
Q2 11:00am No meeting
Q3 1:45pm No meeting
Q4 3:30pm No meeting


Meeting minutes are available to download at

Following are preliminary meeting minutes:


WG-20 Voting Members Present

  • Agfa HealthCare - Brad Genereaux
  • Change Healthcare - Elliot Silver
  • Penrad Inc - Richard Esmond
  • Philips - Chris Melo

WG-20 Voting Members Absent

  • ACR - Jim Philbin
  • Corista - David Allen
  • Laitek - Doug Sluis
  • Merge/IBM - Ken Meyer
  • PixelMed - David Clunie
  • Siemens Healthcare GmbH - Eric Martin
  • QualiTest Group - Winn Swarr
  • Toshiba - Kevin O’Donnell
  • Vital Imaging (Toshiba) - Jonathan Whitby

WG-20 Alternate Voting Representatives, Observers, Guests Present

  • Aegis - Richard Ettema
  • Defined IT/VA/DOD - David Parker
  • Epic - Michael Donnelly, Danielle Friend, Vassil Peytehev, Isaac Vetter
  • Furore - Ewout Kramer
  • HL7 Austria - Reinhard Egelkraut
  • Lantana - Sean McIlvenna
  • NHS Digital - Simon Knee
  • Newport Instruments - Robert Leif
  • RSNA - Jessica Strzesak, Chris Carr
  • Sequoia Project - Matt Blackmon
  • Siemens Healthineers - Andreas Klingler
  • TIBCO Software - Jim Taylor
  • John Moehrke
  • DICOM Secretariat/MTA - Cheryl Kreider Carey

Presiding Officers

  • Brad Genereaux, Agfa Healthcare, Co-Chair
  • Elliot Silver, Change Healthcare, Co-Chair
  • DICOM Secretary - Cheryl Kreider Carey

1. Opening

The meeting was called to order at 9:00 am Pacific Time. The antitrust rules were reviewed. The minutes from August 9 and January 17-19, 2017 were approved.

2. Administrative topics

Elliot Silver’s Co-Chair term is up in September. Voting is open through Sep 13.

3. Topics discussed during the meeting

Epic, Isaac Vetter – proposal for PSS Lite
  • Investigate the creation of a decentralized, web-based context synchronization specification; don’t use CCOW
  • “Context synchronization” between clinical information systems such as radiology information systems, PACS, EHRs and reporting systems are valued and implemented in health systems. Lack of synchronization is a patient safety issue.
  • handful of integration specifications
  • Microsoft COM APIs, exchange of XML files on a file share communicate the current context with the radiology PACS first question - "whose proprietary spec should we use"
  • other side has significant development to conform simpler and more functional than CCOW talk about "who owns CCOW"? and the history for CCOW; CCOW was not reaffirmed but then that was overturned how does it become "just a checkbox on an RFP"
  • The Ask: for II to be principle sponsor. A straw poll indicated interest in proceeding.
  • Action Item: I. Vetter is to finalize the PSS for a vote later in the week or on a call.
PBS Metrics
  • II is green, no concerns.
Workgroup Health Metrics
  • II is green which is good, with only one fault - lack of balloting in the last year.
Project Deadlines
  • Project 1343: Eye Care and Ophthalmology on FHIR
 * Motion: to support Eye Care and Opthalmology as co-sponsor if done with other optical associations.
  • Project 1230: HL7 Endorsement of DICOM PS3.20: Imaging Reports using HL7 CDA
  • New project on FHIR Release 4 updates
Tracker Items: =
  • 12945 – Remove unused KOS title value set
 * Motion: to remove unused KOS title value set. Approved. 5-0-0
  • 13792 – Add study-level body part element to be consistent with DICOM
 * Motion: to close as non-persuasive. Approved. 5-0-0
  • 13793 – Add study-level body part element to be consistent with DICOM
 * Motion: to close as non-persuasive. Approved 5-0-0
3 Year Plan

Reviewed and confirmed the 3-year plan as follows:

  • Develop and support FHIR imaging-related resources- May 2017 - Jan 2019
  • Develop radiology report FHIR profiles and related content - Sep 2017 - Sep 2019
  • Reconcile imaging-centric lifecycle management with FHIR - May 2017 - Jan 2019
  • Develop imaging implementation guide, profiles, and white papers for FHIR - Jan 2018 - May 2019
  • Specialty-specific workflows (cardiovascular - echo/cath reporting, decision support, informatics; ophthalmology; etc.), measurements and reports - Jan 2018 - Jan 2020
  • Summary dose information (with QI Core) for EHR / decision support systems - Jan 2018 - Jan 2020
STU 4 Activities

New PSS is to be created to support this. Brad will create and present later in the week or on a subsequent call

RadReport/FHIR Profile Mapping

This project hasn’t progressed due to lack of interest within the community. Jessica Strzesak and Reinhard Egelkraut both expressed interest and Brad is to provide information if it is not available in meeting folders.

HL7-DICOM Mapping

Action Item: Brad to create Google doc for WG-06 (note: this action item was retracted later in the week)


Discussion on whether ImagingManifest (maturity level 1) can be removed from the FHIR specification with ImagingStudy remaining unchanged. IHE Radiology profile that defined its main use, MHD-I (Mobile access to Health Documents for Imaging) has been under discussion and active revision, and has even undergone a name change to become WIA (Web Image Access), using only DICOMweb resources.

Prior to becoming ImagingManifest, the FHIR object was called ImagingObjectSelection, which essentially represented a DICOM Key Object Selection (KOS) document, which created its own set of confusion by replicating the functionality as the DICOM object with a variety of open-ended problems. We then constrained the object to represent Manifests, like those used in MHD-I - but with MHD-I no longer making use of them, those on the last call felt it would be prudent to discuss removing the resource altogether.

DICOM Thumbnails

Brad presented the status of DICOMweb thumbnail work item. Committee felt it was a good addition and is supportive of its ongoing development.

Q4 – hosted FHIR-I
  • Ballot schedule; Lloyd’s changes to event prototypes by end of this week
  • Reviewed Tracker items mappings
  • FHIR Workflow – ImagingStudy #10350, 13226 and ImagingManifest #10351, 13227
  • #12771 Code Systems – correct DCIM
  • #12477 ImagingStudy elements cardinality
  • Ballot Prep:
 * Action Item: check value sets and see if they meet
  • Not go beyond 3 STU
  • PSS for context switching; II can be principle sponsor or co-sponsor?
  • FMM – need to start working on test scripts, e.g. structured definitions, profiles, to be tested across its scope.
  • To hold hackathon at SIIM needs approval from FMG
  • WG-20 has been dinged because hasn’t been balloted, but included work in STU ballot. John Will bring it up to FMG.
  • Media Resource – beefed up clinical context, shouldn’t be in FHIR-I: move to observation;
 * Earlier today met with O&O to remove media as it is; needs to be done before it goes normative
 * Drop word “document” and say it’s a manifest
  • ImagingManifest, supporting MHD-I; IHE has been reviewing use cases and changed name from MHD to Web Imaging Access/WIA.
 * Corner Grahame, as he interacts with app vendors, find the right audience
  • DICOM thumbnail being balloted
Thursday, September 14 Q1 – Structured Docs hosted
Q2 – HL7 Review with WG-06
  • Reviewed summer tcons
  • Projects as Co-Sponsor:
 * #1343 Eye Care and Ophthalmology on FHIR 
 * #862 Unique Specimen Identifier Requirements (2012)
   * Elliott to have conversation with Riki/Lorraine today. Mention Connectathon coming up. Full side imagining in DICOM picking up.
 * #682 Specimen CMET Second Release (on hold)
  • Projects as Primary Sponsor:
 * Approached this week by EPIC to be primary sponsor of Application Context Sharing, replacement for CCOW. II is best use case for this.
 * Epic and Sectra did prototype during Connectathon this past weekend. Isaac Vetter/Epic will be taking lead. No additional authoring work for WG-20.
 * OK to let WG-23 know of project
  • Three-year plan hasn’t changed since last time we discussed.
  • FHIR Ballot Schedule:
 * Ballot for Release 4 in Dec 2017/Jan 2018 – for comment, get feedback and smooth the next ballot/set of ballots, Apr-May 2018; Normative + STU/Normative reballot?; Publication scheduled for December 2018, including infrastructure resources, data types, REST api definition; patient and observation are only actual clinical resources proposed to go normative.
 * Should DICOM do public comment on relevant parts of FHIR? WG-06 said to develop public comment ballot that HL7 ballot is forthcoming and here are the imaging resources we’re proposing to put into it to disseminate in January 2018. Will have document of resources for WG-06 to review at their next meeting.
 * Value sets maintained by 3rd party other than HL7, will morph and not be on same release dates. 
 * Defining url – Elliott work with Grahame. IHE might stand up terminology group.
  • Media Resource – stuck in limbo between being clinical and non-clinical
 * Proposal for Media to merge into Observation resource with attachments. If merged, then Orders & Observations WG will own it. Discussion re: Binary resource, Document resource, Attachments data type and Observation and when you would use which one.
 * Will be sorted out before comment ballot.
  • I4 – Rich Esmond, Co-Chair of ESI ??
 * Stan Huff chair of HL7 and currently on the Board, well known in Health IT, PCPI, and SIMI. Attracting med societies to participate. I4 meeting next week is to see what interest and get societies involved. Aspirational message there will be a lot of content coming in the future. Drive interest in the process. Cancer interoperability. Problem: to get user community to agree that they want to do this. The people who create the data. Richard will communicate those in charge, to have more focus on how it will affect users bottom line. He’d like this to succeed and would be OK if MITA takes the lead. Richard to provide attendee list. Will have II involved in future meetings. 
  • ImagingManifest (frame references) v Imaging Study (clinical context)
 * ImagingManifest is largely driven by MHD-I, now Web Imaging Access
 * Do we move forward with two imaging resources, or consider removing one or consolidating? 
 * WG-06 doesn’t see a need to keep Manifest 
  • Tracker Items against FHIR
 * Brad will create DICOM mappings
Q3 =
  • PSS: Project to explore Application Context Synchronization in FHIR (no longer Lite)
 * Motion: to sponsor this PSS as presented, and move it forward for Steering Division approval, pending the following updates to PSS:
 * Add recognition that CCOW market has collapsed.
 * Add: that CCOW requires a central context manager, and this aims to be decentralized
 * Add that: technologies that did not exist at the time of CCOW are now available to be leveraged.
 * Add that: The project should attempt to reuse the CCOW abstract model, if possible.
 * Approved. 4-0-0
  • PSS: Develop imaging-related FHIR contentresources for the fourth release
 * Motion: to move ahead with this PSS
 * Approved. 4-0-0
  • Tracker Items against FHIR
 * Brad will create DICOM mappings. Action Item: Use a block vote 
  • It was mentioned that Elliott Silver was reappointed for a 2-year term.

4. Next meetings


REMINDER: During DICOM WG-20 t-cons, we will be using HL7’s system for conference audio: Phone Number: +1 770-657-9270, Participant Passcode: 566532, and GoToMeeting system ONLY for screen sharing.

• Thursday, October 12, 2017, 2:00-3:30 USA ET • Monday, October 23, 2017, 3:00-4:30 USA ET • Thursday, November 9, 2017, 2:00-3:30 USA ET • Monday, November 20, 2017, 2:00-3:30 USA ET • Thursday, December 7, 2017, 2:00-3:30 USA ET


Future Meetings of HL7

2018 • January 27-February 2, 2018, New Orleans, LA • May 12-18, 2018, Cologne, Germany • September 29-October 5, 2018, Baltimore, MD

2019 • January 12-18, 2019, San Antonio, TX

6. Adjournment

Motion: to adjourn. Approved.