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OO Main - Meeting Information

Meeting Details

Date: March 7, 2023

Time: 1 - 2PM ET


Meeting Status

Chair:  Ralf Herzog

Scribe: Riki Merrick

  • Quorum (Co-Chair + 4) Met 

OO Events 


OO Calls Next 7 Days (check if happening)

  • Clinical Order Workflow in FHIR
  • Catalog
  • LAB
  • FHIR Orders Exchange
  • v2-to-FHIR
  • Specimen
  • HCP
  • OO on FHIR
  • Cancer Pathology Reporting
  • IHE SDC/eCC on FHIR 
  • v2-to-FHIR
  • Main Call
  • Nutrition  -TBD

Upcoming Topics/Due Dates



April 8, 2023

September 2023 Ballot - TSC PSS Deadline

May 6, 2023 to May 7, 2023 -HL7 FHIR Connectathon
May 8, 2023 to May 12, 2023 May Working Group Meeting+
May 28, 2023January 2024 Ballot - PMO Deadline
June 25, 2023September 2023 Ballot -NIB Deadline




Ralf HerzogRoche
Rob HausamHausam Consulting
JD NolenMercy Children's Hospital
Riki MerrickVernetzt, LLC / APHL
Christoper HarrisonQuest Diagnostics
Karl NadenMitre
Andrea PitkusUW
Marti VelezisSonrisa / FDA
Dave Hill
Dan RutzEpic
Jose Costa Teixeira
Donna Pertel
Alex GoelCAP
Kathy WalshLabcorp
David Barwin
Elliot SilverResMed

Agenda and Notes:


Approve Minutes

    • 2023-01-16-20 WGM - will do after R5 is published

    • 2023-03-02 Main
      • Motion to approve as posted Marti, Riki, no further discussion, against:0, abstain: 1, in favor: 14

OO Project Proposal Triage

  • PSS-2171 - – Adverse Event Clinical Research Implementation Guide

  • PSS-2170 --School Based Physical Fitness Testing Domain Analysis Model

Other (Project Approvals, NIBs, Expiring standards, etc.)

PAC Submission

  • Request endorsement of the following submission to PAC for O&O attribution in the letter
    • Suggested Paragraph for inclusion in the HL7 response to the CMS-0057-p Advancing Interoperability and Improving Prior Authorization Processes proposed rule

      One of the significant issues identified by the HL7 balloting and review process for the Burden Reduction Implementation Guides is the need to make information regarding prior authorization (PA) and documentation supporting medical necessity assembled by the ordering provider available to the performing provider. This may either be documentation to enable the performing provider or supplier to submit a prior authorization if they are required to do so, or to inform the performing provider supplier that an authorization has been provided. CMS may wish to note that HL7 has approved extending an implementation guide focused on exchange of this information for Durable Medical Equipment (DME) and Home Health services, supported by CMS, to all exchanges of FHIR-based orders and the supporting documentation between an ordering and performing provider.   The updated IG is currently entitled FHIR Orders Exchange (FOE), and is intended to address a common approach across orders and referrals to external providers and suppliers.  It’s primary sponsor is the HL7 Orders and Observations WG  and the updates should be balloted in the HL7 September 2023 ballot cycle.  While this IG is not ready to be cited as recommended or required in the expected final rule, it may be appropriate to note its development in the preamble to encourage implementers to support a common method of exchanging PA information between an ordering and performing provider.

      We also note that enabling the performing provider or supplier to obtain additional information that may have been missing or not yet available on the initial order transaction, the Da Vinci CDex implementation would similarly be targeted to support request for further information form the ordering provider.

    • Motion to submit the updated text (removed extra space before "The updated", fixed typo "form ordering provider" to "From ordering provider" added "yet" in front of "ready to be cited: Riki, Rob, no further discussion, against:0, abstain: 4, in favor: 11

May 2023 WGM - OO, Joints and WGM+ Coordination - not discussed

  • 2/24 - Room Requests have been made - Need to check about 3 weeks out to cancel any rooms not needed.
  • OO WGM 202305 - Agenda
    • Updates to the agenda were posted (link above)
    • Need to follow-up with BR&R with a list of topics (Marti Velezis) and date/time  
  • WGM+ Schedule
    • Monday Q1 - SHALL not schedule WGM 
    • Tuesday Q1 - SHOULD not schedule WGM (ONC/USCDI, Argonaut, Gravity)
    • Rob Hausam (not available TH  Q1/Q2)


V2 Projects/Feedback (Updates in BOLD)

E-signature Update:

  • The e-signature draft was submitted to the PAC.  I did get a request from Christopher at Quest to quote a paragraph and am following up with PAC on when we are locked in enough to do so.


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.

Add 'GTIN' to HL70301 and HL70203

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 topicsb

  • Project Page Link: 
  • Meetings:

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

FHIR Projects/Feedback (Updates in BOLD)

R5 Wrap-Up

  • Update developmental roadmap in diagnostic module – must do by end of QA period
    • Create a confluence page.  JD to make the Jira for this change.
    • Rob will updated before the COW call tomorrow at 10 AM ET.
  • Review FMM levels, because all 0 will be removed by policy, unless we ask for an exception
    • ask FMG to permit to progress into the publication with an FMM0 to allow further development together with the other resources to which they are related.
      • DeviceDispense, missing resource proposal approval
      • InventoryReport
      • InventoryItem – has resource proposal conditionally approved to keep them at FMM0
    • BiologicallyDerivedProductDispense – has approved resource proposal – move up to FMM1
    • DeviceAssociation - has approved resource proposal – move up to FMM1
    • Motion to have the following FMM levels Ralf, Elliot, no further discussion against: 0, abstain; 1, in favor; 11
  • QA issues to deal with: 175
    • Reviewing the ones we agreed to make changes to – need a team call for Rob, Jose, Marti, JD – use the catalog call slot tomorrow for this work

Discussion Topics 

PACIO Question (20 min)

Discuss the use of the Observation.method field in the PACIO Personal Functioning and Engagement IG. We have a ticket (FHIR-38308) from our September ballot about using an approach like Gravity has for personal characteristic observations (e.g., race) within our IG that focuses on therapy-based observations in the post-acute care world. We have a proposal for how this would work on our PACIO IG that we’d like to get feedback on and also get your thoughts on a few edge cases.

  • FHIR-38308
    • Not sure this is an appropriate use of method
    • Should use performer for this instead
    • Method might be appropriate for the actual form used – specific
    • Should use provenance for that -that’s what that is designed
    • US core folks also pointed towards provenance for this use
      • Can indicate the role
    • Performer is the person responsible for the information
      • But this may be sometimes conflated with the person recording the information
      • If the physician asks the question – would that make the patient the performer?
        • You also need to capture who conducts the interview
      • The definition is about “responsible” – the clinician is responsible for recoding this information
      • How is the level of pain answer documented?
        • Assumption is the default is from the patient
      • Should we create a standard extension to the resource to record the source of answer?



Modules (Updates on any progress)

The following are draft pages to organize and author content for each of our health care product resources: 

  • JIRA issues (for discussion)
    • Diagnostic Report
      • FHIR-40540
        • Wait for the FHIR-39168 to determine if the items in this ticket were addressed before closing/retracting
        • Need to check status with Robert Hausam if it has been updated for R5 QA period
      • FHIR-19362 - Incorrect reference direction Procedure -> DiagnosticReport
        • What do we want to do with this — it was not included in R5
      • FHIR-40581 - Getting issue details... STATUS Updates to Developmental Roadmap in Diagnostics Module. 
    • Observation
    • JIRA Backlog Cleanup
      • Plan of attack to cleanup stale JIRAs.
      • Need to triage the older tickets to see if they are still relevant/valid (any volunteers???)
        • We may just want to create block votes for any tickets that are no longer relevant/valid
      • We have been getting 6-12 tickets per meeting if we have prepared the tickets in advance
      • We will continue to work through the backlog

FHIR Projects/Feedback (Updates in BOLD)

ProjectTopicsProject Information
FHIR Orders Exchange (DME/AcuteOrders) (Administrative)
  • Topics:
    • Referrals/PriorAuths/Orders/Claims
    • Focus on exchanges between Ordering Provider and Performing Provider
    • Overlaps with FHIR in the Lab/Workflow - establishing boundaries for each project
  • Project Page Link: 
  • Meetings:
    • Every Monday 12 - 1 PM ET
  • 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(Definition), 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
    • VisionPrescription resource ownership - need to update ownership
    • 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
(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