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  • Joginder Madra (Chair)

  • Craig Newman (Scribe)

  • Maria Michaels
  • Stuart Weinberg
  • Nathan Bunker
  • Cindy
  • Kathleen Figetakis
  • Janet Hui
  • Danny Wise
  • Jo Wenderoth
  • Eric Larson
  • Shu McGarvey
  • Isaac Vetter
  • David DeRoode
  • Sarah Gaunt
  • Daryl Chertcoff
  • Danny Wise
  • Chris Schuler
  • Lura Daussat
  • Rita Altamore
  • Crystal Snare
  • Charles Lamb
  • Maiko Minami


  • Welcome, agenda review, meeting minute approval
  • National Health Care Surveys - STU comment block vote (Sarah Gaunt) - 10 mins
  • Update on Immunization CDS FHIR IG project (Nathan Bunker) - 20 mins
  • Representation of Clinical Practice Guideline Recommendations in FHIR (CPG-on-FHIR) IG (Maria Michaels/Chris Schuler) - 10 min
  • Possible update on CDS projects of interest - 15 mins

Discussion items

5 min

Welcome, agenda review, meeting minute approval

  • Motion to approve minutes from last week (Craig Newman/Sarah Gaunt) 18-0-1
  • ONC and CMS proposed rules expected to be released next Monday with comments due May 3 (probably)
    • HL7 PAC group will be collecting comments from work groups (due early April)
    • A topic has added to the March 21 PH call to collect comments
  • Reminder that projects going to ballot in Sept 2019 must have their PSSs TSC approved by April 7
10 min BFDR comments Sarah
  •  Comment 27
    • The fetal death paper form includes "unknown" as a value along with Male and Female
    • The birth paper form includes an additional value of "not yet determined"
      • SMEs feel that unknown is not appropriate for "not yet determined"
    • The PHINVADS value set doesn't include "not yet determined"
      • A new code will likely be required
    • The Vocab WG has kicked off a Gender Harmony project to tackle some of these problems
      • Shu and Sarah will bring this to their attention
  • Another block vote will be coming out soon for consideration next week
20 minImmunization CDS FHIR IGNathan
  • Review of a project that has previously gone to ballot but is being actively worked on again
  • The project is for a new FHIR IG which creates an operation to send an immunization history to an immunization CDS engine and receive back a set of recommendations for the patient
  • Recommendations for immunizations are complex and fall largely into two categories
    • Standard age based recommendations for children and adolescents
      • Well supported by the immunization community in the US
    • Risk based (special conditions) recommendations
      • Requires much more detailed knowledge about the patient
  • CDS Hooks was explored as a potential method for an exchange like this but CDS Hooks supports EHR workflow needs and not so much the Immunization Information System (IIS) workflow with the CDS engine
    • The CDS engine output is relatively raw and not ready for end user presentation (as CDS Hooks does)
  • The project was originally balloted in Jan 2018
    • Received 44 comments back
    • The project team will be coming back to the WG with dispositions so that they can be cleared up before going back to ballot
  • Going forward, the goal is to reballot in September 2019 with a similar scope with the aim of including special conditions in a future version of the IG
    • Will try and use R4 if the tooling is amenable to this
    • Changes to the resources are not currently planned but may be necessary if testing indicates holes in the resources
  • CDS for Immunizations Update 2019-02-28.pptx
10 minCPG-on-FHIR IGMaria/Chris
  • About a year ago, the CDC drew together folks to discuss why it takes so long to get knowledge into clinical guidelines
  • Need a way to represent clinical guidelines in FHIR
  • The PSS is sponsored by CDS with Patient Care and CQI co-sponsoring
  • The project uses Opioid prescribing support guidelines as a use case
  • Public Health will not be a co-sponsor on this project but will keep an eye out for an upcoming ballot
  • Contact Maria Michaels ( if you'd like to participate in the project
5 minCDS ProjectsCraig
  • No other projects were mentioned
  • We will follow up with the CDS WG to talk about the existing gForge ticket (likely on a CDS call) and report back to the PH WG on a future call
5 mingForge #19810Danny
  • See email from Danny on the PH list serv on 2/28 (3:45 PM Eastern)
  • There is a proposal to update the US Core R4 profile to sync the vaccine code set with the VSAC value set
    • The VSAC value set seems to point back to the CDC web site for CVX
  • However, most immunization exchange in the US is via v2 message, not CDA
    • The v2 table also points back to the same CDC site
  • Functionally, there is probably very little difference if US Core syncs with CDA rather than v2
  • There is jurisdictional variation in which CVX codes are supported (not all jurisdictions support CVX codes for immune globulins and other product types in CVX)
  • US Core should also support sending of NDCs