Project Page Template - This template is for voluntary use, but provides guidance for consistent representation of Confluence pages reporting project information
This template was developed using examples from other project pages: Annotated ECG, BRIDG as DAM, Canonical Pedigree, DCM for Dev, EHR Interop, EHR RM-ES, Oncology EHR, RPS, Templates registry, SPL, VMR
[Link to Project Insight Searchable Database Entry]
- Currently, there is no standard for the exchange of discrete dental observations between dental providers. While some Dental EHRs have implemented the C-CDA for data exchange, it was built primarily for medical care, and does not include the structured data elements necessary for use by dental providers.
- The Dental IG WG plans to develop the necessary CDA templates and supporting implementation guidance to extend the existing C-CDA 2.1 CCD document template to contain the discrete Dental Data called for in the ANSI/ADA 1084 standard. The ultimate objective is to publish an HL7 CDA Implementation Guide that provides a Dental CCD document template and supporting section and entry templates.
- Project Facilitator - Gregory Zeller
- Modeling/Publishing Facilitator - Russell Ott
- Vocabulary Facilitator - Jean Narcisi
- Project Support - Manisha Khatta
- PSS - Dental CCD Implementation Guide PSS
- ADA 1084 Standard
- Name the project listserv if a special one exists
The WG meets every Wednesday 2:30p-3:30p ET. (As of 8/14/19, WG will meet every other Wednesday)
Reviewed the ADA's 1084 document and project intent/goals. Building out a timeline and schedule of expectations was discussed during this meeting.
Updates from Russ: Attachments WG's new WG name is PPIE (Payer/Provider Information Exchange). We need 2 more implementors before PSS approval. DoD is the only one so far.
It was emphasized that logical groupings of dental information should remain separate (odontal, implantable devices, etc).
Reviewed the xls spreadsheet to explain intent for mapping data to C-CDA.
Russ reiterated to the WG the project intent and scope. Karen Clark, DSS presented a DENTRIX use case scenario which allowed the group to gain better context on defining and collecting dental data from an EHR.
There were some data elements that are not listed in the 1084; the group mentioned collecting the "to-be" data elements during requirements gathering for CCD dev.
DENTRIX can grab CCD data now, but the intent for this project is to see how we can add those additional dental data elements within a structured framework.
There was also a brief discussion on utilizing a FHIR connection vs. building a CCD This is a thought for consideration (but will push forward with CCD for now).
Greg, Russ, Manisha, Joel, Jean, Angie, Eric, Tony, LT Col Ford, CDR Stallings
Reviewed high level timeline and group approved. Once we get vendor perspectives, we can solidify timeline.
There was some discussion around the nuance of focusing on CCD or FHIR for the IG version but in some respect can be interchangeable. Open for discussion with the vendors as well.
Shared the current spreadsheet and determined: out of 477 total data elements, 218 can be mapped to CDA; 258 will need structure.
Noted that this WG progress will be discussed during Wed-Q1 at HL7 WGM in Atlanta.
Greg, Manisha, Jack (last name?), Eric Kirnbauer, Joel Bales, CDR Stalling, LT Col Kevin Parker, Jean Narcisi, Chris Brancato, Carla Evans, Karen Clark, Michael (last name?)
Greg reviewed the PSS and excel spreadsheet for new attendees. A question proposed was if CCDA is preferred over FHIR and it was mentioned that CCDA might be a better fit right now.
Jean had a conversation with HL7's CEO, Chuck Jaffe, that potentially after balloting a first final of Dental Summary IG, joining this effort into the FHIR Accelerator Program would be a consideration (if it fits well).
Dental discussion occurred during Tues Q1 of PIE WG. Greg and Russ presented the Dental Summary Exchange Overview slide deck.
Russ pointed that finalizing Ortho IG is top priority but will work simultaneously with this effort.
HL7 is pushing for dual IG's (CDA and FHIR), so consider the strategy for that.
1. Add ortho IG data elements (or note them) in Dental Summary Exchange mapping file.
2. Finalize what WG should review the PSS of this project (PIE, Patient Care, both?)
3. Consider FHIR R5 release when mapping to FHIR.
Tony Magni, Jean Narcisi, Chris Brancato, Greg Zeller, Russ Ott, Col William Baez, LtCol Tansel Acar, LTC Kevin Parker, CDR Steve Stallings, LtCol Jeff Ford, Bob Cox (CDS), Eric Kirnbauer (Tesia), Susan Langford
CDS cannot yet provide a CDA summary document
Henry Schein and DSS were involved in the development of the 1084
DSS and Henry Schein can both produce a CCD today
Col Baez - we've had some challenges with the FHIR interface between Dentrix and Millennium
Col Baez - we only view stuff within the JLV, but we'd like to be able to store data
Bob (CDS) - We could do sandbox creation and testing of a CCD fairly quickly - within a few months
Col Baez - the focus should be on the Dental provider focus, rather than a Dental payer focus
Russ - For the next meeting - we'll review the data elements from the 1084 that map to the baseline C-CDA, and
Greg - If we start with simple straight-forward use cases to build from, that will help us get to meaningful pilots in short term.
Col Baez - the dental referral use case is a common one that is not unique to the military space.
Greg - from a perspective of readiness, the military has a very specific scale of readiness
LTC Parker - the 3 services need to get agreement on what they'll
Col Baez will provide draft use cases with sample data that would be important to convey as part of a Dental Referral/Transition of Care scenario
Russ, Greg, Manisha, Jean, LCDR Bohman, CDR Stalling (BUMED), Joel Bales, Courtney Panaia-Rodi, Eric Kirnbauer, Carla Evans, Craig, Susan Langford, Robin Isgett, LT Col Kevin Parker, Dave DeRoode, Chris Johnson (BCBS)
Review of Col Baez' use case document:
Russ introduced the document content to the group and noted that we should highlight where in each use case does the transfer of data occur. We then can identify where in the CCD that does or should be, discuss implications or details of that data, and comparison to the 1084 for sanity check on appropriateness of data sets. These use cases are also helpful for implementation example when it comes time to publish IG for ballot.
The group started looking at the requirements xls to start the ground work. Discussions include:
1) InformationRecipient: facility type code and facility type. it was noted from a federal rep that this information would be good to have, even if it's unavailable now. Need to determine if dental is included in Location identifiers: SDLOC and HSLOC in CDA.
2) ReceivedOrg: Russ stated that in CDA there is no designation for Organization address or phone. He will take this back to the HL7 community to see if we did want to include it, where could be stored.
3) LegalAuth, assigned entity, id: question if this is one person within the dental world? decided to parking lot this one. (there is some debate on how much we want to shift examples like this for implementors).
4) DocumentationOf. service event, performer: (the care team that directly aligns to the care plan of the given patient). Dental provider types ARE included in VSAC for provider identification in CCDA.
Greg, Jean, Russ, Manisha
CDR Stalling, Joel Bales, Carla Evans, Robin Isgett, Rebeka Fiehn, Michael Honeycutt, Kipp Clemmons (DSS), Lt Col Jeff Ford, Chris Brancato, Col Baez, LCDR Bohman, David DeRoode
LT Col Parker, Joel, Greg, Russ, Jean, Michael Honeycutt, Brett, Kipp, LCDR Bohman, Julie Hawley (DentaQuest), Gyle Gales (HS), Toni, Will, Col Baez
NEW date/time series: Mondays 1-2pm ET
Agenda: detailing out how the summary will be exchanged:
Key Takeaway: if we dont know when a follow up visit may be, pushing this information to one's inbox creates noise unless it is directly related to the visit the provider is working on. Dentrix puts summaries in a holding pattern. Summary exchange for query would be a good use case where dental information is needed. It is also helpful for utilization and treatment needs.
Right now, in many cases (including Army), this process is manual and in free-form note. The provider can add what they want and it is intended to be shared as a blob of context.
|Create a workflow diagram of the referral process discussed|
Bob Cox, Joel Bales, Kipp, Zabrina, Greg, Eric, Susan, Chris, Toni, Carla, Dave DeRoode, Michael Honeycutt, Karen Clark, Rebekah, Jeff Ford, Zack Church (HS), Col Baez
Note: to discuss Procedures during Encounters discussion next week
Consider/brainstorm prioritization of Encounter sub-sections.
Greg Zeller, Manisha Khatta, Russ Ott, Eric Kirnbauer, LCDR Bohman, Karen Clark, Rebekah Fiehn, Carla Evans, Chris Brancato, CDR Steve Stallings, Dave, Zabrina Gonzaga, Mike Honeycutt, Kipp Clemmons, LCDR Kevin Parker, Susan Langford
The WG discussed the prioritization (always expected to be there, sometimes important, and usually not important; noise) of the following logical sub-sections of data for exchange:
Clinical Notes: There are designated areas within the CCDA to include clinical notes, 1) there's a logical structure to anchor the clinical note and build it in as a sub-related structure, or 2) identify a dedicated section for a pile of notes with a framework (separate from discrete data elements). Russ suggested we discuss this in greater detail at another time.
|11/11/19||No Meeting (Veterans Day)|
PM: Greg, Manisha, Jean, Russ
DQ: Rebekah Fiehn, Eric Transby
Federal: CDR Stallings, LCDR Bohman
DSS: Kipp Clemmons, Michael Honeycutt
Other: Rachel Foerster, Christol Green (anthem)
The WG continued down the list of Encounters, discussing prioritization of encompassing data elements:
When considering specific dental measurements, it's important to identify the relationship between the measurements and how it is/can be exchanged. Can assessments be shown as Findings in the record? How important are TMJ Assessments when sharing a record for referral? These are the considerations to look into if we start modeling the data sets.
Russ, Manisha, Greg, Col Baez, Bob Cox, Maj Turney, Bedo, Rebekah, Ubong (new IPO I2TP support for Russ), Dave, Zabrina, Joel, Eric Tranby
The group started the discussion with procedures
Greg, Russ, Manisha, Lt. Col Ford, Chris Brancato, LCDR Stallings, Carla Evans, Rebekah Fiehn, Zabrina, Joel Bales, Ubong, Dave DeRoode, Michael Honeycutt, Col Baez
The group talked a little bit about the format of a referral and consult note, Russ briefly showed what JLV looks like; a chart review platform that pulls from a CCD.
|Draft clinical scenarios for initial data modeling|
- STU1 Dental Summary Exchange CCD Implementation Guide
- A Payer/Provider Information Exchange (PPIE) WG project
- PSS approved by US Realm Steering Committee - Dental CCD Implementation Guide PSS
- Gathering high level requirements and data mappings
- Discuss use cases and identify/map technical data exchange (with a focus on dental referrals)
- Deep dive on Encounter information noted in ADA 1084
The following are living documents updated by the team on a frequent basis. These files will drive discussion during WG calls.
For version control purposes, please contact Manisha Khatta if you would like to make edits/additions to a file.
|ADA Standard No. 1084_May 2019.pdf||ADA Standard No. 1084 (May 2019)|
|data mapping of 1084 to CCDA|
|original use case document from Col Baez|
|details of use cases|
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