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HL7 CDAMG Minutes



Time: 3:30 PM ?

FacilitatorNelsonNote Taker(s)Lisa


PresentNameTerm Ends
Lisa R. NelsonOct 2019 (co-chair)
George DixonOct 2019
Brett MarquardOct 2018 (co-chair)
Jean DuteauOct 2018

Rick Geimer

Oct 2019

Dr Kai U. Heitmann

Oct 2018
Linda MichaelsenOct 2019
Andrew StatlerOct 2019
Yan HerasSep 2020
Raychelle FernandezSep 2020
Quorum: Co-Chair +3

Attendance - Regrets from Jean due to having to cover another WG meeting.

Guest: Matt Rahn


Agenda (with Integrated Minutes)

  • Approve minutes from: (we didn't have quorum - so minutes could not be approved)
    • January 29th
    • January 15th
  • Roadmap review if not covered in call prior
    • This question was posed to the group: Where do you see CDA going in 3 years?
      • Notes attached here.
      • Implementers are attending CDA IATs to address interop issues (virtual, more frequent, driven by implementers)
      • Alignment with FHIR is substantial.
      • Documents are exchanged in CDA or FHIR format to provide context for data collections.
      • Maintenance of C-CDA templates happens at least once per year and value sets too.
      • New versions of existing templates can be systematically absorbed into active specs.
      • All this happens with one set of tools, ie. FHIR tooling stack -(templates are in structure definition)
      • Templates publish individually with the maturity model applied
      • Rather than developing for products individually for CDA, V2, FHIR, we should produce data models one way and then have specs come out in the best tool....sometimes V2 is best, other times CDA or Composition, versus retrieval of current data....We need to identify new use cases and build the appropriate tool.
        • Not agreeing with the "V3 approach".  Models can be harmonized, but the products are distinct.
      • See networks, Carequality, CommonWell, etc. drive our maintenance/enhancement cycle
      • Opportunity for content scoring, guidance, folding in FHIR is quite large
        • scorecard rubric has been helpful, this was a helpful approach
      • would aligning CDA templates with Workgroups help with FHIR alignment? 
        • Workgroups are not interested in this. 
        • Maybe where there are dual IGs being developed
      • Is there a future where CDA templates would be produced out of FHIR?
      • All new templates would be produced through FHIR tooling? 
        • This would need to be a SDWG decision 
      • Updates to C-CDA Score? Maybe every year we could publish a new version of the rubric to drive up CDA data quality
        • Maybe the examples task force should have the charter to make new rules for improving/raising the bar on CDA data quality.
        • Examples task force could add new rubrics to the page and then updates could happen more frequently.
        • C-CDA is likely going to be around for a while. 
    • agree what are key things to address in the 2020-2021 cycle
      • Web publishing through FHIR Tooling stack
      • STU Comments into Jira - This a go, can be a funded activity
        • Wayne Says this is a go....
        • Brett Motions/Rick Seconds to empower wayne to move STU Comments for all CDA IGs into Jira 5-0-0 
      • new way to do CDA IATs - 
        • What is wrong with current format for C-CDA IATs
          • All EHRs are not there, VA/DOD/SSA, not enough reach to get more implementers to participate
          • We want implementer feedback
          • Implementers need to come up with the issues to be addressed.
        • eHealth Exchange and CommonWell are good places to plug in.
        • When the rule is out and we understand what is needed to implement the rule --was the best driver.
        • Should we have one in San Antonio?  
          • New Scorecard
          • New Companion Guide
          • Could we get people there to participate and share document?
        • Need to decide if you will do San Antonio or Baltimore
        • Could you do a call for issues? to allow Implementors to drive the discussion
        • When is the next meeting of Sequoia? In the Fall
        • Have someone promote this idea more often - CDA is going to be around for a while—vibe for CDA needs to be more "supported". 
      • Content exchange in CDA is not great currently.  Just because it isn't great....doesn't mean it can't be better.
        • We want the people using this standard to come forward and work on this together.
        • Need better marketing....cover just want to want to cover....THIS IS YOUR CHANCE.
        • USCDI discussion imply CDA usage too....
  • (Additional Comments from missing CMG members
    • Linda: Lots of problems still - Identifiers, Coding is still a challenge, 
      • Null code for Result.  They have a reference to the text, but you have no way of knowing if they are linking to the right place.
      • Hard to make assumptions 
      • Would like to see the copy of the documents get much better.
      • C-CDA Companion Guide is offering many answers, but has not been implementer
      • Diameter Health has a great feedback process to inform senders of the issues with the source document generator.
        • Not paying for poor quality CCDA document is getting people's attention.
      • Didi - education is needed,  the C-CDA knowledge Gap is the problem
        • Attitude problem:  I am 2015 Certified, I don't need to change anything.
          • This is where ONC Surveillance Programs need to come into play, to flesh out problems in the field.
        • People need to care, "what if this was your Mother's record???"
        • DiDi:  ONC tools don't test enough. People have not known that the problems are there.
          • Tools need to be more comprehensive.
      • Brett:  supporting of the path toward higher quality
      • To raise the bar successfully, the testing tools need to include all the expectations
        • Testing also needs to be done in the field.
      • Brett: ONC hands are tied.  Industry Organizations have more leway to implement additional testing.
      • Didi: These tools have different purposes.  Most vendors change once they understand what they should be doing.
        • Didi notes an incompatibility between CDA R2.0 and C-CDA R2.1.
        • Didi will follow-up on sending this.
    • Rick:  "Away?"
    • George:  can we have a moratorium?  Don't make new document types,  Use what you have and tweak it to make it better.
    • X12 taught us that laws really helped to build unity with the community
    • Some people are just saying - just get the data out, who cares about the quality.  
    • We need to fight against this was the general feeling and CMG members are committed to supporting this 
      • Problems:  SW vendors writing exports for EHR vendors cause issues.  Rick: everyone needs to start paying attention
      • Raychelle:  We need accountability
      • Didi:  People don't know what they don't know.
      • Didi:  New requirements are coming, everyone needs to be brought along, and it isn't a fast process
        • CCD→ now pushing for and encounter summary
        • pushing for clinical notes
        • We move the bar, but it takes 18 months to make change.
      • Update HL7 EICR IG  - for C-CDA R2.1  Emma:  quality is poor.  Interpretations are different in this IG that isn't the same as in C-CDA R2.1. It leaves too much open for implementer interpretation.
        • Something odd about how encompassingEncounter is being used. 
        • Rick:  Report issues ASAP, this is important to address. 
    • Linda: What about Custom Templates 
    • Brett:  Lots of passion about quality of documents!  
  • follow-up on IP questions?
    • Need to follow-up with Wayne on how that turns out.
    • Board was fine with lightening up the IP restrictions....
    • we are going to look at CreativeCommons Level 4?
    • Or Open Web Foundation?
    • Wayne will need to look and recommend the licensing structure - 
  • JIRA migration project - where do we stand on this?
  • Briefly summarize activity on each Initiative - add to the 2/26 agenda.
  • How to move toward shifting Domain Groups engagement  – apart of increasing alignment with FHIR.
    • New IGs will be directed to be developed in the context of a Domain Group with SDWG as an interested party or co-Sponsor, but not as the sponsoring workgroup.
    • New Quality Plan will help shift responsibility for CDA IGs toward Domain Groups
    • Work to validate what Value Sets used by active CDA IGs need to be in UTG will cause Domain Groups to become more aware of their ongoing responsibilities to their CDA IGs
    • Cross-Workgroup Pilot for CDA Template Review with PC WG will begin focusing on Value Set stewardship.
  • How to work better with Financial Management - how to represent a person's insurance card information in FHIR and in CDA?
  • How to work better with Pharmacy?
    • There is more modeling going on that what we are seeing - WG is not well aligned with the implementer community.
    • They are not applying the 80-20 rule....
    • Should we bring this up at the cross product WG meeting Thursday Q0
  • Adjurned at 5:35pm AU

Meeting Outcomes

Summary of Votes/Key Decisions

Next Meeting/Preliminary Agenda Items

Action items

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