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OO Main - Meeting Information

Meeting Details

Time: 1 - 2PM ET


Meeting Status

Chair: JD Nolen

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 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




1Ralf HerzogRoche
2Rob HausamHausam Consulting
3JD Nolen
4Sarah GauntLantana
5Andrea PitkusUW
6Marti VelezisSonrisa / FDA
7Jose Costa Teixeira
8Kathy WalshLabcorp
9Lorraine ConstableConstable Consulting Inc
10David Barwin
11Alex Goel
12Caitlin Kennedy
13Christopher Harrison
14Jackie HemenwayUPMC
15Maidul Islam
16Olga Vovk
17Yanick Gaudet

Agenda and Notes:


Approve Minutes

    • 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

    • 2023-01-26 OO - Main
      • Motion to approve Lorraine Constable/Ralf Herzog : 12-0-1

OO Project Proposal Triage

  • No new Proposals or PSSs to review (reviewed 2/1/2023)

Other (Project Approvals, NIBs, etc.)

    • 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 

        • Updates??  Lorraine Constable  will follow-up

        • Awaiting confirmation if this needs to go through full PSS review or just to TSC
    • Publication Request - Time requested for today's call

    • FHIR Resource Proposal - Time requested for today's call
      • InventoryItem FHIR Resource Proposal
      • Needs formal OO Approval to document on proposal
      • Resource proposal accepted for R5 STU publication as DRAFT only; DRAFT needs to be reviewed before the Resource Proposal is approved by FMG.
      • Jose reviewed the proposal
        • not for use with patient
        • Motion to accept with the following conditions:  
          • Conditions of WG Approval: this would be DRAFT only as there are still some concerns about various aspects of the scope and boundaries.
          • Jose Costa Teixeira / Lorraine Constable : 9 - 1 - 4

V2 Projects/Feedback (Updates in BOLD)


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


  • 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)

ProjectTopicsProject Information
  • Topics:
    • Need to add current topics
  • Project Page Link: 
  • Meetings
    • Every other Friday, 9-10am ET starting 10/1
  • Topics:

    • Need to add current topics

  • Project Page Link: 
  • Meetings:

    • Mondays 1 - 2 PM ET
    • Thursdays 11 - 12 AM EDT

FHIR Projects/Feedback (Updates in BOLD)

Jira Review

  • Today's Block Vote  - Time requested for today's call
TKeyStatusRelated Artifact(s)SpecificationResolutionSummaryReporter
Change Request
FHIR-39687TRIAGEDDocumentReferenceFHIR Core (FHIR)Not Persuasive

Remove securityLabel in DocumentReference -- it duplicates the field

Daniel Tam
Change Request
FHIR-39624TRIAGEDDocumentReferenceFHIR Core (FHIR)Persuasive

DocumentReference $generate output needs clarity

John Moehrke
  • Motion to approve Block: Alex Goel / Jose Costa Teixeira : 14-0-0
    • 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

      • Nutrition Intake
      • 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:
            • 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: 
        • 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 - 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 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!!!!
ProjectTopicsProject Information
DME/Acute Orders/Orders
  • Topics:
    • Expanding scope - see above
    • Overlaps with FHIR in the Lab/Workflow - establishing boundaries for each project

  • Project Page Link: 
  • Meetings:
    • Every Monday 12 - 1 PM ET - ON HOLD
  • Topics:

    • Need to add current topics

  • Project Page Link: 
  • Meetings:

    • Every Monday 2 - 3 PM ET
  • Topics
    • Device Associations
    • Intake/Administration/Procedure Consistencies
    • Device Structure
    • otherwise Jira tickets for Device(Defintiion), BDP, Nutrition
  • 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
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)
  • Topics
    • TBD

  • Project page: 
  • 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
  • Topics

    • Pending resources
    • Working on R5 ballot comments

  • Project page link: 
  • Meetings

    • Every other Wednesday 2-3 ET - ON HOLD
At-Home Test Reporting FHIR IG
  • Topics:
    • Working on publication (out for review)
(FHIR in the Lab) Order Workflow project


  • Workflow 
Order Service Catalog
  • Topics
    • Supply chain and Inventory
    • WHO - Product/Trade Item
  • Topics
    • LIVD IG - Ballot Reconciliation 
    • LRI/LOI
    • Lab related topics


  1. Please either clarify or remove me from an assignment on this page that I don't understand, was never assigned, and have no expertise in the topic. I presume there is a different John that you intended to get these results from.

    1. John Moehrke I removed the reference to your name for the topic of "supportingInfo in DiagnosticReport" - it was introduced a while ago. But we continue to copy over that outstanding set of JIRAs.