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HL7 CDAMG Minutes

Location: online!

Date:

Time: 4:00 PM Eastern

FacilitatorBrettNote Taker(s)Lisa

Attendance:

PresentName
  •  
Lisa R. Nelson, MaxMD
  •  
Linda Michaelsen,  Optum
  •  

Brett Marquard, Wave One Associates

  •  

Jean Duteau, Duteau Design Inc

  •  

Rick Geimer, Lantana Consulting Group

  •  

Giorgio Cangioli, HL7 Italy

  •  
Emma Jones, Allscripts
  •  

Andrew Statler, Cerner Corporation 

  •  

Yan Heras, Optimum eHealth LLC

  •  

Raychelle Fernandez, Dynamic Health IT

Quorum: Co-Chair +3

Guest(s):  Sean McIlvenna

Wayne Kubick

Didi Davis

Natasha Kreisle

Joel Francis

Russell Ott

Matt Rahn



Agenda (with Integrated Minutes)

STANDING BUSINESS

  • Approval Request(s):
    • Publication extension for HL7 Digital Signature - Request for Approval
      • Need to add links for the Publication Request (also add to Document Approval Log)
      • Tabled until discussion with FM and PIE tomorrow.
    • CDA Web IG Publishing PSS - review of draft PSS
      • Link to draft document: CDA Web IG Publishing
      • Additional thoughts
        • How to handle Companion Guides
        • Eliminate unused templates
        • Supplemental Templates could be their own IG
        • Can publisher generate a list of what IG's are dependent on a specific IG, i.e. what IG's use CDA IG
        • Question - should validation be a consideration?  Didi stated it is very important - required fields, nulls allowed, vocabulary bindings.  Allowing for further constraint by other entities
        • Schematrons will no longer exist with Structure Definition profiles; will be reliant on other tooling like IG Publisher, FHIR Validator (java)
      • Open issue - need a path forward for CDA Core R2.1 - may need to be done manually in FHIR model
    • CDA R2.1 errata coming - will work with SD this week and add back to agenda at a later time
    • CDA Pilot on FHIR Structured Document Resources - phase 1 worked on Allergies, Meds, Problems, Results and Vital Signs .  All of Volume 1 has been brought in and is looking good in web.  Some validation QA errors from FHIR Publisher; Graham is working on them.  Until resolved will not be able to validate using FHIR Validator and IG.  Phase 2 is for the rest of the resources - up for HL7 review; currently no funding/anticipated to know in 2 weeks/have approval on current grant.  Pilot is to end in February - affects when it goes to ballot
      • Link to current build: https://build.fhir.org/ig/HL7/cda-ccda-2.2/index.html
      • Do we have a Plan B?  Allow publishing as html but not via FHIR publisher possibility (suggested by Giorgio)  Requires manual management of the changes
        • No "show stoppers" at this point, roadblock has been fixing issues to IG Publisher
        • IPS is in Art Decor FHIR Structure Definition
  • Administrative Updates:
    • Summarize Review of Mission and Charter (2020.09.21 Update Comments), and Decision Making Principles (2020.09.21 Update Comments)
      • Comments and questions have been escalated to SBG and CTO
        • Questions around confluence, how to nominate CDA MG team members, etc  - follow-up after this week if no action this week.
    • Process documentation for communication about product issues deemed "significant"
      • Stylesheet issue discovered last week 
      • Need a way to categorize the level of risk and have appropriate action plans based on assessed level of risk.
        • How do we characterize/define low, moderate, high levels of risk?
          • Need to solidify how we document the level of risk/severity and how it is to be addressed. 
          • Notification is the most urgent process.  Wayne will send out notification in the next couple of days.  
          • Stylesheet not incorporated in standards
        • Does the FMG have definitions or process defined in this area yet?
      • Fix has been implemented in the CDA R2.0/R2.1 Stylesheet version 4.0.2 beta 8. CDA R2.0/R2.1 version 4.0.2 (beta)
        • Steps:
          • Confirm the fix is ready for release (how will we do this?)
          • Create communications that HQ can use to report the problem within the Community
            • Wayne is working on this
          • Devise a plan to address and changes needed to put the fix in place 
            • Stylesheet has bee included in the download page for CDA products published on HL7.org
              • How to identify and work with Lynn to remove from packages/readme
            • All CDA product downloads need to be reviewed, and re-issued with old stylesheet removed and a new READ.ME file added which points to the CDA_SDTC  schema, and CDA R2.0/R2.1 Stylesheet
              • Documentation of what needs to be in each READ.ME file needs to be improved/created (see new Quality Plan)
      • Need to add to quality criteria that there should be a readme and stylesheets should not be included.

NEW BUSINESS

  • Quality Plan and Roadmap Planning (Lisa) 
    • Quality Plan 
      • Link: 
      • No comments after review by Lisa
    • CDA Product Roadmap:  
      • Reviewed current plan
      • Look at multiple year plan, define next three years
      • Each year, refine the next year more and add another year so any one year you only have to add one more year and refine existing ones.
      • USCDI updates should be considered - link: https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi
      • Errata done quarterly -  validators will wait until new spec is published (may delay validator updates)  - will add notes if take in an errata before full CCDA update
        • Will be applied to CCDA at least annually
        • See documentation 


  • Next Meeting:  Wednesday October 7 1-2pm ET
    • Meetings will be moving to use Zoom - Watch for an updated Outlook Invite, and HL7 Calendar update
  • No Meeting on Wednesday October 21 (due to C-CDA IAT)

Adjourned: 5:38 pm

PROJECT REPORT OUTS: 


Scheduled Reviews:

DateProjectWhoResources for Review
9/21/2020Use of Structure Definition

Rick

Jean

Lisa


NEXT STEPS:

Working to transform C-CDA R2.1 into new Web IG Publishing (QA of some templates delivered so far)

OPEN ISSUES:


NOTES:




C-CDA

Update Releases


Brett

Lisa

NEXT STEPS:


OPEN ISSUES:


NOTES:

Depends on new CDA IG Web Publishing capability



 C-CDA

Errata Releases

Brett

Lisa

NEXT STEPS:

Review the current Errata Release Checklist.

OPEN ISSUES:

Can official Errata Releases be prepared by SDWG in the mean time? - discuss at Sept WG meeting


NOTES:




Quality Plan

Lisa

Brett

NEXT STEPS:

OPEN ISSUES:

NOTES:

Backed up behind ballot for Quality Criteria.  Plan is coming along. (and Roadmap updates)



C-CDA Implementation-A-Thon

Lisa

Linda

Raychelle

NEXT STEPS:

  • Call for presenters for October 21, 2020 C-CDA IAT (closes September 15, 2020)

OPEN ISSUES:

  • Plan for 2020 needs to be solidified with Dave Hamill - Discuss at Sept WG meeting
  • Follow-up on Actions from July 2020 IAT


GroupingItemResponsible personStatus 
Life and Death in C-CDA

Add rubric for to check that a patient's name is not changed (using any scheme) to indicate a patient is deceased

John D'AmoreBrett will working with John through Examples Task Force.
Life and Death in C-CDA

Create gold-standard example of problem list containing pregnancy information

John D'AmoreBrett will working with John through Examples Task Force.
Payer Section in C-CDA Documents

Determine where payer identifiers should go in the document and represent with gold-standard example

Linda MichaelsenLinda will continue to advance this need and potential solutions.
Payer Section in C-CDA DocumentsConvey support for the new identifier extensionLisa NelsonLisa Informed SDWG of the need to work on approving and executing this extension.
Extending CDA to add more useful identifiers

Update the Companion Guide to add guidance on using the new extension. 

Lisa NelsonLisa will complete following creation of the extension.
Extending CDA to add more useful identifiers

Determine real-world use cases and develop gold-standard examples - e.g. payer identifiers

Lisa Nelson

Jean Duteau

Should  Lisa do this in working with SDWG?

Implementation Considerations

When Generating C-CDA Encounter

Summary and Patient Summary Documents

Develop guidance for the Companion Guide around when summary documents are exchanged.

Joe LamyLisa will reach out to Joe to determine timeframes for guidance from Carequality/CommonWell.
Implementing Clinical Notes

Seek clarification from the ONC to update Companion Guide to include more concise guidance on use of Clinical Notes


Emma JonesEmma - can you write up a request of specific questions that need to be addressed/answered?
Implementing Clinical NotesWork with Regenstrief on LOINC Codes for Laboratory Reports and Pathology ReportsLisaLisa Initiated conversation with Regenstrief. Out of band meeting planned for later in August.
Implementing Clinical Notes

Develop gold-standard examples for each supported USCDI note type (e.g. Consultation Note, Discharge Summary Note, etc.)

Emma JonesEmma can you drive this in Examples Task Force?

Mapping Author Participation Information to 

FHIR US CDI Resources Derived from C-CDA Documents

Engage with SDWG and Patient Care to clarify how this work can move forward.

Perhaps initially focusing on smaller problems to solve

David RiddleLisa Initiated meetings with PCWG 8/6 following up on 8/13.

NOTES:


CDA Base Standard

Lisa

Brett


NEXT STEPS:

  • Working with Calvin to draft an educational webinar that provides an overview of "what's new in CDA R2.1"
  • Will review progress at the 2020 Sept WG meeting

OPEN ISSUES:


NOTES:





Maturity Model

Brett

Rick

Artifact created:

NEXT STEPS:

  • Implementing this after cutting over to use the FHIR IG publishing mechanisms.

OPEN ISSUES:

Agreed this should be utilized after going to Structured Definition.  SDWG would need to apply the Criteria. Could we get feedback at the IAT to apply the rating? Do we need a checklist to help the decision makers to assign the maturity model.

Would need to work with SDWG as the owner of C-CDA templates, to apply it to their templates.  

NOTES:



Jira Implementation

Andrew

Linda

Raychelle

NEXT STEPS:

OPEN ISSUES:

  • Revisit after February Meeting

NOTES:

Andrew is advancing this sending Wayne what he needs. HL7 supporting this conversion. This is a go via orders from Wayne.




IG RegistryLisa

NEXT STEPS:

  • Working on a list and process to gather accurate information - real-time recording

OPEN ISSUES:


NOTES:



Cross Workgroup Templates Pilot

Lisa

Linda

NEXT STEPS:

  • Lisa is comparing IPS to C-CDA for Problem Concern and Allergy Concern - update provided
    • Some progress comparing to IPS - reported to PC WG
  • Linda is working with FM and other on this actively.
  • Kai to help with Medication Templates. - No action

OPEN ISSUES:

NOTES




Value Set Process and UTG support

Lisa

Brett

NEXT STEPS:

  • This is being worked with Ted Klein and the Vocabulary WG

OPEN ISSUES:

Topic for Sept WG Meeting: Missing FunctionalStatus VS - Sept WG meeting

NOTES:

Need alignment of Vocabulary binding

Harmonization of Value Sets in aligned data models/USCDI v1.



ADDITIONAL TOPICS 

  • KEY GOALS BEFORE September WG
    • JIRA Migration Plan communication of roll-out
    • Quality Plan Creation and Communication of Roll-Out
    • Roadmap update
  • CMG Membership and interest in participation - update CMG objectives and Home Page content
  • Annual items:
    • Term voting, Co-chair confirmations  - July
    • Current member term renewal pattern
      • Even Years: Brett, Jean, Raychelle, Yan, Emma, Giorgio 
      • Odd Years: Lisa, Linda, Rick, 

Meeting Outcomes

Summary of Votes/Key Decisions

Next Meeting/Preliminary Agenda Items

Action items