10:00am ET

1. Call to order 

   1. Call for Attendance

      
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2. Business Updates (10 min)
   1. Additions/modifications to the agenda

   2. Approve minutes from <div class="handy-tip-dialog wiki-content"> <p>This is to approve minutes via general consent. <em>"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."</em></p> </div> 2020-08-20 Agenda and Minutes

   3. HL7
   • • RIM (Austin Kreisler)
     • Steering Division / TSC (Austin Kreisler)
     • CDA-MG (Lisa R. Nelson, Brett Marquard)
     • Vocab (Rob McClure) 
     • Publishing, Electronic Services and Tools (PEST) (Andrew Statler)
     • Patient Care (Emma Jones) 
     • Example Task Force (https://cdasearch.hl7.org) (Brett Marquard)
3. External Updates - ONC and others
4. Project Updates

1.  

5. Additional Items
   1. Extensions

   2. Individual as Custodian

   3. David Riddle - CDA to FHIR mapping questions
   4. Sept. WGM Agenda Review
6. STU Comments
   1. Nick Radov(Expand C-CDA Templates for Clinical Notes DSTU Release 2.1 - US Realm to find Nick's issues)
      1. HL7 CDA® R2 IG: C-CDA Templates for Clinical Notes DSTU Release 2.1 - US Realm
      2.  Click here to expand...

         STU	Last Updated	Commenter	Issue
         1945	14 Apr 2020	Brett Marquard	Encounter Diagnosis (V3) [act: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.80:2015-08-01 (open)] This template wraps relevant problems or diagnoses at the close of a visit or that need to be followed after the visit. If the encounter is associated with a Hospital Discharge, the Hospital Discharge Diagnosis must be used. This entry requires at least one Problem Observation entry.
         1885	03 Jan 2020	@sueann svaby	SHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet Social History Type urn:oid:2.16.840.1.113883.3.88.12.80.60 DYNAMIC (CONF:1198-8558). a. If @codeSystem is not LOINC, then this code SHALL contain at least one [1..*] translation, which SHOULD be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:1198-32951).
         1873	15 Oct 2019	Lisa R. Nelson	Encounter Diagnosis (V3) [act: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.80:2015-08-01 (open)] The template is missing a binding for statusCode. Figure 144 shows a statusCode of "active". This provides the wrong guidance.
         1859	03 Oct 2019	Linda Michaelsen	Please REMOVE/DEPRECATE this commentIn the errata release from June 2019,Figure 162 is wrong and needs to be updated to use the correct Code System OID for CVX 2.16.840.1.113762.1.4.1010.6. It currently shows as 2.16.840.1.113762.12.292
         1825	01 Aug 2019	Lisa R. Nelson	Care Plan (V2) [ClinicalDocument: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.1.15:2015-08-01 (open)] The CDA Care Plan represents an instance of this dynamic Care Plan at a point in time. The CDA document itself is NOT dynamic. Key differentiators between a Care Plan CDA and CCD (another “snapshot in time” document): There are 2 required sections: o Health Concerns o Interventions There are 2 optional sections: o Goals o Outcomes • Provides the ability to identify patient and provider priorities with each act • Provides a header participant to indicate occurrences of Care Plan review A care plan document can include entry references from the information in these sections to the information (entries) in other sections. Please see Volume 1 of this guide to view a Care Plan Relationship diagram and story board.
         1802	02 Jun 2019	Lisa R. Nelson	Smoking Status - Meaningful Use (V2) (urn:hl7ii:2.16.840.1.113883.10.20.22.4.78:2014-06-09) . This value SHALL contain exactly one [1..1] @code, which SHALL be selected from ValueSet Smoking Status urn:oid:2.16.840.1.113883.11.20.9.38 DYNAMIC (CONF:1098-14817).
         1800  1801	13 Jun 2019	Lisa R. Nelson	We have trouble adding new Social History Observations when the US Gov't identifies the observation using LOINC. We really should be using LOINC in the code ("the question"). I recommend creating a Grouping Value Set that combines the original set of concepts using SNOMEDCT (Social History Type (SNOMEDCT)) and then agree to put all new/additional social history observation codes in the Social History Type (LOINC) value set. Use the existing OID for the new Grouping VS and make two new value sets for the parts of the grouping VS.
         1798	10 Jun 2019	Andrew Statler	On page 392, Section 3.61.1, the last three sentences of the text read as follows: "Procedure act is for procedures that alter the physical condition of a patient (e.g., splenectomy). Observation act is for procedures that result in new information about a patient but do not cause physical alteration (e.g., EEG). Act is for all other types of procedures (e.g., dressing change)." This is different from the wording on page 390, Section 3.61 Procedures Section (entries optional) (V2). Updated language is in the proposed section below.
         1793	24 May 2019	Rob McClure	3.41 Immunization Medication Information (V2) includes SHALL have a manufactureMaterial where this code MAY contain zero or more [0..*] translation, which MAY be selected from ValueSet Vaccine Clinical Drug urn:oid:2.16.840.1.113762.1.4.1010.8 DYNAMIC (CONF:1098-31543).
         *1791	08 May 2019	Nick Radov	3.41 Immunization Medication Information (V2) includes SHALL have a manufactureMaterial where this code MAY contain zero or more [0..*] translation, which MAY be selected from ValueSet Vaccine Clinical Drug urn:oid:2.16.840.1.113762.1.4.1010.8 DYNAMIC (CONF:1098-31543).
         *1789	06 May 2019	Nick Radov	We have seen real-world implementation defects where planned future encounters appear in the Encounters section rather than the Plan of Treatment section where they should be. I think some developers are just querying their database encounter tables for all encounters for a particular patient and sticking everything in the Encounters section regardless of whether they are past or future. Let's introduce a new conformance rule to ensure each Encounter activity ends before the document header effectiveTime.
         *1782	03 Apr 2019	Nick Radov	In section 3.81 Procedure Activity Procedure (V2) the Procedure.code (CONF:1098-7656) doesn't mention HCPCS as a possible code system. I think that code system should be explicitly listed because it is in common use in the US realm along with CPT-4. There are many procedures which are in HCPCS but not in CPT-4. This @code SHOULD be selected from LOINC (CodeSystem: 2.16.840.1.113883.6.1) or SNOMED CT (CodeSystem: 2.16.840.1.113883.6.96), and MAY be selected from CPT-4 (CodeSystem: 2.16.840.1.113883.6.12) or ICD10 PCS (CodeSystem: 2.16.840.1.113883.6.4) or CDT-2 (Code System: 2.16.840.1.113883.6.13) (CONF:1098-19207).
         *1428	14 Sep 2017	Nick Radov	Section 3.23, page 483: Table 272: EncounterTypeCode Value Set: EncounterTypeCode urn:oid:2.16.840.1.113883.3.88.12.80.32 This value set includes only the codes of the Current Procedure and Terminology designated for Evaluation and Management (99200 – 99607) (subscription to AMA Required Value Set Source: http://www.amacodingonline.com/
         *1406	17 Aug 2017	Nick Radov	<!-- ************************ ENCOUNTERS *********************** --> <component> <section> <!-- *** Encounters section (entries required) (V3) *** --> <templateId root="2.16.840.1.113883.10.20.22.2.22.1" extension="2015-08-01"/> <templateId root="2.16.840.1.113883.10.20.22.2.22.1"/> I think there is a problem with the sample CCD file C-CDA_R2-1_CCD.xml included in this package.
         1381	14 Jul 2017	Brett Marquard	doseQuanity/@unit and administrationUnitCode/@code are a confusing set of elements, but I will do my best pulling from the base definitions:
         1370	13 Jun 2017	Rick Geimer	In the Comment Activity template (2.16.840.1.113883.10.20.22.4.64): 5. SHALL contain exactly one [1..1] text (CONF:81-9430). a. This text SHALL contain exactly one [1..1] reference (CONF:81-15967).

   2. Matt Szczepankiewicz (expand HL7 CDA® R2 Implementation Guide: C-CDA Templates for Clinical Notes Companion Guide, Release 2 STU - US Realm )

      1.   

          Click here to expand...

         STU	Last Update	Commenter	Comment
         1985	02 Jun 2020	Matt Szczepankiewicz	The Provenance entry in the Appendix C is inconsistent with the author entry in the C-CDAr2.1 IG in terms of allowable values and it is misleading.
         1986	03 Jun 2020	Matt Szczepankiewicz	For the UDI information, can we get clarification on whether it is possible to send other information when we do not have the DI information?
         1948	19 Apr 2020	Emma Jones	Appendix B UDI 1.1 UDI Organizer  Figure 1: Unique Device Identifier (UDI) Organizer Template ID root is incorrect
         1994	10 Jun 2020	Matt Szczepankiewicz	(Vocab issue) Table 9 of the Companion Guide recommends the LOINC codes 11502-2 for Laboratory Narrative notes and 11526-1 for Pathology Narrative notes. However, these codes aren't actually included in the Note Types value set (urn:oid:2.16.840.1.113883.11.20.9.68) as required by the Notes Section and Note Activity templates in Appendix A. Likewise, although no specific LOINC code is recommended for Imaging Narrative notes, the value set doesn't include any codes from the value set recommended for imaging notes in Table 8 (urn:oid:1.3.6.1.4.1.12009.10.2.5).
         1998	17 Jun 2020	Matt Szczepankiewicz	The following unimplemented constraints use the expression "not(.)" throughout the main Companion Guide schematron file: CONF:3250-16902 CONF:3250-16912 CONF:3250-16914 CONF:4435-133 CONF:3250-16942 Typically unimplemented constraints use a dummy expression like "not(tested)" that always returns false (since the current element doesn't have a child named "tested"), but in this case, we're asserting that the current node is null, which returns false, makes the assertion fail, and triggers a false positive schematron error.
         2006	01 Jul 2020	Matt Szczepankiewicz	In Appendix C: vi. This representedOrganization SHOULD contain at least one [1..*] telecom (CONF:4440-12).
         2009	11 Jul 2020	Matt Szczepankiewicz	The Provenance - Author Participation template has a strange-seeming inconsistency between the requirements around the assignedAuthor/id and the assignedAuthor/representedOrganization/id:
         2014	23 Jul 2020	Lisa R. Nelson	The Note Types Value Set (urn:oid:2.16.840.1.113883.11.20.9.68) version 20191017 is missing three note types specific in USCDI v1:
         2015	23 Jul 2020	Lisa R. Nelson	The value Set binding for the Note Types value set in the Notes Section template does not include a binding strength.

      2.  

11:00am ET

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