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OO Main - Meeting Information

Meeting Details

Date: June 22, 2023

Time: 1 - 2PM ET


Meeting Status

Chair:  Hans Buitendijk

Scribe: Hans Buitendijk

  • 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 (DME/Acute/Admin) Pending Friday COW discussion
  • v2-to-FHIR
  • Specimen
  • HCP
  • OO on FHIR

  • Cancer Pathology Reporting
  • IHE SDC/eCC on FHIR 
  • Nutrition (June 28, 2023)
  • Ad Hoc: Observation Panels in FHIR 

  • v2-to-FHIR (on hold)
  • Main Call
  • LIVD

Upcoming Topics/Due Dates

June 25, 2023NIB Deadline


(Names of people present are BOLDED)



Ralf HerzogRoche
Rob HausamHausam Consulting
Hans BuitendijkOracle
Riki MerrickVernetzt, LLC / APHL
Yanick GaudetGlobal Star
Sarah GauntLantana
Andrea PitkusUW
Marti VelezisSonrisa / FDA
Jackie Hemenway
Dan RutzEpic
Jose Costa Teixeira
Olga Volk
Bob DieterleEnable Care
Kathy WalshLabcorp
Lorraine ConstableConstable Consulting
Elliot Silver
Alex GoelCAP
Christopher HarrisonQuest Diagnostics
Claude Nanjo
Kurt Allen
Donna Pertel
Craig NewmanAltarum

Agenda and Notes:


Approve Minutes

  • Topics for Today:

    • V2.9.1 related jiras:

        • Motion to mark the issue to be considered in the future. This ballot stated that only new content would be considered for ballot. Towards the goal of timely resolution of new content, we will not consider out of scope changes at this time. We appreciate the commenter's feedback and will look to incorporate it as time permits.
        • Craig Newman / Marti Velezis :
        • Against: 0; Abstain: 2; In Favor: 9

        • Motion to accept the correction to the grammar.  Craig Newman / Ralf Herzog
          • Against: 0; Abstain: 0; In Favor: 11
        • Motion to defer the following consideration:

          "Add this sentence to the existing definition:

          Implementation Guide authors SHALL clarify if the value of SPM-1 (Set ID – SPM) starts at ‘0' or '1’ and define if sequential increments reset within a message when a new group they are part of starts."
          Craig Newman / Ralf Herzog

          • Against: 0; Abstain: 0; In Favor: 11

        • We referred this to InM.
        • Comment submitted to the JIRA: "In OO meeting we discussed an alternative to create a new component to RFR that is properly named and that can be used as one shifts over to the new concepts.  If not chosen, then RFR.2 would have to be updated to clarify that CWE.3 (HL70001 vs. HL70828 being used) is essential to ensure it is correctly used for backwards compatibility.  While RFR is not used in OBX-7, content from OM2 6-8 and RFR could be used to populate that.  We are concerned with renaming RFR.2"
        • Craig will review with the project team.
    • Add micro discussion to one of the agendas for next week (Craig Newman) - was this already talked about this week?
      • Move to Friday Lab call.
    • Usage of Panel of Observation  –
      • Discussions on how to organize panels using DiagnosticReport and Observations, when to have an Observation and DiagnosticReport instance for the overall panel name, etc.
      • Key challenge is that it is unclear which nodes in the Panel structure should be captured in the 
      • There is not enough guidance in FHIR yet, in part that FHIR is not yet mature enough to settle this topic.
      • In HL7 v2 the challenge is less since the message is only used to convey the information one way and then is discarded, but with FHIR the resources "persist" for query purposes and then the panel node of interest may either be in DiagnosticReport and/or Observation.
      • Suggest to put into a connectathon assessing alternatives.
  • Not discussed 
    • Proposal for patient characteristics
      • Looking for resources to staff this work - update on next week's call
        • Rob McClure put out request - brought Lorraine and Kelly Davison together
        • Lorraine will help draft proposal
        • Will work on this over the summer
    • ADI/ServiceRequest vs. Consent Discussion
      • Need to find a time to discuss with the PACIO/ADI Team.
    • Follow up on whole report level normal / abnormal
      • From Elliot's email: Checking with some Radiology colleagues, they pointed me to the IHE Results Distribution profile: On a quick scan, I don’t see primary vs. incidental findings playing into their discussion, but I do see comments about the normality/abnormality of the report as a whole is the normality/abnormality of the most abnormal finding.
      • Does this need more discussion?
    • FHIR Core
      • DeviceMetricObservationProfile in FHIR Core?
      • ProfileForCatalog in FHIR Core?
    • UDI Cross-Paradigm IG v1 Expiration
      • Monday HCP if we don't get to it.
  • OO Project Proposal Triage

    • We promised to move other items up the agenda for this week. There is one new. Not sure where we want to put this.

E-Signature Update


  • Check back in June for progress



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

  • Leaving UP-44 open for now – so that the new tickets and this one can be linked

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 Status



JIRA Issue Backlog
  • 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
  • Total FHIR = 246 Tickets in Submitted, Triaged, Waiting For Input

    • FHIRCore = 219
    • FHIRCast=1
    • FHIRPath=11
    • FHIR IGs = 8

  • 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
  • Need to determine where to have this discussion – at least to propose dispositions for a block
  • Discussed at WGM – need to determine outstanding JIRAs

Catalog JIRAs
  • Made progress on QA of IG Changes
  • Ballot Reconciliation Spreadsheet is ready to go

Block Vote Pulled JIRA




Elliot Silver pulled FHIR-33042

Hans pulled FHIR-32154, FHIR-25552 

From May 25, 2023

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

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
    • See above for approved 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

    • meeting with CQI around changes to QI core profiles on June 28th call
  • Project page link: 
  • Meetings

    • 4th  Wednesday ONLY 2-3 ET
(FHIR in the Lab) Order Workflow project


  • Workflow 
Order Service Catalog
  • Topics
    • Preparing Publication request
    • Draft content has been sent out
  • Topics
    • LIVD IG - Ballot Reconciliation 
    • LRI/LOI
    • Lab related topics