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September 2012 WGM Baltimore

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PC Baltimore WGM 2012 September

PC Monday Sep 10 2012


PC Monday Q3

Present: Michael Tan, Stephen Chu, Kevin Coonan, William Goosen, Hugh Leslie, Jon Farmer, Chris White, Isebella Gibaud, Adel Ghlamallah

Motion to accept the minutes of the May WGM - Vancouver: Moved Stephen, Second Hugh, 1 abstain, 0 against, 6 for - passed.

Planning for the rest of the week

September Ballot - Quorum was met and all four were complete with only one neg which was withdrawn.

Patient Care Work Plan Review: Review 3 year work plan. Discussion about V2 materials and need for continued development of the V2 messages. Lots of V2 messaging is still ongoing.

Motion: To accept the changes to the work plan (see published spreadsheet). Stephen Moved, Chris White Second - 0 against, 0 abstain, 8 in favour.

PC Monday Q4

O&O - see O&O minutes

PC Tuesday Sep 11 2012

PC Tuesday Q1

Present:William Goossen (Chair), Michael Tan (Scribe), Michael van Campen, Susan Matney, Jean Henri Duteau, Line Andersen, Hugh Leslie, Irma Jongeneel,

The topic of this quarter is the ballot reconciliation. The good news is that the DMIM now has reached the normative status. One negative comment has been submitted, but no comment was sent in. Therefore the negative vote had to be ignored.

A motion has been put to remove DerivationExpr from the walkthrough.

There are 9 entry points of which 3 are not mentioned to the Clinical Statement. Decision to add the 3 entry points to the text of the walkthrough.

The text from the “ServiceDeliverylocation” will be removed.

Jean has to add “status-code”to the act of Transportation .

The 3 variants of “source of” has to be explained. William to add the text. And the Pertinent2 text has to be removed.. The numbers of the act relationship has to be adjusted. The text about authorization has to adjusted.

On the missing diagram, remove the link to the graphic nr.31.

A picture from Isobel Frean’s document has been copied and used as storyboard diagram 33. Decision to let William and Michael to find the pictures or create them once more.

Please look at the remarks on the ballot reconciliation [spreadsheet][1].

A motion was put forward to accept the comments and the dispositions. The motion was put forward by Irma Jongeneel, seconded by Jean Duteau. 0 against, 0 abstain and 11 in favor.

Suggestion to add wording to the ballot material to explain that the standard is co-owned by the patient administration. The DMIM will only be changed in joint meetings with PA and PC. Motion forwarded to make this a formal decision. 0 against, 0 abstain, and 12 in favor. Add text to explain that the RMIM’s are explained in the separate sections of patient care and patient admin. Also explain in the visio of the DMIM.

The negatives votes from Gunther Shadow and Keith Boone have to be withdrawn before the material can be submitted for normative publication. William will approach Keith and Gunther. Action Item WGo. If they do not withdraw their negative votes the PC will follow the normal procedure to vote. This motion has been accepted: 0 against, 0 abstain and 12 in favor.

The visio and the text of the Care Record Query were not in line. Michael had added extra parameters to the query on request of Patient Administration (such as the location of the encounter). However Irma could not remember this request. Therefore the extra parameters will be removed.

William questions whether the care record query should really also be a joint topic between PA and PC, rather than a specific query for PA. A new project scope should be submitted to discuss this subject. A motion was put forward to withdraw the extra parameters from the Care Record Query and to discuss the addition of these parameters in a new project for a future version. The motion was accepted: 0 against, 0 abstain and 12 in favor.

PC Tuesday Q2

Present: Terri Monk, Martin Hurrell, John Walsh, Michael van Campen, Susan Matney, Michael Tan, Kevin Coonan, William Goossen

Joint Anaesthesia and PC William Goosens on Clinical Statement: Clinical statement proper is now being used rather than care statement. Each specific clinical content material needs a further profiling of the clinical statement pattern. ObservationVitalSigns – has been balloted as DSTU in 2007 and extension in 2009 but expired in 2011. So not currently in use. Statement Collector R-MIM allows you to collect statements together – list of vital signs. Patient connected device in OR – ie wave form 200 hz from ECG, patient monitors or reading every 15-30 seconds. Translates to a lot of readings. Too many to associate context with each reading. Kevin suggests context conduction as a solution. Martin Hurrell: 11073 – is relevant balloted vital signs standard. Discussed Kevin’s mind map of heart rate. Discussed CIMI and openEHR models - history model in openEHR Reconciliation of 11703 is important as many clinical models don’t deal with devices well. Possibly Motion: That Anaesthesia and Patient Care WGs seek to create a project scope statement with Healthcare Devices WG for vital signs representation in V3. Moved William Goosen, Seconded Susan Matney. Abstain 0, Against 0 , For 9 Is this development for CDA r2 or CDA r3? V3 would enable us to drop into CDA r3. Motion: Amend previous motion to add Emergency Care WG along with Healthcare Devices WG. Moved: Terri Monk, Seconded: Martin Hurrell Abstain 1, Against 0, For 7

PC Tuesday Q3


PC Tuesday Q4


PC Wednesday Sep 12 2012

PC Wednesday Q1

Hosting PHER and CIC

Present: Margaret Ditloff, Isabelle Gibaud, Nathan Bunker, Rob Savage, Ken Pool, Anita Walden, Dianne Reeves, Meredith Nah, Hugh Leslie, Kevin Coonan, William goossen, Sandy Marr, Jim McClay, Floyd Eisenburg, Laura Heermann, Susan Matney

Patient Care – Wednesday Q1 – Hosting PHER and CIC Agenda – updates from PC, PHER and CIC Patient Care update Patient Care materials – longstanding development since 2000. Clinical statement developed from UK work by Charlie Bishop. William gave overview of clinical statement. Kevin Coonan gave overview of Health Concern – Kevin wants to significantly rework this model. Discussed the allergy/intolerance work. Discussion of problem list problem. Good feedback.

CIC update – Cardiovascular release 2 DAM has been published. Two new projects – mental health Dam and C? CIC are producing informative ballots. DAM discussion – UML may not be the best methodology. Data elements need to be packaged for the best view by clinical domain experts. Collaboration and harmonisation is an issue for DAM creation. PHER update – V3 immunisation message – successful ballot – passed resoundingly. Continue update – Wednesday Q1 at the next meeting.

PC Wednesday Q2


PC Wednesday Q3


Joint meeting with CIC, Emergency, PHER

Registry DAM/DCM/ CS Templates

  • There is a need from CIC for a DAM registry and repository. This is also a common need for search need of DAM’s, templates and DCM. We use the templates very often in the domain of Patient Care.
  • There has been discussion in Vancouver about the setup of a registry. This was reuse of a general repository that would be used for templates. Anita does not the name of the project. This would open up the possibility to store DAMS as well.
  • OpenEHR has also set up a registry for Archtypes. This includes the governance of the model.
  • Hugh states that maintenance is important, because a user will rely on the presence of a particular version. This cannot be changed without the proper procedures.
  • Currently about 18 DAMS can be found on the HL7 Inc website. The list is not complete, but it is not known who maintains the list.
  • It is also important to know which DAMS are in the pipeline and only the balloted ones.
  • William suggests to maintain the DAMS on a special WIKI.
  • Motion: The joint groups agree to post the DAMS to a single wiki. There is already a entry, which was created by Rene Spronk;
    • Vote of the motion: 11 in favor, 0 negative, 0 abstain.
  • Action item: Anita will setup / maintain the meta-data of the DAMS. ( look at Clinical Statement Change request template). We will do a poll on the contents of the meta-data before the next meeting. Anita will send a signal to William if her concept of meta-data information is ready.
  • Each TC will submit there own entries on the WIKI.
  • Action item: Kevin will change the index so that the page for DAMS will show up in the index.
  • Action item: William will arrange the doodle pool on the vote for the meta-data. He will receive a signal from Anita.

PSS for DDF (Dam developement framework)

  • The joint group has a need to create guidelines for DAMS (DAM framework). A Project Scope Statement might be required.
  • The suggestion is to use HL7 Development Framework as an example. However the HDF will be revised. Advise has to be asked to M&M how to carry on.
  • Action item: Kevin to ask M&M about our intention and the question who picks up the work and owns the project.
  • Other issues:
    • Conceptual models, Logical models
    • Data element guidance.
    • Coherence between different artefacts. ( discuss with Huffnagel)
    • Best practices and experiences with DAMs
    • Clarifying the purpose of the DAM.
    • Use cases.

Assessment Scales RMIM

  • Measurements can be put as separate scores.
  • A grouper to bind the separate measurement to form a total score.
  • Motion: to bring the Assessment Scale Material back to ballot:
    • Vote: In favor 10, 0 against, 0 abstain.
  • Action item:: Michael and William will prepare the material for ballot and submit a ballot request.

PC Wednesday Q4

Allergy/Intolerance Project Meeting

Chair: Stephen Chu

Scribe: Margaret Dittloff


Stephen Chu

Russell Leftwich

Jean Duteau

Margaret Dittloff

W Gregory

Jamie Cash

Crystal Wolfe

Isebelle Gibaud

Jon Farmer

Michael Tan

Massimo Frossi

Francesco Rossi

Adel Ghlamallah

Christina Knotts

Lise Stevens

Floyd Eisenberg

Tom Bonina

Peter Goldschmidt

Hugh Leslie

Kevin Coonan

Minutes from July 26th and August 9th meetings for approval Motion: Margaret Dittloff/Russ Leftwich Voting result: Abstain 8, No 0, Yes 12

Use Case Review Brief review of the list of use cases completed as posted on the PC wiki Allergy Intolerance project page.

Review of Current Model Jean Duteau provided a walk-thru of the current model. • Kevin introduced a question about adding a “Risk” attribute to the model. Discussion ensued as whether that is already inherent in the model, e.g., having an allergy/intolerance condition is already saying that the person has a risk. Kevin wants to be more explicit about the risk that they have. Further discussion debated the differences and similarities of a “risk” concept to the “criticality” attribute already in the model. o How to quantify risk? Are there any evidence-based scales or studies using a risk level? o This reaction has a subsequent risk? o Risk – how likely is this to happen again? o Action – further discussions with Kevin to explore the concept further • Model updates o Removed the label on the model diagram under Allergy (“Contraindication to a Substance”). Group agreed this was asserting a clinical judgment which may be implied here for most cased, but we should not say it here. o Sensitivity Tests (on diagram) “provide evidence for” Discussion around whether or how a negative sensitivity test would refute an allergy and then you have an allergy model saying something is not an allergy/intolerance. Jean changed wording to “can provide evidence . . . .” o Next level we will need to know how far to go into the Agent Substance types “is a type of.” Adverse Reaction types will probably need a 1:1 to match up with the types of agent/substances, e.g., –can cause—linkages • Adverse sensitivity to a substances label on the model should say that it is the exposure to the substances that “can result in”/ implicit “substance exposure may result in / is expected to result in” • Briefly discussed negation, e.g., a clinical statement that is saying that this person has no known allergy, which may end up at the logic level. May need to revisit that for the model in future calls. • More discussion on criticality. Russ defined it as “criticality is the seriousness of an expected reaction.” Questions raised: What are the criteria for criticality? American Academy of Allergy, Asthma and Immunology submitted MU Stage 2 comments suggesting there should be an attribute indicating if the condition is life or organ system threatening or not. Kevin suggested looking at the CTCAE (Common Terminology Criteria for Adverse Events) as possible grade/rating system. Some participants strongly objected to seeing the 1-5 scale where death is 5. (Death is an outcome, not a severity.) May need further discussion with Lise Stevens from FDA outcomes are what are tracked.

  Use Case Review

• Started to discuss the Preference Use Case. Patient may have a strong preference not to receive medication, e.g. adrenaline, based on the physiologic effects. But don’t want it listed as contraindicated.

Post Baltimore Conference Calls:

Move meetings to every other Wednesday at 5 PM ET.

Next Meeting: Sept. 26

PC Thursday Sep 13 2012

PC Thursday Q1

Participants list and meeting minutes - please see the powerpoint slide deck

PC Thursday Q2

Joint PCWG, SDWG and Template meeting PCWG Hosting

Chair: Stephen Chu

Scribe: Laura Heermann Langford

Present: 35 participants including chair

Stephen Chu

Brian Scheller

Zalonna Gonzaga

Lisa R Nelson

Laura Heermann

Cathy Welson

Jeff Brown

Rusty Henry

Isbella Gibaud

Zeshan Rajput

George Koromia

Diana Behling

Rick Geimer

Mark Shafarman

Kai Heitmann

Adel Ghlamallah

Kevin Coonan

Anne Smith

Lisa Brooks Taylor

Elizabeth Carey

Chris Millet

Rosemary Kennedy

Keith Boome

Michael Tan

Vinayak Kulkarns

Sarah Gaunt

Gaye Dolin

Bob Dolin

Vin Sekar

(Sign in record only registered 29 participants. Head-count at voting = 34 + 1)

Template WG: Brief Interim report on the Templates ITS Pilot. Significant progress has been achieved. Kai Heitmann provided report on this project (more details will be available at the Friday Q1 Templates WG meeting

Project #885 Overview of DÉCOR projects worldwide cCDA and Tirfolia cCDA can be expressed in DÉCOR Further findings on the wiki Coming up next Model Driven Health Tools (MDHT) MIF FHIR Results will be posted on wiki Art-dé (website for more information)

Details – see powerpoint slides from Kai Heitmann

SDWG update:

SDWG - Questionnaire Assessment / CARE IG ballot reconciliation relevant to PC. Update by Gaye Dolin

There was a document balloted a while ago

Answers to questions were balloted

This is updating the older framework into the newer up dated format that is to home the new acute care tools into (subset of CARE data elements) and modeling them into the assessment tool

If anyone has made comments on this please see/talk with Gaye. (Ballot reconciliation). Would welcome input on the reconciliation of the ballot comments that are being reviewed now.

Upcoming ballots anticipated:

Patient Authored Note. PCWG expressed an interest in being engaged in this project going forward to ballot. Current conference call set up not convenient for participants from Australia. Suggested meeting time change to 5 pm US eastern.

PCWG expressed interest in collaborating with SDWG on Care Plan initiative. The intent is to ensure that: - Current care plan “section” in CDA (as “treatment plan”) is aligned as much as possible to care plan work done by PCWG. Future work on CDA R3 to accommodate care plan structure and work done by PCWG. Closer collaboration preferred.

CCD Regular Update Request: PCWG requested update to CCD annually.

SDWG: there is plan to update Consolidated CDA-IG Ballot. CCD component will be updated at the same time.

Kevin – Motion made to start working on a project scope statement for revision of CCD using current clinical statement with the intent of working in version 3. Which will be adopted in CDA R3.

Seconded – Laura Heermann Langford

Discussion- The real discussion will happen with development of the project scope statement so happy to support this motion to write a project scope statement

CDR3 work will penetrate into this but it doesn’t have to be “done”, but the group needs to be cognizant of changes made through ballot reconciliation.

This approval is to develop the project scope statement (this is not approving the project scope statement).

34 present (not counting chair)

Result: motion carried with the following votes

3 abstain

0 opposed

31 approved.

This project scope statement development is assigned to be a joint development of PC and CD. Kevin Coonan and Bob Dolin will jointly development the PSS with Kevin taking the lead.

Templates Updates:

Status of the Templates Registry Business Process Requirements Informative ballot completed.

Overwhelming pass ballot with one comment.

Templates ITS Pilot Interim Report, a new item: creating a Roadmap of best practices for Templates Designers (starting with a white paper)(Kai Heitmann),

Mark Shafarman provided update on HingX, and HL7 collaboration

Project is at alpha release

Alpha project is accepting feedback and suggestions but not changes will be made during alpha

First implementioan will be in Rwanda

Website healthinginuityexchange

More discussion Friday Q1 – templates committee

Questions –

Is there a formalism for the templates to be stored This is one of the first things to be developed

How to we know it is aligned with what Kai is doing Alignment with the meta data with the template registry is one of the business requirements. Plan is to also allow query templates – want to join with SD, PT care and FHIR

How do we know the workload involved in registering templates

Details – see powerpoint slides from Mark Shafarman

Discussions on Template ID and versioning: Comments from the Templates WG on Kevin Coonan's document of June 24th, “Proposed OID assignment and conventions for HL7 Patient Care templates.”

Dynamic Template binding – needs continued discussion (Kai, Kevin C., Bob Dolin). Backwards compatibility? Performance?


SD has used root and root extension for templates ID. This is considered best practice.

Suggested to go with the simplest way - and it should be driven by the real use case.

According to V3 definition root+extension = ID

Could also have root only to ID is valid

Need to have more discussion on this topic. – need to start grappling with template ID

Have started this in the DECOR project.

Request for Kai, Mark and others to talk to SD Friday morning for more of a discussion on this topic. Onsite scheduling may not work. Will try to do in Q1 Friday, perhaps more in Q2 . If it doesn’t work - will take to a conference call post these meetings.

At this discussion the recommendation is to use the ii approach


Will keep same quarter Thur Q2 for joint meeting next working group meeting. With SD and PCWG.

Meeting adjourned.

Post meeting: Keith brings new project scope statement to team to create a CDA for statement of benefits. Will likely be and S&I framework project, to do it joint with SD and templates.

PC Thursday Q3

Clinical Statement: OO

Present: Stephen Chu attending

Ballot reconciliation: CS September 2012 normative ballot

Last ballot: action item – 3 changes

Observation: added Causative Agent

Encounter: added reason code (PA requirement)

confidentialityCode: changed from 0..1 to 0..*

minor grammar/typo comment; no negative

CS: 3 year plan: basic maintenance; also need to remove CMETs that are incorrectly assigned to CS (e.g. ObservationDxUniversal; observationIntoleraceUniversal; ObservationGeneralUniversal)

Pharmacy/CS alignment – change request from pharmacy from alignment and review processes. A spreadsheet produced with identified change requirements, which contains action items for CS. Change request list on CS wiki: change requests discussed, some yet to be resolved. these changes when completed, will be in next ballot

Education co-chair requested - formal tutorial on Clinical Statement in January 2012 WGM. Need volunteer who is willing to run the tutorial. If no volunteer to do the task, will not be offered. If volunteer identified – notify Education Committee

PC Thursday Q4

No Clinical Statement meeting


PC Friday Sep 14 2012