V2

------No V2 discussions today February 2, 2023----Jump to FHIR below--------

eSignature

• 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)

• V2 Dashboard 

Jira Review

• Today's Block Vote  - Time requested for today's call

T	Key	Status	Related Artifact(s)	Specification	Resolution	Summary	Reporter
	FHIR-39687	TRIAGED	DocumentReference	FHIR Core (FHIR)	Not Persuasive	Remove securityLabel in DocumentReference -- it duplicates the meta.security field	Daniel Tam
	FHIR-39624	TRIAGED	DocumentReference	FHIR Core (FHIR)	Persuasive	DocumentReference $generate output needs clarity	John Moehrke

• Motion to approve Block: Alex Goel / Jose Costa Teixeira : 14-0-0
• IHE SDC eCC on FHIR IG
  • Alex will send a review request of the updated IG to the WG (via the list serve)
  • Alex will prepare the H - Publication Request
  • FMG Checklist (e.g., no QA issues)
  • Add Agenda item to 2/9 Main Call for Publication comments and Request
• OO R5 Sep 2022 Ballot Dashboard
  • Next Block will be distributed today - for next week's Feb 9 Telecon
  • R5 Balot  JIRAs

    • Specimen

      • FHIR-39269 - Remove Specimen from Group member types

        • Bryn Rhodes would you like to chat about this on next week's OO Specimen call 2/6/2023 @ 2PM ET?  Need response from Bryn.

        • No response - move to Specimen 2/6
    • Nutrition Intake
      • FHIR-33400 - How to store a nutrition administration?
        • Move to Mon HCP call if we do not have anyone available for Nutrition
      • FHIR-32294 - Does NutritionIntake resource exist?
        • Move to Mon HCP call if we cannot take disposition this today – this issue has been applied 
    • Observation
      • Extensions
        • FHIR-39112 - Observation.component.value[x] should allow Reference as data type
          • Some use cases added in comments 
          • Do we have enough to move this forward 
          • Related to another ticket – already allowing on observation.value
          • Motion to accept persuasive Lorraine Constable / Yanick Gaudet : 13-0-0
        • FHIR-39113 - relatedArtifact Extension should be allowed on Observation.component
          • Some use cases added in comments 
          • Do we have enough to move this forward 
          • Discussion: this should be handled through DiagnosticReport and the new "supportingInfo" element for this information (eg., citations).  Adding it to Observation.component creates another way to provide this information
          • Non-persuasive at this time; unless there is a use case that is not satisfied by the suggestion to use DiagnosticReport.supportingInfo.
          • Note: the addition of Reference (FHIR-
          • Revisit at 2/9 Main call 
        • FHIR-38971 - observation-precondition should be a modifier extension
          
          • It was determined that a modifier is not applicable to this extension
          • Robert Hausam can you update this ticket with the explanation from FHIR-I/Clinicians on FHIR discussion?  
          • Will add to Block 2/9 if we get Rob to update the ticket by COB
        • FHIR-38924 -observation-replaces extension: expected behavior not clear
          • Disposition proposed – 
          • Motion to find not persuasive with Mod - Ralf Herzog / Yanick Gaudet : 13-0-0
        • FHIR-38976 - gatewayDevice extension (extension-observation-gatewaydevice.html) description missing
          • Weren't we supposed to remove this extension now that Device has an element to specify the gateway? See: http://build.fhir.org/device-definitions.html#Device.gateway
          • Remove the extension as it is now a circular reference with the addition Device.gateway
          • Added to the Block 2/9 - Proposed as Not Persuavive with modification

---------------Adjourned at 2:00PM ET---------

Move these tickets to calls on 2/3  

• • • • CR/Examples: 
        • FHIR-32947 - Example has old valuseset
      • Technical Corrections:
        • FHIR-38956 - Unclear statement
        • FHIR-38955 - A constraint expression is not specifically enough defined
          • Disposition proposed - in "waiting for input"  - should this go into the Feb9 Block Vote?

    • Observation Definition

      • FHIR-38953 - quantitativeDetails is not flexible enough, incomplete and overly complex

        • See comments with proposed disposition - we don't have response from commenter

• 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 https://chat.fhir.org/#narrow/stream/179256-Orders-and-Observation-WG/topic/AOEs.20in.20ServiceRequest.20and.20DiagnosticReport - 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
        • Waiting on example codes from John Moehrke (remove/unlink per request - see comments from OO call on 2/2/2023) Daniel Rutz 
      • 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 Procedure.report 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)
        • Procedure.report changes to 
      • Update from WORKFLOW call December2:
        • NEED TO ADD!!!!