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Susan Langford - Susan_Langford@bcbst.com

Austin - austin.j.kreisler@leidos.com Host

Jeff - jbrown@j2interactive.com

brian - brianreinhold@lnihealth.com

Rob - rmcclure@mdpartners.com

Becky Gradl (Academy of Nutrition and Dietetics) - bgradl@eatright.org

David deRoode - david.deroode@lantanagroup.com

Thomson - tkuhn@acponline.org

Sean McIlvenna - sean.mcilvenna@lantanagroup.com Host

Brett - brett@waveoneassociates.com

Joe Quinn (Optum) - joseph.quinn@optum.com

Calvin - cbeebe@mayo.edu Host

Gay Dolin RN MSN - gdolin@imo-online.com Host

Andrew Statler - strucdoc-cc@lists.hl7.org Host

Rob - rrhausam@gmail.com

Martin - martin.rosner@philips.com

Michael Tyburski - michael.tyburski@ssa.gov

Rita - Rita.Altamore@doh.wa.gov

Emma - emma.jones@allscripts.com

Rachel Johnson - rjohnson@epic.com

Lisa Nelson - LNelson@max.md

George - george.dixon@allscripts.com

Benjamin Flessner - benjamin@redoxengine.com Host

Marti

Joe Quinn (Optum) - joseph.quinn@optum.com

Chris Kundra - ckundra@meditech.com

Matt S - mszczepa@epic.com

Andrew Statler - astatler@cerner.com Host

Lori - lfourquet@ehealthsign.com

Linda Michaelsen - linda.michaelsen@optum.com

Ioana - ioana@eversolve.com

Danielle Friend - dfriend@epic.com

Eric - ehaas@healthedatainc.com




Agenda

  1. Call to order
  2. Business Updates (10 min)
    1. Additions/modifications to the agenda
    2. HL7
      • RIM (AKreisler)
      • Steering Division / TSC (AKreisler)
        • Final Content Deadline – 3/24
        • Ballot Open – 3/29
        • Sept 2019 PSS TSC Approval Deadline – 4/7
      • CDA-MG (Lisa/Brett)
      • Vocab (RHausam)
      • Pub facilitator (AHenket)
      • Electronic Services and Tools (AStatler)
      • Patient Care (EmmaJ/LNelson)
      • Example Task Force (Brett)
  3. External Updates - ONC and others
    1. Discussion of Interim Rule comments from Structured Documents related to raw format messaging.
  4. Project Updates
    1. CDA R2.1 Project
    2. Value Set Issues (Next VSAC Release Package - June 2019/C-CDA value set review

      1. Operationalizing UTG capabilities
      2. Progress on shared ValueSets across Product Families
    3. Cross-WorkGroup CDA Template Review
    4. CDA IG Quality Criteria
  5. Additional Items
    1. Status on representing CDA templates using FHIR (Sean - 5 minutes)
    2. Review of HAI FHIR and CDA IGs for May ballot
      Sarah Gaunt or David DeRoode
    3. Review and approve PSS for C-CDAr2.1 web-publishing - Brett Marquard 
    4. FHIR Chat Discussion "FHIR Documents - mandatory referenced resources"
      See copy of discussion below.
  6. FHIR Tracker Items
  7. FHIR US Core Tracker Items Brett Marquard
    1. Block vote for items related 20025
    2. 19907 - Continue discussion/review from  - PractitionerRole
    3. Additional items
  8. C-CDA STU Comments Lisa R. Nelson
    1. 1752
    2. 1757
    3. 1758
    4. 1760
  9. Adjournment

FHIR Documents - mandatory referenced resources

Ken Sinn: https://www.hl7.org/fhir/stu3/documents.html
"Any resource referenced directly in the Composition SHALL be included in the bundle when the document is assembled."
Does this also apply to resource with logical identifiers, or does it only refer to literal references?

Specifically, if our Composition.subject (Patient) only contains Text and a Patient Identifier (but no Reference), do we still need to include the Patient resource in the bundle? (which is located on another FHIR server)

Lloyd McKenzie: Ick. There's no expectation to resolve references that don't have an actual URL reference. That said, not including the subject of the document in the document is going to break a lot of things - including the formal algorithm for rendering the document.

What use is a document that's patient-specific that can't be resolved to the patient?

Ken Sinn: They have enough information (the identifier) to be able to resolve it against a patient on another server, or on their own internal server/database. We could include a near-empty Patient resource with just an identifier, but is that particularly more helpful, other than syntactically helpful in not breaking any rendering tools?

Lloyd McKenzie: A document is expected to be consumeable "on its own". Not having the subject included means that the subject doesn't need to be known to consume and understand the document - from a computable or human-readable perspective. There certainly are documents where that would be true (e.g. a document describing a protocol). But I can't understand how a clinical document could be consumed by itself that wouldn't expose the name, gender, date of birth and other key information about the subject of all of the other information in the document.

Grahame Grieve: @Rick Geimer I think there's a SD aspect to this in regard to documents.

Rick Geimer: @Sean McIlvenna I think this would be a good topic for SDWG to discuss in May during our joint FHIR-I session. But I agree with Lloyd...ick. Personally I think that you should have a Patient resource, but it may only have Patient.text and Patient.identifier in it. But that's my 2 cents, would be good to hear from SDWG on this.

Notes/Minutes


  1. Call to order
  2. Business Updates (10 min)
    1. Additions/modifications to the agenda
    2. HL7
      • RIM (AKreisler) - Austin shared the RIM harmonization update, marital status was discussed. The next harmonization meeting will be in early July of this year.
      • Steering Division / TSC (AKreisler) Austin shared the deadlines for ballots
        • Final Content Deadline – 3/24
        • Ballot Open – 3/29
        • Sept 2019 PSS TSC Approval Deadline – 4/7
      • CDA-MG (Lisa/Brett) - Lisa provided an update.
      • Vocab (RHausam) - No additional updates
      • Pub facilitator (AHenket) - n/a
      • Electronic Services and Tools (AStatler) - Andrew the WG is working on a PSS for the tools catalog.
      • Patient Care (EmmaJ/LNelson) - Will be meeting on Monday for the C-CDA collaboration call. There is a miss match in care team value set used in different contents. Patient Care will be looking at it.
      • Example Task Force (Brett) - no meeting today, will be meeting next week.  
  3. External Updates - ONC and others
    1. Discussion of Interim Rule comments from Structured Documents related to raw format messaging.  - Calvin will bring back a comment that the SDWG might consider next week in response to the NPRM.
  4. Project Updates
    1. CDA R2.1 Project - nothing this week, we will be meeting next week.
    2. Value Set Issues (Next VSAC Release Package - June 2019 / C-CDA value set review - the annual update for the value set. This update covers STU comments up to 3/21/2018 ( 1 week ).   New comments would need to be dispose of the comments by March 31.

    3. Motion to accept new value set comments for the C-CDA R2.1 until March 31st for each year until we change it, so that the annual value set is produced for the C-CDA R2.1 IG.  Made by: Lisa, Second by Brett - Vote: Opposed: 0 Abstain: 0 For: 22 motion passes
    4. Lisa reviewed DSTU Comments listing and discussed how to identify value set changes that need to be managed. She shared a spreadsheet that she is using to track the nature of the changes that need to be made to manage the updates.  The proposal, is to produce a spreadsheet of the errata content addendum vs a new errata version of the C-CDA R2.1.  Rob suggested that there be an additional column added to the HL7 Download page, Lisa indicated that there is a change supporting a link.  Lisa also indicated that there are desire to support definitional via  intentional.  It was agreed that these come back to the SDWG for review and approval, prior to incorporation into the IG.  Austin suggested that we need to discuss these issues at the WGM.
      1. Operationalizing UTG capabilities
      2. Progress on shared ValueSets across Product Families    
    5. Cross-WorkGroup CDA Template Review
    6. CDA IG Quality Criteria - Austin indicated the ballot is getting ready to be released to the ballot package.
    7. Questionnaire Form updates - The extension included in the ballot was not RIM based and originally it was suggested moving the extensions from the IG.  After checking with implementations it was decided to withdraw from the IG from the ballot to work on it to do it right. 
    8. Motion to pull the Form Definition IG from the ballot - Made by Brain second Martin  Opposed: 0 Abstain: 0 For: 24 motion passes
  5. Additional Items
    1. Status on representing CDA templates using FHIR (Sean - 5 minutes)
      1. Sean has been working with Graham on the FHIR implementation guide that represents the CDA RIM model.
    2. Review of HAI FHIR and CDA IGs for May ballot
      Sarah Gaunt or David DeRoode     -  David review of HAI FHIR and CDA IGs for May ballot. They have made all the change for the ballot. The link is working for the FHIR site.  They are working to fix a couple of broken links.  They have 5 new questionnaires included.  It sounds like a fairly big STU update. The draft copy will be coming out from Sarah.  Looking to approve next week for ballot.
    3. Review and approve PSS for C-CDAr2.1 web-publishing - Brett Marquard - Brett reviewed the Scope of the document. 
    4. Brett motion to approve the "Consolidated CDA STU 2019 update".  Second by Lisa  - discussion about adding CDI clinical notes that in the scope.  The group discussed how to  advance the work.  Likely weekly calls.  Vote: Opposed: 0 Abstain: 2 For: 26 motion passed 
    5. Andrew will forward this to the US Realm and TSC for approvals.
    6. FHIR Chat Discussion "FHIR Documents - mandatory referenced resources"
      See copy of discussion below.
  6. FHIR Tracker Items
  7. FHIR US Core Tracker Items Brett Marquard
    1. Block vote for items related 20025  -
    2. 20029 -There was discussion about a request to reopen the item. Ioana identified a question about production identifiers not being must support. A note was added to clarify what was previously approved. 
    3. Motion to approve the block vote posted March 7th (20066 was pulled) By Brett  Second Lisa - Vote; Against: 0 Abstain: 0 For: 28 - Motion passes
    4. 19907 - Continue discussion/review from  - PractitionerRole - the group reviewed the use of _include, they are making it a SHOULD for now, to support Practitioner and Endpoint and remove the previous references.  See resolution on 19907                                   Motion to approve - Brett second Danielle - Against: 0 Abstain: 0 For: 25 motion passes
    5. 19939 -  Encounter Diagnosis reference to diagnosis vs Condition can create encounter diagnosis were discussed.  - This was discussed and there was no general agreement on how to manage.  This is not a required element in USCDI.
    6. 20125 - Ken requested a unique identifier for resources which could be used to disambiguate instances. Will work with commenter on adding identifiers for the benefit of reducing duplication of results on MedicationStatement and MedicationRequest.  This will only be a "SHOULD"  (potentially business identifiers).  Brett motioned to accept the resolution - Second Rob H.  Against: 0  Abstain: 0 For 23   motion passes
    7. 20123 - DocumentReference - search request to support context.period  - Brett asked if vendors support context.period. Will update documentReference.period to must Support.  This will be included in the block vote #6 for next week. 
  8. C-CDA STU Comments Lisa R. Nelson
    1. 1752
    2. 1757
    3. 1758
    4. 176
  9. Adjournment