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Chair:  Joginder Madra

Scribe: Craig Newman 





Alaina Gregory CDC
Alean Kirnak SW Partners
Ben Levy Lyniate
Chrissy Miner CDC/NCIRD/ISD
Cindy Bush CDC
Craig Newman Altarum
Danny Wise Allscripts
Dave deRoode Lantana Consulting Group
Devann Kirkpatrick TN Dept of Health
Eric Larson AIRA
Eric Schuh DXC
Janet Hui HLN Consulting LLC
Jim Huberty DXC
Joginder Madra Madra Consulting Inc.
Kevin Snow Envision
Laura Conn CDC
Laura Rappleye Altarum
Mari Hilleman DXC
Mead Walker MWC
Melanie Epstein-Corbin California Department of Public Health
Mike Berry HLN
Mike Suralik HLN
Mike Yaskanin Altarum
Nathan Bunker American Immunization Registry Association
Nosipho Beaufort Public Health Informatics Institute
Robert Worden Charteris
Sarah Gaunt Lantana Consulting Group

Minutes Approved as Presented 

This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."

Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

ManagementAgenda Review and Minutes Approval
  • No changes to the agenda
  • Motion to approve last week's minutes (Craig Newman/Danny Wise 19-0-1)
MethodologyPandemic preparedness (Robert Worden)
  • What can HL7 as an organization do to help the pandemic response?
  • Can we utilize FHIR to help public health and providers?
  • We first need to know what public health and providers need world wide
  • Can we put out proposals and get community feedback?
  • There is an existing HL7 FHIR Zulip thread on the topic
  • Alberta has a real-time lab result processing system which uses v2 messaging
  • We need to be cognizant about not adding to the work load of people currently working on this
  • Possible ideas 
    • We might be able to start by cataloging the standards that are available to meet existing use cases
    • Could we help distribute covid-19 related code sets?
    • Query if we can assist vendors with implementing standards (or better understanding them)
  • Please reach out to Robert if you have thoughts
MethodologyPotential updates to V2.8.2 Immunization IG (Alean Kirnak)
  • Continuation of the discussions at the Sydney WGM
  • The v2.8.2 IG doesn't reference IHE profiles for PIX/PDQ which were part of an appendix in Release 1.5 of the v2.5.1 IG that preceded it
    • The San Diego registry has implemented these profiles but most others may not
  • The v2.8.2 IG also does not include the immunization-less VXU message (replaced by a specific ADT profile)
    • The Envision IIS is capable of accepting these types of message
    • We could clarify that other ADT message/trigger types that could also be used by trading partners who would apply the same constraints as defined in the ADT profile
  • The two step query was not included in the 2015 EHR certification required due to the scope of the regulations
    • Could involve demographics queries versus identifier queries
      • Demographics query does not include the patient ID (but the identifier query does)
  • Different systems within a single submitter may be generating demographics messages and immunization event messages
  • The CAIR registry will be updating their demographics exchanges
  • See below for links to IHE profiles mentioned
MethodologyNewly-published rulings from CMS and ONC (Danny Wise)
  • Final rules were published on 3/9/2020
  • Total of over 1700 pages
  • There are several good fact sheets for both rules

  • HL7 has requested any feedback from workgroups on the final rules (due 3/19/2020)
  • Please let the co-chairs know if you have any feedback
  • The ONC rule contains 109 mentions of the words "public health", some of the more interesting references are given below and people should review these as part of their reading of the final rules
    • p108 - electronic case reporting revised with the adoption of USCDI
    • p317 - The expectation is that a Public Health agency could be a communicator as discussed in the Communications section, as well, reports to Public Health shouldn't be restricted in any way
    • p493 - public health Promoting Interoperability requirements will be part of the Real World Testing requirement for certification
    • p502 - Public health should be engaged in real world testing
    • p595 - community based organizations are generally not considered "health care providers" which would fall into the information blocking rules. It's not clear if PH would be included (see p593)
    • p609 - Public Health exemption as a Health IT developer
    • p623 - HIE/HIN definition (and lack of exemption for Public Health)
    • p847 - statement that law trumps personal preference for privacy (ie, not reporting)
  • The CMS rule has several components including:
    • ADT notifications
    • Reporting of providers/hospitals engaged in information blocking
    • Patient access APIs for certain payers
    • Provider directory APIs
    • Payer-to-Payer APIs for certain payers
    • Improved benefits for dual eligible members
 Adjourned at 5PM Eastern

Supporting Documents

Supporting Document  starting Page 33 Patient Identifier Cross-Referencing (PIX).    

  • Note Figure 5-1:  the “Patient Identity Feed” is the ADT
  • Note Figure 5-1.1:  transactions Patient Identity Feed ITI-8 and Patient Identity Management ITI-30 describe the ADTs. 
  • ITI-30 in particular is relevant to immunization registries and other pediatric databases
  • Note references to Pediatric Demographic Option starting Page 36 Patient Identity Feed ITI-8.

  • Note top of Page 37 Section 3.8.2.  Note the reference to Document Registry.  This is a clue that XDS also uses Patient Identity Feed.  XDS registries/repositories are commonly found in Health Information Exchanges (HIEs), enterprise systems, and elsewhere.    
  • Note Figure 3-8.1 indicates the ADT trigger events used by ITI-8.  These include A01, A04, A05, A08 and A40.
  • Note references to Pediatric Demographic Option.  starting Page 12 Patient Identity Management ITI-30.

  • Note and Page 13 setting forth inclusion of ADT trigger events A28, A31 and A47.   
  • Additionally, implementers of the “merge” option must include A40 (merge two patients); implementers of the “link/unlink” option must include A24 (link) and A37 (unlink). Note the concept of “option” in the IHE framework.  Connectathons typically offer separate tests for the base profile and for the addition of the option.  This allows systems that don’t implement (in this case) merges and/or link/unlinks to pass on the base profile, while systems that do implement them can pass on those options.   The 2.8.2 IG might mirror this approach by setting these trigger events forth as options.
  • Also note that “merge” has no inverse operation.    This derives from the HL7 base standard.  There is no such thing as an “unmerge”. 
  • Note describes the additional requirements of  Pediatric Demographic Option.
  • Note Figure 3.30-3.  Pediatric Demographic Option creates additional constraints on everything with “Note 1” as described in the footnote.