2019-02-28 Meeting notes

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
  • All dates are available on the HL7 calendar Confluence site

•  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

• 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

• About a year ago, the CDC drew together folks to discuss why it takes so long to get knowledge into clinical guidelines
  • https://www.cdc.gov/ddphss/clinical-guidelines/index.html
  • There are a lot of "translations" that currently happen before they can get into guidelines
  • One solution is to do some of this work in parallel
• Need a way to represent clinical guidelines in FHIR
• The PSS is sponsored by CDS with Patient Care and CQI co-sponsoring
  • ACG-IG-HL7 Project Scope Statement_2019-01.docx
  • Aiming for a ballot in Sept 2019
• 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 (maria.michaels-at-cdc.gov) if you'd like to participate in the project

• 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

• 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