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TSC Saturday meeting for Atlanta WGM

HL7 TSC Meeting Minutes 

Location: TBD

Date: 2019-09-14
Time: 9:00 am

Facilitator: Austin KreislerNote taker(s): Anne Wizauer

Calvin BeebeHL7 Board Chair

Giorgio CangioliHL7 Affiliate Representativexxxx
Lorraine ConstableHL7 ARB Co-Chairxxxx
Jean DuteauHL7 Affiliate Representativexxx
Floyd EisenbergHL7 Clinical SD Co-Chairxxxx
Rob McClureHL7 Infrastructure SD Co-chairxxxx
Tony JulianHL7 ARB Co-Chairxxxx
Paul KnappHL7 Infrastructure SD Co-Chairx
Austin KreislerTSC Chairxxxx
Wayne KubickHL7 CTO (TSC member ex officio w/vote)xxxx
Mary Kay McDanielAdministrative SD Co-Chairxxxx
Riki MerrickAdministrative SD Co-Chairxxxx
Melva PetersHL7 Clinical SD Co-Chairxxxx
John RobertsAdhoc Member - GOM ExpertRegrets

Virginia LorenziHL7 Organizational Support SD Co-Chairxxxx
Sandra StuartHL7 Organizational Support SD Co-Chairxxxx
Anne Wizauer (scribe, non-voting)HL7 HQxxxx

David Pyke

Clinical SD Cochair Electxxxx
Julie JamesHTA

Walter Suarez

Lynn Laakso

Bob Dieterle

Lenel James


Quorum Requirements (Co-chair +5 with 2 SD Reps) Met: (yes/No)

Agenda Topics

Q1 - 9 am to 10:30 am

  1. Roll Call and Introduction of visitors (including declaration of interests)
  2. Additions to, and acceptance of, agenda
  3. Welcome new TSC member David Pyke (if present)
  4. Temperature check
  5. TSC chair election
  6. Ad hoc positions on TSC
    1. GOC representative
  7. Review of new TSC deadline approach

Q2 - 11 am to 12:30 pm

  1. HTA Update - Julie James
  2. US Realm Update
  3. How to implement US Realm policies on use of US Core profiles and FHIR/C-CDA
  4. Update on accelerator projects and associated processes
    1. Expected interactions
    2. Scalability
    3. WG responsibilities for content and review

Q3 - 1:30 pm to 3 pm

  1. Standards Grid - Lynn
  2. Conformance Strategy
  3. URLs for product families
  4. Universal candidate designation
  5. Implementer-friendly processes

Q4 - 3:30 pm to 5pm

  1. Communications to/issues from WGs
    1. Transition to JIRA tracking
    2. Question regarding approval of ballot content on main WG call vs. project call 
    3. How to implement US Realm policies on use of US Core profiles and FHIR/C-CDA
    4. Cochair Handbook Task Force Update
  2. Technical Deviation Policy - comments from TSC review

Minutes/Conclusions Reached:

Q1 - 9 am to 10:30 am

  1. Roll Call and Introduction of visitors (including declaration of interests)
  2. Additions to, and acceptance of, agenda
    1. Add review of out of cycle ballot e-vote 
      • Anne Wizauer to send new WG request to Melva for Clinical SD review
  3. Welcome new TSC member David Pyke (if present)
    1. David present and welcomed
  4. Temperature check
    1. Tony: Should reconsider criteria for out of cycle ballot. Not getting work done on time is not a good reason. 
    2. Rob: Need to train project leads on process. Used to have more formal facilitators - could reinvigorate that role. Should talk about that in cochair dinner. Need to ensure that facilitators listed are aware that they are on PSSs...sometimes people just add the name from the last project. Could add to the new PSS process some kind of checkbox. 
    3. Riki: Accelerator projects are confusing. 
    4. Austin: Successes in deadline rollouts; they have eased ballot prep. Implementers want us to move faster, which is the big problem we're facing.
    5. Jean: In my experience with other SDOs, we're the only one who regularly breaks deadlines. This meeting used to go Monday - Friday and now most people leave Wednesday and everything is packed into lunches and Q0s. Need to spread out throughout the week again. Should bring up at cochair dinner. 
    6. Melva: Still not solving problems  and getting on with things. We start things and don't get them done. We need to do a better job to hold WGs accountable for ballot reconciliation and publishing. Could make it a PBS metrics infraction. Could have a consolidated report by steering division for the SD cochairs. Lorraine notes we're still not good with SD cochair orientation regarding what they're supposed to do. 
    7. David: Some cochairs are cochairs in name only and don't participate in the role. 
    8. MK: Need to be better with communications, both content and timing. Need to get things out sooner. Accelerator projects are in danger of creating roadblocks for providers to get paid. Not enough reviewers understand the data and transactions. Comments coming back on IGs are not appropriate at times. Who do people come to when they have questions? Austin: accelerators have some responsibility for having some sort of interpretive guide to the guides, like a companion guide. Da Vinci will have to hang around and deal with the aftermath. Lorraine: Some of the accelerators have a culture of discouraging input. 
    9. Sandy: Cochairs who don't lead WGs are a problem - some become cochairs in order to be approved for travel but then don't perform. Might need stricter monitoring. Another issue is groups within a group, such as IEEE who don't post their calls on the HL7 calendar and who don't post minutes. Austin will be addressing some of this at the cochair dinner. 
    10. Lorraine: We've got so much disparate activity going on and it's not being communicated, especially around accelerators. So much stuff going on that doesn't get connected. All of these things are going to affect us and we get caught unaware. 
    11. Virginia: Frustration with people insisting that we give exception to deadlines. 
    12. Giorgio: Some question around the vision of the steering committee in an international organization. We are really US centric. Austin notes that we get stuck dealing with US things because there is no US affiliate. Not dealing with enough governance issues; Austin notes that we could potentially cover some of that stuff on the 90 minutes calls that we may start next cycle.
    13. Floyd: A challenge is accelerator groups requesting early open/out of cycle ballots, which is leading to not getting input from the right people. 
    14. Wayne: Need to focus more on strategic planning in TSC. Status quo is not enough anymore and we have a lot to deal with in terms of change. Need to balance project vs. WG focus. Culture clash between world of open source and the way we have worked on our other standards. It's the boundary where software and standards meet. Need to do much more in terms of communication. We've even lost focus on appropriate channels. Accelerators are consuming so much time and resources. TSC members should forward issues to Wayne and Austin for the board. Should have a retreat for the TSC, perhaps around the Board retreat. Implementation support is still a hot issue at the board level and hasn't had TSC input yet. Could have an ad hoc TSC member covering implementation.
    15. Anne: Confluence is wonderful, love SD Confluence evotes, but WGs are heavily customizing. Responsive PSS form has issues. Losing sight of action items so looking into making them JIRA trackers.
    16. Paul: We need to coordinate overall strategy with the board. Need to do more education with the new communities coming in. We are getting balloters not reading the standards - they're voting affirmative because they support something instead of because they've analyzed the material. We've talked about doing a dummy ballot in the past. Need to figure out how to catch it. Could add language in the JIRA balloting interface to reflect what an affirmative vote means in terms of content review.
  5. TSC chair election
    1. Karen will send an email with a link to the vote.
  6. Ad hoc positions on TSC
    1. GOC representative
      1. John Roberts is retiring. Will need either somebody from the TSC to fill that role or identify another ad hoc position. 
        1. MOTION to appoint Jean as GOC liaison: Jean/Sandy
        2. VOTE: All in favor
      2. Ken McCaslin filled the implementer ad hoc position. Do we want to add an ad hoc implementer from the FHIR community? 
        1. MOTION to add an ad hoc FHIR impelementer position to the TSC: Wayne/Melva
        2. MOTION TABLED until we have the actual description available 
          • Wayne will circulate the board description of implementer position
  7. Review of new TSC deadline approach
    1. Carry forward

Q2 - 11 am to 12:30 pm

  1. HTA Update - Julie James
    1. Julie states the HTA's most pressing issue is supporting FHIR in its use of external terminology, particular in how it identifies external terminology. FHIR is producing URIs for external code systems, and URIs should be produced by the external producer of the code systems. Need to work on a process. They are working on developing artifacts for the community to understand what we're doing. Working to identify and correct the provenance of code system. Are rules being followed? HTA has a set of pages describing the rules around external code systems and are working to find out if we're following those rules.
    2. MK has been working on a problem with FHIR and external vocabulary and we don't have appropriate processes in place. We don't have the right people working with the right groups. Lorraine: Need to educate the organization as a whole on what HTA does and what guidance they provide. Julie notes that groups are unclear on who their vocabulary facilitators are. Also need to define HTA's relationship with the Vocabulary workgroup. Struggle too between roles of SGB, HTA, and Vocabulary. Julie asks MK who the right people are who should be in the room? Need terminology SMEs and domain SMEs in the terminology you're working with. Rob: Need to create an environment where the people who are interested can participate. How do we do the process of making it possible for us to use an externally controlled technology? Need to go to HTA sooner in the process, but people don't know. Austin notes that one problem is how HTA is identified in the GOM. Lorraine: We need to make sure that the rest of the organization is going to HTA when needed.  Julie: We review the FHIR tracker at our meetings in an attempt to engage. Lorraine: It's also our responsibility in the WGs to know when HTA involvement is needed. Rob: When you send something to HTA, it should be an efficient process. Need a documented path, process, and recognized authority. Paul: There should be a terminology scope in the management process. Lorraine: Need to ensure that HTA is getting the right support in cross organizational issues. Julie: We're also missing the difference between things that are global and those things that are purely US.  Part of domain expertise is knowing your environment. US Realm Steering Committee could work on the US items as HTA would like to focus on universal items. Virginia: People need to understand what HTA can do for them. Discussion over accelerator projects. They don't seem to have terminologists. Could do facilitator education although we'd still be missing a large group of people working on accelerator projects, Austin: SGB should be taking a primary role in creating precepts around this. Could invite HTA to product management council. Need to refocus on this in SGB. Chris Chute will be taking the role of vocabulary liaison on  SGB. Paul: Accelerators are even further removed from our processes and are only considering their business processes. Floyd: It should fall to the WGs. Lorraine: ARB should be aware of what they should be looking for in terms of vocabulary when reviewing external content. 
    3. Rob: We need some use cases to work through to describe how these problems get solved in a consistent way. What do we do in different scenarios? Then we communicate the policy on how to proceed. Austin: HTA from a policy perspective works with SGB, not Vocab. Vocab is about methodology, not policy. SGB creates policy, TSC implements policy. HTA can work up a policy and run it through SGB. If it's management/operational stuff, TSC is the place to go. 
    4. Wayne: Need to be careful that we don't create another barrier where everything has to go through HTA. Need to be clear on what terminologies we already have agreements with, and if we don't have an agreement then you have to go to HTA. Need to train people on where to look for things. Austin: What would be a good terminology question to help educate cochairs that Austin can ask at the cochair dinner? 
    5. David asks what the process is for getting something to the HTA? There is no information on how to go about getting permission to use external terminologies. 
      • Anne Wizauerto add HTA to a quarter of the TSC meeting in Sydney
  2. US Realm Update
    1. Last cycle we appointed TSC representatives to the US Realm Steering Committee. 
    2. US Realm is going through the process of identifying a slate of new members for ad hoc and at large membership
      1. Reviewed the list of at large and ad hoc US Realm nominees: Christol Green, Chris Shawn, Danielle Friend, Jenni Syed, and Rob McClure
        1. MOTION to appoint the nominees to the US Realm Steering Committee to fulfill the Ad Hoc and At Large members: Lorraine/Sandy
        2. VOTE: All in favor
  3. How to implement US Realm policies on use of US Core profiles and FHIR/C-CDA
    1. US Realm working on updates to bring back to TSC
    2. Discussion over why US Realm reps aren't coming to TSC. If there's an update for the TSC they should come.
  4. Update on accelerator projects and associated processes
    1. Expected interactions
    2. Scalability
    3. WG responsibilities for content and review
      1. Reviewed current list of accelerators, both approved and proposed, at Wayne's FHIR Accelerators page
      2. One issue is groups bringing forth PSSs before they're an approved accelerator group. AMA, for example, hasn't got an approved agreement yet, but they're bringing forth a project this week.
      3. For the overall accelerator program, we should have an individual who can start guiding these groups on HL7 process before they've even signed up and paid. Ken is putting together a quick start package so people have some information while they're considering signing on.  Virginia: We should make it clear that the word accelerator doesn't mean they can skip processes. Lorraine: We need to make it clear why you would sign on as an accelerator instead of being simply a collaborating organization as we've always had. 
      4. Reviewed The word acceleration is problematic in the strategy section. Need to do some education on what accelerator really means. They can't just dump stuff on WGs, they have to come with people to help do the work. MK: There are 17 calls a week for Da Vinci. They want those calls to be HL7 calls but who can do 17 calls a week? They bring things to FM with a 2 minute description, which isn't enough time. We're ending up with IGs that we're trying to get through that are not conforming to our quality processes. Lorraine: They're bringing resources to work on the IGs, but they're not people who understand our processes. We're overwhelming the WGS. Virginia: Maybe as part of being an accelerator you get education up front. Paul: The projects should have a team, including HL7 people, that develop material that then goes to the WG and through the rest of the process. What occurred instead of this is that IGs were produced without adequate WG review because there was no time. Then during ballot review, people endorsed the material who didn't review it. Rob: We could insist they pay for a project person who receives the education, or two people - one resourced from an existing committee who is paid by the accelerator, then someone from the accelerator organization. Floyd: There should be rules that there are real implementers as part of the review/evaluation process.  Melva: They come to TSC because they can't get the work done on time, and the TSC gets pressured because of regulation to do an early open or out of cycle ballot. We've allowed it twice and we're not helping by allowing that. Austin: That's the point Jean brought up that we need to apply our rules. Lorraine: We tried to encourage Da Vinci to bring things forward and use our process - they are attempting to do that. 
  5. Q3 - 1:30 pm to 3 pm

    1. Out of cycle ballot request for PDex - review e-vote comments
      1. Reviewed comments and request. We no longer actually have out of cycle ballots; we have early open ballots. 
      2. This was pulled out of the last early open ballot. 
      3. Rationale is CMS regulation coming out, and they need to have something published for the payer industry to implement. 
      4. Jean is concerned these exceptions to our process are precedent setting.
      5. Walter: CMS is not going to publish a final rule with this in it - they won't be able to reference this draft. Compliance to this won't be before January 2021.
      6. Melva: They're saying that we don't have the resources to handle reconciliation during the regular ballot cycle. Floyd: The standards won't be listed in the rule; it would make a lot more sense to do testing and input in the regular cycle.
      7. Lorraine: There are negative impacts for rushing things. I would consider voting against. Paul: We should try to work with the community, but everything doesn't have to be an exception. When we make an exception, it's an exception not a precedent. Jean: The previous exceptions used the exactly same arguments. Lorraine: The document is missing document description and changes as well as WG approval meeting minutes.  
      8. Need to have Bob join us to discuss before making a decision. MK will invite him for Q4. 
      9. Virginia wonders if we could have a different type of pre-ballot review process. 
    2. Accelerator projects, continued
      1. Concrete next steps/questions
        1. What exactly are the accelerators paying for when they become an HL7 accelerator? Wayne: They get advisory time, administrative help, marketing. They still have to work under the existing guarantees that their material gets rushed through. 
        2. Lorraine: We need to clarify what is expected of the WGs when these projects come forward. The WGs feel their responsibility is for things to go faster, which isn't actually the case. Need to manage dominant personalities. 
        3. Need advance communication from executive level of HL7 to TSC on what accelerator projects are coming forward
        4. Floyd: Accelerators aren't doing things faster, they're accelerating something that wouldn't have happened without HL7. Rob: There is value in charging organizations to accelerate - not that you can get through the process faster, but to accelerate the traditionally slow process of getting people in to the normally paced process.
          • Wayne Kubick to further define, clarify, and publish what the accelerator process is 
        5. Need to document the impact on the organization.
        6. Ask that we post the accelerator agreements on the website
        7. Document how the accelerators are expected to engage with the WGs
    3. Standards Grid - Lynn
      1. Lynn reviews changes to the intro to HL7 Standards page. Items are now grouped by products.
      2. Master grid is more complex but the navigation is easier. The filters have changed and the search is more robust.
      3. Austin notes we have things in the standards grid that are not standards. Perhaps we should call it the Product Grid, or get the things that aren't standards out of here. Product types are now listed. Other metadata such as realm will also be listed.
      4. Lorraine: The next step in the project was to apply this data to the publication request, which should go to PIC. 
      5. Austin notes that the Agile Standards Task Force was proposing different nomenclature for current state. Shouldn't be showing retired stuff in the grid automatically. You should be able to get to it but should really just show stable and active.
      6. Austin states we should have a link to all active standards.
      7. Virginia suggests video and pictures to spice this up as it is our product page. Apply some marketing.
      8. Floyd: If I'm in the STU site I want to navigate back easily. 
      9. Wayne notes we're putting up a new page to make it easier for people to find new standards being published. Most people want to find the new stuff.
      10. Lorraine requests that we don't change things like this right before the WGM. Change things after the WGM and we have a chance to announce it.
      11. Austin: Going forward, a product can't get in here without going through the TSC with a publication request.
        • Austin Kreisler Next step for Agile Standards Task Force is to ask the management groups to review what's out there for their product and identify if they agree with the classification or not.
    4. Conformance Strategy
      1. Had a recent request from V2+ to have URLs higher than Version 2 for Data Type Flavors and Conformance. This was so they could publish V2 Conformance under it rather than under V2. This would have implications for other families. Recommended that they publish those under V2 instead. 
      2. Instead of them putting together a V2 Conformance document there, the Conformance WG could put a high level Conformance specification and link to product family-specific conformance criteria underneath. ITS WG would be the ones to decide about Data Type Flavors.
    5. URLs for products/web-based publications
      1. Decision was made not to give every individual thing a URL. Our desired pattern is
      2. FHIR build URL is not conformant with our usual URL naming. It's 
        • ACTION: Wayne Kubick to identify whether or not the FHIR build is on an HL7-managed platform
    6. Universal candidate designation
      1. Need to add third choice on PSS form - Universal, US, or Universal Candidate. Would also have to appear on the publication request form.
      2. ARB has a project that is defining how to create a realm transferrable standard. Discussion over relationship between this and that project.
      3. Discussion over whether the Universal Candidate would still be reviewed by US Realm. These have come up when a project is marked US but is universally applicable.
      4. Discussion over having the international council being part of the review process.
    7. Implementer-friendly processes
      1. Discussion started because implementers expressed frustration over difficult processes to make changes to a spec. In what parts of the process could we be more agile?
      2. Could mean a different designation other than STU that is off the Normative track. One step would be to draft out some proposed alternatives and then review those at some kind of retreat session. 
        • Wayne Kubick will put out an RFP to develop a straw man to develop a new potential designation
  6. Q4 - 3:30 pm to 5pm

    1. Out of cycle ballot request for PDex - continued from Q3
      1. Bob Dieterle and Lenel here to discuss reasoning behind early ballot. Directory was not yet ready for last early ballot. Scope has been reduced to a payer directory. They've done two connectathons and are doing another here. Need to get it through ballot so it can be published as an STU by the end of the year or early next year so payers will implement it. This is meant to complete the work started in March. This would be the last request for early ballot. 
      2. Clarification is that it won't be in the upcoming final rule, this is so people can start developing for the rule in the future.
      3. Floyd: The final rule won't specify which standard; the final rule will likely say when the implementation has to occur but Jan 2020 is unrealistically early. Wouldn't there be sufficient time for regular ballot? And if you're doing this in Connectathon, can't that information be used to perfect the information going to ballot  later on? Bob: We're expecting the rule to drop early next year and compliance won't go past Jan 2021. Payers will start doing work when the rule comes out and we want something in place. 
        1. MOTION to approve the out of cycle ballot request for PDex: MK/Rob
        2. VOTE: Clinical and Giorgio opposed. ARB abstains. Remaining in favor (Administrative, Organizational Support, Infrastructure, Wayne)
    2. Communications to/issues from WGs
      1. Transition to JIRA tracking
        1. Reviewed transition plan, target dates, and outstanding questions. Transition would happen on 10/20.
        2. Discussion over tight timeframe. Discussion over how this relates to JIRA balloting. 
        3. Concern over losing information in gforge trackers that is linked to in minutes, especially for decisions on normative content. There are also attachments there.
          1. Questions for Lloyd/Jean:
          2. What was the extent of testing for building the processes and testing of the current ballot process using JIRA?
          3. What about attachments that were in gforge trackers?
          4. In what format are exceptions being logged?
        4. Discussion over QA fixes - some are not completing them. There will have to be an exception list of things that didn't migrate that people will have to fix after the fact.
        5. Somebody needs to validate the conversion.
        6. May have to require the out of cycle ballot to be spreadsheet.
          1. MOTION to approve JIRA tracking migration plan subject to resolving open questions, clarifying task assignments, and having the out of cycle ballot be spreadsheet: Wayne/Floyd
          2. VOTE: All in favor
      2. Question regarding approval of ballot content on main WG call vs. project call 
        1. The project call, if it meets criteria such as being quorate, publicly announced in advance on the listserve, publicly available agenda on Confluence - then decisions can be made there. If it conforms to the WGs DMP then it qualifies for official approval. Decisions must be clearly delineated and posted in public minutes.
        2. There was an instance where decisions were made in private meetings, not publicly announced and available for anyone to attend. Minutes were eventually sent out to a listserve but not publicly posted.
      3. How to implement US Realm policies on use of US Core profiles and FHIR/C-CDA
        1. Carry forward
      4. Cochair Handbook Task Force Update
        1. Melva and Sandy have a list of volunteers from Montreal but it hasn't moved forward yet. Lorraine and Patrick have highlighted and commented on some things that need to be updated. Wayne asked Ken to look at it too, starting with a new table of contents and slowly populate it without bringing everything over. 
        2. Resource Categories should be reviewed as an index of things we need to do something with.
        3. As a cochair is elected or re-elected, we're going to want them to certify that they've reviewed certain material. Should have a cochairs for dummies document. What do we want cochairs to know? They should know where to find things. 
        4. Need to set up a new directory tree that we'll slowly populate. PIC should look at the structure - it's on their agenda this week. 
    3. Review of new deadline approach
      1. Wayne states it's been a success - general agreement in the room. Melva reports there was some pushback at the IG workshop that it's unreasonable.
      2. May have to revisit after we implement the new PSS process. 
      3. Only had one appeal this cycle for late PSS
      4. No current change to the deadline approach at this time. Will revisit in the future with accelerated PSS approval process.
    4. Technical Process Deviation Policy - comments from TSC review
      1. Reviewed comments. Melva notes that the recent update to the GOM may have made this moot.
      2. May need to revisit in light of the FHIR R4 situation with a closed reballot. We don't have official documentation on this in the essential requirements.
      3. We need to make sure that we document specific deviations as they occur.
      4. Waye withdraws the document from consideration.
    5. FHIR Implementer position on TSC - continued
      1. Carry forward
    6. Melva notes that the Board established a small group to review internal policies, to streamline and make changes.
      • Anne Wizauer to send out the Internal Processes document to TSC members for review
  7. Adjourned at 5:01 pm