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Monday Q1

Attendance:

  • Frank
  • Nathan
  • Heather

Discussion Items

Agenda ItemLeadMinutes


Discussed conformance strategy, what is the future of the conformance WG? What should we be working on?

Welcomed Heather to the group, providing orientation. Discussed code sets. Discussed the use of patient identifiers, such as patient gender.

Annual Review of ItemsNathanDiscussed, no change required for the moment.
Health MetricsNathan

Going through Project Insight, updating projects and WGM agenda

Monday Q3

Attendance:

  • Frank
  • Nathan
  • James
  • Oliver

Discussion Items

Agenda ItemLeadMinutes
Preparation for discussion with InMFrank
  • HL7v2+ is the major item for discussion, InM needs to make a statement about the scope of the proposed change. Frank proposes that this is not a methodology change. If InM can't agree then this would be a stop to the work that Frank is doing. The intention is that this work only changes how HL7 v2 is documented in the sense of technical terminology, not how it is used.
  • Update on Data Type Flavors ballot, not balloted in January, Rob Snelick is currently out on Government Shutdown, looks unlikely to ballot even by September, due to NIB deadline in April.
  • Follow up on XPN having a table reference. It's in PID-5, and several other locations. Frank is going to fix it.
Preparation for discussion with FHIRFrank
  • Frank submitted change requests, they will be rehashed for teleconference
    • 19567, 19568, 19570, 19571, 19572
  • Ioana is tracking the version discussion but she is not here, due to Government Shutdown
  • Rob wants more explanation and understanding on Must Support and Cardinality, but he is not here either due to Government Shutdown
  • Update from FHIR folks about conformance constructs, anything new that we should be aware of? Anything that we should be tracking from our end?

Tuesday Q1

Attendance

  • Frank
  • Nathan
  • Robert
  • Heather

Discussion Items

Agenda ItemLeadMinutes

Data Type Flavors Project

  • General Introduction
  • Next Steps
Nathan

Craig introduces the Data Type Flavors project. It would be easier if there was a core set of data type flavors that could be reused.

Discussing hierarchies of Data Type Flavors for different countries. Address is an example of this problem. Talking about Vocabulary binding as well. Representation needs to be simple if you are only selecting a table and doing nothing else. For example having a line for each country to indicate which zip/postal code table to use. Talking about maintaining and presenting this information. These are two different questions. Frank is currently storing this in a relational database as a snapshot. It would be good by only storing the differences. Not sure if this is the best type of database. Talking about how three profiles might have the same changes and so improvements can be made by creating an intermediate profile that can be used by all three and thus reduce the amount of uniqueness in the lower nodes.

Explaining profile components that are used in IGAMT.

Plan is almost-certainly to re-ballot this. We didn't get much feedback on the conceptual model, only feedback on the details. Do we want to continue what we are doing now, just cataloging what is out there, or do we go to a more rich model. Needs more discussion. Put this on the Conformance Call agenda once NIST is back up and running. Frank wants to know how are we going to educate and tell people what to do?

Now discussing HL7v2/HL7v3/FHIR.

Things to talk to with FHIR:

  • How do extensions work with flags of "Must Support" and also cardinality 1...x.

Tuesday Q3 

Joint with InM

Attendance

  • Frank
  • Nathan
  • Robert
  • Heather

Discussion Items

Agenda ItemLeadMinutes
HL7v2+ statement from InMTony (Frank)
  • Notes from Conformance: HL7v2+ is the major item for discussion, InM needs to make a statement about the scope of the proposed change. Frank proposes that this is not a methodology change. If InM can't agree then this would be a stop to the work that Frank is doing. The intention is that this work only changes how HL7 v2 is documented not how it is used.
  • So what is the straw vote from InM on this?
    • One take from the InM group: Doesn't sound like we are changing how to encode, but it is a change for how we documenting it. Not seeing a change in methodology but instead a change in publishing. Will provide more consistently and conformity.
    • Are we going to maintain backward compatibility? What about MSH-2? Shouldn't impact this, all that stays the same.
    • If we maintain all that compatibility then there shouldn't be a problem with methodology.
    • Maybe we need to write down what is "methodology". Tony started recapturing some fundamentals
      • a message consist of segments represented as lines in ER7
      • each message starts with a message header
      • segment are identified by a three letter code
      • etc.
      • InM believes that with v2+ the methodology is not changed, but would like to confirm that during one of the next InM calls.
    • We need some careful validation and do quality checking to make sure everything comes through. Example of one problem can be found here: http://hl7.eu/refactored/ctrl.html scroll down to 5.7.7 Usage and Examples of Formatted Text (2.7.7)
      • Frank is reading this out of Word and the structure is complicated
  • Another discussion is about the scope and purpose of v2+
    • v2.x is available as HTML for many years. So, web publishing is not the major issue of v2+. Latest work is here: http://www.hl7.eu/HL7v2x/hl7contents.htm The website will be updated as Frank makes progress. The next step will be to include 2.9.
    • Frank will continue work on this if there are no major objections. 
    • v2+ should switch to web-based editing. There was a presentation in Reading, UK, in 2001, but due to the readiness of Version 3.0, Rel.1 this was rejected. We now have to reconsider a migration to a different basis.
Data Type Flavors Ballot
  • Update on Data Type Flavors ballot, not balloted in January, Rob Snelick is currently out on Government Shutdown, looks unlikely to ballot even by September, due to NIB deadline in April.
    • Question about whether this project can be continued without input from NIST (Rob Snelick). Currently project depends on efforts at NIST so it is felt that we need to wait.
    • Frank would be willing to incorporate it in, but there are technical issues that will be need be considered
    • We are likely to miss the September Ballot, as NIB must be submitted by April 7.
    • Can we enhance the data type flavors for generic ones that applicable to other countries, like XPN and XAD? Frank is interested in solving some of these problems with this.
XPN table reference update
  • Follow up on XPN having a table reference. It's in PID-5, and several other locations. Frank is going to fix it
    • Frank is going to look in his database. We are all agreed, just a technical correction. Frank will search and fix.
    • This issue applies to all complex datatypes in all segment definitions, not just XPN.
    • Frank will make a list of changes, which can then be forwarded to the authors of each chapter
    • This can be a technical correction for 2.9, need to issue a errata for 2.x.
HL7 v2+ continued discussion

Frank has already done the work to change how it is displayed, but now the change is to make how we define the standard. So concepts such as R, RE, O, X will be gone and will be replaced with cardinality and must support. Changes the expression of the standard, not what is on the wire. Hopefully we can stop having discussions with people about RE.

  • Could rename Segment to Segment / Segment Group
  • Need to make sure that Cardinality is not assumed by reader to override backwards compatibility rules. Do we need to mention the backwards compatibility in the Cardinality section? http://hl7.eu/refactored/msg.html#msgstruct Should put a link back to Control to explain the proper handling for backwards compatibility.
  • Length is not changed, it is still the same.
  • More work to be done on the flags, how they will be displayed
  • Frank could provide tables on how he does the conversion

Wednesday Q2

Attendance

  • X Nathan
  • X Craig
  • X Floyd
  • - Stuart
  • X Eric
  • X Lori
  • - Didi
  • X Danny
  • X Heather
  • X Robert
  • X Frank

The purpose of this meeting is to:

  • Give updates on what you are working on in the immunization space
  • Float ideas for new projects/efforts and get direction on where this would be best to move these items to
  • Give a chance to meet face-to-face with those we normally work on by phone

Discussion Items

Agenda ItemLeadMinutes
2.8.2 procedural questionEric

2.8.2 is now published, is there a page we can go and put comments?

Scope is currently locked by SISC. Are we free to put comments on it?

NDC and CVX codesHeather

Recently received questions about NDC we never saw before

Exploratory/trail vaccinesRobert

Robert, exploratory vaccines, test trials.

The current policy is that if there is no CVX created until it comes to market.

SISC didn't think they wanted to get experimental vaccines.

Would be willing to create a CVX code because an IIS is interested in having it.

UpdateFloyd

Continuing to look for vendors/products to be recognized. No new updates to capabilities and test, because it is still early. AIRA and HIMSS are setting up a collaborative to enable discussion between EHR and IIS stakeholders. For example, what is the workflow when a fridge of vaccinations where found to be bad for an entire week? Some providers wait until patient comes back in to mark the old dose as bad.

At HIMSS they will have an interactive presentation. Mary Beth from AIRA will join and they will use mentimeter. Need Best Practices for both sides, which may feed into changes into the underlying standards too. Not creating standards but identifying best practices. There will be a selective executive committee but the membership will be open.

Discussion on idea for better queries

Also can discuss how FHIR could be leveraged as well

Danny

Continuation of a conversation from Baltimore and discussion with Alean about PIX/PDQ. Problem: in current guide Z44 profile, Z31 is not specified for that. The weighted matching process works 99% of the time, but not 1%. There is the ability to leverage the State Registry (SR) id. Using a two-step process the IIS can send back a possible match and then a second query with the SR id can be used to get the full record.

There is an PIXm and PDQm in the FHIR space. (M is for mobile.)

Ranking of the returned list would be helpful if ranked.

HIMSS are establishing a colloborative, there will be soft launch at HIMSS. These are kind of topics for a sub-group. Get some consensus. This issue might be good for them to put a group together to tackle?

Could contact CIC about Common Clinical Registry Framework (CCRF) http://www.hl7.org/implement/standards/product_brief.cfm?product_id=467

Will take this issue back to AIRA and EHRs and see if there is interest in picking this up as a potential project.

CDS Testing

Nathan
Update on HL7 v2+Craig

HL7 v2.9 has been balloted in January, only a handful of comments, will be published later this year.

Project called HL7 v2+, rework on how it is presented. Feel a lot more similar to FHIR. Changes to how the standard evolves. Might change how it is published. Won't be out until later this year and into next year.

HL7 v2 management group now has management oversight over this. Not on content but on the higher level of the standard itself.

Wednesday Q3

Notes from Monday Q1

  • Frank submitted change requests, they will be rehashed for teleconference
    • 19567, 19568, 19570, 19571, 19572
  • Ioana is tracking the version discussion but she is not here, due to Government Shutdown
  • Rob wants more explanation and understanding on Must Support and Cardinality, but he is not here either due to Government Shutdown
  • Update from FHIR folks about conformance constructs, anything new that we should be aware of? Anything that we should be tracking from our end?

Discussion Items

Agenda ItemLeadMinutes
Review of topics we want to discuss

Must Support can be put in base profiles. So maybe in HL7 v2 then this could be done in the base.

Now discussing "Must Support", shouldn't a cardinality of 1..x simply "Must Support"?

How does the V2-to-FHIR handle RE and R mapping?

Might need to make a definition of Must Support for the HL7 v2 items.

Looking at section 2.1.0.3 here: https://www.hl7.org/fhir/conformance-rules.html An example it would be good to see this with two examples. Need to log a ticket on GForge. Need examples in both JSON and XML.

The phrase "This means that setting an element to a minimum cardinality of 1 does not ensure that valid data will be present; specific FHIRPath constraints are required to ensure that the required data will be present." has a problem because the word "valid" should be taken out.

What about content that is invalid like "ABCD" in a date field.

Version of FHIR
Now that we have the means to say which version the resource. What about a MPI that links to patients from different versions? Not yet decided, waiting for problem to come up to really decided for sure.
Update from FHIR about Conformance Constructs

Resource called Graph Definition, it has move from level 0. Would be interesting to take a look at this. Describes constraints you can have on a tree of data. You can use it to tell you what a tree look like.

Discussion about Conformance Statements. Frank wants to force people to use it, but FHIR says we are not the police. So there is a lot of exchanging going on without Conformance Statements being generated. Frank would like to raise "Conformance" to Level 1 from Level 2.

Could have demonstrations on FHIR tools at our next meeting.

IHE also has the concept of R2 instead of RE. Maybe this is a chance for them to clean that up?

1 Comment

  1. I approve the minutes of these meetings.

    Heather Patrick