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Facilitator:

Austin Kreisler

Date:


Call Details:


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Zoom Information

https://us02web.zoom.us/j/465862913?pwd=cUllR1BndVpYNVpyR3dzc3VIUERTZz09

Meeting ID: 465 862 913

Passcode: 310940

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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."

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Agenda:

10:00am EST

  1. Call to order 
    1. Call for Attendance


  2. Business Updates (10 min)
    1. Additions/modifications to the agenda
    2. Approve minutes from 2020-05-14 Agenda and Minutes and 2020-05-19 Agenda and Minutes Vocab/SD Joint Meeting

  1. HL7
  1. External Updates - ONC and others
  2. Project Updates
    1. Value Set Issues

      1. see 11:00am
    2. Provenance
    3. Other Project Updates
  3. Additional Items
    1. HAI - Ballot reconciliation - 15 min Sarah Gaunt
    2. SNODENT in C-CDA R2.1 Problem Observation - Russell Ott
    3. CDA Extensions Page Update - Andrew Statler
      1. CDA R2 Extensions
      2. CDA Extensions
      3. https://www.ihe.net/uploadedFiles/Documents/Pharmacy/IHE_Pharmacy_Suppl_PRE.pdf
  4. STU Comments
    1. 1922 - ConfidentialityCode - Null Values
      1. Submitted byNick Radov - required field with a ValueSet binding. Little reason to use NullFlavors
      2. Need to do some more checking on this one. Need to determine what the specific reason is we cannot have Null value. Is this a requirement of the rule somewhere? (Andrew StatlerIn a cursory scan, I did not find anything that covered the specific values for Confidentiality code in the final rule.)

11:00am EST

  1. Value Set Updates
  2. Value Set STU Comments
    1. #nnnn
  3. Adjournment

Notes/Minutes

10:00am EST

  1. Call to order 
    1. 10:05am - Meeting Called to order by Austin Kreisler
    2. Call for Attendance


      1. Welcome to new attendees


        1. Keith Carlson from ONC & Liam Davies from Epic 

    3. Business Updates (10 min)
      1. Additions/modifications to the agenda
      2. Approve minutes from 2020-05-14 Agenda and Minutes and 2020-05-19 Agenda and Minutes Vocab/SD Joint Meeting

        1. The minutes were Approved by general consensus.
  1. HL7
  1. External Updates - ONC and others
    1. 14 Cures updates - Tests - the one they won't have is the electronic prescribing which is V3. Electronic Rubric and the UI. Template you receive when you score a C-CDA. Will be released Wednesday Next week  
    2. Project Updates
      1. Value Set Issues

        1. see 11:00am
      2. Provenance
        1. Russ - going to the TSC for approval next week.
      3. Other Project Updates
    3. Additional Items
      1. HAI - Ballot reconciliation - 15 min Sarah Gaunt
        1. There is an issue in the HAI Normative guide. The issue is a technical issue that has been in the guide since it was published, but it does not appear that it has been implemented and therefore has not been discovered until recently. Now that the issue has been found as a technical issue on a Normative guide, this could force the guide back to ballot. We could push the Normative guide back to an STU status as we resolve the issue.
        2. Alternatively, the user could withdraw their current issue and then we will issue an errata.
          1. Matt Szczepankiewicz was the submitter of the issue and indicated on the call that he was amenable to withdrawing his concern in favor of the errata.
          2. With that, the workgroup decided to move forward with this solution.
      2. SNODENT in C-CDA R2.1 Problem Observation - Russell Ott
        1. Not much interoperability between dental systems. Trying to map between CPT and CDT is not very well mapped. Dental to Medical and Medical to Dental. They are going to want to use SNOMED. It this is going into most EMRs, it is likely going to want to be SNOMED for most use cases. The receiving EMR would have no knowledge of SNODENT. Are the codes the same? They are different identifiers. The code system is a different OID as well. It is a logical subset. It looks and functions like a different terminology. How many codes are there in SNODENT. There are about 8000 codes in SNODENT and they could be mapped (already done). Is that publishable? If anybody could pull this, could they reference that. Leave this template alone. Separately provide guidance. Leave SNODENT alone. Put the SNOMED in. Use the mapping that the ADA gave. Show the best practice and let them know that not everyone is there yet.
          1. The proposal is to put the SNOMED in the code and then put SNODENT as the translation.
      3. CDA Extensions Page Update - Andrew Statler
        1. CDA R2 Extensions
        2. CDA Extensions
        3. https://www.ihe.net/uploadedFiles/Documents/Pharmacy/IHE_Pharmacy_Suppl_PRE.pdf
        4. TypeMotion
          Motion

          Motion to split the page into two pages using the CDA R2 format

          By
          Second
          Date

           

          Ref #CDA R2 Extensions Page
          For21
          Neg00
          Abs01
          Status

          APPROVED

          Tally21-00-01 
          Discussion

          Emma Jonesdoes care. She uses the CDA Extensions version with developers and prefers simpler.

          Action

          Andrew Statlerwill split the pages and bring back next week for review.

    4. David Riddle 
      1. If we have any time left after we cover everything on today's agenda, I would like to revisit the question I raised on the 5/14 call about how to handle differences between C-CDA author cardinality and FHIR Resource attributes that author data should be mapped to. i.e., The question I posted on Zulip here: https://chat.fhir.org/#narrow/stream/179273-CCDA-.2F.20FHIR.20mapping.20stream
        1. In the real world there is only one author in the CDA. The CDA did have a sequence number that was left out. From a design perspective, did not give that option. The Sequence number attribute could be used to prioritize, but left them unprioritized. Anything we tell him is going to be arbitrary. CDA author to asserter. Try to use the Problem resource. In the Allscripts implementation. In Problem, they added an author performer. When they ask for a translation between the two. When they do that they have 1 asserter, but they can have multiple authors.
        2. A CDA Problem, the Performer becomes the Asserter, and then authors can be many. Specific authors for specific things. Author pointers. A specific author can be the author on a specific observation. The EHR can allow multiple users.
        3. David is looking for generic logic from CommonWell/CareQuality that is not source specific and convert it into a CDA attribute.
        4. When would we restrict an author? Recorded date, recorder. Asserter. 
        5. Pick the one with the most recent date is a possibility.
        6. If you don't want to lose data. Much of the work is about data mapping. if you have the ability to create extensions, then creating extensions.
        7. That still allows you to pick additional recorder and then you pick one.
    5. STU Comments
      1. 1922 - ConfidentialityCode - Null Values
        1. Submitted byNick Radov - required field with a ValueSet binding. Little reason to use NullFlavors
          1. Need to do some more checking on this one. Need to determine what the specific reason is we cannot have Null value. Is this a requirement of the rule somewhere? (Andrew StatlerIn a cursory scan, I did not find anything that covered the specific values for Confidentiality code in the final rule.)
        2. Matthew Rahn just saw this for the first time. He is going to look into this.
        3. The type is a CE. We discussed upgrading the language to a "SHALL be selected from ValueSet HL7 BasicConfidentialityKind..." so that the requirement is selected from 3 values.
        4. Need to do additional research for next week.
        5. Checked Companion Guide → There is nothing in the Companion Guide that discusses the Confidentiality Code.
    6. Matt Szczepankiewicz has some STU comments that he would like to address at a future meeting. He will send those to the co-chairs so they can be added to a future agenda.
    7. Gay Dolin has a topic on the Pregnancy templates that she will add to a future agenda.

11:00am EST

  1. Value Set Updates
    1. No Value Set Update Topics today
  2. Adjournment
    1. 11:51am → meeting adjourned by Austin Kreisler

 


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