Monday Q3 Sept 2021 PHWG WGM Minutes

• recording in session  
• added discussion on reactions to plenary
• reviewed attendance documentation for the WGM

Agenda review and plans for the week

• 2021-09 WGM Agenda - Public Health - Confluence (hl7.org)
• Added SANER update for Wed Q2. They have some findings from the connectathon testing that they wish to share.
• Thursday Q2 and Q3 are still open
• Survey in Whoova to name the new PH FHIR accelerator
• Learning Health Systems Thurs Q4- Patient Centered Care Team project updates
• Let co-chairs know if you want to schedule something during an open quarter

ADE (Hyperglycemia) FHIR IG Update

• Working on the ADE Hypoglycemia FHIR IG
• Got Pub approval from PH a few weeks ago
• Going to FHIR Management group for approval and expect publishing in a few weeks
• Now working we on NHSN hyperglycemia
• Getting different data between hypo and hyper, like getting different lab results. Don’t know how much of a change it will actually be. Not sure if it will actually need to go to ballot in Jan.
• Need to keep a detailed list of changes so reviewers know where to focus their review.

• FHIR I is hosting a number of workgroups tomorrow during Q2.
• This is where we can get specific time to get our questions answered
• Will likely touch on the confluence page on publisher impacting change process, templates,
• Spirited discussion during Monday FMG session on this
• AMS-Would like a freeze on any changes on the publication tool 2 weeks out from ballot
• Pharm Q4 tomorrow- do we have specific topics?
• We don’t have any specific topics for this WGM and will cancel.

Thoughts on the Plenary Sessions

• Mention of wanting to keep PH IT leadership involved in discussion. Who is PH IT Leadership?
• Agency CIOs need to be engaged
• What people think the role of this workgroup is?
• PH accelerator- what’s the relationship with the PH workgroup?
• Anything needing to go through balloting should come through this workgroup. This could really impact our roadmap.
• ONC and CDC are co-leading the accelerator project
• Expecting it to be more Argonaut with a focus on implementation
• The existence of the accelerator may accelerate the PH Common library and move towards more reuse and less stove pipe.
• Concerns with state, locals, tribal, territorials needs not be represented in the design and development of data modernization strategy
• Need STLT engagement in FHIR accelerator, but also understand challenges with regards to ability and bandwidth
• Standardization and implementation strategies that lend to success
• PH landscape is very diverse and there is no one size fits all, and that diversity needs to be represented at the table
• The NVSS Modernization has been a great forum for this engagement and has been invaluable but how do we scale something like across public health
• As a workgroup, do we want to be actively reaching out to ONC to join a workgroup call to hear more about the Coordinator has in mind for PH?
• Relation to the accelerator project
• Broad public health strategy where the FHIR accelerator just one piece of that. Expecting to see more of that strategy rolled on in the coming weeks (Kathleen Kelly from ONC happy to Coordinate, Any questions from plenary can also to her as well).
• Thoughts on certification of PH systems?
• AIRA evaluation of capabilities of each jurisdictional IIS to really get at local implementation
• Erin from TN likes this idea. We attempted to do this with ELR but had very little uptake
• Certification of Commercial products and their adherence to the standards? Not quite sure that the public health would be quite the same. Would the PH vendors be certified and the PHAs would attest? Could be beneficial for PHAs in assessing vendor capabilities. We learned from EHR certification that not all certified EHRs are implemented as expected.
• Local variability is one of the biggest hurdles against low cost, fast interface configuration and development and implementation. TO minimize local variability to increase chances of plug and play. PH will need to be at the table.
• TEFCA- Anyone thinking actively about TEFCA?
• In LA, working with Local and State with regards to COVID tracking
• Since they are not a QHIN, how to they interface with whatever organization WILL be the designated QHIN.
• NVSS community of practice – some jurisdictions reported working with local/state HIEs. HIEs have the ability to streamline the data flow.
• Assumptions around availability of HIEs?
• Larger Public Health Data Model
• We know that there is some data sharing between PH programs, usually one off point to point integration
• CSTE is a good place to have this discussion
• A lot of program to program, categorical variation
• Is there an approach to engage those super groups to talk harmonization? To start this discussion.
• From an EHR vendor- it would be great to have 1 data model to facilitate a standardized communication. Need to keep in all those different interjurisdictional program needs, as well the jurisdictional to jurisdictional needs.
• Isn’t that what USCDI is trying to do?
• There are still different systems that are not accounted for, there are still separate reporting initiatives  
• USCDI at this point is an impressive bar for everyone to reach, but there is still a lot of key data elements that PH relies on that isn’t represented in USCDI. There needs to be a more direct mechanism to get PH needs represented into USCDI. Is it better for PH to develop a Public Health Data model and then make sure its represented in the data model? This is something as a community that PH should be asking of ONC- how to get the PH data needs better represented in USCDI.
• USCDI+ with a Public Health extension- not specifically mentioned in plenary. In the July guidance, they talked about the USCDI+ for public health. Though USCDI isn’t really a data model, rather just a list of data elements. We can ask about this on Friday during the FHIR accelerator quarter.
• Programs don’t always agree on the most basic data concepts and don’t share that type of information. Could we at the very least get to a baseline using USCDI?
• COPIED FROM CHAT- ONC: "However, we recognize that the USCDI’s focused scope and incremental expansion means that will not always be able to support the entirety of the data needs for a given use case (e.g., a research study, specialty care). Accordingly, ONC has started to explore approaches that can support partners who would like to use USCDI plus additional data elements to extend beyond the USCDI’s scope in way that makes it clear how such additional data complements and relates to the USCDI." Source: https://www.healthit.gov/sites/default/files/page/2021-07/Standards_Bulletin_2021-3.pdf
• Need clarification on this.
• If we have thoughts, and we want to consolidate them- how do we do that and who do we deliver them to?
• What’s the right forum for having this conversation?
• CSTE does have a forum to look at standardizing data elements (specifically around notification)
• CSTE Surveillance and Informatics Steering committee
• Need to not only engage CSTE Surveillance and Informatics, but also need to engage AIRA, Syndromic groups, NVSS/NAPHSIS, HL7… Can we work with ONC, CSTE, CDC to convene a high-level discussion?

Review STUs approaching expiration

• National Healthcare Surveys STU R2- Expiring 10/10/21
• moved on R3 to align with USCDI and deprecating some data elements to make R3 easier to implement. Got some R3 in testing, but no implementations of release 2 known. There is a ton of 1.2. Brian wants to heck with stakeholders to confirm having R2 expire.
• Ambulatory Healthcare provider Reporting to Birth Defects Registries- expiring 11/04/2021
• CDA uptake is limited. No FHIR solution yet.
• May ask for an extension but will depend on how discoverable expired STUs are. Will come back to the workgroup in the next month or so.
• National Healthcare Surveys STU R1.2 Expiring 12/31/21
• National Healthcare Surveys STU 3- Expiring 02/25/22
• ODH FHIR expires 01/10/2022- Need to reach out to Genny
• Case Reporting CDA R2 expires 01/29/22- skipping this version, will let expire
• Case reporting FHIR R1 expires 01/29/22- will likely be letting expire
• Bidirectional eReferrals expires 02/03/22
• Reportability Responses CDA expires 03/11/22

Update Project Roadmap with new projects

• Need to the VCI smartcard
• Hypo/hyper glycemic event
• Maternal and infant health
• Need to add the Registries IG CREDS
• VRDAM seems to be updated every year, currently working on R5 and expecting to work on R6. Seems to be in a continuous maintenance cycle. Do we really need new PSSs every time? Can we do something similar to what was done for the Imm FHIR Resource development and maintenance
• MedMorph is currently in development of 3 content IGs and intending to ballot in January 2022. Ballot recon is wrapping up on Reference Arch IG. All three content IGs were listed in the original PSS. We would need to include these 3 in our project road map.
• Will plan to update on Friday during admin wrap up

Review Mission and Charter