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Project Information

[Link to Project Insight Searchable Database Entry]

Project Description: 

  • 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.

Key Contributors:

Other Links/References:



Data Domain Prioritization (revised 6/29 after initial-modelling):

Dental Referral NoteDental Consult Note
Advanced DirectivesMAYMAY

Dental Findings - includes all of the following:

Encounters (Odontogram - General)

Encounters (Periodontal)

Encounters (Oral Soft Tissue Exam)

Encounters (TMJ Exam)

Encounters (TMD History)

Encounters (Occlusion Exam)

Family HistoryMAYMAY
Functional StatusMAYMAY
History of Present IllnessSHALLSHALL
Medical Equipment (Implantable Devices)MAYMAY
Plan of TreatmentSHALLSHALL
Reason for Referral (Purpose)SHALL
Reason for Visit
Social HistoryMAYMAY
Vital SignsMAYMAY

Meeting Information

The WG meets every Monday 1:00p-2:00p ET.



Action Items


Reviewed the ADA's 1084 document and project intent/goals. Building out a timeline and schedule of expectations was discussed during this meeting.

  1. Socialize this WG with the dental community to see who can participate
  2. Socialize within DoD (Molly Jenkins, Kevin Parker, Steve..) --Russ sent email to Nancy 8/15
  3. Create timeline/roadmap --WIP: Manisha drafting
  4. Create a requirements list of data elements mapped to C-CDA --ongoing


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.

  1. WG to identify two additional implementors for this effort. VA or the Legacy Army are possible POCs
  2. Post new WIP sheet?
  3. Set up meeting (8/13) with PPIE group for project approval


Meeting canceled


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). 

  1. Need to have someone from Henry Schein on the WG call.
  2. Push for more federal representation on this call. Russ to speak to IPO.
  3. Create timeline draft.


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.

  1. Follow up with Will about Henry Shein participation.
  2. Gather vendors for perspective on timeline and implementation format (CDA, FHIR)


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). 

  1. Compile slide deck for HL7 WGM, send draft to Greg and Jean for review.

9/17/19 (WGM)

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

  • Perhaps Dentrix could test this in a smaller sphere, and then port it over to the DoD space
  • What they do to configure or manipulate Dentrix enterprise has to go through the PEO DHMS
  • For us, "we can get to yes faster with CCDA" than trying to do something with FHIR

LTC Parker

  • Henry Schein has produced a CCD that goes to the JLV

Col Baez - we only view stuff within the JLV, but we'd like to be able to store data

  • "I am really eager to provide a use case for this"
  • This wouldn't only be for active duty, but requirements would be provided with them
  • If someone was seen at a community provider location, and they could provide an essential dental record, we could add it to the record
  • Also if someone were to newly become Active Duty, we'd want to capture their Dental status and history
  • This is an opportunity to standardize the baseline information exchanged between dental providers
  • Sometimes people are authorized for a limited set of treatments - that they didn't get billed for extra care.


  • I'm not sure that we have a way to show the progress of Periodontal status is over time
  • The caries risk and caries rate is something that the profession has some agreement

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)

Administrative items:

  • The PSS was approved 10/8/19 by the US Realm Steering Committee. They requested a few clarifications to be added to the PSS language: that not only the CDA template will be created but also FHIR. Other committees that need to approve are the administrative steering division and the technical steering committee.
  • Doodle poll to be sent out for future weekly meetings (changing to weekly vs biweekly). Last Wednesday meeting will be 10/16/19 (230-330pm ET). 

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.

  1. Check with HL7 community on where facility address and phone number (under receiving org) could exist (Russ)
  2. Check to see how facility type code and code would be modeled IF separate from SDLOC and HSLOC (Russ)
  3. Work on the list of facility types (Russ sent CDA list for reference) (Col Parker)
  4. Doodle poll sent to email distro 10/9/19. Finalize new day/time on 10/16. (Manisha)


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

  1. Context around Encounter (single or multiple): discussion landed on a suite of procedures, by performers (multiple), care plans, etc. Confirmation that detail care plan to be built out in spec.
  2. Purpose as defined in 1084. what information is or should this convey and how is it used by recipient of document?
  3. Problems - what terminologies will be used to convey problems? ---did not finalize (question)
  4. Procedures - discuss HL7 way of defining procedures (procedures vs. observations vs. acts) ---did not get to 


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:

  1. What will likely happen in the Dental EHR before summary creation
    1. It was noted in most cases, claims data is the driver for referrals. If a dental profile is created for a patient, it doesn't mean the requirements to fulfill the claims request is met. 
  2. What action will actually trigger the summary creation (and who takes this action)
  3. How the summary will be transmitted to the desired recipient
    1. Dentrix follows a push/pull process for care summary reports.
    2. Query-based methods was also noted as a way to send.
  4. What exactly the receiving organization will do with the summary upon receipt

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

  1. The group reviewed a Dental Summary use case diagram created by the team. 
  2. The group prioritized the following domain areas:
    1. High Priority; Always needed - Advanced Directives, Alerts (Allergies), Medications, Plan of Care, Purpose (reason for referral), Social History
    2. Medium Priority; Include if Relevant - Immunizations, Problems, Vital Signs
    3. Low priority; Generally 'noise' - Family History, Functional Status, Medical Equipment, Results

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:

  1. Procedures - Medium priority
    1. a full list of a patient's procedures is unnecessary unless it is directly related to the referral.  
  2. Encounters (Odontogram – General measurements) - High priority
    1. it was noted that not all data may be needed other than the last set of teeth status.
    2. it was mentioned that if those data elements are required, how does this impact practices that cant fulfill it? dental to non-dental exchange - a 'roadmap' of a patient's record could be something to consider, where we will always have a high level summary of what the patient is going through, but we may not have the full suite of measurements (BUT, would have the set of problems)

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.

No Meeting (Veterans Day)

PM: Greg, Manisha, Jean, Russ

DQ: Rebekah Fiehn, Eric Transby

Federal: CDR Stallings, LCDR Bohman

Lantana: Zabrina

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:

  1. Encounters (Oral Soft Tissue Exam) - Medium/High- If abnormal, then needed
    1. For this particular data set, it could be more of a status; an assessment that was performed at a single point in time, not current state. 
    2. Could the sub-data elements of lips, tongue, floor of mouth, etc, fall into a value set of abnormalities?
    3. IRT Base modeling- Would need to consider active/inactive, or active/resolved; how this data is packaged, and how is it received.
    4. Additional Concepts: identifiers that are loosely tied to the encounter info.

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. 

Next Monday:

  1. TMJ Exam
  2. TMD History


Russ, Manisha, Greg, Col Baez, Bob Cox, Maj Turney, Bedo, Rebekah, Ubong (IPO I2TP support), Dave, Zabrina, Joel, Eric Tranby

The group started the discussion with procedures 

  1. Procedures: within the dental space, there are many complex measurements, complications, and problems among teeth. There are various encounter subsets noted in the 1084 that together, represents what the current status of the patient is. Plan of care is definitely something to be separate from Encounter data subsets. 
  2. TMJ Exam (Deviation upon opening, popping, clicking, crepitus, etc): condition standpoint
  3. TMD History (history of trauma, popping, clicking, crepitus, limited opening, pain upon chewing, etc): standpoint of a patient; could have multiple encounter entries.

Next week:

  1. Implantable devices
  2. Occlusion exam


Greg, Russ, Manisha, Lt. Col Ford, Chris Brancato, LCDR Stallings, Carla Evans, Rebekah Fiehn, Zabrina, Joel Bales, Ubong, Dave DeRoode, Michael Honeycutt, Col Baez

  1. Implantable Devices: High Priority (it is expected that this information would/should be in a record)
    1. this particular data set is sometimes viewed as a checklist, and helpful for future visits.
    2. the group discussed the differences and similarities of general implantable devices (like head and neck), vs. mouth/tooth implantable
  2. Occlusion: Medium Priority 
    1. Data set that essentially tells the dentist/ortho a story
    2. Occlusal classifications are determined on an encounter basis and are visible observations by the dentist/ortho

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

Russ, Greg, Jean, Manisha, Besos, CDR Tearney, Col Baez, Eileen Ulick, Ubong, Chris Brancato, Dave DeRoode, Zabrina Gonzaga, Eric Kirnbauer, Rebekah Fiehn, Clara Ren, Carla Evans, Lt Col Parker, Acar

*Last meeting until Jan 2020*

Russ reviewed the homework assignment to the team. Team to complete homework by Jan 6th so we can review findings and present during next meeting Jan 6th.

The group prioritized content for a “Consult Note” response from a Dental Provider back to the original referring provider. This includes content that could be net new when the referral is sent back to the dentist who originally requested the referral. 

The group briefly looked at Consult Note subcategories in the CCDA to discuss which ones we think are relatable to a dental record. 

Complete homework assignment. Discuss during next meeting in January 2020.

Greg, Russ, Jean, Manisha, Beto, CDR Stallings, Maj Tierney, Col Baez, Clara Ren, Eric Tranby, Eric Kirnbauer, Michael Honeycutt, Ubong, Dave DeRoode, Rachel Forester, Brian Flynn

Continue to prioritize Dental Consult Note data sets:

  1. Odontogram- group decided that this is always needed; if the specialist performed any treatment, the receiving record would need to be updated to show this.
  2. Periodontal- decided to include as always needed; It's not always expected as a receiving referral, but good to have.
  3. Oral soft tissue, TMD, and TMJ were all noted as include in relevant (just as the outbound referral). 

Russ reviewed modeling approach and a few guidelines to follow during the process. 

WG discussed where the narrative content of a consult note would live (to include info such as reason for referral, summary of procedure/services, progress note, etc.), Russ suggested the Assessment and Plan section of the CCDA would be the best place. 

Col Baez and Russ to meet to review project updates.

Russ to receive OID by next week.

Review/add to modeling guiding principles.

Discussed Procedures, modeling guidelines and principles, and introduced the Trifolia modeling tool.Complete some data modeling in Trifolia before next call (2/3)
Meeting canceled - MLK Holiday
Meeting canceled - ONC Annual Meeting

Russ, Greg, Jean, Manisha

CDR Steve Stallings, LCDR Michael Bohman, Besos, Col William Baez, Chris Brancato, Zabrina Gonzaga, Dave DeRoode, Clara Ren, Eric Kirnbauer, Eric Transby, Ubong, Carla Evans, Kipp Clemmons, Rebekah Fiehn, Christopher Breeden (Epic)

Goal to complete draft of FHIR IG by FHIR Connectathon in May (draft to be completed April 15). To prepare for this, we need to build the logical subset for testing purposes during the connectathon. 

The WG discussed other items such as compatible data standards (Snodent), high priority data sets (Odontogram), and that simple display of the data is ideally what would be seen (not images, since it hasn't worked well within CDAs before).

Homework assignment request: 

  1. what are the high level dental specific measures/findings that we need to convey to support a use case.
  2. lower level data points to rebuild supporting Odontogram that one would want to share for the use case example.
Complete homework assignment for next week's discussion

Russ, Manisha, Greg

LTC Parker, Kipp Clemmons, Clara Ren, Christopher Breeden, Rebekah Fiehn, Zabrina, CDR Stallings, Rachel Foerster, Eric Kirnbauer, Michael Honeycutt, Dave DeRoode, Gary Guest, Col Baez, Eric Tranby, Joel Bales, Aishwarya Gandhe, Phil Accio (Cigna)

Discussion focusing mostly on the minimum data reqs related to displaying an Odontogram. The WG discussed the importance of the following data fields from ADA:

"Missing" - tracking this data is important because dentists would want to see if the odontogram data was actually missing vs incomplete/inaccurate.

"Caries" - discussion included the reported surface of caries (all enamel factors/sides), root involved, etc. Caries by tooth and the surface of tooth were noted to be critical points of data for Caries within an Odontogram.

Use cases for FHIR Connectathon - Col Baez, LTC Parker, and Greg offered to attend a separate working session for identifying detailed medical to dental and dental to dental use cases.

FHIR use case working session 2/14
No Meeting

Jean, Greg, Manisha

CDR Steve Stallings, Rebekah Fiehn, Dave DeRoode, Zabrina Gonzaga, Carla Evans, Clara Ren, Rachel Foerster, Kipp Clemmons

Russ was unable to join. Greg, Zabrina, and Dave reviewed the FHIR Connectathon use cases that were compiled during an offline use case working session. The WG added more detail to one of the use cases; Dave to post on Confluence and share link. Next meeting Greg will talk through the next use case to gain additional feedback on that scenario.


Jean Narcisi, Greg Zeller, CDR Steve Stallings, Rebekah Fiehn, Dave DeRoode, Zabrina Gonzaga, Carla Evans, Clara Ren, Rachel Foerster, Kipp Clemmons, Eric Kirnbauer, Chris Breeden, Chris Brancato, Susan Langford, Michael Honeycutt, Ubong Ikpe, Sonya May, Beto (DSS)

  • Allergies (AllergyIntolerance Resource):
    • Epic's Wisdom is part of the overall Epic stack and uses the same exchange
    • DSS (Beto) - we don't receive or exchange this data today - I'm not sure even hold it in our system, but it is something we've been wanting to use for a while
  • Patient Education/Instruction (Communication Resource)
    • This is going to be unstructured content that will be conveyed in text
  • Conditions (Problems such as Hypertension):
    • Generally captured as narrative text. The only data that's really captured in a codified manner today are the CDT procedure codes
  • Coverage (Payer/Insurance):
    • This is generally captured as narrative text.
  • Encounters (Referral Urgency)
    • This captures the "planned encounter" needed from the POV of the Medical Provider issuing the referral
    • Capturing the "priority" on the referral is important, at least in Oregon, as they need to report on timeliness of servicing referrals.
    • Oregon Health Plan Priority Categories (per Rebekah Fiehn):
      • Emergent - Enrollees are appointed for emergency concerns within 24 hours.
      • Urgent - Enrollees are appointed for urgent concerns one to two weeks, depending on the enrollee’s condition.
      • Routine - Enrollees are appointed within eight weeks. Pregnant enrollees are appointed within an average of two weeks.


Russ, Manisha, Greg, Col Baez, LCDR Stallings, Joel Bales, Rebekah Fiehn, Jean Narcisi, Sonya May, Zabrina, Chris Brancato, Dave DeRoode, Rachel Foerster, Kipp Clemmons, Michael Honeycutt, Chris Khanoyan

Zabrina and Dave walked through the first iteration of the FHIR use case narrative and data sets.

Risk Assessment discussion: potential to add null flavors for risk assessments not performed. The team viewed a document sent by CDR Stallings that included caries risk assessment details. 

Final Q to the group: what details of vital signs would a dentist want to see for outbound and receiving dental referral? BP, temperature, pulse, and perhaps respiration was noted.

Come up with the most common reasons for referral
Meeting canceled due to technical difficulties.

Russ, Manisha, Greg, Jean, Zabrina, Dave, Michael Honeycutt, Chris Breeden, Joel, Kipp, Rebekah Fiehn, Matt Szczepankiewicz, Dan Rutz, Chris Khanoyan,  LCDR Bohman, Michelle Barry, Col Baez, Toni Magni, Ubong Ikpe, Carla Evans

Dave reviewed the reason for referral value set codes within the FHIR use cases. After walking through the content, the group agreed to package the details as is, post to confluence, and identify the value sets for specific data elements.

Mixed terminology communication discussion topic: e.g., relationship between code systems such as SNOMED and SNODENT. SNODENT is a subset of SNOMED and its codes are maintained by a small work group (ADA). 


Greg, Russ, Manisha, Zabrina, Dave, Jean, CDR Stalling, LTC Bohman, LTC Parker, Col Baez, Michael Honeycutt, Chris Breeden, Dan Rutz (Epic), Toni Magni, Chris B., Matt Szcz, Kipp Clemmons (DSS), Rebekah Fiehn, Carla Evans, Nancy Orvis, Joel Bales, Ubong, Eric Kirnbauer, Christopher Khanoyan

The group reviewed the value set list for reason for referral. Some edits were made to the current version. Vendors spoke to preparedness level of testing their system against the FHIR draft specifications, mentioning they will not be ready, but are interested in building such capabilities. 

The group decided it would be best to continue to prepare the specifications for the FHIR Connectathon, but will be shifting more robust testing for September 2020. This would mean that posting IG for ballot will extend to January 2021. The group will continue to work through incremental capabilities that are more attainable from a testing standpoint. 


Russ, Jean, Greg, Manisha, Dave, Michael Honeycutt, Col Baez, LTC Parker, CDR Stalling, LCDR Bohman, Rebekah, Chris B., Ubong, Joel, Kipp, Beto, Chris K.

Discuss what we need for data flow for the focus areas we chose for incremental testing (preferably what we can test during the Connectathon)

Manisha Khatta, Greg Zeller , Dave DeRoode, Zabrina Gonzaga, Jean Narcisi, Eric Kirnbauer, Carla Evans, LTC Parker, Chris Breeden, Joel Bales, Kipp Clemmons, CDR Steve Stallings, Chris Khanoyan, Chris Brancato, Beto Sepulveda, Michael Honeycutt, LCDR Bohman, Col Jeff Ford, Col William Baez, Gyle Gales

  1. The group discussed Reason for Referral context, specifically "Establish a Dental Home" CPT D0150 (similar code for initial visit). 
  2. DICOM imaging - FHIR spec: DICOM images are not stored in the ImagingStudy resource, use of DICOM WADO-RS server or other storage mechanism is needed. From DHA side, system for images is DART, however, it is managed by external partner; they just receive output.  
  3. Readiness for Connectathon: CDS update: The main discussion was about a lot of different codes and how they are not utilized. They only use CPT codes but are trying to get consensus on what codes to use. Epic mentioned they support SNOMED but are unsure of how much or if SNODENT is utilized; Jean mentioned she has the code list and can share with Chris (Epic). 
Vendors to follow up on FHIR Connectathon participation.
4/20/20Russ, Greg, Jean, Chris Khanoyan, Rebekah Fiehn, Joel Bales, Chris Breeden, Carla Evans, Kipp Clemmons, CDR Steve Stallings, Dave Deroode, Greg, Zabrina, LCDR Parker, Eric Kirnbauer, Gyle Gale, Ubong Ikpe, Beto, Matt Szczepankievicz, Dan Rutz, Michael Honeycutt

Brief note about FHIR Connectathon updates, including logistics and registration.

Gyle from HS noted that they use CDA spec and are more comfortable testing through that standard vs. FHIR.

The group walked through use case 3 to discuss additional data categories. Beto mentioned CDS does not capture allergy information (Allergy Intolerance). Michael from DSS noted allergy info is not coded by Vista; it is text only, and defined by a set of classes. 

Vital Signs - CDS noted they capture the info but not the codes; Jean could help with the mapping of this. DSS noted that there is a clinical tab that spits out from FHIR a list of the vitals, not the codes. There is potential to spit out LOINC codes but that's not what the end user relies on. 

Beto (CDS) to do some mapping and see if we are able to make some progress.

Dave to update the use case list with additional vital sign data.


Russ, Greg, Jean, Zabrina, Dave, Carla Evans, Chris Breeden, LCDR Kevin Parker, Ubong, Beto, Chris, Susan Langford, Rebekah Fiehn, Kipp Clemmons, Gyle Gale, Col Baez, Joel Bales, Chris Brancato, Michael Honeycutt, Mike S.

FHIR Connectathon updates and logistics - April 30th is a General Information Session. Zoom account has been set by PIE WG; which we can use for our track session. 

FHIR Connectathon attendance confirmation: Col Baez, LCDR Parker, Beto, Greg, Jean, Kipp (and/or others from DSS), Rebekah Fiehn- DentaQuest (however no actual vendors can attend)

Overview of time slots for our track:

May 14 - 10am ET (kick off, test remote access, review logistics), 1p and 4 p ET checkpoints on testing progress. 6/630p wrap up.

Get JIRA set up; provide brief overview of how it works.

Group to look at the tables within use cases to better prepare for testing detail.


Rebekah Fiehn, Sharon Stanford?, Kipp, Dave Deroode, Eric K., Chris Breeden, Mike Honeycutt, Jean, Greg, Col Baez, Chris (Epic), Gyle Gale, Matt S., Joel Bales, Col Ford, LTC Parker, Susan Langford

Dave reviewed the xml format of the use cases 1 and 3: Adjustments to the connectathon table structures to add any detailed data from the narrative that was missed - Dave reviewed the xml format of the use cases 1 and 3. 

5/11/20Greg, Jean, Russ, Manisha, Dave, Zabrina, Susan Langford, Zabrina Gonzaga, Cathy Plattner, Meredith Fischer, Michael Honeycutt, Kipp Clemmons, Chris Brancato, Wendy Wise, Rebekah Fiehn, Gyle Gale, LTC Parker, Rick Geimer, Sharon Stanford, Col Baez, Gary Guest, BetoWe will use this meeting time to cover the FHIR Connectathon Track Orientation. If you are not participating in the FHIR Connectathon you do not need to attend this call.
5/18/20Greg, Jean, Dave, Russ, Manisha, Kipp Clemmons, Chris Breeden, Rebekah Fiehn, Sharon Stanford, Michael Honeycutt, Chris Brancato, LTC Parker, CDR Stallings, Chris Khanoyan, Zack Church, Matt S., Gyle Gale, Robin, Ubong, Carla, Nancy OrvisThe group recapped findings and outcomes from the FHIR Connectathon (May 14-15). Gyle shared an example of CCDA output from his system. Other topics included: Planned procedure, Physical Exam findings, Prognosis
  1. Russ to contact the SD and PC WG
  2. Russ to follow up with Gyle about the modeling he showed
  3. Dave is making edits to the modeling for FHIR IG
No Meeting - Holiday
6/1/20Russ, Manisha, Jean, Greg, Dave, LTC Parker, Susan Langford, Gyle Gale, Chris Breeden, Col Baez, Matt S., Eric, Kipp, Col FordRuss presented the 6 week timeline for CDA and FHIR Implementation Guide draft to be ready for Comment only ballot this September 2020. The CDA IG will be broken down into 2 volumes (1. Narrative Context/Background, 2. Data Modeling for CDA). The group plans to share CDA and FHIR samples in the first draft.Dave/Russ to post/point to CDA and FHIR samples for the group.

Greg, Russ, Jean, Dave, Manisha, Col Baez, CDR Stallings, LTC Parker, Chris Breeden, Chris Brancato, Durwin Day (HCSC), Rebekah Fiehn, Ubong Ikpe, Susan Langford, Chris Khanoyan, Kipp Clemmons, Eric Kirnbauer, Carla Evans, Matt Szczepankiewicz, Sharon Stanford, Zack Church

Presented a first draft of CDA and FHIR Implementation Guide to the group. Reviewed data modeling detail, discussing designations for data like TargetSiteCode for tooth number. Discussed SNOMED/SNODENT best practice, and the post-coordination of data concepts.

Russ- Find out from SDWG on CDA examples of post-coordinated concepts.
6/15/20Russ, Greg, Manisha, Jean, Col Baez, Col Ford, LTC Parker, CDR Stalling, Kipp Clemmons, Michael Honeycutt, Chris Breeden, Eric Kirnbauer, Chris Brancato, Bohman, Rebekah, Matt S., Sharon Stanford, Rachel Foerster, Chris Khanoyan, Gyle Gale

Revisited and reviewed all (realistic) templates for use in IG.

  1. Verified Medical Equipment is still important to include as Optional section (will add Insulin pump and Type 1 Diabetes to Scenario 1).
  2. Immunizations are also important as Optional section (adding Hep B vaccine to Scenario 1).
  3. Advanced Directives are also important as an Optional section.
  4. Discussion around needing specific Dental content that can fit in the standard Problem and Results section


Russ, Manisha, Greg, Jean, Dave, Zabrina, Kipp Clemmons, Michael Honeycutt, Chris K., Sharon Stanford, Chris B., Chris Johnson, Matt S., Gale Gyle, Susan Langford

Reminder: 4 weeks until IG submission to HL7. Group discussed the results organizer and the difference of capturing dental data in the Results Obs vs the Problem Obs. Results Obs is preferred. Adding best practice to CCDA IG Vol 1 on dental findings data and problems section data.

Reviewed the data concepts required and optional, and introduced the Dental Findings data concepts (less critical/important findings). 


Russ, Manisha, Greg, Dave, Zabrina, Eric K. LTC Parker, Gary Guest, Susan L, Sharon S, Michelle Barry, Matt S, Chris Breeden, Kipp, Michael Honeycutt, Carla Evans, LTC Ford

Dave mentioned the Prognosis topic: there is a resource called clinical impression (mat level 0) that he does not plan to include in the IG. Prognosis will be conveyed as text within this IG iteration. Scenario 4 is a good example to add Prognosis data.

There are 3 net new templates for the IG that Russ covered:

  1. Dental consult note
  2. Dental Referral note
  3. Dental Findings section

Russ explained the difference between Assessment and Plan Section, Assessment Section, and Plan of Treatment section within the CCDA. 

There are also some templates included in the CCDA IG that were not reviewed/discussed by the group: Instructions and Payers.

Made Social History optional template.


Russ, Manisha, Greg, Dave, Zabrina, Michelle Barry, Rachel Foerster, Matt S., Joel Bales, Rebekah Fiehn, CDR Steve Stallings, Chris Khanoyan, Chris Brancato, Erik Kirnbauer, Gyle Gale

Reviewed Scenario 1 example. Discussed Med rec and allergy info. Identified the difference of data elements reconciled within the referral problems, consult problems, referral dental findings, and consult dental findings.

Manisha- post updated Vol 1 to Confluence page.

Manisha/Russ to review Vol 1 + use case details/narrative.

Agenda: WG to be prepared to review Vol 1 CCDA IG and provide feedback/comments by July 15/16.


  • (June 2020) - Drafting STU1 Dental Summary Exchange CCD Implementation Guide
  • A Payer/Provider Information Exchange (PPIE) WG project
  • PSS approved by US Realm Steering Committee - Dental Data Exchange (CDA and FHIR) PSS

Project Documents

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.pdfADA Standard No. 1084 (May 2019)
data mapping of 1084 to CCDA
original use case document from Col Baez
details of use cases
DentalExchange_UseCaseDiagrams_20191209.pptxDiagrams of exchange use cases and prioritization of content within those exchanges.
HL7_Dental_Encounter_Referral_Template.xlsxReferral Example Use Case - Homework Assignment (for WG to complete before Jan 6th)
HL7_Dental_Encounter_Referral_Compilation.xlsxAggregate use case scenarios from WG members
Initial draft of Volume 1 C-CDA Implementation Guide


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