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OO Main - Meeting Information

Meeting Details

Date: September 28, 2023

Time: 1 - 2PM ET


Meeting Status

Chair:  Hans Buitendijk

Scribe: Hans Buitendijk, Riki Merrick

  • Quorum (Co-Chair + 4) Met 

OO Events 


OO Calls Next 7 Days (check if happening)

  • Clinical Order Workflow (COW) in FHIR/FHIR Orders Exchange (FOE) (DME/Acute/Admin)
  • Catalog/OO on FHIR
  • LAB
  • 2-to-FHIR
  • Specimen
  • HCP
  • OO on FHIR

  • Cancer Pathology Reporting
  • Nutrition - 4th Wed

  • v2-to-FHIR
  • Main Call
  • 10/12 - LIVD (2-3)

Upcoming Topics/Due Dates

Sep 2023 Connectathon / Ballot / WGM
WGM Minutes postedSep 29, 2023
Other Deadlines

2024 Jan Connectathon and Ballot
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
2024 Jan Connectathon and Ballot




Ralf HerzogRoche
Rob HausamHausam Consulting
Hans BuitendijkOracle
JD NolenMercy Children's Hospital
Riki MerrickVernetzt, LLC / APHL
Yanick GaudetKLYG Solution / Star Global 
Declan KieranNHS England
Adam PageNHS England
Marti VelezisSonrisa / FDA
Craig Newman


Dan RutzEpic
Jose Costa Teixeira
Olga Volk
Bob DieterleEnable Care
Kathy WalshLabcorp
Lorraine ConstableConstable Consulting
Elliot SilverResMed
David Barwin
Donna Pertel
Michelle Ashafa
John Moehrke

Agenda and Notes:


Approve Minutes

OO Project Proposal Triage

  • None


  • COW IG Proposal
  • Anatomic Inventory and Person Characteristics Project PSS-2280
    • Have some input from Canadian Sex and Gender and some other interested parties
    • Target is May 2025 ballot
    • Needs a lot more work
    • Need more international participants
    • Need to find the correct link to Grahame’s starting material for organ inventory
  • v2-FHIR JIRA Question
    • IG build is getting better, but are now tackling observation jiras
      • Some have been decided, but need vote
      • Others need to be dispositioned
      • What time would be good to bring these to more folks outside of the V2-FHIR mapping call?
    • OO on FHIR call on Tuesday October 3, 2-3 PM ET
    • Hans to forward list of items to OO-Co-chairs and Craig
  • Panel Discussion Update
    • Background info
    • In Europe need to have a document approach for the overall report, using composition to organize the elements with one or more sections, so that the signature nature of the CDA can be retained
    • At WGM there seemed to be a strong leaning towards option B
    • In Europe they are currently use CDA for lab reports, which has the ability to sign the document, so in FHIR that is currently done as a FHIR composition
    • We could add an extension to DR for legal authenticator to represent the document in FHIR, which would make it more consistent to get the data across the same way
    • How to order DR sections – that would still be handled by pointing to composition to represent
    • FHIR document:
      • First resource is composition, bundle type = document all resources must be findable from the composition (which is backwards from how we want to reference from DR to composition to arrange the pieces – SD WG was ok with that, but Grahame does not consider just reverse linkages to
    • Option B is what the larger EHR-s vendors have
    • Using observation for grouping has been discussed for reflex testing
    • Original intent of DiagnosticReport is what the laboratory sends
    • Panel is an orderable test with many observations
      • Some of those observations can also be ordered separately
    • Can a panel be part of another panel?
      • OrderSets – that is for convenience of the physician
    • V2-FHIR mapping equivalent:
      • ORC to ServiceRequest and task
      • OBR to ServiceRequest (when in an order message) and DiagnosticReport (when in a result message), which would result in multiple DiagnosticReports in the FHIR translation
      • OBX to observation
      • Have more discussion around this in OO on FHIR calls
    • Seems we may end up with different solutions at a country level, which we should try to avoid
    • IPS is at a higher level
    • Next steps:
      • Put back on the agenda main call next week and have longer discussion on OO on FHIR in 2 weeks 10/10 2-3 PM ET
      • FHIR document representation clarification
      • Option A or Option B

Adjourned 2:02 PM ET

E-Signature Update

  • Yes
  • No

Any updates?


  • Yes
  • No

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) 

  • Yes
  • No

Projects/Feedback (Updates in BOLD)

  • Yes
  • No

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 Discussion Topics: 

  • Yes
  • No

Block Vote Pulled JIRA

JIRA Status



Block Vote Pulled JIRA

From June 2023



Hans pulled FHIR-32154FHIR-25552 

From May 25, 2023

JIRA Triage

JIRA Status



JIRA Issue Triage
  • 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 = 262Tickets in Submitted, Triaged, Waiting For Input (not ready to be applied)

    • FHIRCore = 226
    • FHIRCast=1
    • FHIRPath=11
    • FHIR IGs = 17

JIRAs to Be Applied (FHIR Core)

JIRAs to Be Applied (IGs)

  • Status of tickets

Total To be Applied:
  • 70 FHIRCore
  • 74 IG related
At Home testing

  • 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
JIRAS to be marked Published

Note - these are in the published R5 on

Modules - Updates on progress

  • Yes
  • No

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

  • BiologicallyDerivedProduct
  • Devices
    • some work by devices WG
    • do we need to differentiate lab devices (pre/post- analytical devices from analytical devices in the lab)?
    • Need to decide to what level of detail this page should go, or if we need this then how to document some of this content = may not belong here, but rather on the device related resource pages
  • Nutrition Product
  • VisionPrescription

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)

  • Yes
  • No
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

  • Project page link: 
  • Meetings

    • 4th  Wednesday ONLY 2-3 ET
  • Topics
    • LIVD IG - Ballot Reconciliation 
    • Next Call: Sep 26, 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