Minutes of Joint Meeting of Patient Care, O&O, Structured Documents TCs.

Clinical Statement Working Group.

Noordwijkerhout, Netherlands.

Thursday 5th May, 2005 Q3+Q4

Attendance List

Name / Organisation / email
Liora Alschuler / Alschuler Spinosa /
Bob Dolin / Kaiser Permanente /
Heath Frankel / HL7 Australia /
Hans Buitendijk / Siemens /
David Rowed / HL7 Australia /
Charlie Bishop / NHS National Programme for IT /
Rik Smithies / NProgram Ltd /
David Markwell / HL7 Australia /
Andrew Perry / HL7 UK /
Vassil Peytchev / Epic Systems /
Mike Kenig / Epic Systems /
Corey Smith / Health Language /
Helmut Konig / Siemens /
Karen Eckert / Wolters Kluwer Health/Medispan /
Jinwook Choi / HL7 Korea /
Timo Tarhonen / HL7 Finand /
Mary Ann Juurlink / Gpinformatics /
Diana Perez / Siemens /
Harry Solomon / GE Healthcare Medical Systems /
John Firl / McKesson /
Calvin Beebe / Mayo Clinic /
Marana Casella Dos Santos / L & C /
Fred Behlen / AmericanCollege of Radiology /
Christina Hansson / Oracle /
John Hatem / Oracle /
Doug Castle / IDX Systems /
Matt Walker / Cerner Corp. /
Antero Ensio / Ensitieto Ltd /
Keith W. Boone / Dictaphone Corp. /
Christof Gessner / Optimal Systems /
Peter Kress / ACTS Retirement /
Evelyn Hovenga / CentralQueenslandUniversity /
Anita Walden / Duke Clinical Research Institute /
Richard Dickson Hughes / HL7 Australia /
Brian McCourt / Duke Clinical Research Institute /
Dan Russler / McKesson /
William Goossen / HL7 NL /
Michael Legg / HL7 Australia /
Davera Gabriel / UC Davis Health Systems /
Mead Walker / Mead Walker Consulting /
Rob Hausam / TheraDoc /
Heath Frankel / HL7 Australia /
Linda Walsh / Oracle /
Julie James / Blue Wave Informatics /
Masaharu Obayashi / Kanrikogaku Ltd /
Stephen Chu / HL7 NZ /
Anmon Shabo / IBM Research /
Mark Shafarman / Shafarman Consulting /
Angelo Rossi Mori / HL7 Italy /
John Arnett / NHS National Programme for IT /
Scott Robertson / Kaiser Permanente /
Mariana Casella Dos Santos / Language & Computing /
Vesa Paxarinen / VTT Information Technology /
Austin Kreisler / SAIC-Sceince Applications Internat. /
Patrick Loyd / Oracle Corp. /
Ed Hammond /
Tom de Jong / HL7NL /
Name / Organisation / email
Liora Alschuler / Alschuler Spinosa /
Bob Dolin / Kaiser Permanente /
Heath Frankel / HL7 Australia /
Hans Buitendijk / Siemens /
David Rowed / HL7 Australia /
Charlie Bishop / NHS National Programme for IT /
Rik Smithies / NProgram Ltd /
David Markwell / HL7 Australia /
Andrew Perry / HL7 UK /
Vassil Peytchev / Epic Systems /
Mike Kenig / Epic Systems /
Corey Smith / Health Language /
Helmut Konig / Siemens /
Karen Eckert / Wolters Kluwer Health/Medispan /
Jinwook Choi / HL7 Korea /
Timo Tarhonen / HL7 Finand /
Mary Ann Juurlink / Gpinformatics /
Diana Perez / Siemens /
Harry Solomon / GE Healthcare Medical Systems /
John Firl / McKesson /
Calvin Beebe / Mayo Clinic /
Marana Casella Dos Santos / L & C /
Fred Behlen / AmericanCollege of Radiology /
Christina Hansson / Oracle /
John Hatem / Oracle /
Doug Castle / IDX Systems /
Matt Walker / Cerner Corp. /
Antero Ensio / Ensitieto Ltd /
Keith W. Boone / Dictaphone Corp. /
Christof Gessner / Optimal Systems /
Peter Kress / ACTS Retirement /
Evelyn Hovenga / CentralQueenslandUniversity /
Anita Walden / Duke Clinical Research Institute /
Richard Dickson Hughes / HL7 Australia /
Brian McCourt / Duke Clinical Research Institute /
Dan Russler / McKesson /
William Goossen / HL7 NL /
Michael Legg / HL7 Australia /
Davera Gabriel / UC Davis Health Systems /
Mead Walker / Mead Walker Consulting /
Rob Hausam / TheraDoc /
Heath Frankel / HL7 Australia /
Linda Walsh / Oracle /
Julie James / Blue Wave Informatics /
Masaharu Obayashi / Kanrikogaku Ltd /
Stephen Chu / HL7 NZ /
Anmon Shabo / IBM Research /
Mark Shafarman / Shafarman Consulting /
Angelo Rossi Mori / HL7 Italy /
John Arnett / NHS National Programme for IT /
Scott Robertson / Kaiser Permanente /
Mariana Casella Dos Santos / Language & Computing /
Vesa Paxarinen / VTT Information Technology /
Austin Kreisler / SAIC-Sceince Applications Internat. /
Patrick Loyd / Oracle Corp. /
Ed Hammond /
Tom de Jong / HL7NL /

ProposedA draft agenda which was reviewed to:

–Last Teleconference

–Ballot Comments

–Outstanding CRs

–(Patient) Care Structures

–Location in Ballot

–Instance Identifiers

–Publishing Issues

–Next Ballot

–Ongoing Work Arrangements

–Nature of Clinical Statement

–Stubs etc

–Current Use of CS

Ballot comments were reviewed. The ballot was informative only.

Considering ballot comment on need for Person ID:

David Markwell moved:

"Person ID is on-persuasive as it done through patient role id and there is no clear use case to add it at this point in time".

Seconded Charlie Bishop.

Against: 1

Abstain: 22

In Favor 24

Present: 47.

See ballot spreadsheet for detailed feedback and follow-up.

Status of the ballot:

It is possible to have as Draft (Not for Comment).

It was agreed we would have the Clinical Statement in this form for the present.

Instance Identifiers.

Austin reported that the issue of Instance Identifiers for Clinical Statement was impairing on its use in lab.

ActRef needs instance identifier to be the message sent so system can query back for information.

The problem hinges around instance identifier of snapshot vs instance identifier of the object which changes over time.

There is a 'snapshot id' in the control wrapper but this is irrelevant to the CS pattern.

Patrick Loyd: Oracle implements version id to enable same act id through different dynamic states.

David Markwell: Versioning a problem because of different systems and may need a 'version server'.

Gunther: Use cases are needed. These are communication vs implementation issues.

Does the Oracle id belong in the RIM? Consider the availability time.

This is now an agreed problem. There is a need to work on it and develop a proposal on how CS is managed / developed to handle this.

Bob: DICOM has similar issues in relation to document id.

Patrick Loyd, David Markwell and hopefully Charlie McCKay (nominated in absentia) will work on this.

Outstanding Change Requests:

Change Requests CRs are numbered and have been on the Clinical Statement section of the website.

Work commenced on those outstanding from the teleconferences since the January meeting.

Change Requests have been resolved in the teleconferences up to and including CR21 except for CR 19.

Change Request 19 (re contextControlCode usage ):

Discussion --conformance should be mandatory or required?

Charlie agreed to alter the CR wording from 'mandatory' to 'required'.

Motion by Charlie was seconded "Accept Change Request 19 with change that conformance should be required instead of mandatory".

Abstain:13.

Against:0.

In Favor:32.

Present: 45. Motion Carried.

CR 22: ‘Redundant’ attribute.

ActChoice.sourceOf1.contextConductionInd attribute must always be “false”.

Discussion: really a tooling problem. If tooling fixed then would propose a value. Want value fixed as 'false'. Express as constraint.

Motion put by Charlie, seconded by Patrick:

"Attribute to be fixed as 'false'. Put the constraint on it in the short term, and remove constraint when 'Boolean' can be fixed".

Against:0.

Abstain:8.

In Favor:35

Present:43. Carried.

CR 23: Clinical Statement Relationship Attributes.

Issue: Need to be able to convey more information about the nature of the relationships between Clinical Statements.

Original CR's Recommendation:

Add the following attributes to ActChoice.sourceOf1 and ActChoice.sourceOf2/targetOf:

  1. inversionInd - cardinality [1..1], conformance Mandatory and default of “false”
  2. negationInd - cardinality [1..1], conformance Mandatory and default of “false”
  3. seperatableInd - cardinality [1..1], conformance Mandatory and default of “true”

Motion: put by Charlie:

"Accept the recommendation as per the CR 23 for all 3 attributes except that they be '[0..1] Required' ".

Against:0.

Abstain:11.

In Favor: 31.

Present:42. Carried.

CR 24: seperatableInd.

Issue is that we need to be able to indicate that a clinical statement is not intended to be interpreted independently of a related reference range or condition.

Original recommendation: Add seperatableInd to Observation.referenceRange and ActChoice.conditions with cardinality [1..1] and conformance Mandatory.

Discussion: CR to have cardinality and conformance altered.

Motion put by Charlie and seconded by Bob:

"Add seperatableInd to Observation.referenceRange and ActChoice.conditions with cardinality [0..1] and conformance 'Required'."

Against:1.

Abstain:8

In Favor:30

Present:39. Carried.

The remaining outstanding CRs will be dealt with by teleconference between now and the September meeting.

Times for Teleconferences:

This was agreed to be 4.30pm Eastern time on alternate Wednesdays (US / Europe day of week) starting Wed 18th May.

Meeting closed 5.10pm.