HL7 Attachments Workgroup (ASIG) Minutes (Draft)

Jan 11 – 15, 2009 Orlando, FL

ASIG Co-Chairs

  1. Rob Root, PGBA
  2. Durwin Day, BC/BS Illinois
  3. Jim McKinley, BC/BS Alabama
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Attendees

  • See file: ASIG 2008-09Vancouver Sign-in Sheets Final.xls, and (if reading these minutes as a PDF, the final page below)

The ZIP file containing the referenced presentations and other documents are available on the “Meeting Minutes” section of the web page.

Note 1: The end of this document contains a quick summary of motions, presentation file names, and new action items.

Monday (January 11) - Q1

Plenary session. The ASIG did not meet.

Monday – Q1

Agenda Review

Minutes will be voted on at the next bi-weekly conference.

MLB – add White Paper to the agenda for this week since the Final will be published this year.

Tue Q1: CPHS update: David Boss has the document, we need to do page-turning exercise.

Introductions

As is standard protocol for the ASIG, everyone in the room introduced him/herself, stating their name and the company they represent.

Co-chair Nominations

Historically the co-chairs have operated with 4 co-chairs. More recently, the ASIG is operating with 3 co-chairs. Are there any volunteers to fill the fourth position? It is a two-year commitment? Nancy suggested he share his time commitment: Rob hasn’t spent as much time as the co-chairs in the past have. Rob spends 1-2 hours per week on his activity/responsibilities. Rob doesn’t find the commitment to be very demanding. Bi-weekly call is an hour; any subsequent work items don’t take that long. The last 6-8 months of reviewing documents have increased his time a bit. Bottom line: no more than 10 hours per month. Nancy: clarified that a co-chair is not responsible for being an author. Ideally, the SME will step in to produce the work items.

Nancy: When we get a rule, there will be a ton of work. That responsibility falls on the co-chairs. We had a lot of resources during the last rule that we don’t have now. It is an involved/time consuming process. The folks that set the timelines don’t consult with us before the timelines are established. We should be prepared to push back.

MLG: agrees w/ Nancy. A lot of questions and participation because there will be a lot of questions. We had a lot of questions when we implemented the pilot. We should expect a flood of questions, which substantiates the need of reviewing the White Paper. OESS is in discussion w/ their lawyers (trying to get it out the door) which is why we expect publication by the end of the year. The final rule will specify the time to implement. Attachments have gone through the clearance process.

OMB just signed off on ICD10 & 5010. June: indications make it believe that we will see it in phases: ICD10 & 5010 are expected out this week (Friday).

MLB: the 5010 completely surprised her.

JIM: do we have anyone in the room that are CDA strong. We will need to have CDA advocate. Anyone in the room have CDA R2 experience? Nancy feels that there are a dozen people in the year. JIM: in reviewing the Rehab Guide, realized the Xpath statements and the composites/questions/answers format is questionable. Jim has been in touch with Penny & Mike regarding their knowledge base: they knew enough to get it going.

Laurie Darst: they had to go to Calvin Beebe as a resource for his CDA experience.

Nancy: if we don’t have a guide that the folks in this workgroup can’t figure out, then there is an issue. We either have a complex system to put in place or we need documentation that answers all the questions.

JIM: We did speak w/ HL7 & was given permission to contract someone to complete our guides with us. His contact w/ Penny & Mike led him to believe they don’t have the SME we need. Durwin’s P2P experience, SD put a line in the sand and said you have to learn this stuff. We are in the same situation

LAURIE D: Medicaid

NANCY: we should have to always go to Calvin or Kepa

JUNE: the training gives us a basis. The exercise w/ Penny (use case through the entire process), the skills we learned were very good but we don’t use it on a daily basis. In the long term, we need in-house training for this workgroup. We have to apply it to an existing guide: start-to-finish.

MiKE JOLLEY: send a piece out and get that back/

JIM: we guide more specific in the guide, hoping to make it easier for the implementer. Why did we go to that level in the guide when the implementer should know HL7?

JUNE: if we can’t tell them, how are they going to know?

MLB: with their NPRM experience, they added lots of into to the IG and the booklets. Not a problem w/ the details (LOINCS) cause they weren’t doing the codified (doing scanned). Believes the upcoming implementers will also be doing the scanned. No matter, we will still get a lot of questions. When in development, they will be looking at the guides differently than we do. In learning from that approach, we don’t have any idea what questions. Should wait until the questions come as a result of the implementation.

JIM: the guides are in print. We shouldreview them to verify is in print is correct?

CRAIG: are the XML examples well-formed? If not, the developers will say the guide isn’t any good.

ROB: we do have a volunteer (from the web); Let’s ask him if what we have is correct.

MLB: Final rule has to have the guides published before a rule can go out.

The Empire pilot did not test the machine readable. Kepa was able to develop something that thought it would convert it, but it was never tested.

JIM: on part of the booklets have been tested in the pilot. The P2P is a clone of what we are doing in attachments. The standards they wanted to do phase 2 on isn’t quite ready.

CRAIG: Claredi would have a vested interest in getting

MLB: Larry Watkins (represents Ingenix, who bought Claredi) but we could ask if they have

JUNE: We have contacted this person, ask HL7 if he has registered. We may have a few fol

JIM: P2P guide, Durwin ran into that issue, and contracted Alschuler & Assoc to do that work.

MLB: we have done as much as we can. We need someone to review them to see if anything is missing. Correct?

JIM: the volunteers are not V2 experts, and have not done it. In the Rehab Guide, isn’t comfortable with the multiple answer parts that exist.

ROB: ask someone (Dr Srini Kandada) that can review and tell us if they are right/wrong.

JIM: we need XML and LOINC structure is correct?

JUNE: will put an email out to Kaiser to solicit our needs. Someone to validate our booklets.

Co-chair elections:

the ballot is ‘blank’ allowing for write-ins only.

Out-of-cycle meeting

Approved to be held in April in Las Vegas April 14 -17 (Tue, Wed, Thu) during the same timeframe as the Harmonization. We have a room, but we need an overhead projector.

Assuming it is a Hampton. Not sure if there is a registration fee. He asked for approval to hold an out-of-cycle, a room, and AV equipment.

Matt: will there be gov’t rate rooms?

HL7 will put up a registration page for us. Rob may have to get the rooms (block), but he believes HL7 will do so (tacking on to their meeting).

MLB: we did not have to pay the registration but we had to pay for own meals.

Dual meetings in September

HL7 : Rob will be here.

13 people attend both. 6.5 of the 13 will definitely attend X12. 5 are undecided.

7.5 will definitely attend HL7.

Nancy: we should file a complaint with HL7 that they promised this wouldn’t happen again. We need to start with Maria. Tim McNeil is X12’s liason to HL7. Schedules are made and the hotel plans made 5 years in advance.

This is the third time this has happened, and was committed it wouldn’t happen again.

Sue: NCPDP should be brought into the loop.

June: we should coordinate with WEDI, NCPDP, NUCC, NUBC, HL7, X12; HITSP. As PIC, they can take it on as a concern.

Nancy: we may already have a problem on the schedule now for the next two years. Nancy will discuss with Karen.

ROB: we will have to deal with it as it stands.

NANCY: why don’t we have this group meet at X12? Don’t know that we will have nice meeting room space. It would provide some synergy. It might be worthwhile to attend some of those meetings. We would call it an HL7 meeting at X12. Our location just happens to be different.

JIM: options~ we could share go-to-meeting option (conference in).

JUNE: will bring it to Karen on Tuesday and have a response on Wednesday.

Monday – Q2

BOOKLETS

June Rosploch (reviewing the booklets; has made some updates in 3-4 of the booklets.

LOINC MODIFIERS (rob’s booklet directory, _modifier codes final & review notes).

Review notes document: broke it up by booklets, person name, comments, person name, responses.

DAVE FEINBERG comments: JUNE: on the numbers/letters, if you look at 2.1: in reading through the booklet, there were days that were written out and numbered (mix case). Rob sent a note to Kathy Mercer for Dave’s (a) item and (b) item: hasn’t heard back (she wasn’t in the office last week).

SUE: move the default value out of the 18789-8 LOINC and place it in the 18793-0 LOINC

JIM: comparing the two on RELMA, the 793-0 has a part time of scale and the other does not. Doesn’t know if scale is a relative term to CDA. => CLEM question. ANSWER: scale is just a component of property name. No, it is not relative to CDA.

Amendment

Q1:

Craig: looked at the empire pilot project, put out detail information on implementation. Believes it would be a source for an in-depth insight for development & implementation. Nat’l govt services.com. Trying to get it on the website yet. ACTION ITEM Craig has softcopy and will share it with the workgroup.Will send to Rob and Rob can distribute. Rob: can that be part of the white paper? MLB: that was the intent of the white paper. We could incorporate some of the real life info from the pilot into the white paper. WEDI is getting ready to produce a similar document, so perhaps the ASIG can work with WEDI and produce one document. Mel can go back to WPS to see if they have any documentation they can share for the White Paper

Do we have a suggestion on the rule of numbers vs verbiage for numbers. The decision was made to us the numbers in a mixed case situation. June will review the booklets and make the numbering change. She is also working on validation of the booklets. Rob will get the LOINCs.

ROB: since we don’t have a central repository for the booklets, this week Rob owns all booklets except Rehab. Jim has Rehab at this time. The ASIG will have another review for ‘one last look’.

AMBULANCE Booklet

Comments from June on the work she had done.

Cannot go into the picture and change the scanned document. She needs the .jpg in order to changed the circled items. ACTION ITEMJIM McKinley will acquire the images from Penny or Mike (sent email 01/11/2009).

LOINC codes (formatting June went through and checked): we agreed the answer would follow and they don’t. Boils down to repeating the question LOINC since the answer LOINC are one in the same.

MISSING LOINC CODES: the description exists but without a LOINC code. Passed info to Rob to request from Regenstrief. Rob has yet to submit, and will do so.

MEDICATIONS Booklet

She inserted the answer parts to keep things consistent.

Rob will request the missing LOINCs.

Every component had a number and a question. When the answer was a composite (multiples), there were many different answers. RULE from JIM (per Mike Cassidy): when a composite, the question will never be the answer. Rob downloaded RELMA (rgnfuse.regenstrief.org). RELMA shows 5 answer parts, but does not look right. JIM will ask Kathy Mercer (Regenstrief site and download the RELMA, click HIPAA attachments, medications and RELMA has NAME + ID) to remove the trailing LOINC code for IDENTIFIER.

18605-6 : June handled.

LABORATORY Booklet

Will review for number issues, LOINC issues already discussed today.

CLINICAL REPORTS Booklet
Tamara is review this booklet. She is looking through it, and will get back to us later today or tomorrow.

REHABILITATION Booklet

Jim sent an email regarding the language crafted in Vancouver for LOINC Code (component & answer). See Section 3 in the Rehab Booklet.

In some instance, RELMA has an additional Answer Part than what we have in the guides. Was it deleted from our guide and not sent to Regenstrief (52174 question/ 52175 deleted).

ROB: we need to make sure the examples in the guide are valid examples. Craig suggested we use XML Spy to do the validation.

DURWIN: UK Nat’l Health Service has some patient safety training classes going on Wed/Thu that are free. Information being passed. Please feel free to attend.

Monday – Q3

REHABILITATION Booklet

We left off why there is a LOINC code in RELMA that isn’t in our guide. It is strange that her component part is listed last in her component part. Jim will ask Kathy Mercer if she has any documentation on it. Marguerite will check OLD versions of the Rehab document to see if it existed in a much earlier version. CLEM reminded the ASIG that the values in the guides aren’t absolute. RELMA contains the complete dataset.

Table 2 is the high level version of Table 3. The word narrative is inconsistently populated throughout both sections. Not sure if it should be included. Example 52406-6. Do we want to add or delete the NARRATIVE from the description. What if NARRATIVE is part of the component and some are not but are part of the ( ).

Verify the name. If it is not part of the name but has a scale of NAR, we need to determine the correct format. 29185-6 is a narrative, but we only know that by the scale in RELMA. The AIS IG is quantitative, nominal, narrative. The balloted Rehab (NPRM) NARRATIVE was in and was always at the end in parenthesis. The RULE: identity all LOINC codes that do not match the LOINC description in RELMA related to the word NARRATIVE. MLB reminded the ASIG that some of these examples may be the new codes. Sue in the list of components have examples of NARRATIVE w/out parenthesis. It doesn’t appear to be listed in the detail. In section 3 table, narrative appears both ways, some with parenthesis and some not. MATT: look up 52384-5…

Go through the booklets and review NARRATIVE, but DATERANGE… looking at the quarters and trying to attack it now… The rest of today will be spent reviewing the booklets. All LOINC codes that have NARRATIVE as scale should be added to the tables (2 & 3).

Anything else we find in parenthetical should be questioned, and brought to the workgroup’s attention. Description must match RELMA.

Tuesday (January 13) - Q1

Out-of-cycle Meeting (Las Vegas)

Venue is Ceasars. Have blocked extra rooms for ASIG. Karen is going to check into the snack itssue: perhaps a snack table. Will check into including ASIG in their lunch package and refreshments. She ‘feels’ we may want to purchase our own lunch. HL7 will coordinate a registration page on the web-site. Durwin may be able to provide an overhead projector. Rob will request April 14-16. Meeting room for Tue-Thu (04/14-16/2009). The block of rooms will be under HL7.

Co-chair meeting

By Durwin Day=

  1. Stats from ballots. Missed passing the PHR by one vote. Feels they will be able to switch some
  2. Kyoto: room assignments to Lilian. Meeting rooms are paid for separately. Staying in a room after 5 PM let Lilian know. They are overbooked today and looking for rooms.
  3. Freida Hall: project services workgroup. Open-mike meeting today at 11 AM. Any questions regarding projects we are doing. Round-table at lunch today. Thursday Q4 is a free tutorial about their services. There are 60 projects on the books. A question came up at the meeting about HITSP => would be nice to coordinate the projects across organizations. (Rob: implementation guides on the HL7 website => our booklets are not IG, but are based on the CDA R2 standard). If a project request on the committee’s three-year plan, it won’t be approved. The three-year plan provides outreach to others to let them know what we are doing. It also ‘solicits’ expertise.
  4. John Quinn talked about
  5. Tooling, ITSDO, UK Nat’l Health Svcs, message implementation manuals, CEN 403, SAFE project (used by HITSP Service Foundation Committee), harmonization on data types; in 2009, first ballot is March 30;
  6. Decision-making practice document: looking for one document that all would use. DMP v2 will be posted. For this committee, check to see if any items that changed are ‘hot’ topics. There is always a standard DMP document: looked at all the DMP documents and the variances by committee. Tried to incorporate all they could. Hit everything but voting. The changes are not significant. Make sure the standard document contains all we need. MIKE JOLLEY: in SD yesterday, the talked about an IG whether to use LOINC or SNOMED. Stan Huff (Clem too). mentioned a coordinated effort between LOINC and SNOMED (in 2009) and may be the beginning of the
  7. Best practices.
  8. Steering Division meetings.
  • Nancy Orvis. IDR & IER will be used to map services to the Functional Model. Looking for first ballot in March.
  • Nancy Wilson-Ramon:

-the second web-site vendor didn’t work out.