2018 October CIC Agenda and Notes

Dates: October 1-5, 2018

Notes

Monday Q3

Tuesday Q2

Tuesday Q3

Wednesday Q1

Attendees:   Laura Heermann, Amy Nordo, Bruce Bray, Matt Elrod,  

Agenda:

Business Meeting - 

    Plan for the update WG documents, -

             Laura has drafted updated documents: Mission and Charter, SWOT analysis, decision making practices, and 3 year plan

             Attendees contributed to update the SWOT analysis. This included a discussion on the difference between CIC and CIIC, how to engage the regulatory and international community,

             Attendees contributed to update the decision making practices. Only sections 5,7 and 8 can be modified. Discussed section 7, electronic voting and the quorum calculation. Question as to whether item 7e should be set to have quorum the same as other voting avenues. Decision to make one adjustment to the decision making practices.

              Mission and charter is quite length. This will be posted to the Confluence site for comments and then will be e-voted. We are proposing the Co-Chairs will be clinicians. We recognize that some clinicians to maintain their licenses we are looking for appropriate language. Discussion around the appropriate language.

               3 year plan: There are items on HL7 Project Insight that may need to be updated. There are some items on here that are part of the previous three year plan that may no longer be relevant. Need expected completed date. While the completion date is part of the PSS, the completion date can be adjusted based on the project progress without updating the PSS. There are projects on this list that are duplicative or are not appropriate for the CIC workgroup. Need to determine how to update this list.  

• Amy CramerAmy to create a Confluence page with the three year plan and ask for comments on the confluence page.
•   Laura Heermann-Langford Laura to arrange a Co-Chair meeting to review the documents before finalizing for a vote.
• Laura Heermann-Langford to post other administrative documents to Confluence
• Amy Cramer add to 3 year plan the Co-Chairs who are leads for each project

    Vanguard PSS- (Venous Access National Guideline and Registry Development) see Project Insight for the PSS.

                            Does CIC have the resources to support this project? The project team is aware that CIC does not have the resources to support this project beyond Co-Chair duties for HL7.

                            Is there an expectation that CIC will be responsible for engaging the clinical stakeholders? One of the Facilitators is a Clinician and will be able to engage the stakeholders.

                           CIMI is the Sponsor and CIC is a Co-Sponsor

Motion: CIC agree to So-Sponsor Venous Access National Guideline and Registry Development project. (Amy Nordo)

               Second: Bruce Bray

Discussion: Bruce Bray will be a CIC representative on this project.

Vote:

               3  Affirmative

                0  Abstain

                0  Negative

    Look at Anita's PSS

Scheduling of Business meeting

Wednesday Q2

Attendees:   

Agenda

Joint with CIC/CIMI

• Relationship between CIC and CIIC, and CIMI's role in both. Specific CIIC projects that might be of interest to CIC
  • Consider the relationship of the groups considering external events·        
• CIC/CIMI Cardiology Model Collaboration
• Project VANGUARD (care of central lines) - ecqms
• Next steps for integrating the CIC common Data Elements into CIMI models
• How to support DE->FHIR project
•  Cancer Interoperability project, and next steps (how do we best collaborate/coordinate on this?)

Notes:

with appreciation from Richard Esmund

CIMI / CIC Wed Q2 Joint meeting minutes

Agenda:

• Relationship between CIC and CIIC, and CIMI's role in both.

• Consider the relationship of the groups considering external events

• CIIC will provide guidance and expertise to new CIC project teams

• Determine whether balloted accreditation is needed for a project

• CIC will provide balloting pathway for CIIC projects - when needed

• CIMI provides the underlying architecture for modeling

• How do we best collaborate / coordinate on this?

• Working toward a more formally described process

• Possible joint ‘report out’ between groups

• Shared calendar of HL7 Deadlines

• Specific CIIC projects that might be of interest to CIC

• CIC / CIMI Cardiology Model Collaboration

• Jimmy Chang / Common Data Elements (?)

• Project VANGUARD (care of central lines) - eCQM’s

• Dr Kevin Baskin

• PSS has approved Co-Sponsorship (likely CIC should be sponsor)

• Next steps for integrating the CIC Common Data Elements into CIMI models

• How to support CDE -> FHIR project

• Refine content request process

• Cancer Interoperability project, and next steps

• Breast-Cancer Radiology models and profiles targeted for May cycle

• Imaging Integration has been informed and asked to Co-Sponsor

• Surgery modeling work is also beginning, but is in a very early phase

• Project timing: TBD

With appreciation from Anita Walden

CIC

Wed Q2

Laura Heermann-Langford – Co-Chair Facilitator

Anita Walden - Notes

 Joint meeting with CIMI

 ACTION: Laura will contact Kevin Baskin to talk with Anita about setting up a project team

 CIIC- CIC relationship

• Work together to help ballot materials from CIIC.
• Question does this need to be an ANSI standard. If you are looking for consensus only than CIIC is the place for vetting.
• CIC may coordinate moving projects through the HL7 process to other working groups.
• CIC may also identify projects that should go to CIIC and questions are raised about what that process looks like.
• More work and refinement is needed to determine the process for working together.

Project submission to CIMI

• Currently there is a spreadsheet for submission of the content but eventually there will be tooling to assist with the process.

External Relationships

• Alignment once a year for meetings between HL7, HSPC and CIIC so that others can attend. Can someone from CIIC report out during the HL7 meeting the activities that are taking place.  Maybe have a report out during one of the Quarters during the HL7 meeting.
• Should there be a memo of understanding? There is one between HSPC and HL7.

CIMI-CIC Model Collaboration

• There is a cardiology project. The Cardiology DAM is an old project that was balloted several years ago. They are not planning to move to the CIMI process. MDEpiNet is planning to use CIMI but it is not a HL7 project.

Vanguard status

• Should CIC be Sponsor or co-Sponsor?
• What about other projects? What is the process for developing or processing clinical content and preparing it for CIMI, CDA, FHIR…?
• Which projects should go through HL7? Should all CIMI projects go through it? Maybe those who are government or regulatory projects.
• Richard, Anita and Stan will be happy to help Kevin with guidance on putting together a project team to develop a budget and project team.

ACTION: Laura will contact Kevin Baskin to talk with Anita about setting up a project team

• CIMI hasn’t voted on being Sponsor for this project. TSC will kick it back if CIMI is sponsor.
• Going through CIMI is going to a different steering division
• Recommendation is that all of these content projects should go through CIIC. Financing is needed to continue modeling.

Cancer Interoperability

• Working on Radiology and Surgery
• Mitre is working with ASCO

Additional notes from LKHL

Cancer Interoperability project, and next steps (how do we best collaborate/coordinate on this?)

2nd ballot just cycled.  

will be doing cancer staging in January, but the rest of the document will be balloted in May

will be increasing scope to include lung cancer next (currently just breast ca)

Mitre also working with ASCO - to work on establishing basic/common data elements for all cancers - Biden, Cancerlink, xxx, and create encode - minimal cancer encoding data elements.  this will put breast ca balloting off for a cycle or two . Richard is working with the imaging WG to be co-sponsors on the radiology part of the project.  Getting more consistent support and engagement of a group of interested folks.  The latest ballot = 14 affirmative votes from the FDA.  Also seeing some positive movement from the AJCC -who has IP interests in this work.  

when considering and designing the request process - consider the starting points (cancer interoperability project example - literature review...)

Wednesday Q3

Attendees:  Anita Walden, Seth Blumenthal, Amy Nordo, Margaret Dittloff, Tom Kuhn, Susan Matney, Chrystal Price, Laura Heerman- Langford, Julia Skepik, P Goldschmidt, Nadia Ramey, Bruce Bray, Lisa Anderson, Nancy Orvis, Chris Melo

Agenda

• Introductions of attendees
• Accomplishments since last workgroup

  • Review of Purpose, Interoperability and Exchange standards. (see slide show:@Anita Walden) Most of the focus has been on the clinical content. There was a birds of the feather meeting yesterday at the Workgroup that reviewed some standards they will recommend.

  • Drafting of data elements
  • initiating FHIR reporting interest group
  • Identified key stakeholders for early vetting of data standards
  • Draft of invitation letter
  • Anita Walden to provide slide deck 
• Announcements and updates
  • Update from Women's Health Initiative Meeting: more of a planning meeting, however this was the attendees first time at the meeting. They had a report out by attendees on their use of the data elements. Ultimately hope to have a unified set of data elements. They have a lot of partners and seem to be more focused on research. Several members of that group attend the CCRF meetings. Discussion of other Women's Health Initiative groups working on domain analysis models or data elements. The projects are very independent and it was discussed to bring them together.
  • Part of this project is in CIIC. This project is used at a pilot because these common data elements can be used across all of healthcare. This project has a number of homes because of different funding sources and key stakeholder groups. All these parties are working together. We will need multiple places in multiple places to develop a robust implementation guide. This is outside the current PSS but may be a natural progression to a future PSS.
  • What is the current state of the letter to the stakeholders. Seth sent an email to the listserv yesterday and put out a version of the spec. This allows for the reviewers to put their feedback.
  • @Seth Blumenthal will continue to develop the letter to the stakeholders
  • MD-EpiNet is willing to be a pilot. Seth's organization , AMA - Integrated Health Model Initiative, is also willing to be a pilot. There are registry groups that have expressed an interest to participate and will work with sites to secure participation. Jimmy Tcheng has been socializing this in the cardiology domain.
• Review of CDEs
•     Susan provided educational introduction.  Unsure what the intent of the PEW Grant is because many of the data elements are in the FHIR Core or CIMI, so it is unclear why we have people commenting on them. The intent of this is not clear to Susan. The PEW study wanted to look at data elements are common across registry. The low hanging fruit was developed from data sets that were given from registries. This was based off the Meaningful Use data sets but the thought was there was additional feedback needed from the clinical community. The PEW team may have been unaware of other standards. Why are you using PHINVADS because there is no API around this. (This is a vocabulary service.) The value sets are exactly the same. Analytics where done on the questions and the answers. The job of the project is to come up with a set of common data elements and discuss with the individual registry to see if they would accept the proposed common data elements. Need to consider the granularity and optionality. FHIR allows information to be left allowed or not required.

STEPS of the PROJECT:

1. Scan of environment
2. Gap analysis
3. Socialize revised list of common data elements to the community for feedback 

            example the smoking status- which came from meaningful use which included the answer set. These answer sets do not align with what is acceptable to the clinical community.

             discussion around the NPI value set. Maybe we need to identify the role of the provider and connect to NPI. No this is not the best practice. Have a field for proceduralist and one for attending. This is why it is challenging because you need to create multiple fields to represent similar data.

             need to further define items- such like what represents one drink- a shot or a bottle

             fundamental issue that registry wants specific information, in a specific way for a specific purpose but that often does not align with the data available in the electronic health record.

       The cost of data collection just for cardiology is roughly 1 billion US dollars a year.

       Lets point people where possible to the existing standards and then have discussions around the ones that the individual registry don't agree to.

              If you want information about a specific drug or class you need to ask for that specific drug or class. But the CDISC model asks for drug but doesn't ask for the medication. This is unable to be exchanged. This is an area that needs to be discussed in further detail. This is an option for the registry. We should show the registries US Core for medications and gather the feedback from the stakeholders. This needs to be a dedicated meeting. Discussion around this. Can't registry use logic to combine data elements- for instance like a medication given after a procedure.? Many of these are meant to be paper forms that are created for ease to move on. The shift is now to make the process for ease from reuse of EHR data.

• @Julia will investigate this issue of medication with the goal of arranging a dedicated meeting to discuss

Does anyone remember the gentlemen at the PEW meetings who is working on modeling of medications? MED-RT briefly discussed . This is a lot bigger discussion and doesn't need to be a part of this discussion. Recommendation to reach out to Clem McDonald as head of interoperability for NLM

• @Susan Matney will follow up with Clem McDonald

Are there any recommended sources for the following value sets? Ok to use current sets as a starting point. These items are the areas that should be focused on.

• Alcohol use - JC has some resources
• Drug Use
• NPI
• Medication
• Tobacco Use-JC has some resources

Ballot Discussion - Are we ready to ballot the data elements in Jan? Why would you ballot items that you already balloted. The extensions, profiles and implementation guides should be balloted. Should we wait until the CIMI work is finished? Before CIMI there needs to be clarified first. The timeline is too tight to ballot in January. This is a FHIR implementation guide or is it some other type of implementation guide? This may be a new type of implementation guide.  This will be added as a topic to the next CCRF meeting. Clarity that the goal is to standardize how data is collected from the EHR.; data requested by the EHR. 

Meeting adjourned a 2:59 pm.

Wednesday Q4

Attendees:  Anita Walden, Laura Heermann, Jay Lyle, Senthil Nachimuthu, Matt Elrod, Meredith Zozus, 

Agenda:

Review all things  Registries with new attendees.  

Meeting abruptly ended with fire alarm clearing the building.