HL7 CDAMG Minutes

Location: online

Date: 18 Nov 2020

Time: 1:00 PM Eastern

Facilitator

Lisa

Note Taker(s)

Linda

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Meeting ID: 935 3262 7375
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Attendance:

Present	Name
	Lisa R. Nelson, MaxMD
	Linda Michaelsen, Optum
	Brett Marquard, Wave One Associates
	Jean Duteau, Duteau Design Inc
	Rick Geimer, Lantana Consulting Group
	Giorgio Cangioli, HL7 Italy
	Emma Jones, Allscripts
	Andrew Statler, Cerner Corporation
	Yan Heras, Optimum eHealth LLC
	Raychelle Fernandez, Dynamic Health IT
Quorum: Co-Chair +3 Guest(s): Wayne Kubick, Brennon (Allscripts) Austin Kreisler Didi Davis Sean McIvenna Courney Panai-Rodi Natasha Kreisle Walter Suarez, MD, MPH

Agenda (with Integrated Minutes)

STANDING BUSINESS

Quorum
- Attained
Attendance Review
Approve Minutes of 2020.11.04
- Minutes approved by consensus

Approval Request(s):
- No Pending Approval Requests
Administrative Updates (5 mins)
- CDA Stylesheet Issue - Project Completed
  - 7 Packages required Errata Updates
  - HL7.org updates are being made today, 11/18/2020
- Discuss Cancelling the December 30th, 2020 meeting, motion to Cancel - Rick, Linda 6.0.0
- CMG Co-chairs Invited to join a meeting with V2 Product Management Co-Chairs and HL7 Reimagining Task WG Leaders (Micky Tripathi and Bryn Rhodes ) to discuss Re-imagining Principle 1 focus - TBD
Update from Lantana for update on Web IG C-CDA Pilot Project (Courtney Panaia-Rodi, Sean McIlvena) (15 minutes)
- Slide deck
  - QA Complete with exception of IG Publisher issues
  - IG Publisher issues - see slide 5
    - Needs Graham's insight
    - Wayne said they will set up a regular meeting time starting in the New Year and Mark will be involved
    - Tooling issues are logged in Github; standards in Jira -clarified by Wayne
    - Brett - could we set labels for "Blocking Issues"? Only contributors can - Wayne said they will set that up
    - Missing valuesets need to be entered in UTG - not a small amount of work per Sean; need someone to do this
      - Sean will provide list for CDAMG to facilitate resolution
      - This does not block work just needs recompiled after added
    - Validating CCD's needs to be discussed more - Sean
HL7 Re-imagining Impact on CDA (30 minutes)
- Update on Board Initiative: Austin Kreisler, Wayne Kubick, Walter Suarez
- Open feedback/discussion from CMG members (Five_Principles_and_Recommendations_Prioritized_.02.pdf) - Walter Suarez
  - Focus, Agility, Sustainability, Community
  - Oversight Committee Appointed - planning phase
  - Task Groups have been created - inviting people to participate (organized around principles -some more than one) - will flush out, recommendations, timelines, budget for same
  - Expect to have recommendations in 2-3 months
  - Start early next year, 2021
  - Shared links
    - Initial Re-Envisioning HL7 Membership Announcement: https://mailchi.mp/648ad903bd42/announcing-hl7-fhir-devdays-198402?e=cad2ead36d Second Re-Envisioning HL7 Membership Announcement: https://mailchi.mp/224a3b575b37/reenvisioning-update?e=cad2ead36d List of Priority Recommendations by Core Principle: https://mcusercontent.com/2b25415351d5c5f116ed63d05/files/19f3f09b-f4f3-446b-a52d-2e95509c3c16/Five_Principles_and_Recommendations_Prioritized_.02.pdf?utm_source=HL7+Current+Members+List&utm_campaign=9abdd21806-EMAIL_CAMPAIGN_2018_01_29_COPY_01&utm_medium=email&utm_term=0_96aaebb68f-9abdd21806-55685209 Re-Envisioning Oversight Committee, Task Groups and Communications Group: https://mcusercontent.com/2b25415351d5c5f116ed63d05/files/b55cdf03-7af8-4b97-a928-fcdf616bca21/Re_Envisioning_Task_Groups_.01.pdf?utm_source=HL7+Current+Members+List&utm_campaign=9abdd21806-EMAIL_CAMPAIGN_2018_01_29_COPY_01&utm_medium=email&utm_term=0_96aaebb68f-9abdd21806-55685209
  - TSC Work - Austin
    - Streamlining
      - New PSS workflow
      - Term limits
      - More input from Work Groups
      - ARB, Standards Board - sun setting
      - Governance will be directly in TSC
      - Meeting with co-chairs of Management Groups later this week
      - Changes to GOM to be authored and approved
      - Want to have stood up by January
  - General Notes
    - HL7 has a contract with ONC to update CCDA 2.1
    - Does making CDA IG's web publishable meet the Focus requirement OR does there have to be a FHIR equivalent of all active CDA IG's - Board has not discussed yet, needs to go back
    - Unclear if we move forward with CDA 2.1
    - Do we consider changes to CDA to make it more compatible with FHIR. Austin - that would be something SD should consider
    - Linda - how do we move forward with roadmap.
      - Wayne - base on what we know and give it to TSC for feedback, iterative process

NEW BUSINESS

Draft PSS CDA Web IG Publishing - review
- Link to draft document: CDA Web IG Publishing
Summarize Review of Mission and Charter (2020.09.21 Update Comments), and Decision Making Principles (2020.09.21 Update Comments) waiting until after Nov 4 call

Comments and questions have been escalated to SBG and CTO

CDA IG Quality Criteria – request summary of next steps - waiting until after Nov 4 call
CDA Quality Plan – brief update -waiting until after Nov 4 call
CDA Roadmap – brief update -waiting until after Nov 4 call
Discuss Value Set and Release Errata page(s) to CMG agenda
CDA R2.1 errata coming soon???
- Republication: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=375
Next Meeting: Wednesday December 2, 1 - 2 pm ET

Adjourned:

PROJECT REPORT OUTS:

Scheduled Reviews:

Date

Project

Who

Resources for Review

11/18

Use of Structure Definition

Rick

Jean

Lisa

NEXT STEPS:

Working to transform C-CDA R2.1 into new Web IG Publishing (QA of some templates delivered so far)

CDA 2.0 IG available - need link https://build.fhir.org/ig/HL7/cda-core-2.0/index.html

OPEN ISSUES:

NOTES:

CDA

Product Line

Update Releases

Brett

Lisa

NEXT STEPS:

OPEN ISSUES:

NOTES:

Depends on new CDA IG Web Publishing capability

CDA

Errata Releases

Brett

Lisa

NEXT STEPS:

Review the current Errata Release Checklist.

OPEN ISSUES:

Can official Errata Releases be prepared by SDWG in the mean time? - discuss at Sept WG meeting

NOTES:

12/2

CDA Quality Plan

Lisa

Brett

NEXT STEPS:

Need to complete the Quality Plan

OPEN ISSUES:

NOTES:

CDA Announcements & Notifications

Lisa

NEXT STEPS:

OPEN ISSUES:

NOTES:

CDA R2 C-CDA 2.1 Implementation-A-Thon

Lisa

Linda

Raychelle

NEXT STEPS:

Call for presenters for March 24, 2020 C-CDA IAT (closes ??? 15, 2020)

OPEN ISSUES:

Plan for 2020 needs to be solidified with Dave Hamill - Discuss at Sept WG meeting
Follow-up on Actions from July and October 2020 IAT

Grouping	Item	Responsible person	Status
Life and Death in C-CDA	Add rubric for to check that a patient's name is not changed (using any scheme) to indicate a patient is deceased	John D'Amore	A Rubric rule needs to be request to confirm that a patient's name is not changed to include a concept like "deceased". The analysis of common "bad habits" will be performed in conjunction with other analysis and the results will information the recommendations for th Rubric Rule.
Life and Death in C-CDA	Create gold-standard example of problem list containing pregnancy information	John D'Amore	Completed http://hl7-c-cda-examples.herokuapp.com/examples/view/Problems/Pregnancy%20with%20Week%20Gestation
Payer Section in C-CDA Documents	Convey support for the new identifier extension	Lisa Nelson	Completed and the extension was implemented in the October 2020 CDA_SDTC schema extension which now lives in gitHub. https://github.com/HL7/cda-core-2.0
Extending CDA to add more useful identifiers	Update the Companion Guide to add guidance on using the new extension.	Lisa Nelson	An STU Comment (#2050) was added against the Companion Guide to request inclusion of this extension. It needs to be approved by SDWG.
Payer Section in C-CDA Documents	Determine where payer identifiers should go in the document and represent with gold-standard example	Linda Michaelsen	Linda is working to create an example of using this new extension to represent the payer identifier. Linda would like to provide an example for review at the October 2020 IAT.
Extending CDA to add more useful identifiers	Determine real-world use cases and develop gold-standard examples - e.g. payer identifiers	Linda Michaelsen ~~Jean Duteau~~	Linda will show the use of the extension to represent the payer identifiers.
Implementation Considerations When Generating C-CDA Encounter Summary and Patient Summary Documents	Develop guidance for the Companion Guide around when summary documents are exchanged.	Joe Lamy	Joe is doing a topic on this at the October 2020 IAT. This topic will be taken up under the new Sequoia Data Usability Workgroup.
Implementing Clinical Notes	Work with Regenstrief on LOINC Codes for Laboratory Reports and Pathology Reports	Lisa	Regenstrief has issued several proposals to address the confusion around the Clinical Notes USCDI V1 data class. Proposed comments related to USCDI on behalf of the LOINC Document Ontology Subcommittee. https://loinc.org/files/meetings/document-ontology/20201005%20DRAFT%20USCDI%20Clinical%20Notes%20comments%20and%20new%20data%20element%20proposals.pdf?utm_source=Workgroups&utm_campaign=eb7d080c2f-EMAIL_CAMPAIGN_2020_10_05_08_06&utm_medium=email&utm_term=0_d6fe8d9574-eb7d080c2f-450653981 USCDI ONDEC Submission Form - Clinical Notes Data Elements https://loinc.org/files/meetings/document-ontology/20201005%20DRAFT%20USCDI-ONDEC-Submission-Form-Prep-Sheet_ClinicalNotes%20data%20elements.pdf?utm_source=Workgroups&utm_campaign=eb7d080c2f-EMAIL_CAMPAIGN_2020_10_05_08_06&utm_medium=email&utm_term=0_d6fe8d9574-eb7d080c2f-450653981 USCDI ONDEC Submission Form - Imaging Data Element https://loinc.org/files/meetings/document-ontology/20201005%20DRAFT%20USCDI-ONDEC-Submission-Form-Prep-Sheet_Imaging%20data%20element.pdf?utm_source=Workgroups&utm_campaign=eb7d080c2f-EMAIL_CAMPAIGN_2020_10_05_08_06&utm_medium=email&utm_term=0_d6fe8d9574-eb7d080c2f-450653981
Implementing Clinical Notes	Develop gold-standard examples for each supported USCDI note type (e.g. Consultation Note, Discharge Summary Note, etc.)	Emma Jones	Emma can you drive this in Examples Task Force?
Implementing Clinical Notes	Seek clarification from the ONC to update Companion Guide to include more concise guidance on use of Clinical Notes	Emma Jones	Emma - can you write up a request of specific questions that need to be addressed/answered?
Mapping Author Participation Information to FHIR US CDI Resources Derived from C-CDA Documents	Engage with SDWG and Patient Care to clarify how this work can move forward. Perhaps initially focusing on smaller problems to solve	David Riddle	Follow-up was done with PC WG and this topic was discussed at the HL7 WG meeting in September 2020. This is a bigger issue than can be solved at this level. Alignment and mapping work between CDA and FHIR will need to handle this on a more global level.
Added during October 2020 C-CDA IAT
C-CDA and IPS	Poll larger implementer community about use of problem/concern template	CDA Management Group	Gather feedback from community through: listservers, C-CDA Zulip Chat, and polling to measure interest and impact.
C-CDA and IPS	Rework problem/concern templates to better align with clinical/business use - e.g. allow use of either concern/problem structure or problem observations, limit to one problem observation per concern, etc.	CDA Management Group	Lisa will work with Giorgio and Brett to document one or two options that the community could consider for improving these templates.
	Report an19 STU comment against the Companion Guide to fix the IG references CDA_SDTC schema in footnote #19 in chapter 2.2	Lisa Nelson	Completed. STU Comment 2055.
Participation Roles in C-CDA	Establish descriptive guidance and bring examples for approval. End goal would be to add this to the Companion Guide.	John D'Amore	Companion Guide STU Comment 2056 added. (LRN) Examples need to be completed by John.
Participation Roles in C-CDA	How to deal with IDs over time (e.g. with different assignment schemes)? Refer to SDWG.	John D'Amore/CDA Examples Task Force	Address this topic when making the examples. Should the id elements remain the same from one document instance to another?
Use Cases Driven IG's for CDA	Bring forward to SDWG the suggestion to formalize the inclusion of use cases as part of the quality criteria for IGs	CDA Management Group	Discussions were initiated. Follow through needed. SDWG needs to explain how the CDA IG Quality Criteria will get updated.
Ask the ONC	Matt Rahn to dig into why the (e) 2 clinical summary was dropped and what is the linkage to newer certification criteria	Matt Rahn	Confirm if this document type is related to the LOINC Outpatient Summary.
Document Lifecycles	Time-constrained section requirements to be discussed further with the examples task force/SDWG	CDA Examples Task Force	Work with Joe Lamy and Brett Marquard to clarify when Section Time range would be needed and how to express last N entries.

NOTES:

CDA Base Standard

Lisa

Brett

NEXT STEPS:

Working with Calvin to draft an educational webinar that provides an overview of "what's new in CDA R2.1"
Will review progress at the 2020 Sept WG meeting

OPEN ISSUES:

NOTES:

CDA Maturity Model

Brett

Rick

Artifact created:

https://docs.google.com/document/d/1q_LaMpGZLfJu7Bq8XBoaz6RTHuMIsi3Id87YHOPFj1A/edit

NEXT STEPS:

Implementing this after cutting over to use the FHIR IG publishing mechanisms.

OPEN ISSUES:

Agreed this should be utilized after going to Structured Definition. SDWG would need to apply the Criteria. Could we get feedback at the IAT to apply the rating? Do we need a checklist to help the decision makers to assign the maturity model.

Would need to work with SDWG as the owner of C-CDA templates, to apply it to their templates.

NOTES:

Jira Implementation

Andrew

Linda

Raychelle

NEXT STEPS:

OPEN ISSUES:

Revisit after February Meeting

NOTES:

Andrew is advancing this sending Wayne what he needs. HL7 supporting this conversion. This is a go via orders from Wayne.

PSS & Product Registry

Lisa

NEXT STEPS:

Working on a list and process to gather accurate information - real-time recording

OPEN ISSUES:

NOTES:

Cross Workgroup Templates Pilot

Lisa

Giorgio

Linda

NEXT STEPS:

Lisa is comparing IPS to C-CDA for Problem Concern and Allergy Concern - update provided
- Some progress comparing to IPS - reported to PC WG, any possibility for harmonized templates
Linda is working with FM: Progress stalled due to FM's need to focus on FHIR IGs under ballot
Medication Templates. - No action due to no resourcing

OPEN ISSUES:

NOTES

Value Set Process and UTG support

Lisa

Brett

NEXT STEPS:

OPEN ISSUES:

NOTES:

Sean has reported additional missing CDA R2.0 Value Sets.

CDA to FHIR mapping

New focus

NEXT STEPS:

OPEN ISSUES:

NOTES:

ADDITIONAL TOPICS

KEY GOALS BEFORE September WG
- JIRA Migration Plan communication of roll-out
- Quality Plan Creation and Communication of Roll-Out
- Roadmap update
CMG Membership and interest in participation - update CMG objectives and Home Page content
Annual items:
- Term voting, Co-chair confirmations - July
- Current member term renewal pattern
  - Even Years: Brett, Jean, Raychelle, Yan, Emma, Giorgio
  - Odd Years: Lisa, Linda, Rick,

Meeting Outcomes

Summary of Votes/Key Decisions
Next Meeting/Preliminary Agenda Items

Action items

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