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Facilitator:

Austin Kreisler

Date:


Attendees:

(404) 452-4962

(865) 671-1624

3607919411

(917) 733-3735

(763) 732-8803 - UHG

(201) 963-0005

Lisa Nelson - LNelson@max.md

Natasha Kreisle - nkreisle@max.md

Didi Davis - ddavis@sequoiaproject.org

Paul Knapp - pknapp@pknapp.com

Crystal Snare (WA) - crystal.snare@doh.wa.gov

John - jdamore@diameterhealth.com

Natasha Kreisle - nkreisle@max.md

Andrew Statler - astatler@cerner.com Host

Stuart Ward - sward@max.md

Benjamin Flessner - benjamin@redoxengine.com Host

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

Linda Michaelsen (Optum) - linda.michaelsen@optum.com

Anne Smith - smith@ncqa.org

George Dixon - george.dixon@allscripts.com

Emma - emma.jones@allscripts.com

Peter Muir - peter.muir@esacinc.com


Agenda:

  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

    3. Consolidated CDA Ballot Comments
    4. Consolidated CDA STU 2019 Updates Lisa R. Nelson Brett Marquard
    5. C-CDA Companion Guide Reconciliation
    6. Other Project Updates
  5. Additional Items
    1. CDA Implementation Guide Quality Criteria Maintenance Draft for Comment Ballot Recon Block Vote 1 (Austin Kreisler)
    2. Review Brian's CDA Extension
    3. Final ODH Publication Package approval
      1. http://www.hl7.org/documentcenter/public/wg/structure/ODH%20SD%20Publication%20Package%206-18-2019.zip
    4. C-CDA Companion Guide Block Vote
    5. September WGM Agenda Review
  6. US Core FHIR Trackers (second hour)
    1. US Core Block Vote
  7. FHIR Tracker Items (if time is available)
    1. Composition confidentiality #17301
  8. Adjournment

Notes/Minutes

  1. Call to order
    1. Meeting called to order at  02:04 PM  CST
    2. Reviewed the agenda
    3. Tom had a question about whether we had plans to review ONC ISA?
      1. workgroups are supposed to get their comments. http://www.onc.gov/isa
  2. Business Updates (10 min)
    1. Additions/modifications to the agenda
    2. HL7
      • RIM Austin Kreisler
      • Steering Division / TSC Austin Kreisler
      • CDA-MG Lisa R. Nelson Brett Marquard
        • renewed the terms for several of the members
        • approved the creation of a new logo
        • Approved the CDAR2.1
      • Vocab Sheila Abner
        • No updates. Vocab call this afternoon.
        • SNOMED Codes for Primary Care Provider. There is a code for PCP. This needs a more detailed discussion with Vocab in the future.
          • Would need to be an agenda item for a Joint meeting with Vocab. Andrew Statler
        • The notion of PCP is with the function code. The taxonomy is where you find out the person's role. If we can clarify the role code to tell their role.
        • We will schedule a discussion around this.
      • Pub facilitator Alexander Henket
        • No updates
      • Electronic Services and Tools Andrew Statler
        • Publishing for V2 is starting to pilot under the FHIR publishing model. Would like to share tips with the CDA publishing projects.
        • Lisa asked that things that are published with the artifacts. Clear business requirements with the named thing that it was published from. Linkage from the tool and what it's called in the tool.
        • PSS Process Updates
        • Tooling Project is updated
        • Publishing always needs to include a pointer at least to the web page to the external terminologies and what is used.
          • Need to get some pre-cept work around this with SGB.
            • Andrew Statler provide information on what V2 is doing with FHIR publishing to CDA Management Group/SDWG
            • Andrew Statler  take tooling requirements back to EST
      • Patient Care Emma Jones 
        • No updates
      • Example Task Force Brett Marquard
        • Meeting - Issues for reconciling the Companion Guide.
  3. External Updates - ONC and others
    1. Lisa R. Nelson The Gravity Project. The use case project where interventions and assessments for people for that are not personal or legal taxonomy value sets and blend into the existing value sets. Try to combine in to the existing conversation around the PCP discussion. Year 1 is gaps and overlaps of the screening/diagnosis/goals/overlaps. Patient Care confluence site has the information. It's an accelerator group under Davinci now.
  4. Project Updates
    1. CDA R2.1 Project
      1. Approved by CDA Management group. Will wait for final approvals.
    2. Value Set Issues

      1. Don't have anything for this.
    3. Consolidated CDA Ballot Comments
      1. later.
    4. Consolidated CDA STU 2019 Updates Lisa R. Nelson Brett Marquard
      1. None.
    5. C-CDA Companion Guide Reconciliation
      1. None.
    6. Other Project Updates
      1. None.
  5. Additional Items
    1. CDA Implementation Guide Quality Criteria Maintenance Draft for Comment Ballot Recon Block Vote 1 (Austin Kreisler)
      1. TypeMotion
        Motion

        Motion to approve the block of comments as disposed for the CDA Implementation Guide Quality Criteria Maintenance Draft.

        By
        Second
        Date

         

        Ref #1,2,3,4,5,7,8,9,10,11,13,14,15,16,17,18,19,20,23,29,31,32,35,44,45,46,48,49,50,51,72,79,80,81,82
        For29
        Neg00
        Abs01
        Status

        MOTION CARRIES

        Tally29-0-1
        Discussion
    2. Review Brian's CDA Extension
      1. delayed
    3. Final ODH Publication Package approval
      1. http://www.hl7.org/documentcenter/public/wg/structure/ODH%20SD%20Publication%20Package%206-18-2019.zip
      2. This was an agenda item on an earlier call. It was rejected. It was revised. It is backed with corrections. 
      3. This has been out for committee review for an extended period of time.
      4. We will extend this for one more week. We will vote on this on mm-dd-yyyy
        • Gay Dolin committed to look at this. We would like others to commit to review the document as well.  
      5. There is a document on the CDA Management Workgroup for the quality criteria at C-CDA Implementation Guide Publication Checklist Review Process. This can be used as a guide to help in reviewing the material in the package.
    4. C-CDA Companion Guide Block Vote.
      1. TypeMotion
        Motion

        Motion to approve the block of comments as disposed for the C-CDA Companion Guide.

        By
        Second
        Date

         

        Ref #32,117,119,120,121,122,124,125,127,129,130,131,135,136,143,145,372
        For29
        Neg00
        Abs01
        Status

        MOTION CARRIES

        Tally29-0-1
        Discussion

        No requests to pull anything out of the block.

        No additional discussion

        FW: C-CDA R2.1 Companion Guide R2 ballot comment dispositions - 8/15/2019 Block Vote

      2. Comment 137 - Commenter asks for an example. Vital Signs Organizer and the Vital Signs Observation. There is an example in the document that includes a translation.
        1. Rob McClure In FHIR, the recommendation is to send multiple codes. FHIR specifies to use multiple codes. So important to exchange Vital Signs. If you want to exchange something other than Height, you send the expected code and then you send another code. If we do this with CDA, we should do this consistently.
          1. codeable concepts - multiple codings
          2. codings - single value
          3. translation - refinement
            • Lisa R. Nelson Will send a note to the C-CDA to FHIR mapping team on that. Will add a couple of human readable sentences to go with the example to explain the translation. The proposed disposition with the changes will go out with the block vote. That still has an action item.
      3. Provenance - The Companion Guide includes a Provenance template - Author Participation
        1. Used in the Header and other places - additional constraints. Complexities around things. SHALL have assignedAuthor - Author can be an org or a device. It asks for an example to cover this. If the org of the provider is unknown. The sender shall be recorded as the organization. These comments are challenging the template. The SHALL on the template. MAY on the Org. 
        2. Disposing of this as no action required. The template does support the author and device and it is allowed.
    5. September WGM Agenda Review
      1. Agenda is available now at September 2019 - Atlanta 
      2. Co-chairs need to enter their conflicts on the schedule for the September meetings
      3. Topics can be added to the page as well
  6. US Core FHIR Trackers (second hour)
    1. US Core Block Vote
      1. TypeMotion
        Motion

        Motion to approve the block of comments listed above.

        By
        Second
        Date

         

        Ref #
         US Core Block List
        1. 20901 Adopt restricted set of manifestations (Jay Lyle) Considered - No action required
        2. 20526 Need a unified code set%28s%29 to use in Encounters for encounters which are not covered by E%26M codes%2C like hospitalizations (Linda Michaelsen) Considered - Question Answered
        3. 20527 Inability to identify a principal procedure (Lisa Anderson) In Person Considered - Question Answered
        4. 21066 Directories of Published US Core Versions are not showing published version list (Linda Michaelsen) Considered - Question Answered
        5. 22124 General Device Profie (Hans Buitendijk) In Person Considered - Question Answered
        6. 22125 De-Identified Device Profile (Hans Buitendijk) In Person Considered - Question Answered
        7. 22621 US Core Synthea Examples (Jason Walonoski) Considered - Question Answered
        8. 22781 Strange to have repeated Coding with bound system on US Core extensions (Nick George) Considered - Question Answered
        9. 20571 Add a Coverage Profile to US Core to Support Interactions with Payers (Linda Michaelsen) Considered for Future Use
        10. 21302 update CCDS table to USCDI table in Guidance section (Eric Haas)
        11. 22753 Add language support guidance (Eric Haas)
        12. 21208 US Core Profiles - missing comma (Patty Craig) Persuasive
        13. 22275 remove comment about date based search from home page (Eric Haas) Persuasive
        14. 22276 update guidance on when source has no data (Eric Haas) Persuasive
        15. 22750 Remove extra patient search syntax from US Core (Eric Haas) Persuasive
        16. 22751 Add med list guidance and update MedRequest profile to support med list (Eric Haas) Persuasive
        17. 22754 Provide guidance on Search filters and hidden default values by EHRs (Eric Haas) Persuasive
        18. 22755 Add R2 to R4 conversion and guidance (Eric Haas) Persuasive
        19. 22756 Add SHALL support multipleOR on Statuses (Eric Haas) Persuasive
        20. 22771 Update Organization requirements to support more than just provider directory (Brett Marquard) Persuasive
        21. 22772 change careplan slice disciminator from pattern to slice for easier reading in diff (Eric Haas) Persuasive
        22. 22806 Update US Core DocumentReference.identifier to 0..%2A (Brett Marquard) Persuasive
        23. 22853 Add SNOMED back to Encounter Type Value Set (Brett Marquard) Persuasive
        24. 23006 Update Us Core Allergy Substance to match VSAC Definition (Brett Marquard) Persuasive
        25. 19796 Clarify that this US Core Device profile is actually %22US Core Implanted Device Profile%22 rather than a generic %22US Core Device%22... (Ioana Singureanu) In Person Persuasive with Mod
        26. 22488 review vocabulary to align with CCDA (Robert McClure) In Person Persuasive with Mod
        27. 22901 Update Device Intro and Examples per FDA (Terrie Reed) Persuasive with Mod
        28. 23041 us-core-practitionerrole%3A change cardinality of code %28role%29 from 0..1 to 1..%2A (Saul Kravitz) Persuasive with Mod
        29. 23053 US Core Procedure Code Value Set Description and Content Don%27t Match (Kensaku Kawamoto) Persuasive with Mod
        For26
        Neg00
        Abs01
        Status

        MOTION CARRIES

        Tally26-0-1
        Discussion
        1. 22124 & 22125 have been pulled.
        2. Any items to pull from this block
        3. Robert Hausam 22751 & 22772
        4. No further discussion
    2. 20616 - Pulse Oximetry
      1. TypeMotion
        Motion

        Motion to approve 20616 as dispensed.

        By
        Second
        Date

         

        Ref #20616
        For25
        Neg00
        Abs01
        Status

        MOTION CARRIES

        Tally25-0-1
        Discussion
        1. Pulse Oximetry - added to Vitals - Single recording of pulse oximetry
          1. In FHIR - You have the Oxygen Saturation where you send the code for 2708-6 and then send the more specific LOINC code for the Pulse Oximetry of 59408-5.
          2. Is it necessary to record the device? Is that Provenance? In observation, there is device. This is a bit off-topic for today, but that is a good question. It belongs with a link to the device. 
    3. 22751 Add med list guidance and update MedRequest profile to support med list (Eric Haas) Persuasive
        1. TypeMotion
          Motion

          Motion to approve 22751 as dispensed.

          By
          Second

          None

          Date

           

          Ref #22751
          For--
          Neg--
          Abs--
          Status

          MOTION FAILED TO REACH THE FLOOR

          Tally--
          Discussion
            1. Robert Hausam discomfort from med request and not from med statement.
              1. Eric Haas vendors are developing based on med request and not med statement.
            2. We don't have the follow-up on this issue.
              1. Lisa R. Nelson The work we've had on this in the C-CDA space makes it seem like this is a step backward.
            3. Seems like we should at least have a statement from pharmacy to say that is what they are doing. Would like Pharmacy state that it is appropriate. The accepted practice previously was to use the medication statement and not the medication request. We need to know the pharmacy has some degree of involvement in this decision.
              1. No second on this. The motion dies.
        2. TypeMotion
          Motion

          Motion to document in GForge the outcome of the conversation with Pharmacy prior to voting on this issue. If we've already discussed it with them, we don't have to discuss it with them any further.

          By
          Second

          Amendment 1 by Rob McClure

          Motion to have conversation with pharmacy needs to include a focused path forward where the approach that is currently being done in the field can be aligned with the desired outcome because that is what we want. goal to come up with a plan that aligns the way the current Argonaut approach with the desired outcome of Pharmacy's approach. We need a process to align these two things.
          Amendment 1 Status

          REJECTED by Robert Hausam

          Amendment 2 by Lisa R. Nelson

          Will document in the tracker on the discussions with Pharmacy and will involve Pharmacy in the wording of the documentation.
          Amendment 2 Status

          AMENDMENT APPROVED by Robert Hausam

          AMENDMENT APPROVED by Calvin E. Beebe

          Date

           

          Ref #22751
          For25
          Neg00
          Abs00
          Status

          MOTION CARRIES

          Tally25-0-0
          Discussion

          People will wonder why we are breaking backwards compatibility with Argonaut.

        3. Need to take ISA offline to try and have a special call to discuss the ISA information.
        4. There is a page out there for the September Atlanta Agenda.
    4. 22772 change careplan slice disciminator from pattern to slice for easier reading in diff (Eric Haas) Persuasive
      1. Sounds like a technical issue.
      2. Robert Hausam & Eric Haas will talk about this off line.
  7. FHIR Tracker Items (if time is available)
    1. Composition confidentiality #17301
      1. This was not prepared for today. Will move to future meeting.
  8. Adjournment
    1. Meeting was adjourned at 12:00pm EST