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OO Main - Meeting Information

Meeting Details

Date: July 20, 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)

  • Catalog
  • LAB
  • v2-to-FHIR
  • Specimen
  • HCP
  • OO on FHIR
  • Cancer Pathology Reporting
  • IHE SDC/eCC on FHIR 

  • Nutrition  - every 4th of Month
  • v2-to-FHIR
  • Main Call

  • LIVD

Reminder: LIVD call will be today July 20, 2023

Upcoming Topics/Due Dates

Sep 2023 Connectathon / Ballot / WGM
Ballot FHIR IG approval July 18 - July 27, 2023
Final ballot content deadlineJuly 30, 2023
WGM Agenda postedAug 11, 2023
WGM Minutes postedSep 29, 2023
Other Deadlines
TSC Representative ElectionJuly 31, 2023
2024 Jan Connectathon and Ballot
TSC Approved PSS deadlineAug 11, 2023
FHIR IG proposals to FMGOct 22, 2023
NIB deadlineNov 11, 2023
FHIR Connectathon Track Proposal dueNov 17, 2023
FHIR Core substantive Content freezeDec 5, 2023
Prior ballot recon dueDec 3, 2023
Ballot FHIR IG approval 
Final ballot content deadlineDec 17, 2023
WGM Agenda posted
WGM Minutes posted
DateUpcoming Agenda Topics
TBDNeed to check Block Vote readiness for June JIRA tickets


(Names of people present are BOLDED)



Ralf HerzogRoche
Rob HausamHausam Consulting
JD Nolen
Hans BuitendijkOracle
Riki MerrickVernetzt, LLC / APHL
Yanick GaudetStar Global 
Sarah GauntLantana
Andrea PitkusUW
Marti VelezisSonrisa / FDA
Jackie Hemenway
Dan RutzEpic
Jose Costa Teixeira
Christopher HarrisonQuest Diagnostics
Bob DieterleEnable Care
Kathy WalshLabcorp
Lorraine Constable
Elliot SilverResMed
Donna Pertel
Susan DownerJMC / APHL
Patrick Loyd
Matt Elrod
Dave HillMitre
Maria Moen

Agenda and Notes:


Approve Minutes

  • 2023-07-13 Main - Motion to accept as published.  Kathy Walsh, Yanick Gaudet

    • Against: 0; Abstain: 6; In Favor: 8


  • Co-chair elections
    • Currently in flight. 
    • All workgroup members (those on the can vote.
    • Please vote by July 31.
    • If you are a write in candidate, let us know so we can create awareness.
  • TSC Representatives
    • OO needs to vote on 2 of three candidates. 
    • One of them is Riki Merrick (well known to many).  Lloyd McKenzie and Gora Data are the others.
    • We will finalize who to vote for next week and submit.

OO Project Proposal Triage - Not discussed

  • PSS-2246 - Getting issue details... STATUS -HL7 Implementation Guide for CDA® Release 2: National Healthcare Safety Network (NHSN) Healthcare Associated Infection (HAI) Reports for Antimicrobial Use (AU) reporting from Long Term Care Facilities (HAI-AU-LTCF-CDA)

    • The only reason to be involved would be to review vocab for suggested data elements - Riki thInks we can pass on this one - but maybe bring up on call?!

Today's topics:


  • Goal is to identify the proper resources for patient preferences
  • Slides: 
  • There are three types of ADI
    • Type 1 - Patient authored ADI - what do they want for a future event.
    • Type 2 - Practitioner authored Encounter Centered Instruction - practitioner
    • Type 3 - Practitioner/Person for portable constables
  • Preferences are not just for end of life.  Need to align across align when using FHIR resources.
  • The IG is focused on the US (sponsored by CMS).  If it were international, there is a concern some may not fit with certain countries.
  • Slide 12 summarizes the direction that PACIO is heading for the publication.
  • There are concerns with just using FHIR Observation for the Type 1 ADI.
    • Observations are frequently used as an easy mechanism to put various information, but where there are other constructs available that fit better, that should not be done.  Observations are primarily around assertions about current things, although can cover past recollections.  Goals are available, so using Observations for what essentially are goals would be a concern.  Similarly for ServiceRequest and other requests.
    • Goals are indicated to not be feasible as FHIR US Core requires support for a start and target date.  That would require an exception.  That may actually not be that difficult to obtain and should not be considered a limitation.
    • ServiceRequest are a challenge as they seem to be focusing orderables, yet nothing is being ordered, as well as systems may get confused on what it represents.  However, a concern with that is that it mis-represents ServiceRequest and does not realize that it has the relevant context.  The ServiceRequest does not assume it will be done: it is a request, it may be denied.  A patient can be the author.  And in the context of a patient authored CarePlan it should be clear to any system that it is not a clinical order.
  • There is agreement that FHIR Consent is not appropriate beyond the limited use to affirm that another person can make decisions on behalf of the patient with a power of attorney (or similar documentation).
  • PACIO seeks further feedback by way of this Jira ticket ( FHIR-35078 ) or this Zulip chat as soon as possible.  They are not seeking an OO vote.
  • It was noted that USCDI v4 may include preferences if not ADI as a type of care plan.  If so, the topic would then be further discussed in FHIR US Core as to how to include it and a number of these topics would come up.

WGM Agenda

September Connectathon Participation


Discussed ProfileForCatalog on July 7th Catalog call and have the following recommendation

  • This profile is self contained - i.e., the sections (listing of healthcare items) are part of the profile 
  • The goal is to have a structured representation of the sections as in the Catalog IG
  • We recommend deprecating the ProfileForCatalog by R6 and add a pink ribbon comment on the ProfileForCatalog to inform implementers to move to the Catalog IG for guidance
  • Need review from more OO members to determine if this course of action is ok:
    • Marti Velezis to make a Jira to add the pink ribbon once the IG is published so we can directly link to the IG.
    • will bring back up when OO reviews the publication request - goal is July 27 main call

Update on FHIR Tracker related to family attributes

  • Created matrix - see: 2023-07-18 OO on FHIR 
  • discussion is generating additional Jira tickets
  • will continue next week on OO on FHIR call July 24, 2023 2-3 PM ET
  • will bring recommendations from these calls to the main call when compiled

privacy/consent/workflow zulip topic in v2

Diagnostic Report and CLIA Zulip

Zulip chat:


Possible LRI Newborn Screening (NDBS) change request

  • Would like to discuss options for updating the LRI NBS grouping requirements - we will take up this topic on July 28th on the lab call 1 -2 PM
  • There are also some jiras for LOI and LRI NDBS Component we should look at at that time

Adjourned at 2:02 PM ET - below not discussed

FHIR jiras

Discussing the pulled items:

  • 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
  • Topics:

    • Need to add current topics

  • Project Page Link: 
  • Meetings:

    • Every Monday 2 - 3 PM ET
  • Topics
    • Device Association
    • Module for Device, BDP and Nutrition
    • Intake/Administration/Procedure Consistencies
    • otherwise Jira tickets for Device(Definition), BDP, Nutrition
  • Topics
    • 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
    • Publication Pending

  • 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

    • Next Call July 26, 2023
  • Project page link: 
  • Meetings

    • 4th  Wednesday ONLY 2-3 ET
  • Topics
    • LIVD IG - Ballot Reconciliation 
    • Next Call: July 20, 2023

(FHIR in the Lab) Order Workflow project is merged with: FHIR Orders Exchange (DME/AcuteOrders) (Administrative)


  • FHIR in the Lab/Workflow - establishing boundaries for each project
  • FOE
    • Referrals/PriorAuths/Orders/Claims
    • Focus on exchanges between Ordering Provider and Performing Provider

Order Service Catalog
  • Topics
    • Preparing Publication request
    • Draft content has been sent out
  • Topics
    • LRI/LOI
    • Lab related topics