SOA Meeting Minutes and Attendance

Sept 2016 HL7 Plenary and WGM, Baltimore MD

MON Q3

- attendees:

  1. Workgroup Overview / HSSP Intro / New Attendee "Jumpstart"
  2. Provides overview of the workgroup, mission, charter, objectives, current work, etc.

All of the attendees were already familiar and active in SOA so we opened the floor to anyone who wanted to share about what they are involved with.

Jerry Goodnough: Discussion revolved around changes happening to Pub/sub. As far as Jerry knows, no one on Patient Care who goes to OMG also attends HL7. Ordering Service - October 7 initial submission but likely will end up slipping that entry. Models are on HSBC.

Diana brought up the question regarding attendance at SOA All hands meetings

Ken: HSPC has agreed to own the project.

Vadim, Jerry, and Preston are planning to meet to discuss (what Ken introduced).

Vadim: Need to identify use cases which would lead to implementation guides.

We have 2 quarters this week looking at the HSSP/OMG process with HL7. Graham will be joining us Q4 Wed.

Right now it's a bit waterfall. Graham would like to see it more Agile.

Talking about FHIR-I joint meeting: What do we want that meeting agenda to consist of?

Mon Q4

- attendees: 10

  1. Welcome and Introductions: Went around and introduced ourselves
  2. Agenda Review, approval 10 attendees: Passed unanimously
  3. Round Robin updates
  4. New HSSP cover page: Vincent displayed the new cover page on the HSSP.
  5. PASS Access Control: Diana - Ballot reconciliation package has been uploaded. Will vote on to bring this to publication this week.
  6. PASS Audit: resurrecting the previous effort. Using all previous work and comments. Will bring this to ballot in January 2017.
  7. Clinical Decision Support on FHIR: (Claude not present) Manoj - Connectathon. Leveraged work on Decision Support Model work. CDS Hook is geared toward integration into the EMR. Claude is trying to establish an ongoing CDS FHIR connectathon every two weeks for CDS. Goal is to get the cycles going faster. CDS on FHIR is a methodology and series of resources for pulling information to support a CDS. This supports all CDS use cases.
  8. Cross-Paradigm Interoperability Project Update: Ken Lord - all the objections in ballot have been addressed and resolved. Ballot reconciliation package has been updated. This was an informative ballot. Australia has been using this as well as folks in the US. Implementation guide is in 2 part, behavioral and informational (MDMI). On the MDMI, did information exchange using open source tools. Have had multiple implementations on the informational (MDMI) side of this guide. Expect to go into some pilots with some HIEs in the short term. Working with FHIM, VPR, DES among others. VA, as part of standards and interop, knowledge-based services (Ken Rubin). Australia has shown interest in MDMI and MDHT. Question: where do we go from here? Maybe provide some information on the HSSP website? This is an OMG standard.
  9. Coordination of Care Service - Tech Spec Status: Emma - collaboration between patient care and SOA. Been through the STU phases and in the process of getting the FM published. Finishing up the publication request. Will submit the pub request this week. FM is based on the care plan DAM.
  10. Ordering Service - Jerry - RFP Update: Currently at OMG. Letters of intent period has closed but don't know who has actually submitted a letter of intent. Initial sub is in Nov 7. Final submission date targeted for March but will likely slip to September. HL7 members are entitled to participate in OMG activities. May have some implementation by mid 2017.
  11. Event Notification/Escalation Service: EPS and Unified Communication Service? Jerry isn't sure what is meant by this.
  12. HL7 Cloud Planning Guide Document: Vadim - Market need to identify resources for a Cloud Service. Next step is to break it down and start writing a draft blueprint.
  13. Pub/Sub Service: Reference implementation is still at OMG. Published. Good until Feb 2017. At the September 2016 meeting, review DSTU comments and see if ready to proceed to Normative in Jan 2017 or if more time is needed to implement before publishing then request DSTU extension in Jan 2017 meeting.
  14. Unified Communications Service: Published. Good until Feb 2017. At the September 2016 meeting, review DSTU comments and see if ready to proceed to Normative in Jan 2017 or if more time is needed to implement before publishing then request DSTU extension in Jan 2017 meeting.
  15. FHIR Connect-a-thon: See CDS - FHIR Scheduling resources - need to align with the Scheduling service. Ordering Service have a lot of behavioral components that aren't currently in FHIR. Clause was also integrating the Unified Communications Service with FHIR but not successful yet.
  16. SOA on FHIR: This is going to be Q3-4 on Wednesday. Have some concrete proposals based on discussions between Graham and Ken.
  17. Scheduling/Resource Management Service: Have a draft PSS. Will be finalizing this during the WGM.
  18. All Hands meeting schedule and attendance: General consensus that we move to once a month, status update meeting. Other business to be discussed after the status updates as needed.

TUE Q1

- attendees: 12

  1. Joint With FHIR Infrastructure (confirmed)
  2. SOA specification within FHIR: Claude: Connectathon brief. Were able to connect the careweb into the HAPI JPA server, EPS, and CDS Manager. Ran into problems with the connection to the UCS. Claude did a short demo as much as he could but one of the servers that he needed wasn't available. Discussion on solutions to problem encountered.

The SOA specification pre-dated FHIR. Question is how we bridge that gap? Question are we creating APIs that can interface with FHIR or do we create FHIR APIs. How do we bring the two worlds together? How do you make the bridge btwn functional and behavioral? Vadim: Is there a conflict in the first place? The question is really one of design process? Because of our relationship with OMG, we are in the unusual position of implementation being ahead of development. 2 possible approaches:

  1. Use FHIR only as payload
  2. Use FHIR as the data end

What's available in FHIR (three pillars): PUB/SUB Operations

looking at the order service and the order resource in FHIR, what is the relationship. Jerry: simple question without a simple answer. Ken: how do we get consistent behavior across different implementations? Vince: FHIR spec of operations should do that. Discussion on possible solutions led to the conclusion that we may need to create an implementation guide for a specific service, such as scheduling service. Need to figure out how this implementation guide would fit into the OMG process. How do we move from waterfall to more Agile in developing SOA spec. Right now you need to have a completed STU before moving into the OMG process. We want to move to some parallel development of STU, FHIR resources, and OMG project.

Work these questions in the CDS project.

Catalog service: If trying to do CDS that is evidence based, difficult to do this because of different vocabularies in different systems. The catalog service helps to keep all catalogs in sync. This includes vocab and bindings/constraints associated as well as the ability to constrain using context.

We will have a joint meeting between SOA and FHIR-I at the January WGM. Diana will make that invitation.

Notes from Vince:

  • FHIR Foundation – Implementation support FHIR.org
  • CDS on FHIR using OpenCDS – see slides
  • Using Event Pub/sub called from FHIR which triggers CDS – output via Universal Communication service (UCS)
  • Mechanism to hook to FHIR – Either a “bespoke” hook imbedded in the server (an interceptor) or add a front end to pub/sub service that implements the FHIR Subscription resource

Proposal:

  • Use the FHIR Operations concept to define FHIR resources that are Service inputs and outputs and define a set of operations that SOA manages with specified operation names.
  • A typical Service would require 3 or 4 operations – use CDS as the guinea pig (maybe Human Services directory also – Brian to discuss) where being used for the current catalogue service.

Note Thursday Q1 O+O, PC, CDS will discuss the catalogue

TUE Q2

- attendees: see below

  1. Joint w/ Patient Care (Confirmed)
  2. Scheduling Service: Update - Working on the PSS which will be distributed to Patient Care to be a co-sponsor. This is a PA sponsored project.
  3. Care Coordination Service SFM -
  4. Care Coordination Service Publication - Laura H.: Missed publication date. Working on the publication request. Will send the publication request to Ken and cc Diana in order to finish the request.
  5. Care Plan - (See notes from Vince below)

Care plan: Emma will send Diana a link to information on this.

Ken is an OMG Co-chair which makes it difficult for him to be directly involved on any OMG submissions. Ken described the OMG process. The important part is that we come through this process with something that Patient care is willing to accept (ie: any deviation from the STU is understood and accepted).

Mega-Joint meetings: Early in week having joint meetings with multiple WGs so that only go through the slides once.

Next steps:

  • Continue having a joint meeting (ambassador coming from Patient Care). Make it a three-way joint between Patient Care, SOA, and Patient Administration? Approach Brian (PA co-chair) to see if this consolidation proposal will work.
  • Patient Care is contemplating having a quarter that is all care plan/care coordination. Targeting Thurs Q1 for this.
  • Laura has action to send publication request to Ken.
  • Ken has action item to send PSS for scheduling service to PC.
  • Ken to get to clarity with Wayne on the HL7 vote to OMG on Care Coordination.
  • Patient Care has expressed interest in scheduling service as a possible co-sponsor.
  • If aware of other folks with interest in care plan resources and bring them to OMG's attention.

12:15 - Adjourned the Patient Care meeting.

New discussion - SOA Ontology - what do we do with this? Maybe kill the project in HL7 and find another group who wants to take it on? Decision: Kill the current project and explore other options if we want to resurrect the project.

Notes from VinceJoint with Patient Care (PC)

Status of Coordination of Care Service SFM publication

  • Was missed in publication cycle.
  • Publication request form is being finalised by PC this week – to be reviewed by Ken on behalf of SOA.
  • Actual document is ready to go.
  • Coordination of Care OMG submission status
  • OMG meeting Chicago last week => submission cycle re-opened because only one official submitter (MEDisched with support from Allscripts). Believe that Allscripts will join. State of New York may also be a submitter. Re-opened until Dec 2016.

Revised initial submission date March 2017, revised submission date September 2017 Technical – now planning to do a FHIR implementation – still working up how to that with current FHIR resources around care plan. Using the clinical Connectathon to test the FHIR resources.

  • Careplan specification has been implemented as an IHE profile – being trialed at the January 2017 connectathon.
  • Ken strongly suggested that PC provide a delegate to the submission team to represent HL7 interests.
  • ONC is trying to coordinate all care planning standards activity – PC will be exploring this to have a multi-committee quarter next WG

Scheduling Service

  • Has been developed by SOA. PA has agreed to be primary sponsor, FHIR is a co-sponsor.
  • Ken described scope as per SOA website and relationship to FHIR scheduling resource
  • Question: are PC interested in being a co-sponsor?
  • PSS is being prepared and should be ready by end of week.
  • Planning DSTU Jan 18 ballot cycle
  • General feeling PC does want to co-sponsor – will discuss with workgroup and let us know level of support to be noted in the PSS.

TUE Q3

- attendees: 7

  1. Patient Administration (Confirmed)
  2. Scheduling Service Discussion:
  • Finished up the PSS for scheduling service.
  • Motion by Cooper. Seconded by Diana: SOA WG recommends that PA accept the PSS for Scheduling Service as posted on 9/20/2016. Passed unanimously: 6/0/0
  • DSTU ballot for SFM Sep 2017. In FHIR Ballot for Jan 2018

Cooper was asked about making the joint meeting Tues Q2 to include Patient Care and Patient Administration. Keep Tues Q3 as joint with PA.

TUE Q4

- attendees: 8

  1. Ordering Service Discussion
  2. Walkthrough of ordering service technical specification work,
  3. relationship to FHIR workflow activities, and
  4. state of OMG submissions

Jerry presented the SFM diagram and a draft version of the PIM data Model. Requirement Association, status and requirement will be changing in the PIM.

Will show curated content in the PISM.

Not just an order execution service any more. Allows for advice and changes in the process.

Order catalog management is the other part of the specification. Building and dist of evidence-based catalogs.

Claude has agreed to blaze the trail with FHIR and catalog stuff.

Changed language from "fuzzy" query language to explicit language.

Still looking for a good work-flow model. When we get to PISM will need to determine the FHIR workflow.

This is posted to

Now have a reference type which allows us to associate certain information to validate the order.

Would like feedback into the FM.

PIM: you can have semantic profiles. At the PIM level you can get away with less strong typing.

Getting key data elevated in order to be able to do first order processing.

Referrals are in scope.

Timeline: Nov 7 submission. Order catalog is behind by about 6 months.

Suggestion to do a peer review in January.

Action item: Ask for an extension on for Pub/Sub and E&S during the Jan 2017 meeting.

Notes from Vince

Order Service

  • Current HL7 DSTU
  • OMG submission underway for 1 year
  • Two parts – order management and order catalogue. Order management allows order building as well as execution.

Catalogue allows building of an appropriate order from an order type specific catalogue to arrive at an appropriate order e.g. no L/S spine Xray order for back pain.

  • Also includes an interface to a fulfilment service.
  • See HSPC site for OMG current draft
  1. X-Paradigm Interoperability Project Discussion
  2. Action Item for Ken Lord: Need to make sure that the ballot reconciliation package has been uploaded.

WED Q1: Split meeting

  1. Joint w/EHR, Security, CBCC, SOA, FHIR (See EHR for meeting minutes)

- attendees:

  1. Scheduling Service Continuing discussion - cancelled

WED Q2

- attendees: see below

1. PASS ACS vote to request publication.

Ballot completed and reconciliation package uploaded. All negative votes have been withdrawn.

Motion – Proposed: Mike Davis Seconded Trish Williams

“SOA approves PASS ACS project go forward to publication as Normative”

Vote 11/1/0 Motion passes.

Mike and Kathleen will help Diana with the publication request formalities.

2. HL7 Cloud Planning Guide

Ken Rubin informed the meeting of current progress with the HL7 Cloud planning Guide document can be found at hssp.wikispaces.com/cloud

Survey on this topic conducted since last WGM – 3 page questionnaire taking 15 minutes to complete

  • 50 responses
  • 70% USA, 20% Europe, 10% Asia

70% indicated there were residency policy restrictions for where Health data can be hosted.

Ken went through results which demonstrated wide interest – they will be published on the wiki in the near future. There were two areas where there were Health specific issues one of which was security. However, we could not get security involvement previously.

Now SOA is once again seeking input.

Mike Davis – increased interest due to new solutions from Amazon and Microsoft with security adequate for healthcare data/HIPAA requirements. Renewed interest in software as a service (SAAS). Further work will be undertaken on this Q1 Thursday following a presentation by guest speaker from Amazon web services and plans for Health data in the cloud.

Japan – Amazon in Tokyo is bound by the USA Patriot act under which the FBI can block access to data. Japan thus currently requires separation between private and public cloud.

The intent of the document is (i) make people aware of what the issues are, (ii) where to look for possible information and solutions, (iii) Identify patterns that may be useful

Plan to ballot as informative document for January cycle.TCs bi-weekly. Trish Williams indicated she would like to participate, Mike David will look at document and let us know. Microsoft have indicated they will provide a participant. Kathleen will provide some references.

Kathleen – after completing this may need to revise privacy and security recommends to take into account specific cloud issues. Trish to look at what work is relevant at ISO TC215 WG 4.