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David deRoode -

Andrew Statler - Host

Austin - Host

Thomson -

Sheila Abner -

Becky Gradl (Academy of Nutrition and Dietetics) -

Michael -

Sean McIlvenna - Host

Calvin - Host

Lisa -

Benjamin Flessner - Host

Didi Davis -

Emma -

Rob -

Gay Dolin RN MSN - Host

Susan Langford -

Shelly Spiro -

Martin Rosner -

Serafina Versaggi -

Brett -

Matt -

George -

Becky Angeles -

Chris Kundra -

Martin -


Joe Lamy -

Chris Kundra -

Michelle -

Eric -

Linda Michaelsen -

Drew Torres -


  1. Call to order
  2. Business Updates (10 min)
    1. Additions/modifications to the agenda
    2. HL7
  3. External Updates - ONC and others
  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
  5. US Core Ballot Reconciliation Items (Brett Marquard)
  6. Additional Items
    1. NPRM SDWG Comments to contribute to HL7 Official Comments (Calvin E. Beebe)
    2. Occupational Data on Health (Andrew Statler)
    3. Companion Guide Updates (Lisa R. Nelson)
    4. Templates Merger
  7. FHIR Tracker Items
  8. Adjournment


  1. Call to order
    1. 10:04EST Meeting called to order
  2. Business Updates (10 min)
    1. Additions/modifications to the agenda
      1. Need to start thinking about topics for May WG meeting. Will discuss at end if time allows.
    2. HL7
  3. External Updates - ONC and others
    1. None
  4. Project Updates
    1. CDA R2.1 Project
      1. Calvin E. Beebe - meeting this week. Andy has not had a chance to do a build. May be deferred. Really need to get the necessary files. Last quality point need to get through. Meeting in two weeks.
    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

        1. Lisa R. Nelson Harvested all of the comments from the C-CDA and prioritized them and categorized them into 3 categories. Some that had disposition comment that the item had been addressed but were in a new status. Strategy for this week and next week were a big list on Patient Care and Attachments with list of High Priority with list of What to do. Discuss that list in Monday's meeting to see if working group agrees to bring that back to the SDWG or if quorum to vote on less visible ones and bring the rest back to this meeting next Thursday to get through the pile of changes for the June update. Have a collaborative and transparent thought process and Rob and Lisa will go through this.
        2. Rob McClure - there will still be a majority of Value Sets that we will not go through. They will appear
        3. Lisa R. Nelson - Making certain value sets from static to dynamic. There will be a minor handful by next week to have a small set of errata. The Problem Set Resolution that points to the same Value Set. They looked at the list posted and identified which Value Sets were static and could be changed to dynamic and they found some where they could look at the logic. They discovered a couple of spots highlighted.
        4. Rob McClure - ValueSets that were static
        5. Lisa R. Nelson - copy with some shaded in blue,
        6. Austin Kreisler - RIM Data Types, asking for them to be changed and that's something that would be problematic because those would need to be re-balloted.
        7. Rob McClure - We probably need to look at that because we've painted ourselves into a corner
        8. Calvin E. Beebe - would like to look at the use case
        9. Lisa R. Nelson - Lantana comment that was Persuasive with Mod; should that have not been Persuasive with Mod?
        10. Austin Kreisler - this would be a harmonization request to different version of the RIM.
        11. Austin Kreisler - put it in a disposition status that it is out of scope for us.
        12. Calvin E. Beebe - needs to move forward through other groups.
        13. Austin Kreisler - need to re-ballot for release 1
        14. Rob McClure - give up on this and move to FHIR maybe
        15. Lisa R. Nelson - will put this out and can talk about Monday.
        16. Rob McClure - worried about this being a topic on Monday.
        17. Lisa R. Nelson - will bring this back next Thursday.
    3. Cross-WorkGroup CDA Template Review
      1. Discussing Allergies
  5. Additional Items
    1. NPRM SDWG Comments to contribute to HL7 Official Comments (Calvin E. Beebe)
      1. Calvin E. Beebe - small group that was meeting to deal with these comments. Last meeting was Tuesday or Wednesday. We could spend a few minutes going through those. The due date on these is Wednesday of next week. Calvin is offering these up to the committee. We could hold a meeting next Wednesday.
      2. Calvin E. Beebe displayed the notes from the NPRM
        1. Emma Jones - functional reconciliation vs. technical reconciliation. This doesn't necessarily meet the needs of functional reconciliation. The performer may overwrite the author. If the provider makes the diagnosis and the nurse enters the information, making sure the nurse does not get captured as the author of the diagnosis.
        2. Lisa R. Nelson - does it make sense to capture the concept of informers and others. Just author is too low. If you are just using author, it might not be sufficient. If the person typing it in. The person who made the diagnosis.
        3. Calvin E. Beebe - The documents are not being thrown away. We are holding the documents for all their original data. As you reconcile, it 
        4. Matthew Rahn - Asked about the April 3 deadline.
        5. Calvin E. Beebe - Clarified it is due April 3. That is an HL7 deadline so we can reconcile all the comments. We will have a follow-up e-mail.
    2. Occupational Data on Health (Andrew Statler)
      1. Andrew Statler brought up that the ODH publication had been brought to the SDWG WGM in January 2019 for review. The group reviewed and sent to CDAMG, but the package was incomplete and it was sent back to SDWG. The question is what the appropriate course of action should be since it not a publication that SDWG is the primary for.
      2. Austin Kreisler indicated that the group that is primary needs to take the action and that we should contact them and let them know that they have additional steps they need to take as the primary.
      3. Andrew Statler will reach out to Lori Fourquet to address the additional discrepancies with their publication and follow-up with the SDWG co-chairs via e-mail.  
    3. Companion Guide Updates (Lisa R. Nelson)
      1. Brett Marquard - Release 2.2 - RFP went out. If all goes well and new Companion Guide. NPRM. Reference to the Companion Guide. Also referenced the 2015 Edition. Don't have great guidance for the Care Team. We would remove references to the 2015 Edition and add the Care Team into the back.
      2. Austin Kreisler - An update into the September ballot is a done deal.
      3. Calvin E. Beebe - Vendors liked best practices separate. They easily become shalls.
      4. Lisa R. Nelson - What we heard yesterday was similar.
      5. Austin Kreisler - Would suggest switching it to STU
      6. Austin Kreisler - Informative would require ? or a ballot
      7. Lisa R. Nelson - a lot of this work would go into R2.2. This would be a way to reference the Companion Guide.
      8. Emma Jones - really important that we keep Best Practices separate from the rule
      9. Lisa R. Nelson - isn't that a separate layer? ONC companion guide?
      10. Emma Jones - make sure we clearly define it.
      11. Brett Marquard - the Companion Guide is trying to offer guidance to the regulation. This is what the rule said.
      12. Calvin E. Beebe - not sure if its possible, but if we can identify what will be in the guide and let people react to it, that may help.
      13. Calvin E. Beebe - there is some best practice that just needs to be best practice.
      14. Brett Marquard - Have a hard time finding the original project ID number
      15. Austin Kreisler - when he hands it off for the project...
      16. Brett Marquard - found the number
      17. Lisa R. Nelson - Concern that once the rule was finalized identifying what was possible. How can we create an update to the companion guide now against proposed rule-making.
      18. Austin Kreisler - may need multiple version.
      19. Matthew Rahn - may be good to make comments on the rule.
      20. Matthew Rahn - would be good to review the 2015 edition. If the Care Team gets added, that's fine. Once the rule is finalized, there may be another companion guide.
      21. Austin Kreisler - One bit of follow-up to whether we can switch tracks. Updates need to happen, so we need to figure out how to make that happen.
    4. Templates Merger
      1. Austin Kreisler - got an e-mail out to the Templates co-chairs and invited them to the Templates co-chairs to attend the SDWG co-chairs meeting and review the conditions of the merger.
  6. US Core Ballot Reconciliation Items (Brett Marquard)
    1. 12137 - motion to approve - Motion Brett, Lisa, abstain Michelle Miller/Sheila Abner/Linda Michaelson/Serafina Veragassi 21/0/4
    2. 19939 - Diagnosis and Encounter - Encounter schema does not include the diagnosis. remove the must Support so that encounter could be returned without the diagnosis.
      1. Proposal is to change the 
      2. Brett Marquard - the comment must support encounter linking to diagnosis. There are two ways. Vendors are going to do it different ways. Recommend we remove the Must Support. We add guidance as optional and indicate that systems may support one or both methods. That is Brett's proposal.
      3. Brett Marquard - is going to mark that as Persuasive as Mod.
      4. Eric Haas - reversing myself
      5. Brett Marquard - Add to Quick Start SHOULD searches 
      6. Eric Haas Makes a motion to approve. Brett Marquard Seconds. No further discussion. No opposition. 1 Abstention. Count 21-0-1. Motion carries
    3. 15944 - principal diagnosis - 
      1. Michelle Miller - proposal in the backlog to support that condition. Don't want to go to encounter to find some of those things. He wanted to move some of those things from Encounter
      2. There are multiple diagnosis
      3. * Condition.category - can be used to specify granular type code?

      4. * Add Encounter.diagnoses elements to Condition

      5. * Encounter.reason and Encounter.diagnosis

      6. Michelle Miller - Claims is a third place to go and get this information.
      7. Drew Torres - Epic and Cerner both philosophically agreed that it did not belong on the Encounter resource
      8. Brett Marquard - nobody is saying that encounter.diagnosis does not matter, we are just saying, "how do you get to it?"
      9. Lisa R. Nelson - how are all these systems handling it now?
      10. Drew Torres - it is easier to go get it based on the encounter document where you have contextual information vs standalone. Encounter diagnosis and encounter reason.
      11. Brett Marquard - going to suggest that this is non-persuasive when it is clear that diagnosis is going to be sent by FHIR core or QI core, this will be considered.
      12. Eric Haas - motion to approve. Drew Torres will second this. Any further discussion?
      13. Calvin E. Beebe - wonder if worth looking at the DaVinci work.
      14. They are working at payer to payer. payer to provider. This is definitely crossing into DaVinci work.
      15. Calvin E. Beebe - not sure that they are actually working on this.
      16. Brett Marquard - DaVinci - at a future time, they are encouraged to share their findings.
      17. Linda Michaelsen - May want to include CQI. They are going to have some end thoughts on it.
      18. Brett Marquard - We don't have a good answer because folks don't have good experience with it.
      19. Linda Michaelsen - Principal diagnosis would be hospital. Primary diagnosis would be more ambulatory.
      20. Yes - this is very confusing.
      21. Austin Kreisler - are we revising the motion?
      22. Brett Marquard - revised the motion
      23. Eric Haas - is happy with the revised motion. Drew Torres is happy. opposed - none. abstentions - none. 21 in favor. 21-0-0. Motion carries.
    4. 20527 - copy the same thing we just did? No, this is more complex. Will require additional discussion.
    5. Eric Haas added three trackers. These are things that we have existing profiles we support adding these things. These new trackers were added and will be considered next week for inclusion.
    6. Lisa R. Nelson - any guidance on how to represent the patient's direct address. 
  7. Companion Guide
    1. Austin Kreisler - Companion Guide was closed and archived. The scope was clearly around the 2015 rule.
    2. Brett Marquard Either way, we have to do a project. People are interested in seeing them as distinct. Structured Documents.
    3. Brett Marquard Keep it as it is. Motion to pre-approve a project scope statement: Approve a C-CDA Companion Guide based on the existing Companion Guide with a new Appendix.?
  8. FHIR Tracker Items
    1. No activity on this topic.
  9. Adjournment
    1. Adjourned 12:04PM EST