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Date: 15 September 2019 

Quarter: Sunday Q3

Agenda Topics

September 2019 - WGM Agenda - International Council

Supporting Documents

Minutes/Conclusions Reached

Opening Announcements and Call to Order

  • Welcome - Line welcomed everyone to Atlanta and to the International Council
  • Moment of silence for Professor Li Baoluo who passed away in July
  • Introductions Round Table
    • Round table introductions
    • Current Membership =37
    • Confirm proxies and quorum - 18 in attendance
      • Quorum for Decisions (40%=15), Directions (33%=12), Financial Decisions (51%=19) 
        • quorate for decisions and direction
    • Lapsed affiliates - 2 lapsed - HL7 Pakistan and HL7 UAE
  • Secretary Report
    • Review of use of Confluence - Line reminded all Affiliate Chairs to get account on Confluence if they haven't already
    • Review agenda
      • no additional items
      • please forward items for Thursday to IC Co-chairs
    • Reminder to put Affiliate presentation on Confluence
  • HL7 International Board Report & Welcome - Calvin Beebe
    • Calvin's terms as Board Chair ends December 2019
    • Board Meeting topics
      • Review HL7's Strategic Plan - have been reviewing it and keeping it up to date
      • Financial results for 2019 - fairly positive
        • energy in FHIR is helping HL7 in funding the programs
      • HL7's Implementer Strategy - looking to contract a position to help get this in place
      • Report out from Business Model Committees
    • Challenges ahead
      • HL7/FHIR's success
        • Accelerator program has been a success, but presents challenges.
          • The TSC has been dealing with this
          • Will be a challenge going forward
      • Membership
        • Challenge in membership and in the workforce
        • Limited workforce.
        • Need to grow the workforce, not just for dollars, but also to get things done
  • CEO Report - Chuck Jaffee
    • FHIR Accelerator Program
      • Applying the US experience to the global community
        • how can this experience be leveraged to the global stage
      • 2010 - HL7 Fresh Look Taskforce
      • 2014 - Jason Taskforce and Argonaut Program
      • 2015 - ONC Open API requirement
      • January 2018 - Apple iOS FHIR integration
      • July 2018 - Cloud Vendors commit to FHIR
      • December 2018 - FHIR R4
      • March 2019 - ONC and CMS NPRM
      • FHIR has been enabled in 87% of hospitals and 70% of eligible clinicians - despite the fact that FHIR was NOT required for EHR certification
      • Assists implementers across the health care spectrum in the creation of FHIR Implementation Guides 
      • 5 programs at this point and more in the pipeline
        • Argonaut Project - Apple iOS 11.3 and later releases support patient aggregation of clinical information based on Argonaut Project Implementation Guide
          • discussion with regulators worldwide to support aggregation of patient data
        • daVinci project - advances "value based care" by leveraging FHIR for capture of granular clinical data from patient records to improve quality, to reduce costs and to enhance care management
        • Gravity Project - a private sector initiative to leverage FHIR to integrate the social determinants of health care into the delivery process
        • CodeX Project - a multi-stakeholder community leveraging FHIR to produce computable data for cancer care and research
      • Emerging Projects
        • AMA - Clinical information modelling
          • bringing a large number of clinicians into HL7
        • CDC - population health initiatives
        • NLM . clinical research programs
        • NCQA - quality measures on FHIR
        • GA4GH - genomics collaboratives
      • Tech giants have committed to collaboration on FHIR API for healthcare cloud interoperability and to implementation fo Bulk Data on FHIR
      • Accelerator and FHIR Community Process
        • Commonality - both are managed by HL7 International and both share identical FHIR specifications for the API and the resources
        • Distinctions - accelerator members develop profiles and implementation guides balloted within HL7
        • Community process members do not have the immediate intent of balloting artefacts
  • FHIR Update - Grahame Grieve
    • Largest Connectathon in Atlanta - 413 attendees
      • 38 tracks
    • Had hoped to survey market to get opinions about when to publish R5
      • did not have to develop the survey
    • Reviewed the progress of the FHIR community - FMG confirmed that will not bring FHIR to ballot for the Sydney meeting
      • community is not ready
      • earliest will be able to publish R5 - early in 2021
      • seeking opinions from Work Groups this week to see if can do an interim trial use publication of some material
        • based on outcome of discussions will look to see if it is possible
      • business developing Implementation Guides
      • Working this week on Sydney preparations
      • Earlier this week did a number of tutorials on developing FHIR implementation guides
        • Creating FHIR IG
        • Terminology
        • Reviewing FHIR IGs
        • Tutorials were funded by ONC - funded them with them intent of growing the capacity of the community in the US to meet US Government initiatives
        • Will likely be repeating the tutorials in January in the US
        • May be review the IG Tutorial via webinars
        • Question for IC:  Should we try to produce the tutorials in Sydney
          • For Sydney will be publishing possible tutorials and asking for input from AU members on which one to do - will be done over the next two months
          • could do some material by webinar for some of the material, but not all
          • Will depend on the tutorial
          • HL7 NZ - encouraged the production of the tutorials for Sydney
          • do some advertising so people are aware of what the tutorials are
          • could this be done in Affiliates? - would be costly to do this
          • Affiliates could identify a few individuals who will be leads for developing implementation guides and a larger number of people to review implementation guides/ballots
    • Affiliates are producing Implementation Guides and have communities producing Implementation guides - of variable quality
      • Very big degree of variability in preparation and publication
      • Public registry of Implementation Guides - have asked Affiliates to register IGs - only 3 Affiliates (including US) have registered IGs
      • If an affiliate wishes to ballot Affiliate IG in HL7 process - it is possible to do this
        • voting has been resolved so that the Affiliate voters (not named HL7 voters) can vote - process and policy has been approved
        • can be published in Affiliate language - it is intended only for Affiliate community
        • IG Publisher doesn't currently support multi-language implementation guides - but it is a planned enhancement
        • Question about how the Affiliate Agreement may be impacted
          • no localisations of FHIR
          • base license of FHIR - creative commons public domain
          • no license restriction
    • FHIR Community Process
      • very little has happened with this process, but it is now high on priority list
      • will have process and collateral complete
      • Will start reaching out to partners in US first and then around the world - asking them to be members and participants
      • Will advertise the members
      • There will be Affiliate Chapters - Affiliates must sign up with the Community Process directly themselves - not a member by virtue of being the HL7 Affiliate
        • changes to Affiliate Agreement to make membership by Affiliate mandatory
      • What if Affiliate already has a process in place
        • assumes that Affiliates will have different processes, but must meet 5 requirements
        • should not need to change processes within Affiliate
      • Use of HL7 Logo and FHIR logo
        • Affiliates are licensed to use FHIR logo
        • Affiliates (and external organizations) should not be using HL7 International logo - should use Affiliate logo
        • Needs further discussion once agreed/approved by HL7 Executive Committee
    • FHIR Foundation
      • at the last meeting described how FHIR Foundation and HL7 Board were in discussion about relationship and implementation support
      • haven't progressed very far with this issue
      • have not identified solutions going forward
      • how close are we to the deadline (if FHIR Foundation hasn't done anything, will close) - no sense of how close we are
  • FHIR Implementation Feedback from Affiliates - Update
    • email was sent to all Affiliate Chairs asking for feedback on moving to R5 and FHIR Community Process
      • limited response
      • Moving to R5
        • Canada - no hurry to move to R5
          • working on baseline profiles using R4
        • UK - would be useful to update libraries
          • will be dropping milestones in the lead up to meetings
        • AUS - moving to R4 - will likely stay there for a long time - difficult to move to R5
        • Norway - going for R4, but there are some resources in R5 that are important
          • need to press on to R5
          • more relaxed with versions - taking latest release and updating accordingly
          • making national profile on each resource -
          • if it works don't fix it - if implementation in DSTU2 - won't change if it works and they are paid to fix
        • ARG - working on R4
        • Switzerland - working on R4
          • hoping that it will be easy to switch versions between R4 and R5
        • NZ - have implementations R2 and R3
          • first national implementation - R4
          • big concern from implementations - medication resources - will there be breaking changes in R5
        • Is there guidance to moving to R5?
          • reference implementations support R2, R3, R4 and R5
          • there is no policy on mandatory move
      • FHIR Community Process
        • presented to a group in NZ - was responded to fairly positively
        • Canada - has been discussed - challenge - need to up governance game for HL7 Canada
          • there is a will to do so, but need structure in place
  • Policy Advisory Committee (PAC) - Jamie Ferguson
    • PAC met this morning
    • discussed need for international representation on PAC
    • most of work for PAC has been US centric 
    • seeking international representation and a liaison from International Council
    • WHO Strategy for Digital Health - opportunity for HL7 to comment on standards
    • need consistent story and talking points on standards for policy makers
    • in Sydney - will invite International Council Reps to PAC - Sunday Q2

Action items

  • Affiliates are asked to respond to Grahame if the tutorial on IG production should produced in Sydney
  • Grahame will send email to IC Co-Chairs that will send out to International list - about registering Implementation Guides

Date: 15 September 2019 

Quarter: Sunday Q4

Agenda Topics

Supporting Documents

Minutes/Conclusions Reached

  • Affiliate Presentation - HL7 Saudi Arabia
  • Update on Guidance for the Crafting of International Standards Project (RTSS) - Ron Parker
    • IC is the co-sponsor of this project
    • still under way - meeting with 3 methodology groups this week
  • Sydney WGM
    • hl7.sydney 
      • discount code - 
      • raffle for a free flight to Sydney - will be drawn on Thursday - postcard.hl7.sydney
      • promotions - Jason will be promoting at various events including IHIC 2019
      • discounts for groups?
      • discounts for speakers?
      • discount codes for Affiliate Chairs - use 'ACHAIR'
      • if you have upcoming events and want to promote - will send you postcards with discount codes
  • Regional Reports
    • HL7 Europe
    • HL7 Asia - no presentation
    • HL7 Latam
      • HL7 Chile - Affiliate approval is on Board agenda for Tuesday meeting at this WGM
        • planning an event
        • Shared EHR project - based on CDA and IHE XDS - but ministry changed
      • HL7 Argentina - lots of profiles in Simplifier
      • Uruguay - CDA and XDS based
      • Equador - working on a standards based project
      • Columbia - beginning the process of creating an Affiliate
      • Diego meeting with countries in Central America next week to see how they can help to learn HL7 Standards
  • HL7 Around the World
  • Thursday Agenda Topics - please send any additional topics before Wednesday
    • Affiliate Agreement (Mark/Wayne)
    • IHIC 2019 (Roman)
    • HL7 Asia Pacific meeting (Michio)
    • Proposed HL7 Implementers Community Strategy (45 min) (Walter)
    • HL7 Business Plan (Walter)
    • African Project (20 min) (AMS)
    • Affiliate Health
    • February 2020 WGM Planning
    • 2022 International Meeting
    • PAC Liaison from IC
    • FHIR Versioning
    • Report from the Joint Initiative Council
    • HL7 Around the World
  • Closing Remarks

Action items

Date: 19 September 2019 

Quarter: Thursday Q2

Agenda Topics

September 2019 - WGM Agenda - International Council

Supporting Documents

Minutes/Conclusions Reached

  • Opening Announcements
  • Introductions Round Table
  • Confirm proxies and quorum
    • 18 in attendance - quorate for decisions and directions, but not financial decisions
      • Current Membership = 36
      • Quorum for Decisions (40%=15), Directions (33%=12), Financial Decisions (51%=19) 
  • Secretary Report
    • Review agenda
    • Approval of Minutes - 
      • Motion by HL7 Australia - seconded by HL7 Japan to approve the minutes from Montreal - 16-0-2 Carried
    • Elections: IC Co-Chair, Affiliate Director, Affiliate Representatives to the TSC
      • IC Co-Chair - Melva is retiring after 5 years.  Thank you for her service
        • Ron Parker has been elected as the incoming IC Co-Chair
      • Affiliate Director - Peter Jordan elected as Affiliate Director for 2 year term
        • Thank you to Line Saele for her service to the Board for the past 2 years
      • Affiliate Representatives to the TSC - Giorgio Cangioli
    • Co-Chair elections (candidates & voters) - determining membership
      • From the GOC - determining eligibility to be a co-chair and to vote for co-chairs
        • trying to make it open to all Affiliate member and not just named voters from the Affiliate
        • WG co-chairs do not need to be a named voters
        • Do not to exclude members from being able to be a co-chair
        • For Affiliates - asking for them to provide membership list and keep it up to date
          • HQ will be sending emails to Affiliates to confirm eligibility to be a co-chair and to vote in Co-Chair election
  • Review of Budget and Financial Requests (15 mins)
    • Funding Request: HL7 Japan
      • 30 notification was provided for the funding request
      • Motion to approve funding request from HL7 Japan - HL7 Norway - HL7 Australia - 19-0-0 Carried
        • Singapore hosting next year
  • Affiliate Representation on the US Realm Steering Committee
    • Currently Lorraine Constable has been providing this role on the USRSC
    • Ed pointed out that Lorraine was extremely valuable in bring points from the international perspective
    • Commitment is to a weekly teleconference - may be cancelled if there is no business - Tuesday at 1pm Eastern and 1 quarter at the WGM
    • Should solicit from the Affiliates 
    • Who ever we choose there will be gaps in the ability to represent the international perspective
    • RTSS project may provide guidance on how to assess realm transferable standards
    • Propose we defer the decision until Sydney and that we ask USRSC 
    • Motion: ask Lorraine Constable to be the International representative in an interim position until Sydney and that the Affiliates seek other candidates from their country. - 19-0-0 Carried
  • Affiliate Representation on the PAC
    • PAC is asking for international representation to PAC
    • Melva and Diego met with PAC this WGM
    • Diego suggested a team to meet with PAC - maybe not have to attend each meeting
      • one person is not aware of all of the issues 
      • maybe have a representation from each region
    • Christof - previously established for HL7 Europe - maybe could re-established and have chair of the European Strategic Advisory Committee
      • could represent the European perspective
    • Could we have a template so that information can be channelled in to the PAC?
    • Suggest have group to develop a template for funnelling information to the PAC
    • Diego will ask different regions for issues to represent to the PAC at the WGM
      • Chair of European Strategic Advisory - Christof
      • Chair of HL7 Asia - Michio
      • Canada - Ron Parker
      • New Zealand - Peter
      • Australia - Jason
  • HL7 FHIR Community Process
    • Chairs feel that this needs discussion prior to Grahame coming to IC
    • Australia - there are organizations that are ready to sign up and HL7 Australia isn't ready to respond
    • Connections with this to the Affiliate Agreement
    • For Canada - need to change the way we behave
      • not structured for QA, governance
      • under FCP - have a structure to go and establish this
      • there is role for Affiliates
      • not without implications
      • Consistent behaviour - believe there are expectations for consistency of behaviour of the Affiliates
      • need to take the FCP description - and figure out what it looks like in each Affiliate
  • FHIR (Grahame)
    • asked Affiliates a number of questions on Sunday
    • tutorials - FHIR IG
      • need to know which to plan for Sydney
      • Suggest FHIR IG Review, not the other tutorials
    • Speaker about FHIR in late October in Moscow - FHIR and disruption in healthcare
      • is there an Affiliate that would be able to do this presentation
      • Should there be a process to identify potential speakers for conferences that Grahame gets asked about
      • Ron - there should be a process
      • Restrictive list - asking for speaker for a particular topic
      • Suggest ask the Affiliate Chairs - should be a directed to the Affiliate Chairs
      • Speaking on behalf of HL7 International - needs to be sorted out
        • there hasn't been discussion about this
        • Ed - there should be a group that does this - with identified people
      • Who is funding - often there is funded for travel, but no honorarium
      • Should get a list of people who speak on behalf of HL7 International
      • Need to know nature of the event
        • Need to declare who speaking on behalf of
        • expectations of content
      • Need an email list for just the Affiliate Chairs
      • Currently Board Chair and CEO can speak on behalf of HL7
      • But many can speak to what work is underway at HL7 - status type reporting - not controversial
      • If there is something more "spicy" - should be official speakers of HL7
      • Grahame will email the IC Co-Chairs with these types of requests
    • Versions - still seeking feedback about decisions about R5
      • forward feedback to Grahame

Action items

  • add discussion of International member to USRC to Sydney agenda
  • Notify USRSC of decision 
  • Ask HQ to create list server for just the Affiliate Chairs plus IC Co-Chairs - Mark will send request

Date: 19 September 2019 

Quarter: Thursday Q3

Agenda Topics

September 2019 - WGM Agenda - International Council

Supporting Documents

Minutes/Conclusions Reached

  • African Project
    • have re-engaged the team and adjusted the timeline
    • Are in communication planning stage
      • Catherine - have you discussed with Policy Advisory Committee?
      • What is your activity with donor programs?  Perhaps a survey
      • AMS - haven't looked at this, but good suggestion
      • Catherine
        • Mobile Health WG should be engaged
        • European Commissions - projects to support Africa
        • ISO
      • Ron - will pursue those paths
      • Jason - path to membership with milestones and criteria
        • first time, lite membership - what would it look like
      • Ron - input from ADDC would be useful
    • How would the IC like to engage in the project?
    • How and when should the Board be engaged?
      • believe the Board should be made aware to ensure it is in line with strategy
    • Use of HL7 communication and collaboration tools
      • work through IC Co-chairs
  • Affiliate Agreement
    • Mark is asking for input on the Affiliate Agreement
    • The Affiliates have made a Confluence page for this
    • Affiliate Agreement - Draft 2019
    • Discussion about making the FHIR Community Process a part of the Affiliate Agreement. The FCP is not yet ready for this, as it is not completed.
    • Rob comment that Grahame might look for help on developing the FCP in the right direction.
    • Mark says that the Affiliate Agreement should be ready by January. Not likely that FCP is ready by then.
    • Oct 15 is the deadline of making changes to the Affiliate Agreement
    • co-chairs of IC will consolidate the comments and give Mark one Affiliate Agreement suggestion.
  • IHIC 2019
  • Affiliate Health
    • Affiliate Health 
    • Some affiliates join and then disappear
    • Have developed affiliate health criteria 

Action items

Date: 19 September 2019 

Quarter: Thursday Q4

Agenda Topics

September 2019 - WGM Agenda - International Council

Supporting Documents

Report from JIC 

2022 International Meeting 

IPS_IC_WGM_Montreal_2019.pptx

HL7_Finland_Summary-Sep2019.ppt

Minutes/Conclusions Reached

  • JIC (see report
    • new chair is GS1
    • no major activity
  • Funding for other HL7 regions (Ed)
    • impressed with what HL7 Europe has done
    • should be reflected in other areas
    • paying an equal amount of money to HL7 Asia and HL7 Latin America (including the Caribbean)
    • get a lot more visibility into Affiliates
    • is there value in creating regions and supporting them financially
    • Christof - not so sure if it is related to financial support, but having a person in charge
      • budget for Europe is primarily from projects
      • putting a person there to support may be best
    • Ed - money starts this
      • getting and paying a person to start this is a smart thing
    • Jason
      • hoping to have an off line conversation with Asia
      • would be keen to do something on a trial basis in their region with Asian focus streams to Sydney WGM
      • good to have some contact before 2020
    • Michio
      • has discussions with IHE - difficult
      • in Europe, once approved, can be marketed across Europe, but this isn't the same for Asia
      • standard should be interoperable, but market is different in Asia
    • Jason
      • need to recognize differences in the Asia region
      • still worth a try
      • opportunity to share and help each other out
    • Ed
      • consider putting some money on this 
      • look toward putting some money towards Asia and Latin America
    • Motion by Ed - Catherine  :  Recommend that HL7 International moves in a direction of funding establishing regional activities - 19-0-0 Carried
      • Jose - feels this is like what Diego is doing in South America
      • Alexander - needs to be linked to a governance - targets, goals, processes for a regional HL7 organization
      • Rob - should in each region, wait until there is a big project, then there is something to work with
        • wait for a big project in a region, then respond to that
      • Ed - there are projects
        • no consolidated way to put projects together
  • Planning for 2020 (see slide deck)
    • Jason will send out Sydney 2020 URL for posting
    • Events for advertising
      • opportunities for people to come and speak and share findings
      • could a government agency issue invitation for European projects to speak - may get people coming to speak
    • Jason will be promoting at eHealth Network in Hong Kong
    • Joint letters of invitation
    • Round table in Sydney with request for abstract
    • Christof - may not attract large number of participants
      • not as optimistic about this approach
      • eHealth science/informatics - may be a community that would be interested
        • using FHIR to get data interoperable
        • may attract students
        • could increase numbers
    • Ben - if government agency invited, there is a UK policy that might get some interest
    • IC meetings will be Monday afternoon and Friday Q2 - Q4
      • Devote one quarter to working on Affiliate Agreement or FHIR community process - Friday Q2
        • ask Affiliate Chairs to come prepared
    • Please send feedback 
      • getting feedback that an international meeting interrupts the work that needs to be done
      • large number of Australians - new people will interrupt
      • some co-chairs - issues when meeting outside America
      • IC - needs to consider the feedback
        • if going to maintain international organization - needs to move around
    • Following 6 meetings after Sydney will be in North America
  • 2022 International Meeting
    • looking at May 2022 for the next international meeting
    • 2 Affiliates have found venues that are viable
    • Netherlands (2 venues) and Madrid (same as last time and 2 venues downtown)
    • are in the process of reviewing materials
    • will share the information to the Affiliates
    • If there options after the review, will ask Affiliates for a recommendation
    • HL7 Netherlands is exploring the option of taking on taking on the financial responsibility for the event
  • International Patient Summary (see slide deck) - Rob Hausaum and Giorgio 
    • Discussion about getting others engaged in the work
    • don't have a reference implementation
    • Rob M - how active is IPS being implemented in connectathons and DevDays
      • Rob H - struggling with this
        • giving a presentation at DevDays in November
        • may be a connectathon at DevDays
        • Need to do more
    • Ben - need a reference application
    • Rob - need to demonstrate how to get data out of the FHIR server
    • currently STU publication 
  • HL7 UK Presentation (see slide deck)
  • HL7 Finland (see slide deck)
  • Closing Remarks
    • thank you for coming!
    • safe travels!
    • do as much preparation before the next meeting - contribute to the Affiliate Agreement and FHIR Community Process