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Date

Jan 16, 2019

Agenda


  • Roadmap update for CDA MGMT
    • CDA Jira tracker that CDA-MG is working on (Andrew)[CDAMG]
    • Errata Releases for C-CDA R2.1 (post mortem on 2018Nov errata)
    • Update for C-CDA R2.1 (R2.2) Inclusion of Companion Guide Templates and other enhancements
  • Future of CDA and C-CDA
  • C-CDA IAT Update - Lisa
  • Other emergent topics

Notes

  • CDAR2.1 base standard & C-CDA, whatever will happen with that.
  • Quality plan, whatever will happen with that. Clarifying the plans with that. The Criteria, and the procedural stuff. The review process. Combo CDA. Consistently and with high quality enforce the criteria enforce the criteria. Make sure the material that comes in is already meeting the criteria when it reaches the CDAMG so that it is not so late in the process
    • Keith - Groups are creating 500 page documents - publication format process?
      • Lisa - Project at the bottom of the list, use of StructuredDefinition to represent templates. Using the FHIR definition to represent the CDA documents that will allow us to use FHIR publishing process at that point.
      • Austin - Also allows us to get into a build process and gates. More of a real-time build.
      • Lisa - Use of StructuredDefinition gets us into a process - smooth guidance to represent information that is in FHIR and CDA. Will improve our ability to map in both.
      • Calvin - Think it's a good idea. Will that create challenges in sections? We have a challenge with our section.
      • Keith - Graham has done some work in this space.
      • Jean - There has been some work in this space that Graham has done.
      • Lisa - In preparing for this, we've had some projects preparing for this. When we talk about the future of C-CDA, this is something we will go through. This is part of the maturity model. Some of the more flexible ways. The C-CDA templates could benefit from this. How mature and flexible they are. Very similar to the FHIR concept of stuff. Looking at changing the master grid. You would look for Consolidated-CDA it was all over the place. Worked hard to set it up. You would get a single product page. We are trying to press toward thinking about CDA as a product family as a set of versioned things or resources. 
  • Templates - did some work with Art-Decor and Trifolia. Looking for some consistency there.
  • Cross-Workgroup CDA template assessment pilot - that works, but they don't have the knowledge.
    • Calvin - if we transition to FHIR tooling, how does that impact this?
    • Lisa - It gets better because there has been more work to push FHIR knowledge into the Workgroups.
    • Austin- we are actually at a higher level of maturity with templates than we are with FHIR IG.
    • Emma - C-CDA has a good way of letting us know, errata, SD meeting, go to example task force.
    • Austin - none of that will change.
    • Emma - other IGs don't. These are IGs that don't. Examples are wrong. Schema are wrong. That costs money.
    • Lisa - That is a quality issue.
    • Shelly - we are working with the pharmacy FHIR. Ready to ballot in 2019. Need to get this out. Put a website out that was shared. eplaninitiative.com.
      • comment only ballot in Sept 2017. Rick Geimer did the tooling with Sarah. Goal is to get the package ready for May.
    • Lisa - one thing to tie Emma's comment with Shelly's. We look at a solution through ballot. The post-publication commitment to an IG that they address the post publication. A huge amount of maintenance.
    • Calvin - FHIR tooling isn't the only thing. FHIR is a place for things to accumulate. We have a place for things to accumulate until they become a pile. One of the things the CDAMG might want to think about is the acccumulation of issues/errata.
    • Keith - think we need a pilot project, something like 2.1 and take it that way. 2.1 templates are already in Trifolia. It is just turning it into StructuredDefinition templates.
    • Calvin - that is a great goal. More curious about the process. As good as our process is. The way we have everything structured, we can make it better.
    • Lisa - we have a group that is working on moving that to JIRA. Take C-CDA forward or a set of templates into this space or a smaller amount of work and using JIRA like FHIR is.
    • Lisa - USCDI is the main place that we have Structured Data. Getting ONC support to narrow the focus. That is a good place to align across FHIR and CDA. The HL7 process work for the ownership and evolution and build in JIRA. The last step in that bigger picture is that we are not done. At that granular level is that we are not done. What concepts are in a ValueSet. How do you do errata and stuff. How are we going to do a release. We know it doesn't work without the funding.
    • Gay - Does that mean that as we identify something we could fix it right away? 
    • Calvin - We need to look at how FHIR is doing it.
    • Gay - Does that work with government?
    • Calvin - Look at how FHIR is dealing with it.
    • Keith - the way FHIR handles it, they do regular scheduled releases and point releases. A common version. At the same time that a version is available there is still ongoing changes.
    • Calvin - We tend to be single threaded in a release where they tend to be more multi-threaded. We let the work pile up.
    • Andrew - The JIRA process is waiting on LLoyd to finish the FHIR JIRA workflow and we will mirror that project for CDA/CCDA which covers all of ballot commenting.
    • Keith - We will lose half our week following the FHIR pattern.
    • Brett - Think we need liaisons to Patient Care, O&O, etc
    • Austin - Thoughts on trying to break this up into more digestible chunks.
    • Calvin - Good that we are considering all the issues.
  • Errata Release Post-mortem
    • Lisa - This last release felt tricky. The list was a bit dicey in terms of really getting confirmation on what would be getting included in the errata. The process of doing a bunch of work that builds up over time. The target of what gets addressed next. Everybody forgets what we are forgetting to do.
    • Austin - We ask volunteers to do this and they were driven by another need. They are driven by their own need. They weren't stepping up to do the work Lisa wanted. If it is volunteers driving the work, the things that we get may not be the desired result.
    • Gay - JIRA was flagged incorrectly on things. Lack of clarity on what we were doing. Two places it broke. Review of everything we thought would be in there was in there. What can we do to make sure the static vs. dynamic binding criteria is brought in. 
    • Lisa - We do not have a clear process. In order to do errata, here are the steps you need to go through. 
    • Brett - Can we never do a word document errata process? 
    • Sean - Takes a long time. 8 hours doing solid work. 20 hours coordinating. Talking to Wayne and this group. 17 fairly minor changes. 
    • Calvin - Can we categorize where the problems lie?
    • Brett - If we could apply changes more like FHIR, then we may not have the problem like we do today.
    • Keith - Maybe need to focus on accelerating the work that will get us to the future state.
    • Keith - using the FHIR tooling allows you to use the versioning.
    • Gay - What is the first next step?
    • Lisa - What are the pain points?
    • Sean - We found that there were a couple of changes to the IG that we needed to undo.
    • Gay - Then we don't do another errata release until we figure that out?
    • Sean - schema-tron is not a document that we are balloting, why do we need to figure that out?
    • Calvin - processable schema-tron as an instance of a type need to be provided with these standards. It was a request from the government or the industry.
    • Calvin - It came to the work-group. It is not applied equally. We are one of the few groups that have processable schema
    • Lisa - would it be possible to make a Confluence page. C-CDA next errata. every time we make an errata, pick up anything that is listed and put them all on a single page so we an see the volume of work.
    • Brett - no more errata until we move off this platform.
    • Brett - Motion that after HL7 publishes the existing errata and other supplemental C-CDA projects in progress, we will never publish another release including supplements, errata solely in document form (example: PDF, Word). We SHALL initiate a project to publish using alternative publishing format.

Motion
  • Motion by: Brett Marquard

    After HL7 publishes the existing errata and other supplemental C-CDA projects in progress, we will never publish another release including supplements, errata solely in document form (example: PDF, Word). We SHALL initiate a project to publish using alternative publishing format.

  • Second by: Keith W. Boone
  • Discussion:
    • Motion by: Austin Kreisler
    • Motion withdrawn
    • Calvin: no requirement to do ValueSet publication for errata.
    • Austin: We need to initiate a project to publish using alternative web-based tooling.
    • Motion is amended to include any release, not just 
    • Jean: why say what you don't want?
    • This is related to C-CDAs
    • Does this include supplemental templates?
    • There are projects in flight.
    • We would not be sponsor or co-sponsor on any new projects using current document-based tooling. 
    • New projects started today, would need to work with the new alternative tooling.
    • We will forward this to the CDAMG for formal approval.
    • Lisa - What is the scope of control?
    • We don't control all.
ForAgainstAbstain
1912
  • Negative comment, too broad in scope for the Against vote.
  • C-CDAr2.2
    • Lisa - would it make sense to create a PSS to talk about what would go into C-CDAr2.2?
    • Keith - would be a large scope to try and take on a new version of C-CDA at the same time we are moving to a new publishing format.
    • Lisa - when we try to make progress, there is so much in C-CDAr2.1, we need to constrain it down.
    • Keith - this is a way to get to C-CDAr2.1.
    • Calvin - pockets that has trouble getting work done.
    • Austin - this sounds like an investigative project. To figure out what C-CDAr2.2 ought to be.
    • Brett - we have pieces that are not in this guide. provenance is not in this guide. It would be helpful to have these things in this guide and it would be something we have to version. 
    • Calvin - Can we phase the big project of identifying scope?
    • Keith - 1st thing would be US Realm header, then pick a template. nothing would be new content yet. anything new coming out is using old stuff. If we don't have old stuff in the new format, we won't have content.
    • Want something that can be used, but don't want to create something until we know we can use it. Feels like we are trying to block progress.
    • Keith - agree that there needs to be parallel work. 
    • Don't want one to block the other.
    • Austin - C-CDAr2.2, for September cycle, we have a short cycle.
    • Gay - we need to carry this discussion forward to another quarter.
    • We can get a project out and see where we are. 
    • Sean - Trifolia already allows for publishing in HTML format.
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