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!!! Don't forget to log your attendance


MondayQ1 9:00amNo meetingN/A
Q2 11:00amNo meetingN/A
Q3 1:45pmClinical Interoperability Council hosting Imaging Integration,Clinical Information Modeling Initiative 

Cancer Interoperability related projects

Q4 3:30pmFHIR Infrastructure hosting II, FM, MnM

FHIR-I Topics

TuesdayQ1 9:00amII/WG-20

1. Opening

  • Call to order, introductions, and welcome.
  • Review & approval of the Agenda
  • Minutes of the previous meeting.
  • Antitrust rules.

2. General Administration

  • Review PBS Metrics (May 2020 interim /  May 2020 final)
  • Review Workgroup Health Metrics (May 2020 interim / May 2020 final)
  • Review joint meeting agendas
  • Review and approve DMP document 
  • Review any other housekeeping topics
Q2 11:00amII/WG-20

3. Review Projects and update Project Deadlines

  • Sponsor
    • ImagingStudy and R5
    • ImagingReference
    • Status of Potential Project: FHIR Release 4 II Objects
    • (Cancer project Q3)
    • Status of Project 1230: HL7 Endorsement of DICOM PS3.20: Imaging Reports using HL7 CDA
  • Co-sponsor
    • Status of Project 1343 (Eye Care and Ophthalmology on FHIR)
    • Status of Project 1010 (Ordering service interface spec)
    • Status of Project 862 (Unique Specimen Identifier Requirements)
  • Dental Interop Project #1482 Discussion (II is an "interested party")
Q3 1:45pmII/WG-20
Review Imaging Reference extension to Document Reference with Breast Cancer Reporting group / ACR
Q4 3:30pmInfrastructure and Messaging hosting II


  • Overview & status
  • STU2 ballot status
  • Future goals and timelines
  • Transition of ownership

WednesdayQ1 9:00amII/WG-20

Continue with work on FHIRCast

Q2 11:00amOrders and Observations hosting II representatives


Q3 1:45pmII/WG-20

Continue with work on ImagingReference, ImagingStudy

Q4 3:30pmII/WG-20 hosting FHIR Infrastructure

Joint meeting with FHIR-I


ThursdayQ1 9:00amII/WG-20

Q2 11:00amOrders and Observations hosting II

Q3 1:45pmNo meeting

Q4 3:30pmNo meeting


FridayQ1 9:00amNo meetingN/AN/A
Q2 11:00amNo meetingN/AN/A
Q3 1:45pmNo meetingN/AN/A
Q4 3:30pmNo meetingN/AN/A


Voting Members Present                             Represented by                 9/17                     9/18                       9/19

Agfa HealthCare                                                Bill Wallace                                                         x

GE Healthcare                                                    Chris Lindop                        x                              x                              x

Change Healthcare                                          Elliot Silver                          x

Philips                                                                   Chris Melo                                                           x

Siemens Healthineers                                     Eric Martin

Vital/Canon                                                        Jonathan Whitby              x                              x                              x

Voting Members Not Present                      Represented by

AAPM                                                                   Lawrence Tarbox

ACR                                                                        Jim Philbin

Carl Zeiss                                                              Regis Deshayes

Canon Medical Research                                Kevin O’Donnell

Corista                                                                  David Allen

Laitek                                                                    Fred Behlen

NCI/CBIIT                                                             Ulrike Wagner  

NVIDIA                                                                 Brad Genereaux

PixelMed                                                             David Clunie

Sectra                                                                    Niklas Svenzen                                  

Web3D Consortium                                         Nicholas Polys                                   

Alternate, Observers, Guests                     Represented by

By Light Professional Services                   John Moehrke/HL7                                          x

Epic                                                                     Isaac Vetter/HL7                                               x                              x

FHIR/Furore/HL7                                              Ewout Kramer                                                   x

HL7 Austria and DICOM Usergroup Austria Reinhard Egelkraut     x                              x                              x

Mayo Clinic                                          Anthony Julian              x

MITA/NEMA                                         Luiza Kowalczyk            x                       x                       x

Kaiser Permanente                               Sandra Stuart               x

Regenstrief Institute                                       Daniel Vreeman                                                x

Presiding Officers:                                                            Jonathan Whitby, Vital/Canon

                                                                                         Christopher Lindop, GE Healthcare

DICOM Secretariat:                                                          Luiza Kowalczyk, MITA/NEMA


The meeting was called to order at 09:00 a.m. local time.

The antitrust rules were reviewed, and DICOM patent policy as well.

The agenda was approved:


  • Announcement of a new co-chair of WG-20 II: Christopher Lindop, GE Healthcare. Congratulations, Chris! Thank you for stepping up to this position!
  • Reviewed Workgroup Health Metrics (Sep 2019 interim / Sep2019 final)
  • Reviewed joint meeting agendas
  • DMP document 
  • It will be reviewed at the next WG-20 II mtg.
  • 3-year plan
  • It will be reviewed at the next WG-20 II mtg.
    • Change in years: from 3 to 5 years.
  • HL7 review at the DICOM WG-06 Base Standard 2019 November meeting.
    • Action item: Prepare a PPT for the review.


  • FHIRcast work will remain under WG-20 II.
  • InM Group (Infrastructure and Massaging) will be the primary sponsor for this project with II as a co-sponsor.
  • Members of InM will be invited to participate in each scheduled FHIRcast call.
  • STU 1 Ballot
      • Balloted at STU1 May 19, 2019
      • 161 issues
  • Comments addressed and merged in one document.
  • An email went out to withdraw any negative votes.
  • Changes from STU 1 Ballot
    • SMART is recommended, nor required
    • Events are named based on FHIR resources
    • OAuth scopes got more interesting
    • Remove query for current context
    • Hub.topic is a guid, not url
  • Websocket proposal:

Please click on the following link for more details on the FHIRcast roadmap:

Next steps:

Note: If anyone wants to provide any feedback for Websockets for STU 2 ,please go to GitHub:


  • Project 1230: HL7 Endorsement of DICOM PS3.20: Imaging Reports using HL7 CDA-Ongoing.

Action items:

  1. Follow up with Diana .O – L. Kowalczyk
  2. Schedule a t-con
  3. Remove Elliot Silver as a facilitator from this project:

Track Items:

Work in progress

  • Please click on the following link to see work in progress:

ImageManifest resource: Reviewed and updated: Draft of ImagingReference for R5. Please click on the link for more details:

The following use cases on Imaging Manifest were discussed:

  1. Communication of split/sort between applications.  Suppose I have an MG study, with 8 objects, TOMO and single-image instance LCC, RCC, LMLO, RMLO, and the source systems sends those in as 2 series, one for all single images and one for all tomos.  I’d like to be able to communicate that such a study is sorted into either of: All View types, with single image first, followed by multi-frame in same series.  Or, all view types, single image, then all view types tomo.  There isn’t an obvious other place to put such information.
  2. Storage of set-aside/remember view – like #1 more or less, but also includes some extra information on what is currently in view, and what GSPS is applied.
  3. XDS.i synchronization – like to query FHIR to XDS.I without needing any new framework (yes, this is ugly as sin, but it is still useful)
  4. Communication of measurements AS measurements from imaging application to reporting application – where only the measurement information is of interest, and the reporting application isn’t actually showing the image, but needs to ensure exact copying of the measurement.  This requires adding some sort of communication of measurement values AS measurement, not as “GSPS”.  My suggestion is include an AIM/TID.1500 section at the series or instance level.
  5. FHIRCast – communication of what is currently displayed in given viewports – where we only care about series/instance/frame information that is actually displayed right at the moment (so really a manifest of ONLY what is visible, nothing else.  It is complete for that purpose)
  6. Storage of what to display initially – the problem with XDS.I display is that there is no organization in the manifest.  So, if you have a multi-echo MR, all in one series, it doesn’t tell you anything.  I’d really like something in the manifest that says “display this stuff first, and in this order.”  Make that available on the XDS.I side as well so that you DON’T have to load every single instance before you can start displaying, and you still don’t need to worry about the order of the instances.
  7. Storage of what images were used for generating a report.  So, if the study gets more images after the report is generated, it is obvious exactly what images are new, and it is easy to review just the new stuff.  This might reference some series as only for 3d reconstruction (eg thin slice data), which requires slightly more sophisticated references.  This could be done with KO, but it isn’t QUITE key objects, but rather used/viewed/handled images.
  8. FHIRCast – communication of what key image is currently interesting for a report generation.  Note that this is subtly different from storing the key image itself, it is more about the fact that RIGHT NOW this key object got generated and it is what the author of the report is using for the report.  It is also probably a dynamic representation, and at the time the author says yes, store this report, then the actual key object gets generated. 


  1. Indication of complete, partial or delta  (complete means full reference, partial means reference to everything currently of interest, delta means that it only adds to the previous (if any) manifest)
  2. Indication of suitability for display (suitable means that the images can be displayed in order, and if you don’t have enough space, then display the first ones first, or perhaps the marked instances first)
  3. For series, indication that this is a repeat, and a title for the repeat and the reason for this repeat
  4. For series and image level, the annotation relevant to this level (either as GSPS link or as AIM data, or perhaps both)
  5. The purpose of the manifest – with some standard values such as “regrouping”, “xds”, “fhircast”, “set aside” – not sure what all here.

Action Items:

  • Organize the connecthaton tracker item for 2020 May.
  • Target for the connecthaton in May 2020.
  • Send an email to WG-20 II to see how much interest in it within a group.

New Business

Next Meetings


  • Monday, October 7, 2019, 9:00-10:00 US ET, FHIRcast.
    • STU1 Publication Request Review
  • Monday, October 28, 2019, 9:00-10:00 US ET, FHIRcast.
    • STU2 Notice of Intent to Ballot Preparation
  • Friday, November 15, 2019, 9:00-10:30 US ET, WG-20 II
  • Monday, December 16, 2019, 10:00-11:30 US ET, WG-20 II
  • Thursday, January 9, 2020, 10:00-11:30 US ET, WG-20 II

Dial-in information:

Future Meetings of HL7


  • February 1-7, 2020, Sydney, Australia, International Conference & WGM

Secretary note: WG-20 II will not have an official meeting in Sydney.

  • May 16-22, 2020, San Antonio, TX, WGM
  • September 19-25, 2020, Baltimore, MD, 34th Annual Plenary & WGM

Adjournment The meeting was adjourned on Thursday, September 19, 2019, 12:00 p.m. local time.



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