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HL7 CDAMG Minutes

Location: online

Date:

Time: 1:00 PM Eastern

FacilitatorLisaNote Taker(s)Linda

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Meeting ID: 935 3262 7375
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Meeting ID: 935 3262 7375

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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):  Natasha Kreisler

Courtney Panaia-Rodi

Didi Davis

Hans Buitendijk (briefly for V2 to FHIR, not on agenda)

Bob Milius

Diane Wright

Matt Rahn

Ruby Nash

Zabrina Gonzaga

Agenda (with Integrated Minutes)

STANDING BUSINESS

  • Quorum
    • Attained
  • Attendance Review
  • Approve Minutes of 2020.10.07
    • Minutes approved by consensus 
  • Approval Request(s):
    • Clinical Genomics WG 
    • Pre-publication preview package of the HL7 CDA® R2 Implementation Guide: National Healthcare Safety Network (NHSN) Healthcare Associated Infection (HAI) Reports for Long Term Care Facilities (HAI-LTCF-CDA), Release 1- US Realm (1st Standard for Trial Use Ballot)
    • Asked for volunteers to meet with SD on their Tuesday meeting where they will be discussing their roadmap and help refine roadmap for CDA MG workgroup
      • Meeting is at 3:30 Eastern on Tuesday 11/10
      • Lisa to send out invitation information
      • Rick, Linda to join Lisa - possibly Brett

Below not discussed

  • CDA Web IG Publishing
    • Draft PSS - review of draft PSS on 11/18
    • Update from Lantana for update on Web IG C-CDA Pilot Project
  • Administrative Updates:
    • CDA Stylesheet Issue
    • Request to meet jointly with SDWG for Roadmap Planning starting Tuesday 11/10 at 3:30pm ET for 30 minutes
  • Update from CTO/HL7 regarding Vision Re-Imagining and the "Maintenance" categorization for CDA
    • What does Maintenance Mode for CDA mean to HL7 and CMG?
    • What specific questions would we want to have addressed? For Nov 4th meeting
      • What does ONC plan for the maintenance of CCDA for USCDI going forward? 
      • What does ONC/HL7 have planned for the evolution of CCDA on FHIR
      • What about CDA IGs like eCR, Cancer Registry, QRDA, etc? Can these be continued/under CDA R2.0

NEW BUSINESS

Adjourned: 

PROJECT REPORT OUTS: 


Scheduled Reviews:


DateProjectWhoResources for Review

Use 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:




CDA

Product Line

Update Releases


Brett

Lisa

NEXT STEPS:


OPEN ISSUES:


NOTES:

Depends on new CDA IG Web Publishing capability



 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:




CDA Quality Plan

Lisa

Brett

NEXT STEPS:

OPEN ISSUES:

NOTES:

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



CDA Announcements & NotificationsLisa

NEXT STEPS:

OPEN ISSUES:

NOTES:


CDA R2 C-CDA 2.1 Implementation-A-Thon

Lisa

Linda

Raychelle

NEXT STEPS:

  • Call for presenters for March 24, 2020 C-CDA IAT (closes ??? 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 and October 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'AmoreA Rubric rule needs to be request to confirm that a patient's name is not changed to include a concept like "deceased". The analysis of common "bad habits" will be performed in conjunction with other analysis and the results will information the recommendations for th Rubric Rule.
Life and Death in C-CDA

Create gold-standard example of problem list containing pregnancy information

John D'Amore

Completed

http://hl7-c-cda-examples.herokuapp.com/examples/view/Problems/Pregnancy%20with%20Week%20Gestation

Payer Section in C-CDA DocumentsConvey support for the new identifier extensionLisa NelsonCompleted and the extension was implemented in the October 2020 CDA_SDTC schema extension which now lives in gitHub. https://github.com/HL7/cda-core-2.0 
Extending CDA to add more useful identifiers

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

Lisa NelsonAn STU Comment (#2050) was added against the Companion Guide to request inclusion of this extension. It needs to be approved by SDWG.
Payer Section in C-CDA Documents

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

Linda MichaelsenLinda is working to create an example of using this new extension to represent the payer identifier. Linda would like to provide an example for review at the October 2020 IAT.
Extending CDA to add more useful identifiers

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

Linda Michaelsen

Jean Duteau

Linda will show the use of the extension to represent the payer identifiers.

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 LamyJoe is doing a topic on this at the October 2020 IAT. This topic will be taken up under the new Sequoia Data Usability Workgroup.
Implementing Clinical NotesWork with Regenstrief on LOINC Codes for Laboratory Reports and Pathology ReportsLisa

Regenstrief has issued several proposals to address the confusion around the Clinical Notes USCDI V1 data class.

Proposed comments related to USCDI on behalf of the LOINC Document Ontology Subcommittee.

https://loinc.org/files/meetings/document-ontology/20201005%20DRAFT%20USCDI%20Clinical%20Notes%20comments%20and%20new%20data%20element%20proposals.pdf?utm_source=Workgroups&utm_campaign=eb7d080c2f-EMAIL_CAMPAIGN_2020_10_05_08_06&utm_medium=email&utm_term=0_d6fe8d9574-eb7d080c2f-450653981

USCDI ONDEC Submission Form - Clinical Notes Data Elements

https://loinc.org/files/meetings/document-ontology/20201005%20DRAFT%20USCDI-ONDEC-Submission-Form-Prep-Sheet_ClinicalNotes%20data%20elements.pdf?utm_source=Workgroups&utm_campaign=eb7d080c2f-EMAIL_CAMPAIGN_2020_10_05_08_06&utm_medium=email&utm_term=0_d6fe8d9574-eb7d080c2f-450653981

USCDI ONDEC Submission Form - Imaging Data Element

https://loinc.org/files/meetings/document-ontology/20201005%20DRAFT%20USCDI-ONDEC-Submission-Form-Prep-Sheet_Imaging%20data%20element.pdf?utm_source=Workgroups&utm_campaign=eb7d080c2f-EMAIL_CAMPAIGN_2020_10_05_08_06&utm_medium=email&utm_term=0_d6fe8d9574-eb7d080c2f-450653981

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?
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?

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 Riddle

Follow-up was done with PC WG and this topic was discussed at the HL7 WG meeting in September 2020. This is a bigger issue than can be solved at this level.  

Alignment and mapping work between CDA and FHIR will need to handle this on a more global level.



Added during October 2020 C-CDA IAT

C-CDA and IPSPoll larger implementer community about use of problem/concern templateCDA Management GroupGather feedback from community through: listservers, C-CDA Zulip Chat, and polling to measure interest and impact.
C-CDA and IPSRework problem/concern templates to better align with clinical/business use - e.g. allow use of either concern/problem structure or problem observations, limit to one problem observation per concern, etc.CDA Management GroupLisa will work with Giorgio and Brett to document one or two options that the community could consider for improving these templates.

Report an19 STU comment against the Companion Guide to fix the IG references CDA_SDTC schema in footnote #19 in chapter 2.2Lisa NelsonCompleted. STU Comment 2055.
Participation Roles in C-CDAEstablish descriptive guidance and bring examples for approval.  End goal would be to add this to the Companion Guide.John D'Amore

Companion Guide STU Comment 2056 added. (LRN)

Examples need to be completed by John.

Participation Roles in C-CDAHow to deal with IDs over time (e.g. with different assignment schemes)?  Refer to SDWG.John D'Amore/CDA Examples Task ForceAddress this topic when making the examples. Should the id elements remain the same from one document instance to another?
Use Cases Driven IG's for CDABring forward to SDWG the suggestion to formalize the inclusion of use cases as part of the quality criteria for IGsCDA Management GroupDiscussions were initiated.  Follow through needed. SDWG needs to explain how the CDA IG Quality Criteria will get updated.
Ask the ONCMatt Rahn to dig into why the (e) 2 clinical summary was dropped and what is the linkage to newer certification criteriaMatt RahnConfirm if this document type is related to the LOINC Outpatient Summary.
Document LifecyclesTime-constrained section requirements to be discussed further with the examples task force/SDWGCDA Examples Task ForceWork with Joe Lamy and Brett Marquard to clarify when Section Time range would be needed and how to express last N entries.

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:





CDA 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.




PSS & Product RegistryLisa

NEXT STEPS:

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

OPEN ISSUES:


NOTES:



Cross Workgroup Templates Pilot

Lisa

Giorgio

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, any possibility for harmonized templates
  • Linda is working with FM: Progress stalled due to FM's need to focus on FHIR IGs under ballot
  • Medication Templates. - No action due to no resourcing

OPEN ISSUES:

NOTES




Value Set Process and UTG support

Lisa

Brett

NEXT STEPS:


OPEN ISSUES:


NOTES:

Sean has reported additional missing CDA R2.0 Value Sets.



CDA to FHIR mappingNew focus 

NEXT STEPS:


OPEN ISSUES:


NOTES:



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