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Template Usage Information:

  1. Project Name and ID

FHIRcast: Application Context Synchronization in FHIR

Project ID: 1392

Complete this section for all “Direct to Normative” ballot projects and when a project proceeds from “Informative to Normative” or “STU to Normative”.

Forward PSS to the TSC (via tscpm@HL7.org); this triggers American National Standards Institute (ANSI) Project Initiation Notification (PINS) submission.


TSC Notification:  Informative/STU to Normative 

Date:  Submission date


- or -                     Direct to Normative (no STU) (includes reaffirmations)       


Identify ISO, IEC or ISO/IEC standard to be adopted in text box below

Enter info here if an ISO, IEC, or ISO/IEC Standard is to be adopted as an American National Standard; Enter the designation of the standard(s) to be adopted:

Includes text from ISO, IEC or ISO/IEC standard: Check here if this standard includes excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption.




Select the unit of measure used in the standard; if no measurements are in the standard, select N/A









Investigative Project (aka PSS-Lite)

Date : 

Check this box when the project is investigative or exploratory in nature, which allows limited project scope definition. Sections 1-Project Name, 2-Sponsoring Group(s)/Project Team, 3a-Project Scope, 3b-Project Need, 3e-Project Objectives/Deliverables/Target Dates, 3i-Project Document Repository, 6b-[Realm, if known], and 6d-[applicable Approval Dates] are required for Investigative Project. Investigative Project specific instructions are highlighted in yellow. An investigative project must advance in two WGM cycles, requiring a full scope statement. Otherwise the project will be closed.

2. Sponsoring Group(s) / Project Team

2.a. Primary Sponsor/Work Group

Primary Sponsor/Work Group
(1 (And Only 1) Allowed)

Transfered to : Infrastructure and Messaging(InM)

2.b. Co-sponsor Work Group(s)

Co-sponsor Work Group(s):

(Enter co-sponsor approval dates in Section 6.d Project Approval Dates)

Imaging Integration Work Group

FHIR Infrastructure Work Group

Clinical Decision Support Work Group

Security Work Group

International Mentoring Committee

Indicate the level of involvement that the co-sponsor will have for this project:
X Request formal content review prior to ballot
X Request periodic project updates. Specify periodAt WGMs
X Other Involvement. Specify details here: Joint testing in Connectathons and ongoing implementation and testing.

2.c. Project Team

All names should have confirmed their role in the project prior to submission to the TSC.

Project facilitator (1Mandatory)

Isaac Vetter

Other interested parties and their roles

Elliot Silver, II co-chair

Grahame Grieve, FHIR-I

Brad Genereaux, II co-chair

Multi-disciplinary project team (recommended)

Niklas Svenzén, Sectra

Isaac Vetter, Epic

     Modeling facilitator

Elliot Silver

     Publishing facilitator

Elliot Silver

     Vocabulary facilitator

Elliot Silver

     Domain expert rep

Elliot Silver, Brad Genereaux, Niklas Svenzén

     Business requirement analyst

Niklas Svenzén, Sectra

     Conformance facilitator (for IG projects)

     Other facilitators (SOA, etc)

Implementers (2Mandatory for STU projects)

FHIR Project Note: The implementer requirement will be handled by the “balloting” project.  Therefore work groups do not fill out the above section.  However, feel free to list implementers specific to your work group’s resources if you know of any.

1)   Isaac Vetter, Epic

2)   Niklas Svenzén, Sectra

3) Grahame Grieve, FHIR
4) Martin Bellehumeur, Siemens Healthineers

3. Project Definition

3.a. Project Scope

This project proposes the creation of a decentralized, web-based context synchronization specification. This specification will enable secure integration across different devices, systems, and/or, networks – not tie the user’s session to a single machine. This specification will natively enable synchronization of SMART on FHIR apps. Project scope is not limited to imaging integration.

This project should enable tighter integration of SMART on FHIR servers; and should not conflict with or duplicate the SMART on FHIR specification nor the CDS Hooks specification. In particular, this project will focus on a more fine-grained and continuous synchronization than the SMART on FHIR launch context. It will also support synchronization outside of the host app/client frame addressed by SMART on FHIR, for example supporting synchronization between applications on a tablet and a workstation.

Example events to share for context synchronization include "Open Encounter”, "Show Study", "User logout".

The existing CCOW specification will not only be used to inform both best practices and lessons learned for an implementable application context synchronization specification, but further this project will try to reuse the existing CCOW abstract model. Since the initial creation of CCOW, new technologies and exchange patterns have arisen that may simplify context synchronization. The project should attempt to reuse the CCOW abstract model if possible.

3.b. Project Need

“Context synchronization” between clinical information systems, such as radiology information systems, PACS, EHRs, reporting systems, etc. is both highly valued and widely implemented in health systems. Lack of application context synchronization is commonly regarded as a risk to patient safety. HL7’s CCOW standard lacks commercial server implementations and instead, a large number of proprietary mechanisms are used in health systems’ production settings.

These proprietary specifications not only present a barrier to adoption, but also discourage innovation by any given vendor who supports a significant number of these specifications.

As systems look to tighten the integration by exchanging new and additional types of data, a new, simple, and most importantly standard method of simple context integration is necessary.

3.c. Security Risks

Will this project produce executable(s), for example, schemas, transforms, style sheets, executable program, etc.  If so the project must review and document security risks. Refer to the Cookbook for Security Considerations for additional guidance, including sample spreadsheets that may be used to conduct the security risk assessment. 





3.d. External Drivers

Describe any external schedules or calendars which may not be known outside of the project team that are driving target dates for this project..

3.e. Project Objectives / Deliverables / Target Dates


Several target dates precede the date of this PSS. This is an update to an existing PSS that was never formally approved. Most sponsoring WGs approved the earlier PSS in 2017, but it was never brought forward for SD and TSC approval. The earlier PSS was also submitted to the HL7 project office, which is why this is listed as an unapproved project in the database. The earlier PSS was investigative, however sufficient work has now been done to move forward as standard.

Within each row, enter the explicit work product(s) / objective(s).  Indicate their target date at the right in WGM/Ballot Cycle format.  Include the project end date as the last objective (for standards projects, the end date will be the projected ANSI approval date). 

Target Date(in WGM or ballot cycle format, e.g.

‘2017 Sept WGM’ or

‘2017 Jan Ballot’)

Initial draft specification for Connectathon testing

Dec 2017

Connectathon testing

2018 January WGM

Connectathon testing

2018 May WGM

Connectathon testing

2018 Sep WGM

Submit for STU Ballot (First Ballot Cycle)

2019 May Ballot

Reconcile STU ballot

2019 May WGM

Publish STU

2019 Sept 

STU1 Period – 12 months

2019 Jun – 2020 Jun

Submit for STU2 Ballot (First Ballot Cycle)

2020 Feb Ballot

Reconcile STU2 ballot2020 Feb WGM
Publish STU22020 Jun 
STU Period – 12 monthsFeb 2021 – Feb 2022
Submit for STU3 Ballot (First Ballot Cycle) - May, 2022
Reconcile STU3 ballotMay 2022 - Jan 2023
Publish STU3Feb 2023
STU PeriodFeb 2023 - Feb 2024
Submit for partial normative ballotMay 2024
Reconcile partial normative ballot May 2024- Jan 2025
 Publish partial normative  Feb, 2025
STU PeriodFeb 2025- Feb 2026
Submit for normative ballotMay 2026
Reconcile normative ballotMay 2026-Jan 2027
Publish normativeFeb 2027

Project End Date (all objectives have been met)

Note:  For PSS-Lite/Investigative Project, End date must be no more than two WGM cycles, e.g. project initiated at January WGM must complete investigation by September WGM.
May 2027 WGM

3.f.   Common Names / Keywords / Aliases

FHIRcast, Application synchronization, Context synchronization, Context sharing, CCOW on FHIR

3.g.   Lineage


3.h. Project Dependencies


3.i.   HL7-Managed Project Document Repository Location

Enter the SPECIFIC URL of the HL7-MANAGED SITE where supporting project documents, deliverables, ballot reconciliation work and other project information will be kept



Additional locations :.

 InM Projects


The FHIRcast specification is currently hosted at http://fhircast.hl7.org and tracked at https://github.com/hl7/fhircast-docs

3.j.   Backwards Compatibility

Are the items being produced by this project backward compatible?






If you check 'Yes' please indicate the earliest prior release and/or version to which the compatibility applies:

For V3, are you using the current data types? 

(Refer to TSC position statement on new projects using R2B for more information on the current V3 data types)






If you check no, please explain the reason:

If desired, enter additional information regarding Backwards Compatibility.

3.k. External Vocabularies

Will this project include/reference external vocabularies?






If Yes, please enter the vocabularies:

4. Products (check all that apply)

Arden Syntax

V2 Messages – Administrative

Clinical Information Modeling Initiative (CIMI)

V2 Messages - Clinical

Clinical Context Object Workgroup (CCOW)

V2 Messages - Departmental

Domain Analysis Model (DAM)

V2 Messages – Infrastructure

Electronic Health Record (EHR) Functional Profile

V3 Domain Information Model (DIM / DMIM)

FHIR Extensions

V3 Documents – Administrative (e.g. SPL)

FHIR Implementation Guide (enter FHIR product version below)

V3 Documents – Clinical (e.g. CDA)

FHIR Profiles (enter FHIR product version below)

V3 Documents - Knowledge

FHIR Resources

V3 Foundation – RIM

Guidance (e.g. Companion Guide, Cookbook, etc)

V3 Foundation – Vocab Domains & Value Sets

Logical Model

V3 Messages - Administrative

New/Modified/HL7 Policy/Procedure/Process

V3 Messages - Clinical

New Product Definition (please define below)

V3 Messages - Departmental


New Product Family (please define below)

V3 Messages - Infrastructure

Non Product Project - (Educ. Marketing, Elec. Services, etc.)

V3 Rules - GELLO

White Paper

V3 Services – Java Services (ITS Work Group)

Creating/Using a tool not listed in the HL7 Tool Inventory

V3 Services – Web Services (SOA)

If you checked New Product Definition or New Product Family, please define below:

FHIRcast will be a complementary standard to HL7 FHIR, and while using some aspects of FHIR, and SMART on FHIR, it is neither an extension, implementation guide, nor profile of FHIR. It is also not part of FHIR, nor any an other HL7 standard.

For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

Compliant with STU 3 and Release 4

5. Project Intent (check all that apply)


Create new standard

Supplement to a current standard

Revise current standard (see text box below)

Implementation Guide (IG) will be created/modified

Reaffirmation of a standard

Project is adopting/endorsing an externally developed IG:

New/Modified HL7 Policy/Procedure/Process

Specify external organization in Sec. 6 below;

Externally developed IG is to be (select one):

White Paper (select one):

Adopted  - OR -



Balloted Informative OR

Non-balloted WG White Paper

N/A  (Project not directly related to an HL7 Standard)

If revising a current standard, indicate the following:

-    Name of the standard being revised:
-    Date it was published (or request for publication, or ANSI designation date)
-    Rationale for revision
-    The relationship between the new standard and the current standard (is it designed to replace the current standard, a supplement to the current standard, etc.)

5.a. Ballot Type (check all that apply)

Comment (aka Comment-Only)

Joint Ballot (with other SDOs)


N/A  (project won’t go through ballot)


STU to Normative     - OR -

Normative (no STU)

If necessary, add any additional ballot information here.  If artifacts will be jointly balloted with other SDOs, list the other groups.

5.b. Joint Copyright

Check this box if you will be pursuing a joint copyright.  Note that when this box is checked, a Joint Copyright Letter of Agreement must be submitted to the TSC in order for the PSS to receive TSC approval.

Joint Copyrighted Material will be produced?




6. Project Logistics

6.a. External Project Collaboration

Include SDOs or other external entities you are collaborating with, including government agencies as well as any industry outreach.  Indicate the nature and status of the Memorandum of Understanding (MOU) if applicable.

For projects that have some of their content already developed:

Collaborative development with DICOM WG-20 under existing HL7-DICOM MOU.

How much content for this project is already developed?

90% at December 2018

Was the content externally developed ? :


Is this a hosted (externally funded) project?  (not asking for amount just if funded)




6.b. Realm



- OR -


Realm Specific


Check here if this standard balloted or was previously approved as realm specific standard

Enter “U.S.” or name of HL7 affiliate(s) here.  Provide explanation/justification of realm selection. For projects producing deliverables applicable to multiple realms, document those details here. 

For Investigative projects, indicate if the project is planned to be Realm Specific or Universal, if known. Work Groups are encouraged designating project a Universal project initially, and discover which Realms can contribute to the work effort during the discovery phase of the project. Note: This status is subject to change during the investigative process.

***Universal Realm is justified by participation of Sectra (Sweden), Philips (Netherlands), Siemens (Germany) and Agfa (Belgium), Oridashi (Australia), and several US-based companies (e.g. Epic) as well as use of no known realm-specific content. 

6.c. Stakeholders / Vendors / Providers

This section must be completed for projects containing items expected to be ANSI approved, as it is an ANSI requirement for all ballots








Clinical and Public Health Laboratories




Clinical and Public Health Laboratories


Immunization Registries




Emergency Services


Quality Reporting Agencies




Local and State Departments of Health


Regulatory Agency


Health Care IT


Medical Imaging Service


Standards Development Organizations (SDOs)


Clinical Decision Support Systems


Healthcare Institutions (hospitals, long term care, home care, mental health)






Other (specify in text box below)


Other (specify in text box below)








Other (specify below)







Other:  Indicate other stakeholders, vendors or providers not listed above.

XPACS XImage Viewer VendorsXReporting Vendors

6.d. Project Approval Dates

Click here to go to HL7 Project Scope Statement Instructions#Appendix A for more information regarding this section.
Approvals are by simple majority vote of the approving body

Sponsoring Work Group Approval Date:

WG Approval Date


Administrative review – in parallel with Work Group Approval

Co-Sponsor Group Approval Date

List each Co-Sponsor and their Approval Date

FHIR-I 2017-09-13

CDS 2017-09-12

Security 2017-09-14

InM 2019-02-28

Family Management Group Approval Date(s)

CIMI Projects: CIMI Management Group

CIMI MG Approval Date


CDA Projects: CDA Management Group

CDA MG Approval Date


FHIR Projects: FHIR Management Group

FMG Approval Date

FMG 2018-10-24

V2/Publishing Projects: V2 Management Group

V2 MG Approval Date


US Realm Projects: US Realm Steering Committee Approval
(Email WG approved PSS to: tscpm@HL7.org)

USRSC Approval Date


Affiliate Specific Projects: Affiliate Approval Date

Affiliate Approval Date


Submit PSS to Steering Division after all of the above approvals are received

Steering Division (of Primary Sponsor WG) Approval Date:

ASD Approval Date CCYY-MM-DD


Last PBS Metrics Score:




PBS Metrics Reviewed? (required for SD Approval if not green)



ARB and Steering Division approval may be in parallel

Architectural Review Board Approval Date:

(required for externally developed content)

ARB Approval Date


TSC Approval

If applicable, TSC has received a Joint Copyright/Distribution Agreement (containing the verbiage outlined within the SOU),
signed by both parties.




Technical Steering Committee Approval Date:
(Email SD WG approved PSS to: tscpm@HL7.org)

TSC Approval Date

2019-02-18 TSC Call Agenda/Minutes