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Chair:  Jean Duteau

Scribe: Floyd EisenbergJean Duteau  

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    Meeting ID: 915 0605 8769

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    Wave One Associates

    Health Data Incehaas@healthedatainc.comiParsimonyfeisenberg@iparsimony.comConsultantfm@frankmckinney.comGay Dolin
    AllscriptsCernerMathematicaJRubini@mathematica-mpr.comIris Health
    ESACpeter.muir@esacinc.comPiper RanalloAmerican Academy of NeurologyPRanallo@aan.comMD

    Previous Meetings: 

    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."

    Agenda Topics

    Agenda Outline

    Agenda Item

    Meeting Minutes from Discussion

    Decision Link(if not child)

    • Minutes Approval (2020-09-03 Meeting Minutes/Agenda)
    • Going forward, consider CGP WGMs more regular than every other week - for planning. Consider every 2nd and 4th Thursday of every month.

    Minutes approved by general consent.

    Agreed to schedule CGP meetings after the WGM to be every 2nd and 4th Thursday of the month.

    Military History Project

    Report from Military History Project team 

    Confluence page: Military Service History and Status FHIR Profiles Project Page  Document

    FHIR Connectathon 25:

    2020-09 Social History: Verification of Military Service History and Status  Consider whether the API can be used for veteran status for DaVinci use cases.

    US Core Methodology

    Publication completed:

    Status update - Brett Marquard, Eric Haas

    Follow up from August 20, 2020 discussion points:

    1. Discussion about a routine process for tracker item review and a release plans for US Core updates/versions. Consider a block vote for some of the existing outstanding trackers (especially the variances requested for Pharmacy listed in the description column to the left).
    2. Process for review of trackers: Once per month - first meeting of the month starting in October
    3. FHIR Connectathon -  2020-09 Argonaut US Core Track
    4. Consider how to handle variances:
      1. Does each require approval from CGP/US Core?
      2. If so, what is the enforcement?
      3. Is enforcement a US Realm decision?
    5. Consider the following US Core Variance Process:
      1. A proposed variance should generate a tracker for US Core to determine if US Core should make the change. Justification There are good reasons for variances and US Core project should be aware of these reasons.
      2. If US Core does not agree with the change, the variance must be reviewed for approval by US Realm. And US Realm will review the reason for "not persuasive" decision in CGP.
        1. The US Realm decision should be part of a publication request (I.e., approval Vs lack of approval)
        2. TSC should require that variances have been approved before publication approval
        3. Example: Financial Management is added modifications "approval" to the publication check-list. The effort is manual but it represents an attempt to review variances.
      3. Potential variances must be identified as the work progresses and not only immediately before publication.
    6. Jean will create a draft process (confluence page) and include links to the work the must be done. 
    7. Can a tool allow review of where MUST SUPPORT is not followed consistently - would alleviate the human work effort needed to review the requests?

    Next Steps for US Core Errata

    Details to follow.

    Presented at US Realm call 8 September 2020 regarding US Core/USCDI release considerations

    Road to US Core Discussion

    Details to follow.
    US Core MUST Jean reviewed the Connectathon report.
    US Core MUST Support Consideration Request

    Request from Orders and Observations (Hans Buitendijk):

    Review 20 items: US Core MUST SUPPORT - Consider Overinterpretation

    During the last call, Hans Buitendijk presented the issue about ONC interpretation of US Core Must Support (see  US Core MUST SUPPORT - Consider Overinterpretation).

    Basically the intent of US Core Must Support designation may not be consistent with the level of conformance requirements expected by ONC certification (Inferno). While Inferno does not test for every detail to test successfully, but conformance with all levels must be demonstrable.

    Lloyd indicated that from a Modeling and Methodology perspective, MUST SUPPORT can be declared on any element, component or sub-component. However an element listed as MUST SUPPORT does not mean that any of the components or sub-components must be supported.

    Hans suggested that general guidance and specific item review will help the US Core IG avoid conflict and indicate which attributes/components are not required. ONC had interpreted that all components/datatypes must be supported.  

    The general US Core intent was to be more permissive rather than constrained.

    US Core editors did not consider MUST SUPPORT at:

    • datatype choices (example - Observation.value[x] doesn't not specify which choice must be made)
    • target choices (reference and canonical - if author can be Patient, Practitioner, RelatedPerson do all 3 need to be supported)
    • vocabulary (example - if Patient.gender is required binding is female, male, unknown, is the vendor ok with just supporting Unknown)
    • the datatype component level (example - CodeableConcept - Example - Encounter.reasonCode bare minimum text might be sufficient)

    As a result provide guidance (wording needs to be adjusted with a small team and return with appropriate language consistent with the intent of FHIR-28375). Once finalized, review language with ONC.

    Hans, Brett and Eric agreed to work on the text for review during this call.

    Also, review activity from the breakout in the Inferno track during the Connectathon 25 (9-11 September). 

    US Core Pending Trackers

    Previous trackers for US Core pending resolution:

    Additional US Core FHIR Trackers (Frank McKinney) regarding Real-Time Pharmacy Benefit Check (RTPBC) Implementation Guide - variance for profiles regarding Patient and MedicationRequest (see Tracker links bullet below). 

    Current expectations: Expecting errata package for US Core toward the end of June 2020 for a 2-week comment period followed by a vote for approval and publication in early July 2020.

    Jira Issue Summary (Reporter) Resolution

    1. J#27867 add reaction to allergies (ehaas) Persuasive
    2. J#27857 Add Reference to US Core Patient in Vitals Signs Profiles (Brett.Marquard) Persuasive
    3. J#27846 US Core Pulse Oximetry Profile: observation.value and component.value constraints are different (emmanurse) Persuasive with Modification
    4. J#27836 Expand Procedure Codes Value Set to include ICD-10 PCS codes (ekivemark) Persuasive
    5. J#27117 ICD-10-PCS: Note ownership and availability for Use. Include Codes. (saul_kravitz) Persuasive with Modification
    6. J#27116 Change Description of ICD-10-PCS Value Set (saul_kravitz) Persuasive
    7.  J#27876 - Remove Must Support References to non US Core Profiles (Brett.Marquard) Persuasive
    8. J#27857 Add Reference to US Core Patient in Vitals Signs Profiles (Brett.Marquard) Persuasive
    9. J#27117 ICD-10-PCS: Note ownership and availability for Use. Include Codes. (saul_kravitz) Persuasive with Modification
      • Deferred - the copyright for the value set is owned by US Realm Steering Committee - request clarification from commenter.

    Also deferred but reviewed in the US Realm Steering Committee and determined acceptable:

    1. FHIR-27732 US Core MedicationRequest variance – encounter
    2. FHIR-27731 US Core Patient variance – Patient.telecom
    3. FHIR-27730 US Core Patient variance – Patient.communication.language
    4. FHIR-27729 US Core Patient variance - us-core-birthsex
    5. FHIR-27728 US Core Patient variance – us-core-ethnicity
    6. FHIR-27727 US Core Patient variance – us-core-race
    7. FHIR-27770 - Need to work with Vocabulary and HTA since the current publication indicates reference to only one license year (2014) and CPT has a new license every year.  Need a reasonable way to manage the code system version. The version is based on the date of service. The OID, code and reference does not change but the version changes with every year of service
      1. Briefly discussed on June 18 call and will require additional work - Deferred for clarification 

    Hans discussed what the FMG is looking at in terms of Must Support:

    • FMG has been coordinating effort within HL7 to allow for greater expressibility of MustSupport
    • Working with FHIR-I and M&M and Conformance to evolve the definition of MustSupport
    • Hans pointed out that Provenance has MustSupport on author which includes Patient

    US Core Track at the Connectathon also discussed Must Support and the linked presentation had some action items:  US Core Must Support presentation

    September Virtual WGM Agenda

    September HL7 Virtual WGM schedule - NEXT WEEK - Monday, September 21 noon ET through Friday, September 25 at 6:00 PM ET (2 hour slots on a 24 hour basis through the week).

    Thursday, September 24 from 2:00 - 4:00 PM ET

    Consider topics for this session.

    Virtual WGM Agenda/Minutes 2020-09-2020 - Cross-Group Projects (CGP)

    Adjourned at 1:30pm.

    Supporting Documents

    Outline Reference

    Supporting Document

    Minute Approval