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OO Main - Meeting Information

Meeting Details

Date:  April 27, 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 (FOE) (previously DME/Acute/Admin) - starting 30 min late every other week - next time 4/17
  • v2-to-FHIR
  • Specimen
  • HCP
  • OO on FHIR
  • Cancer Pathology Reporting
  • IHE SDC/eCC on FHIR 
  • Nutrition
  • v2-to-FHIR
  • Main Call
  • LIVD

Upcoming Topics/Due Dates - 



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


(Names of people present are BOLDED)



Ralf HerzogRoche
Rob HausamHausam Consulting
Hans BuitendijkOracle
Riki MerrickVernetzt, LLC / APHL
Yanick GaudetGlobal Star
JD NolenMercy Children's Hospital
Andrea PitkusUW
Marti VelezisSonrisa / FDA
Donna Pertel
Dan RutzEpic
Jose Costa Teixeira
Alex GoelCAP
Craig NewmanAltarum
Kathy WalshLabcorp
Lorraine ConstableConstable Consulting
Elliot SilverResMed
Alicia Francis
Scott FradkinFlexion

Agenda and Notes:


Approve Minutes

    • 2023-04-20 Main - Motion to approve minutes from last week – JD Nolen, Kathy Walsh, no further discussion, against:0, abstain: 0, in favor: 9

Key Topics for Today

  • WGM Agenda review - Meeting Rooms
  • FHIR JIRA Tickets (below)

OO Project Proposal Triage

  • No new proposals or PSS to review.  Checked on 4/27/2023.

Other (Project Approvals, NIBs, etc.) 

  • Expiration of standards:
    • HL7 Version 3 Standard: Clinical Statement Pattern, Release 1 - August 2024 - Re-affirmation or Withdrawal for May 2024 Ballot
  • Catalog Ballot Reconciliation (2020-Sept)
    • Where are we with validating that the meeting minutes can be applied to jiras and update those jiras – there is one row missing a disposition
      • We will handle this on the catalog call tomorrow along with any other outstanding jiras
  • ONC New Proposed Rule HTI-1 on Information blocking and increase USCDI to version 3
    • Laboratory RFI (LOI, LRI, FHIR COW/FOE, and could consider commenting on Catalog, LIVD efforts) - See pages 331 - 334

May 2023 WGM - OO, Joints and WGM+ Coordination

  • OO WGM 202305 - Agenda
    • Please indicate if you are attending = OO WGM 202305 - Attendance Log
    • Release of Rooms for Tues Q1 - Riki to let Mary Ann know
    • Wed Q4 will do Jira work with whoever is there - Hans chairing
    • BR&R meeting is now Tue Q4
    • Added some device jiras for Thu Q2
      • DEV understands that the FHIR-I input will be focused
        • discussion around what should be normative in R6 – should the more rigorous review, especially for structural changes (FMM levels changed by FMG vs the WG)
        • QA and jira
    • GS1 will participate on Fri Q1 – GTIN work
  • WGM+ Schedule (NEW LINK)
    • Monday Q1 - SHALL not schedule WGM 
    • Tuesday Q1 - SHOULD not schedule WGM (ONC/USCDI, Argonaut, Gravity)
    • Rob Hausam (not available TH  Q1/Q2)
    • WGM+ meeting has virtual option for all days
    • Combined meeting with Health BPM Wed + Thu, may run into Friday

E-Signature Update


  • Check back in June for progress



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 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.

Discussion this week:

  • The following value set should be used: - This binding was done in FHIR
  • Code system is pointing to NCBI Thesaurus
  • Used in DEV-14
  • Add to the HCP Call
  • Craig Newman: already references the FHIR value set for device safety
    • Need to determine if this is matching in Table 2C - make sure Michael Faughan is aware of this issue – he is working on syncing Chapter 2C content
    • and determine if it gets updated in the next release
    • For V2 we will use what is in the FHIR value set
    • Will need to figure out how to properly document the fact that the value set is drawn from 2 code systems 
  • Next THO deadline is June 4, 2023
  • Create a JIRA for v2
  • Leaving UP-44 open for now – so that the new tickets and this one can be linked

Add GTIN - v2 - to HL70301 and HL70203


Add "GTIN", "serialized GTIN" and other UDI Types to UniveralIDType ( to be able to specify that a Universal ID is of "GTIN" Universal ID Type.

This would help to apply to HD Data, EI Data, EIP Data, etc. the Universal ID Type "GTIN", examples are:

HD based Data (HD-2 (Universal ID) is of "GTIN" Universal ID Type:

  • MSH-3 (Sending Application), 
  • MSH-5 (Receiving Application), 

EI based Data (EI-3 (Universal ID) is of "GTIN" Universal ID Type:

  • SAC-3 (Container Identifier), 
  • SAC-4 (Primary (Parent) Container Identifier)
  • PRT-10 (Device ID)
  • PRT-16 (UDI Device Identifier)

EIP based Data (EIP-1-3 and EIP-2-3 (Universal ID) is of "GTIN" Universal ID Type:

  • SPM-2 (Specimen ID), 
  • SPM-3 (Specimen Parent IDs), etc.
    • Both of these are related to the work GS1 is currently discussing to maybe create a "serialized" GTIN for all containers which would be a worldwide unique code (would be default barcode on tubes, slides, tags etc.) 

CX datatype uses HL70203 for example in PID-3 (not applicable), but maybe in OBX-5.

V2-25519 - Getting issue details... STATUS  

Discussion today:

  • New jira is to track which agencies need to be considered
  • Also use in EI – for the serial number of the device ID
  • GS1 has other application identifiers – GTIN is only one of them, so may have to review these and then we could use the GD1 data matrix format for many different identifiers
    • 10, 11 17 and 21 already have other parts in the UDI carrier

V2-Jira Review (time permitting) 


Projects/Feedback (Updates in BOLD)


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

Discussion Topics: 



Block Vote of old Jira trackers set for next main call - see:

JIRA StatusJIRA IDDiscussion/Disposition

JIRA Issue Backlog

  • ServiceRequest.asNeeded[x] and ServiceRequest.reason
    • Follow-up on Zulip discussion

    • Updated the Proposed disposition
    • Add to the Thursday April 20, 2023 OO Main teleconference
    • 4/27 NOTES:
      • we need Rx input – Marti sent email, got some input on the jira, but not sufficient, so needs follow up

Total FHIR = 268 Tickets in Submitted, Triaged, Waiting For Input

  • FHIRCore = 228
  • FHIRCast=1
  • FHIRPath=11
  • FHIR IGs = 28
  • Should the extension be removed?
    • 4/27 NOTES:
    • Side-bar: There are also several extensions on other resources, for example for nutrition that we are not sure where the extensions came from
    • Related Jira referenced in comments = FHIR-29273
      • This jira mentions these artifacts
        • Blood Pressure Panel
        • Body Length
        • Body Weight
        • Head Occipital-Frontal Circumference by Tape Measure
      •  came from Rita Pyle
    • A component is different from a qualifier
      • It is not in the definition for component, but mentioned in text in we say “or may provide qualifying information to observation.code”
        • Can we find out how this text got added? – It is in R4, but not R3, so maybe we can find it
      • Is the bodyposition an observation that is part of the bloodpressure measurement procedure?
        • Diastolic pressure
        • Systolic pressure
        • Body position – this would have to apply to both of those measurement
      • The old jira came from Rita Pyle – let’s ask her to supply the list of qualifiers that are modeled differently – add comment to this Jira tagging her
      • Add Overall comment? We see a difference between qualifiers and components of an observation – let’s do some more research first


  • Add the ability to reference QuestionnaireResponse from DiagnosticReport
  • Pulled from Block for further Discussion by Dan Rutz 
    • Needs "a better evaluation of real examples of which workflow, procedures, and data structure truly invoke a DiagnosticReport which involves an embedded QuestionnaireResponse as part of the .result element.  It may be valid, but needs to be well-substantiated."


  • At-home Test - Deferred tickets that have been reopened.
  • This group is not meeting – how or when do these tickets get resolved?
  • Grouping the tickets with Observation.category changes
Catalog JIRAs
  • Reopened FHIR-28354 and added proposed disposition
  • Continuing to update the JIRA tickets and review the spreadsheet to determine if all of the changes applied
  • 4/27 Notes:
    • See above under Catalog ballot recon - will be worked on on tomorrow's catalog call
Other - Nutrition DAM
  • All have been applied and published since last week

JIRAs to Be Applied (FHIR Core)

JIRAs to Be Applied (IGs)

  • Status of tickets


Total To be Applied:
  • 41 FHIRCore
  • 115 IG related
JIRAS to be marked Published


Note - these are in the published R5 on

  • 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

Modules - Updates on progress


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

OO Resource Coverage

  • Need to discuss developmental roadmap for each of the OO resources for R6
  • Added R6 planning to WGM agenda
  • Need to discuss what needs to be done prior to WGM to prep for discussions
  • Add Resource reorg comments to module pages


  • Marti revised related resource for each topic area to where the resources align to current modules
  • Definitional resources were in workflow (pattern is still there) but those are now in administrative – Marti and Jose to take off-line

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 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

    • 2nd and 4th  Wednesday 2-3 ET (Restarts April 12, 2023)
(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


  • Andrea Pitkus 1:38 PM
    • Is this for any observation that can be supine, standing, sitting, etc? Or radial venipunctures vs other for blood gases
  • Andrea Pitkus 1:49 PM
    • What are the use cases that are in mind for this