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OO Main - Meeting Information

Meeting Details

Date: February 9, 2023

Time: 1 - 2PM ET


Meeting Status

Chair:  Hans Buitendijk

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 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




Rob HausamHausam Consulting
JD Nolen
Hans BuitendijkOracle
Andrea PitkusUW
Marti VelezisSonrisa / FDA
Jose Costa Teixeira
Kathy WalshLabcorp
Lorraine ConstableConstable Consulting Inc
Elliot Silver
Christopher Harrison
Nancy SpectorAMA
Sandy JonesCDC
Alex Goel
David Barwin

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

    • 2023-02-02+Main 
      • Next week

OO Project Proposal Triage

  • No new Proposals or PSSs to review (reviewed 2/7/2023)

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

      • Awaiting confirmation if this needs to go through full PSS review or just to TSC
      • Anne indicated that TSC is going to vote without consensus review as steps were not clear and don't want to hold this up.

    • Publication Request 

    • VisionPrescription Ownership
      • Motion to agree to take ownership of resource.  Lorraine Constable, Jose Costa Teixeira.
        • Will work on this as soon as we can, but no expectations on Feb 24 deadlines to clarify boundaries with Device/DeviceDefinition
        • Against: 0; Abstain - 0; In Favor: 13

    • Withdrawal Requests for CPM CMET, MFRI, and Abstract Transport (whichever OO owns).
      • Will proceed to submit unless a ballot comment is still there that requires OO discussion.
    • Room requests and WGM+
      • Start to think about WGM+ quarter allocations.  We don't believe so far we can cancel any quarters.
      • Otherwise requests for May to go in tomorrow.

V2 Projects/Feedback (Updates in BOLD)



UP-44 -no value set content defined for v2 table 963 value set

  • We had discussed and taken a vote on this back on 2022-06-10, but I'm not sure at this point if that is still what we actually still will want to do.  If we discuss it again together hopefully we can decide if that is what we want or we can figure out a good alternative plan.

2/9 Note: Rob indicated this could wait.

------February 9, 2023----Jump to FHIR below (please)-------


  • 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 R5 Ballot Ticket Backlog

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

Request to pull FHIR-38976 - gatewayDevice description missing  - to be discussed at the HCP meeting on 2/13/2023.










Considered - Question answered

Why having an Instant data type for Observation.effective[x], when a DateTime is allowed as well?

Ana Kostadinovska




Not Persuasive with Modification

gatewayDevice description missing

Bas van den Heuvel




Not Persuasive

Purpose of facilityType and practiceSetting.

Bas van den Heuvel




Persuasive with Modification

Media allowed for searchable references to bodyparts, DocumentReference does not

Bas van den Heuvel




Persuasive with Modification

Include boundaries and relationship information from Media resource

Bas van den Heuvel




Considered for Future Use

Inconsistent representation of negation across resources

Marti Velezis

Motion to accept the JIRAs as proposed minus the one pull. 

  • JD Nolen, Marti Velezis.
  • In Favor: 12; Against: 0; Abstain: 1

R5 Ballot JIRA Tickets

  • Observation
    • Comment:
      • FHIR-38956 - Unclear statement
        • Hans to work on potential clarifying language.
    • Change Requests
      • FHIR-38976 -gatewayDevice description missing
        • The proposed disposition was not accepted - need to pull 2/9 for discussion, but can we determine a response to comments
      • FHIR-39113 - relatedArtifact Extension should be allowed on Observation.component
        • Still not resolved by the responses in comments
        • Motion to find Persuasive
          • Rob Hausam / Jose Costa Teixeira : 12-0-1
          • Assigned to Rob Hausam
      • FHIR-38971 - observation-precondition should be a modifier extension
        • Explanation added by Rob
        • Reassigned to FHIR-I
  • InventoryItem
    • FHIR-39161 -Product resource for inventory, catalog, supply
    • Can this be linked to the InventoryItem resource draft
      • Motion to find Persuasive with Modification 
        • Jose Costa Teixeira / Marti Velezis : 13-0-0
        • Assigned to Jose Costa Teixeira
  • Nutrition
    • FHIR-33400 - How to store a nutrition administration?
      • The examples are about "feeding" which should be the Procedure.code
        • Note that "enteral feeding" and "bottle feeding" which is coded under "384760004 | Feeding and dietary regime (regime/therapy) |" under the SNOMED CT Procedure codes
      • Should this be dispositioned as "Not persuasive"  The request for routes of administration should be 417985001 | Enteral route (qualifier value) | or 26643006 | Oral route (qualifier value) |, which are included in the 284009009 (Route of administration values) and are about "administration" that are handled by other resources - e.g., Observation.
      • Motion to find Not Persuasive
        • Marti Velezis / Jose Costa Teixeira : 11-0-0
        • No changes required at this time.

---------------------------Adjourned at 4:05PM EDT--------------------------------------

  • 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!!!!
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
    • Pending IG updates and Publication Request

  • 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