Emeasure Lunch Session(Georgia 11)

SDWGMinutes

(Sept 2009)

Monday Attendance

Name / Affiliation / E-Mail / 3 / 4
Keith Boone / GE Healthcare / / X / X
Calvin Beebe / Mayo Clinic / / X / X
Doug Pratt / Siemens / / X / X
Xinzi Wu / TheraDoc / / X
Geraldine Wade / Clinical Informatic Consult / / X / X
Karen May / Iatric Systems / / X / X
Bonnie McAllister / Iatric Systems / / X / X
Diana Behling / Iatric Systems / / X / X
Sean Muir / V.H.A. / / X
Crystal Kallem / AHIMA / / X / X
Gay Giannone / Alschuler Associates / / X / X
David Katz / Social Security Administration / / X
Shane Rossman / Social Security Administration / / X
Shann Shakib / 3M Health Informatics Svc. / / X
Gaby Jewell / Cerner / / X
Jingdong Li / Alschuler Associates / / X / X
Judy Logan / OHSU / / X / X
Liora Alschuler / AALLC / / X / X
Stephen Chu / Nehta, Australia / / X
Brett Marquard / AALLC / / X / X
David Hay / HL7 New Zealand / / X
Freida Hall / VHA / / X
Amnon Shabo / IBM Research – Haifa / / X
Kate Hamilton / AALLC / / X
Thomson Kuhn / ACP / / X / X
John Timm / IBM / / X / X
Dave Carlson / VHA / / X / X
Amit Popat / Epic / / X / X
Reve Spronk / HL7 Netherland ?? / / X
Matthew Greene / VHA / / X / X
Manish Parekhj / IFMC / / X
Grahame Grieve / Kestral / / X
Robert Worden / Chatein / / X
Bob Dolin / Semantically Yours / / X / X
Cecile Pistre / Snaufinavenlis / / X
Daniel Vreeman / Regenstrief Institute / / X
Chad Bennett / IFMC / / X
Delane Heldt / AMA / / X
Patty Craig / The Joint Commission / / X
Scott Robertson / Kaiser Permanente / / X
Lori Reed-Fourquet / e-HealthSign / / X
Phil Barr / Thomson Reuters / / X
Zhijing Lin / Siemens / / X

• Q1-Q2: Plenary
• eMeasure lunch session(Georgia 11)
• Q3: SDWG solo (Georgia 6)
• (20 min) planning– Keith sent out to list.
• Wiki CDA R3 proposals

New suggestions we would close off at the end of Sept. For the formal proposals needed, what should be the cut-off date for the formal proposal submission.

Motion: The deadline for turning suggestions into Formal CDA R3 Proposals will be Nov 19 WG Call. Bob - Second Liora, Opposed: 0 Abstain: 0 For: 33 Motion Passes

Publish Co-Chair List, SD LIST

• (20 min) new projects (neonatal, procedure)

Procedure Note – What’s makes it a procedure note? The project scope has been approved, with the request to make it international. Added Imaging Integration as interested party.

What do we need to clarify this quarter? Health Story participation – will be discussed on Tuesday AM calls.

Neonatal Note – Gay reviewed the new project – Moving on to the steering committee. A subset of 700 (100) data elements. PowerPoint was presented. The group using this will have different systems in place. Demonstrate how data can be collected and placed into registries. Assume that there would be a call for participation and conference calls.

• (45 min) templated CDA tooling

UML based CDA tools – Open Source based tools

Open Health Tools – slides on the project site

VA & IBM joint project.

Support the goal of generating CDA R2 templates using UML and generate template constraints using UML and OCL. Goal of supporting reuse of templates., with the generation of JAVA libraries with RUNTIME API and generate Implementation Guides (future).

Bob proposed that we need to make an assessment and then looking at the next steps that we might want to look at. What is the means that the committee can provide feedback to this work and direct this work?What were displayed on the screen were very ULM class diagrams. The format is XMI compliant format for the serialization of the models that are generated by the tool. By working with JAVA classes bases on the specializations and with names that are reflective of the constraints.

Next steps – how do we integrate in to HL7?

Mapping & Transformation Tools – Read in a CDA schema and schematron creating a model which allows transformations between. The lessons needed to track the inheritance between templates. There were many ambiguities in CCR that would be difficult to manage via the transformations.

• Addition of another co-chair. Non US base co-chair proposal.
• Interim co-chair.

Motion: To request a fifth position of co-chair for SD. Naming Graham as interim co-chair. JD seconds For: 33, Abstain: 0 Against: 0 - Motion passes

• Q4: SDWG hosting CDS(Georgia 6)
• Ballot reconciliationeMeasure

The official ballot reconciliation responses for eMeasure are recorded in ballot spreadsheet. This are notes from the discussion. There are 120 comments that need to be considered.

Scott Robertson’s 5 comments

#127 Affirmative suggestions – make clear the conformance statements

Abstain: 0 Against: 0 For: 31 Motion passes

#128 US Realm Vs Universal which is it. – It is international realm

What are the US specific indications? No vote required.

#129 – Negative – Can we see an example of complex Boolean examples. Proposal to add an example of complex Boolean logic. Resolution: Will add an example to show how complex Boolean logic. See also Delane’s comment looking for examples.

Persuasive – Abstain: 0 Against: 0 For: 31 Motion passes

#130 – Question about how the measures could be calculated as well as collected?

Where are the calculation steps? Would this also include what is an acceptable threshold? After some discussion it was determined that things like risk models are changing overtime, it was decided that it is not considered a part of the measure.

Neither measure adjustments are required for reporting. Risk adjustment models and the co-efficient and the algorithms associated with the calculation of the risk assessment are not a part of the model.

A-Q – A complete reporting specification would require additional information about reporting.

There is a question about how quality measures are made and cited.How numerators and denominators are defined.

#131 – Serious concerns about the large set of choices that are provided to the users in the model. Wednesday Q2 there will be a review of the scope and modeling that is planned for the e-Measure.

Phil’s comments

#115 – Neg – the issue of flavors – the meta-data around the measure. There are many ways that measures will be grouped and versioned. How do we see that the measures come from the same tree? Is there a need for two sets of relationships between measures.

The definition of measure set – is typically defined as a set of measures applied to a common initial population.

Resolution: Bob will provide additional text in the measure set definition to help with Phil’s concern. Abstain: 0 Against: 0 For: 30 Motion Passes

• Tuesday Attendance

Name / Affiliation / E-Mail / 1 / 2
Calvin Beebe / Mayo Clinic / / X / X
Bob Dolin / Semantically Yours / / X / X
Keith Boone / GE Healthcare / / X / X
Kendra Hanley / AMA / / X
Masaharu Obayashi / Kanrikogaku, Ltd. / / X
Karen May / Iatric Systems / / X / X
Gordon Raup / Care Facts / / X / X
Matthew Greene / VHA / / X / X
Margie Kennedy / HL7 Canada / CHI / / X
Michael van Campen / HL7 Canada / / X
Scott Robertson / Kaiser Permanente / / X
Crystal Kallem / AHIMA / / X / X
Chad Bennett / IFMC / / X
Patty Craig / The Joint Commission / / X
Brett Marquard / AALLC / / X / X
Amit Popat / Epic / / X / X
Liora Alschuler / AALLC / / X / X
Phil Barr / Thomson Reuters / / X
Judi Logan / OHSU / / X
Thomson Kuhn / ACP / / X
Michael Marhin / AAVLD / / X
Doug Pratt / Siemens / / X / X
Peter Henbler / Kaiser / X
Xinxin Wu / TheraDoc / Xinx / X
Shann Shakib / 3M Health Informatics Svc. / / X
Xinzi Wu / TheraDoc / / X
Daniel Vreeman / Regenstrief Institute / / X
Gay Giannone / Alschuler Associates / / X
John Roberts / TN Dept of Heath / / X
Harry Rhodes / AHIMA / / X
Austin Kreisler / SAIC / CDC / / X
Margaret Marshburn / SAIC / CDC / / X
Kristi Eckerson / EmoryUniversity / / X
Gaby Jewell / Cerner / / X
Marla Albitz / CDC / Lockheed / / X
Larry McKnight / Siemens / / X
Vassil Peyfchev / Epic / / X
Kate Hamilton / AALLC / / X

• Q1: SDWG hosting CDS(Georgia 6)
• Ballot reconciliationeMeasure

The minutes for this quarter were provided Keith Boone.

Reviewed Doug Pratt’s comments on eMeasure

#49: Non Persuasive 14/0/0, subsequently withdrawn by Doug.

#53: Add a reference back to the appropriate section. 24/0/0

#54: Add a link back to the relevant passage. 24/1/0

We discussed the fact that this specification is intended for use with Data Types Release 2. However, we aren’t certain about when this will be available for use.

#55: This will be updated when we go to data types release 2. 25/0/0

Reviewing Phil Barr’s comments.

#108: Persuasive 26/2/0

#109: Withdrawn

#110: Persuasive 28/0/0

#111: Non-persuasive 26/0/0

#112: Withdrawn

#114: Referred to Publications for Guidance 26/0/0

Question about the status of the ballot with regards to Data Types Release 2.0 – We will look into what can be done using Data Type Release 2.0.

• Q2: SDWG solo(Georgia 6)
• Ballot reconciliationDischarge summary

Larry’s comments

#30 – Comment about the format of the guide. The format changed to a more structured patterned format. The future of the health story project will be to place in a repository and format.

Considered for future use

Abstain: 0 Against: 0 For: 20 Motion passes.

#34 – embedding local codes and how to represent translated data types. Translation from any root to the child element. If the specification requires a standard code, but we were using a local code. Does the standard code need to be in the root element or in the tree. By their reading of Data Types 1 – In Data Types in release 2. Indicates that the guidance for DT 2 goes into the base. For data types release 1 – there is a specific order to that code and translation. But inclusion of the local code is not specifically indicated where the code should be placed.

The question about how the translations of codes in CDA R2 with DT R1 and translation values in codes. Required code in root. The original intent of the implementation guides that is root contains the required codes, and allow for translation in the extensions.

Resolution –this will be brought back to a conference call.

Vaciel

#56– location of the discharge disposition code in the header / body.

Disposition Section in IAG. Carry the discharge disposition code in the section. Discharge Disposition code in the body.

Alignment of discharge disposition sections

Discharge Disposition Code

Discharge Disposition Display

Add a Discharge Disposition section w/ a level 3 code in the section, and remove it from the header.

Abstain: 2 Against: 0 For 25 Motion Carries.

# 57 - In the guide, there is guidance that sections can occur in any order and within any sections. Comment – define how sections should be nested for processing. Suggest for this comment – local policy decides.

Withdrawn

• Ballot reconciliationHAI

There are two changes to the new templates format.

25 comments

#7 – Larry’s Comments

The standard is getting longer, it might be a good idea that we might want to split the document into multiple documents. Maintain and ballot would seem easier to manage. Implementer view of the package – and standards developer review view of the material.

Management issue in splitting it out, there is a fair amount of material which is shared and there is a risk in getting out of sync. Compliance is at the report type or document.

Make it clear what was new and look at future modes for publication.

Motion: Non-persuasive with mod - with ensure that the content currently under ballot is clearly identified

Bob - Second – Gay Abstain: 0 Against: 2 For: 22 - Motion Carries.

• Q3: Patient care (hosting) SDWG(Georgia 9)
• Ballot reconciliationeMeasure

Patient Care hosting and took minutes for the session.

• Q4: II (hosting)SDWG (Georgia 12)

IIWG Hosted the meeting and took minutes for the session, these are notes.

Reviewed a number of IIWG suggested enhancements for CDA R3 that II (DICOM) would like to see. The joint group discussed the suggestions and identified the Nov 19th deadline for the submission of Formal Proposals for CDA R3.

• Evening: tooling committee demo of open source tools

All open source tools

• Wednesday Q3 Attendance

Name / Affiliation / E-Mail / 3
Liora Alschuler / AALLC / / X
Gay Giannone / Alschuler Associates / / X
David Katz / SSA / / X
Sue Thompson / NCPDP / / X
Matthew Greene / X
Doug Pratt / Siemens / / X
Shann Shakib / 3M Health Informatics Svc. / / X
David Hay / / X
Brett Marquard / AALLC / / X
Crystal Kallem / AHIMA / / X

• Q1: Joint with EHR / Security (Georgia 2)

EHR hosted the meeting and took minutes.

• Q2: (CDS hosting)(Georgia 6)

As CDS hosted the meeting, these are notes,

not minutes for Quarter 2 Wednesday:

• Ballot reconciliationeMeasure

Woody comments ()

Need a participation from Role to Act, and more. Who do we walk thru roles we need to allow multiple paths thru RMIM vs DMIM which do not need to.

The approach in the ballot – very detailed authoring guidelines.

Keith the right hand side of the model needs to be CMET.

Do we approve the approach of listing the narrative?

There needs to be mood code constraints on the classes. All of the models be criteria mood or definition moods and support criteria mode codes.

The extent that we make it general or specific. Block the participation of the section.

Fixed = true (#147)

Not sure you want to have context conduction turned off. Fix it to false.

#148

Amended to match – a bunch of new criteria moods – for the acts. EVN

Motion to add the other mood codes, move with a constrained set of moods and let this out for DTSU. If we run into a problem, we will extend it in the future.

Def with all the specialization of CRT – drafting the proposal on wiki.

#149 – A-C Answered

Motion: Something like the original RIMM with bi-directional flow in a DMIM and RIMM with expansion of pathways with a CMET starting at the ACT choice.

Discussion: About a use case for this.

Abstain: 0 Against: 0 For: 39 Motion Carries

• Q3:SDWG solo (Atlanta 1)
• Ballot reconciliation Discharge summary

Minutes: Ballot reconciliation on Discharge Summary, per ballot reconciliation spreadsheet.

• Q4:TSC, ArB, … (Capital Ballroom South & Center)
• TSC Hosted the meeting on SAEAF

• Evening: templated CDA tooling (Dave, Ravi, Robert Worden)

Templated CDA Tooling 7:00 pm (Georgia 2)

Thursday Q1 Attendance

Gaby Jewell / / 1
Helmet Koenig / / X
Brett Marquard / / X
Doug Pratt / / X
Austin Kreisler / / X
John Roberts / / X
Jennifer Cockle / / X
Sue Thompson / / X
Cecile Pistre / / X
Matthew Greene / / X
David Barnet / / X
Andy Gregorowicz / / X
Francois Macary / / X
Jingding Li / / X
Grahame Grieve / / X
Brian Ellenberger / / X
Thomas Beckum / / X
Liora Alschuler / / X
Patrick Loyd / / X
Shane Rossman / / X
David Kotz / / X
Robert Crawford / / X
David Hay / / X
Robert Worden / / X
Bob Dolin / / X

Agenda:(Georgia 6)

The quarter was divided into two halves:

• ballot reconciliation - Discharge Summary
• Discussion of CDA R3 as SAEAF alpha project (joint with ArB)

Ballot Reconciliation (Discharge Summary)

Austin's ballot comment: use of CCD template instead of consistency with lab domain

Discussion about the problems between CCD and lab. Austin withdraws because the IG guide is dependent on CCD, and the CCD needs synchronisation with Lab. Agreement to add a notice that there are variances between what is done here and the laboratory domain, specifically in regard to specimen collection time, and that this will be addressed in the future. (add this comment in other DSTUs as well). Also Refer comment in the disposition spreadsheet.

motion to find the line item Persuasive with mod: austin/Keith 23-0-3

Keith Boone, conformance to HITSP specs

Needs to be consistent. Much discussion about the relationship between this specification and HITSP and IHE specifications, and why it exists at all. The specification is intended to be consistent with c48 - and that instances can be conformant. What this specification is supposed to offer is stability and to reset the bar. The intent therefore is that this document makes all the rules that c48 does, or at least documents all the rules of c48, as well as making it's own entries, then the document would be a useful one, not a confusing one. But this is not what is happening at this time.

Motion: Persuasive with mod: the published guide will contain guidance on where additional constraints are required for c48 compliance. Liora/Keith. 20-2-5

Discussion of CDA R3 as SAEAF alpha project

Keith presented based on a SAEAF slide to discuss how parts of CDA fit into the SAEAF specification stack:

There was discussion from the audience fleshing out which parts of the CDA specification fit into which parts of the SAEAF stack. Agreement that the basic outline contained in the presentation is consistent with the intent of the CDA R2 specification.

The meeting was adjourned at 10:30.

• Thursday Q2 Attendance: SDWG solo (Georgia 9)

Name / Affiliation / E-Mail / 2
Liora Alschuler / AALLC / / X
David Katz / SSA / / X
Matthew Greene / X
Doug Pratt / Siemens / / X
Brett Marquard / AALLC / / X
Larry McKnight / X
Thomas Beckum / X
Brian Ellenberger / X

• Ballot reconciliation Discharge summary

Minutes: Ballot reconciliation on Discharge Summary, per ballot reconciliation spreadsheet.

• Q3: SDWG solo (Georgia 2)
• CDA R3 right hand side of model "bake off"
• Q4 Clinical Statement(Georgia 5)

Joining meeting of Clinical Statement, who took minutes.

• Friday
• Q1: templates, vocab, PC (Georgia 6)

These are notes taken and not official minutes for Q1 Friday.

Templates Agenda – Draft Business Requirements

• HL7 Template Registry
• Two Tooling Proposals
• Next Steps

Business Requirements for the HL7 Registry

The business requirements include HITSP requirement and HL7 requirements

• Client Systems
• Authoring Tools
• Web Brower
• Repository
• Registry
• Federated Registry
• Web Server

Attempting to support multiple methodologies

Definition of the models and their constraints and there derivation (parentage)

One of the requirements for the template registry is the maintenance of links between templates and models. There is a need to promote this solution to the CLOUD.

Certification will be managed via an approval by approver.Verification of the minimum metadata will be provided, user credentials and policies and make IP rights to the use templates accessible from the registry.

Versioning of templates and the system maintenance requirements will need to be considered. Question about what is a new version and what is a new template with a new template with a new id. This is an author assertion based on published guidelines.

Grouping needs to likely support inclusion of templates into groups based upon the template version instance. Allowing groups to be defined which are defined to different given versions. It was noted that searching needs to support structural links.

It was requested that interested parties read and comment on the document reviewed:

The technical requirements for a template registry.