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OO Main - Meeting Information

Meeting Details

Time: 1 - 2PM ET


Meeting Status

Chair: Ralf Herzog

Scribe: Marti Velezis

  • Quorum (Co-Chair + 4) Met 

OO Events 


OO Calls Next 7 Days (check if happening)

  • At-Home Test Reporting on FHIR 
  • Order Workflow in FHIR
  • Catalog
  • LAB
  • v2-to-FHIR
  • Specimen
  • HCP
  • OO on FHIR
  • Cancer Pathology Reporting
  • IHE SDC/eCC on FHIR 
  • v2-to-FHIR
  • Main Call
  • Nutrition  -TBD
  • Orders (Acute/DME) - TBD

Upcoming Topics/Due Dates



February 2, 2023 WG Call
  • Block Vote - WGM 
February 5, 2023September 2023 Ballot - PMO Deadline
February 9, 2023 WG Call
  • Block Vote - Distributed Feb2
February 12,  2023Due Date for UTG Approvals (freeze on changes)
February 16, 2023 WG Call
  • Final R5 Ballot Reconciliation 
February 19, 2023May 2023 Ballot - NIB Deadline
February 23, 2023 WG Call
  • R5 Ballot Reconciliation complete?
February 24, 2023FHIR R5 Ballot Reconciliation and Revisions to the CI Build (i.e., FHIR R5 QA begins)
February 30, 2023 WG Call
March 6, 2023 WG Call
April 10, 2023

September 2023 Ballot - TSC PSS Deadline

May 28, 2023January 2024 Ballot - PMO Deadline




Ralf HerzogRoche
Rob HausamHausam Consulting
JD Nolen
Sarah GauntLantana
Andrea PitkusUW
Marti VelezisSonrisa / FDA
Dan RutzEpic
Jose Costa Teixeira
Kathy WalshLabcorp
Lorraine ConstableConstable Consulting Inc
Elliot Silver
David Barwin
Alex Goel
Frieda Hall: ) Retired 
Sandy Jones CDC

Agenda and Notes:


Project Announcements

  • At-home Test Report IG will be distributed for a publication QA today for a 1 week review by OO members. 
    • The group would like to submit it for publication next month.
    • Add to next week's teleconference for discussion/approval
  • January 27 OO Calls (Workflow, Catalog and OO) will be dedicated to outstanding R5 Ballot issues (see list below)

Approve Minutes

    • 2023-01-12 Main
      • Elliot Silver / JD Nolen : 11-0-2
    • 2023-01-16-20 WGM - give folks some time to still update and then review
      • Request for review of current minutes - and note any omissions
      • Approve at future meeting

OO Project Proposal Triage

      • PSS-2153 - Person-Centric FHIR-View
        • Issue with individual entity relationship 
        • Patient does not always fit the need (can the name of the resource be adjusted?)
        • From OO perspective, not clear what the actual need is for the project - i.e., what is/are the change(s) to FHIR?
        • Posted a comment on the JIRA (link)
        • Lorraine Constable / Elliot Silver : 13-0-0


    • Expiring Specs:
      • no STUs in the next 6 months
    • Post Acute/DME
      • PSS was sent to TSC, no word yet
      • PSS-2158 - Updated FHIR DME Orders Project 
        • Project Scope Statement - JIRA created and is in Draft mode (1/23/2023)



  • Decide in January if we want to use a PAC comment on this
    • Rule includes CDA Attachment of Lab Order with electronic signatures
    • Need to decide if we still want to submit comments
    • Need to follow up with Hans and Dan
    • (Note this is Frieda's last OO Main call)
  • PAC deadline??? Hans Buitendijk 
  • Comments due March 21, 2023

V2-Jira Review (time permitting)


Jira Review

  • OO R5 Sep 2022 Ballot Dashboard
    • R5 Ballot Reconciliation Status: 
      • Total Outstanding Ballot Comments: TBD
      • Number of JIRAs waiting Disposition:  (Note - minus the 9 JIRAs in Block Vote)
      • Number of JIRAs to Be Applied: TBD


    • OO-WGM-Block-R5 (link)  19 of 9 as at: 2023-01-20 08:04
    • Note - Elliot would like to discuss FHIR-40292 (pull request)




Related Artifact(s)





Change Request
FHIR-40292TRIAGEDObservationFHIR Core (FHIR)Persuasive

Add in valueReference(Any) to both Observation.value and Observation.component

John D.L. Nolen
Change Request
FHIR Core (FHIR)Persuasive

Add/change string resources in Observation and DiagnosticReport

John D.L. Nolen
Change Request
FHIR Core (FHIR)Persuasive with Modification

Consider whether to add intendedUse or instructionsForUse elements to Device, DeviceDefinition

Elliot Silver
Change Request
FHIR-39061TRIAGEDObservationFHIR Core (FHIR)Not Persuasive with Modification

Not all value[x] options are covered

Ana Kostadinovska
Change Request
FHIR-38985TRIAGEDObservationFHIR Core (FHIR)Considered for Future Use

What happens if the definition deviates from the Observation?

Ana Kostadinovska
Change Request
FHIR-38984TRIAGEDObservationFHIR Core (FHIR)Persuasive

Suggest to add text explaining relation to ObservationDefinition

Ana Kostadinovska
Change Request
FHIR-38780TRIAGEDTransportFHIR Core (FHIR)Persuasive

Fix reference in Transport.partOf

John D.L. Nolen
Change Request
FHIR-38732TRIAGEDSpecimenFHIR Core (FHIR)Persuasive

Guidance on Specimen Grouping

Alex Goel
Change Request
FHIR-32575TRIAGEDDiagnosticReportFHIR Core (FHIR)Persuasive with Modification

Procedure shouldn't be a subject

Lloyd McKenzie

    • Motion to accept block vote with 8 JIRAs 
      • Lorraine Constable / Elliot Silver : 10-0-2 
      • Marti will update votes on JIRA tickets after the call
    • FHIR-40292  - Discussed adding search parameters  
      • In addition to the requested change, add search parameters for the new elements
      • Motion to find persuasive with modification
        • Elliot Silver / JD Nolen : 12-0-1
        • Assigned to JD Nolen
  • WGM Follow-up R5 JIRA Tickets
    • FHIR-38971 - observation-precondition should be a modifier extension
      • Rob H. updated the ticket with comments from Clinician on FHIR/FHIR-I
    • FHIR-33389 -How to store parameters related to devices when executing a procedure? - see proposed disposition.  This was moved from a change on Procedure to a change on Observation.  Only text instructions on how to handle device settings.  All other changes were clarified on how to convey the requested information. 
      • Motion to accept disposition
        • Marti Velezis / Elliot Silver : 10 - 0 - 2
        • Discussion - what settings were on the device (e.g., during blood gas panels during lab draw) - there is nothing with this proposed disposition that would preclude it.  We can add more examples in the future; when is the device the subject of the observation vs. patient as the subject.  Elliot will add another JIRA ticket about this adjacent topic.
        • Assigned to: Jose Costa Teixeira
    • Add to outstanding R5 ticket below--did not discuss
      • FHIR-38986 - Why having an Instant data type for Observation.effective[x], when a DateTime is allowed as well?
      • Still need clarity on dateTime vs. Instant
      • Can we "Answer Question"?
    • Announcement: DeviceAssociation FHIR Resource Proposal was approved by the FMG on Wednesday, January 25, 2023.  This is in queue to be put into the CI Build.
  • New Resource Proposal
    • For Inventory - Catalog
      • Can the OO group entertain for the R5 build?
      • Pull the Inventory.item backbone into a Resource
      • Deadline passed, but we can still ask for it

---------------Adjourned the meeting at 2:05PM EDT----------------

  • Other R5 JIRA Tickets - needs disposition/review - next block??
    • DocumentReference
      • FHIR-38950 - Include boundaries and relationship information from Media resource
        • See comments - for proposed new text (from John Moehrke)
      • FHIR-38634 - Raise DocumentReference to FMM 4
        • See comments - wait for additional testing?
    • ObservationDefinition
      • FHIR-38953 - quantitativeDetails is not flexible enough, incomplete and overly complex
        • See comments - Partial proposed resolution
    • Observation
      • FHIR-38633 -Target Awareness Element or Extension
        • RE: Observation, Condition
      • FHIR-38924 - observation-replaces extension: expected behavior not clear
        • Needs disposition
      • FHIR-38955 A constraint expression is not specifically enough defined 
        • Needs disposition
      • FHIR-38956  Unclear statement
        • Needs disposition
    • Specimen
      • FHIR-38733 - Should Specimen.parent be changed to Specimen.children?
        • See comments - Partial proposed resolution
    • Device/DeviceDefinition/DeviceDispense
      • Any outstanding issues on Monday, January 30 will be added to the next block vote.
      • Continuing to address the groups of JIRA to make sure our changes are finalized for editor
  • R5 JIRA Tickets - Not owned by OO (but affects one or more OO Resources)
    • FHIR-38936 -Reference to Citation and Citation Lists from text
      • Requires further discussion in order suggest anything but extension
      • RE: DiagnosticReport
      • Owned by CDS
  • Backlog JIRA issues
    • FHIR-37964 AOE implementation in ServiceRequest
      • Proposed Motion to convert ServiceRequest.supportingInfo
        • to backbone for supportingInfo similar to DiagnosticReport, but with type attribute as 0..1, example binding to V2 Observation type
        • reference to any
        • discussion: will need to update to newer version of IG will have to review the updates to the underlying standard and how that will work
        • separate attribute (to be able to match 1:1 to DataInputObservationDefinition in catalog) or supportingInfo - discussion from Friday's calls (2022-08-19 Order Logical Model Application to FHIR and 2022-08-19 Lab)
          1. Option 1: Use the same structure but add an invariant to restrict the reference to Observation if type equals AOE and make the same invariant for supportingInfo in DiagnosticReport with an alias for AOE
          2. Option 2: Make another structure that only for AOEs (InputObservationResponse) with an alias for AOE and also add a similar structure to DiagnosticReport
        • Zullip chat - so far no answers
        • Also to be included in the discussion - supportingInfo in DiagnosticReport FHIR-36858 - Provide a mechanism to reference "prior studies" WAITING FOR INPUT
        • Some examples of AOEs:
          • Examples Last Menstrual period
          • Urine volume and duration of collection, etc. when used in the calculation of results being reported
          • Specimen source
            • Often included as AOE in the panel (may be important to have the clinical information) – but that does not need to be represented in the data exchange paradigm
            • How does this work with CLIA requirements – might restructure LIS
            • We need to support regulatory behavior in the standard to support the regulatory requirements, but not define the regulation
        • Out of the 3 options listed:
          • Hans did not like to add a new element specific for AOEs
        • We can currently do this with existing structure, but we would like to have a better way to provide guidance how specifically handle AOEs
          • If we use observation as the reference from supportingInfo – then we can still have “free text” in observation.value, but do we need to make an invariant for this to allow only observation as reference – could potentially also have questionnaire and questionarieResponse
      • FHIR-19362 -  Incorrect reference direction Procedure -> DiagnosticReport
        • FROM OO on FHIR call on November 8, 2022 added the disposition "Persuasive with Modification"
          • OO will add .partOf to DiagnosticReport and DocumentReference, per the Event pattern. 
          • OO will ask Structured Documents WG to also add .partOf to Composition, per the Event pattern.
          • OO will ask Patient Care WG to consider removing the 0..*    Reference(DiagnosticReport | DocumentReference | Composition) in light of the changes to the referenced resources
        • FROM Main call December 1, 2022: 
          • If change is made to Diagnostic Report – the other changes (to resources not owned by OO) would need to be changed
          • The change would be better now while Resources are not normative
          • IGs are affected (e.g., US Core - and specifically US Core Lab results)
          • changes to 
        • Update from WORKFLOW call December2:
          • NEED TO ADD!!!!

Projects/Feedback (Updates in BOLD)

    • Cancer Pathology Reporting 
      • Topics
        • IG has been reviewed and approved by FMG with the caveat that it not be published until the MedMorph Reference Architecture IG is published (checking on ETA)
      • Project page: Cancer ePathology Reporting
      • Meetings:
        • Every Wednesday 10 - 11 AM ET starting 10/12
    • IHE SDC/eCC on FHIR 
      • Topics
      • Meetings
        • Every Wednesday 2 -4 PM ET
        • Note that the call is listed on call calendar only as 1 hour call, since conference center won't let calls overlap
      • Project page: IHE SDC/eCC on FHIR
    • At-Home Test Reporting FHIR IG
    • OO on FHIR
      • Topics:
        • Treatment Orders discussion - see OO-on-FHIR Meeting minutes from 11/15
          • To standardize Portable Medical Orders/Advance Directives, etc.
          • Patient Care will evaluate ServiceRequest, Consent, CarePlan and follow-up with OO 
        • Looking at PC involvement so we can track down related people on observations – boundary between observation.subject and observation.relatedPerson - familyMemberHistory profile review, FM has similar conversations around subject and beneficiary
        • also should review at Gravity work around sexual orientation
        • Jira tickets work
      • Meetings:
        • Every Tuesday 2 -3 PM ET
    • (FHIR in the Lab) Order Workflow project
    • Nutrition

      • Topics:
        • see above
      • Meetings

        • Every other Wednesday 2-3 ET - ON HOLD
      • Project page link: Nutrition
    • Order Service Catalog

    • Specimen

    • DME

      • Topics:
        • Expanding scope - see above
      • Meetings:
        • Every Monday 12 - 1 PM ET
      • Project Page Link: DME Project
    • HCP

      • Topics:
        • Device Associations
        • Intake/Administration/Procedure Consistencies
        • Device Structure
        • otherwise Jira tickets for Device, deviceDefintion, BDP
      • Meeting: Every Monday 3 -4 PM ET
      • Project Page Link: Healthcare Product
    • Supply

    • V2+ 

      • Topics:

      • Meetings:
        • Every other Friday, 9-10am ET starting 10/1
        • Project Page Link: V2+
    • V2-FHIR