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Chair:  Erin Holt Coyne

Scribe: Craig Newman 





AbdulMalik Shakir Hi3 Solution
Alaina Gregory CDC
Cindy Bush CDC
Craig Newman Altarum
Crystal Snare Washington
Crystal Snare Washington Department of Health
Danny Wise Allscripts
Dave deRoode Lantana
Dave Trepanier ISDS
Emily Lamb ISDS
Erin Holt TN Dept of Health
Joginder Madra Madra Consulting Inc.
John Loonsk APHL
John Roberts TN Dept of Health
John Stamm Epic
Justine Maxwell Tennessee
Kathy Walsh Labcorp
Laura Conn CDC
Laura Rappleye Altarum
Loren Rodgers CDC
Lura Daussat PHII
Mead Walker Mead Walker Consulting
Michael Coletta CDC
Natalie Viator Collins Public Health Informatics Institute
Pat Quinlan Allscripts
Peter Hicks CDC
Rita Altamore Washington
Shandy Dearth ISDS
Shandy Dearth ISDS
Tony Steryermark Minnesota

Minutes Approved as Presented 


  1. Welcome, agenda review, meeting minute approval - 5 min
  2. VRDR FHIR IG ballot reconciliation (AMS) - 15 min
    1. Comment group 3: Date precision and unknown values
    2. Comment group 4: Injury place and injury location
    3. ballotcomments_FHIR_IG_VRDR_R1_D1_2019MAY (version 2).xls
  3. TEFCA comments (Craig) - 10 min
  4. eICR CDA IG Release 2 block I vote (John and Sarah) - 10 min 
  5. Syndromic IG, next steps - 10 mins

Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Management Minutes Approval
  • No changes to the agenda
  • Motion to approve minutes from 5/23 (Joginder Madra/AMS) 17-0-0
  • The publication request for the VR DAM has been sent in but negatives still need to be requested to be removed
MethodologyVRDR FHIR IG ballot reconciliation (AMS)
  • See supporting document spreadsheet for the proposed dispositions of specific comments
  • Block 3 - 127, 128, 129 and 130
    • Related to partial or unknown dates
      • NCHS allows partial or unknown dates
      • The comments are about how this will be represented in FHIR
        • FHIR allows partial dates
        • Where an unknown date/time is allowed as an observation value, a slide will be added which allows a null flavor of unknown
        • An extension will be created for InjuryIncident.effectiveDateTime
  • Block 4 - 3, 48, 46, 61, 47 and 165
    • Comments  regarding injury place and injury location
    • Request to make sure the difference between Injury Location and Place of Injury (as explained in the spreadsheet) is included in the IG (comment 47)
  • Motion to approve blocks 3 and 4 (AMS/John Roberts) 26-0-2
MethodologyTEFCA comments (Craig)
  • TEFCA comments are due to HL7's PAC by May 31
  • Agreed upon comments
    • The Public Health work group greatly appreciates the explicit inclusion of our community as a key stakeholder in and contributor to TEFCA.
    • The Public Health work group fully supports the inclusion of QHIN Message Delivery (push modality) as a core component of TEFCA . This modality is a key part of public health interoperability today and will be crucial to our success in TEFCA.
    • The Public Health work group has concerns about the concept of Meaningful Choice (defined as the individual’s choice with respect to the use or disclosure of EHI) as the issue of consent is high complex. Public Health reporting mandates, opt-in/opt-out provisions, age-based requirements for reporting, age-based consent for inclusion, automated vs. manual reporting, modified or rescinded consent over time all add complexity to a nation-wide approach to interoperability. Often, public health reporting is non-optional. TEFCA implementation should not preclude TEFCA participants from supporting statutory reporting. We feel these specific issues and others related to the intersection of law/policy and individual choice should be further articulated in the final TEFCA document.
    • The Public Health work group has some concerns regarding the provisions for Individual Access Services and whether a public health registry is required to respond to such a request if it is unable or unwilling to do so. Some public health laws and rules do not allow individuals to access their own data or restrict how access is obtained (Example: a state rule requires the patient to come in person with photo ID for identity proofing). We request that public health be provided a specific exemption from this requirement. A suggestion is to update 8.21 on page 67 to extend the exemption provided to federal agencies there to state and local agencies.
    • The Public Health work group is concerned about removal of language present in Draft 1 regarding fees applied to queries for public health purposes. It is not clear what the implication is if Public Health related queries are not exempted from fees. Does this mean that a Public Health entity may need to pay for access to data held by QHINs and their participants? Does this mean that a Public Health entity may charge users for access to data held by the entity? Given the critically important role Public Health data plays in maintaining healthy populations, we strongly advocate that TEFCA clearly state that Public Health entities may not be charged fees to access or receive data.
    • The FHIR Standards identified for "push messaging" in the future need to include "FHIR Messaging" (bundle and message header) if messages are to be routed though the QHIN
  • There is still some work to be done on a final comment relating to the need to preserve the option to use v2 where it is in general use today.
  • Motion to submit the 6 agreed upon comments on behalf of our WG (Craig Newman/Crystal Snare) 19-0-0
MethodologyeICR CDA IG Release 2 block I vote (John and Sarah)
  • 21 comments in Block 1
  • No requests to pull comments
  • The in person resolution comments have been signed off on
  • Motion to approve Block 1 (Laura Conn/Justine Maxwell) 26-0-1
MethodologySyndromic IG, next steps
  • The last block of comments was resolved last week
  • Next steps:
    • Post the ballot reconciliation spreadsheet
      • Ask for negative votes to be reconciled
    • Provide the WG with an updated version of the IG
      • Post the document on the members only site 
        • The updated IG should be ready next week
      • Notify the listserv once it's been posted
      • Give 1-2 weeks for review by the WG before coming back to the WG for approval to publish
    • There is a publication request form to fill out once it's WG approved
  • The project team will work with Craig to get these steps fulfilled
  • New folks are taking over the IG from ISDS
    • The ISDS agreement ends at the end of June
    • Loren Rodgers' (CDC) team will be taking over the work on the IG
Management Next agenda
 Adjourned at 5:07 PM Eastern

Supporting Documents

Action Items