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Date: 16-19 September 2019

Quarters: Q3 Monday - Q4 Thursday

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."

Goals

Set goals, objectives or some context for this meeting.

Discussion items

TimeItemWhoNotes

9/16/2019
Monday, Q3

Welcome, Introductions, Rules

  • IEEE Patent Policy
  • Review of Previous Meeting Minutes and Action Items 

Officers (John Rhoads - IEEE PoCD Chair)

Tom Thompson (IEEE-SA Liaison)
John Garguilo (IEEE PoCD Secretary)

Welcome, Introductions, Rules

  • Welcome by John Rhoads and John Garguilo
  • (IEEE PoCD Chair - Rhoads) Introduction to meeting & Introduction by attendees (and on-line)
  • Agenda review (Garguilo),
    • note of use of Confluence and HL7 HCD Confluence pages
    • Group going forward is to use Confluence for attendance, meeting agenda and meeting minutes/notes.  Encouraged attendees to get an account.
  • Tom Thompson (IEEE-SA) provided IEEE Patent Policy 
    • No patent issues mentioned by attendees in room and on Teleconference
  • IEEE (portion) Meeting Minutes Reviewed (Garguilo)
    • Motion to approve Montreal (May 2019) meeting minutes. 
      Motion by Todd Cooper, Second by Brian Reinhold
    • Motion accepted 17-0-0 (positive-negative-abstain)
  • John J. Garguilo : Action Item for John Garguilo to follow up w/ Josh P. from HL7 headquarters about migrating the HL7 HCD Projects Page. (Action items)
    • John G. sent Josh Procious and David Hamel email asking to do the migration of HL7.org work group Projects page to HCD Confluence Page (9/19/2019)
      • Response from David Hamill on 9/19/2019: "

        With confluence being utilized for projects more and more, you have a great suggestion.   Let Josh and I chat about it with other staffers and come up with a proposal.  We’ll want to run it across the Electronic Services and Tools Work Group as well, as it’s within their domain of interest.

        "
9/16/2019
Monday, Q4
  • 11073 PHD Status / PAR Report
  • 11073 PoCD Status / PAR Report
  • 11073 SC and PoCD P&Ps
  • 2020 Feb Sydney Planning:  Meeting?

Tom Thompson / Ken Fuchs / Daidi Zhong

Ken Fuchs / Tom Thompson
Co-Chairs


9/17/2019
Tuesday, Q2

Welcome, Introductions, Rules

  • 11073 SDC:
    • General Update
    • SDC related PARs
    • IHE SDPi WP - Overview / Roadmap
    • OR.NET
    • SDC Connectathon - Update / Planning

Rhoads, IEEE Staff


Schlichting / Andersen / Gregorczyk

Note: Q1 joint w/ O&O (refer to O&O Meeting Mins):  O&O stated the group will enter multiple Tracker items in GForge, and HCD will get notified when action needed.

11073 SDC

  • 11073 SDC Update and presentation (Stefan Schlichting) provided and overview, update, and on-going work regarding 11073-SDC standards (see presentation).
  • 11073-10701, content complete, 80 Requirements, D0 was created in 07/2019
  • 11073-10107, Content collection running, approximately 15 Actions, request for more Actions/Operations (please provide to Stefan); Open Questions: 1) Which code Partition or reuse ACT block of Part 1? 2) MDC_ACT_Prefix?

Stefan suggested starting ballot directly after Feb '20 HL7 meetings.

Stefan would like to start balloting in April 2020.  Also proposed having a Webinar to walk through details prior to having folks receive package...  Todd Cooper suggested perhaps doing a call when folks are together in Cleveland for IHE-NA Connectathon.

--

Bjorn Anderson

  • Bjorn presented the block diagram of a device specialization for an 'Insufflator' 
  • Bjorn estimated and projected to have "feature complete" for April 2020

  • Focus on modeling at this point.
  • Bjorn showed for IEEE 11073-10207 IG on SIMPLIFIER.NET
  • Bjorn suggested forming a task force on PoC IG integration.


(Bjorn) A "hack-a-thon" is scheduled in Lübeck with real devices to get more into the application - Middle of October.  Also, there will be device simulators to do the conversion of SDC –> FHIR respective resources ("SDC FHIR Conversion"...  This is on the scheduled for Thursday afternoon and Friday if necessary.  

There will be more details in other details later this week.

--

Todd Cooper - White Paper under IHE PCD called "Service-oriented Device Point-of-Care Interoperability (SDPi)" a device-to-device connectivity in high-acuity healthcare environments using Web Services Technology.

  • Out for Public Comment - due VERY soon (9/20/19)
  • Idea of the White Paper is for a broad audience - Intent was to get enough high level knowledge in one place for many perspectives.
  • Todd walked through the sections of the white paper.
  • Todd also mentioned to please take a close look at the Road Map (3-year); in terms of public feedback, Todd is looking for response to "Additional Roadmap Considerations...."  (line 3000 of document).


9/17/2019
Tuesday, Q3
  • PoCD Cybersecurity:
    •   11073 PHD Cybersecurity
    •   AAMI TIR57, SW96, TIR97,
    •   UL2900
    •   Security topics from JWG7


  • "Quiet Hospital" Use Case Discussion

Chairs 

All




Cooper / Schlichting 

General status updates provided by Todd Cooper & Stephan Schlichting,

Links provided by Üwe Meyer related to Cybersecurity discussion for attendees:

https://www.iec.ch/dyn/www/f?p=103:14:147749851869::::FSP_ORG_ID,FSP_LANG_ID:22678,25

https://www.fda.gov/media/123070/download

--
Quiet Hospital: Todd Cooper provided a general overview.  Stefan provide a presentation from a previous presentation...

Slides presented on SDC Alarming/reporting etc.

No Action items

Re9/17/2019
Tuesday, Q4
  • U.S. Government MDIRA Project


  • X73 PoCD/PHD "Scoping" Discussion


  • Review and Adjourn IEEE Portion of Meeting

Steve Griffiths


Ken Fuchs


Todd Cooper


IEEE PoCD Chair

Steve Griffiths

MDIRA

Overview (Government funding project, in addition to military, FDA, NIH)



Adapters (see diagram above green/pink boxes) given lack of interoperability...



IHE SDPi Use Cases:


9/18/2019
Wednesday, Q1
  • Welcome and Introductions
  • Intellectual Property Policy


  • DEV WG Agenda Review
  • Report out from DESD & HL7 Co-chair mtgs.


  • NIST RTMMS II
  • NIST Tooling

Co-Chairs



Co-Chairs


Faughn / Garguilo (NIST)









NIST Tool Discussion (Michael Faughn/ John Garguilo)

  • Please refer to Michael's submitted presentation in Confluence "Documents" posted presentations here entitled "Atlanta_11073_NIST-Prometheus_September_2019"
9/18/2019
Wednesday, Q2

FHIR  Projects Update

  • Issue relating to 10101R to submit XML files of all the tables

Devices on FHIR :

  • Alerting (incl. DeviceAlert resource proposal)
  • PHD IG Ballot Comment Resolution
  • PoCD IG: 
    • Status Update
    • Content Proposals (see HERE)

Rhoads

Malcolm Clarke


Stefan Schlichting


Reinhold / Rosner
Rhoads / Karl


Issue relating to 10101R submission of XML files of all the tables (Malcolm Clarke)

  • It would be valuable for the tables in the standard to be made available in machine-readable (XML) form, but due to near term deadline (Friday, September 20, 2019) for IEEE document process and submission, and the rule that supplementary material must be available at publication time and not added later, made this impractical.
  • Therefore, a motion was proposed to "strike footnote from IEEE submission document which indicates submission of XML files of all the 10101R tables"
    • Motion made by Michael Faughn, second by Todd Cooper
    • Motion passed 11-0-0 by IEEE voting members

Devices on FHIR Discussion: Device Alerts, Events and Alarms

  • [John R. ] noted: Agenda item is to give a viewing and awareness to the HL7 FHIR Management group; further discussion would occur on DoF weekly call.... Todd 
  • Todd Cooper: Action Item for Todd Cooper to follow up w/ DaVinci folks that device alert is a different 'alert' than the to date understanding by DaVinci group Action items

Note: no formal document/presentation submitted to HCD WG, JSON resource definition example shown and discussed at meeting

  • Discussion to call "device" item "alertSource" from "2019-06-17AlertResourceDiscussionNotes.docx" (Action Item: John Rhoads to post to documents page of Confluence

  • John Rhoads asked if anyone had anything further to discuss on Alerting?
    • Paul Schluter noted regarding Event Phase ("start" and "End" and "Continue" captured in effective time...  Stefan Schlichting noted that when one changes the 'status of the resource'... perhaps change to "Alert Phase"

PHD IG Ballot Comment Resolution

  • Brian Reinhold noted that a discussion occurred with Clem (who has some outstanding negative items, and that Brian has responded and is waiting on Clem's review.  Clem indicated he agreed to review outstanding issues (persuasive) to be resolved (i.e., accepted by Clem).
  • Status update provided by Martin Rosner:
    • Comments and status changes to be made in GForge (and indicated updates will be added in the very near term
    • Assuming Clem's responses (are favorable), wrap up of PHD Implementation Guide (IG) items should be resolved over the next few DoF weekly calls (Wednesday, 9 am EST calls).

PoCD IG

  • From John Rhoads: Some administrative items to be addressed by John R., as moving towards another revision... Reference Punch list  (see HERE
  • Fill in 
9/18/2019
Wednesday, Q3
Terminology:
  • 10101 to LOINC mapping updates
  • 10101 / LOINC review panel plan


  • IEEE P11073-10101b
    • parameters (NMT, TPTD-CCO, infusion?
    • event and alert nomenclature
    • additional body and measurement sites
  • IEEE -10103 IDCO
  • Harmonized Rosetta (hRTM2a) updates


Abhyankar / McDonald
John Rhoads


Paul Schluter

LOINC mapping updates and Review Panel Plan

  • Dr. Abhyankar indicated that few new terms were added since the last WG meetings  into the LOINC database and due to staffing issues, she will dedicate more of her time to the database end and thus for the short term not have the resources to dedicate attention to more mappings.
  • Action Item: John Rhoads noted HCD will attempt to establish volunteer effort (perhaps through IHE) to help with the terminology review and mappings.

Terminology (Schluter)

  • Please see posted presentations here entitled "IEEE_11073_2019-09-18.Atlanta.5d.2019-09-18T10" and
  • Please see the Implantable Device report out here "IDCO HRS Interoperability Report-out Sep 2019"
9/18/2019
Wednesday, Q4
  • Joint with Mobile Health
  • Terminology (continuation of Q3 if needed)
  • FHIR Tooling Discussion


Matt Graham / Gora Datta



Mobile Health Joint Session

  • Keith Boone presented Mobile Health PSS-lite project 
    • Keith asked for a "show of hands" of who in HCD are interested in participating as subject matter experts (Brian, John Rhoads and Martin responded favorably).
  • Status Update (Matthew Graham)
    • Please see posted presentations here entitled "2019 Sept Mobile Health Projects Update"
    • New work from last WG report out: "School Healthcare Information Framework utilizing Technology (SHIFT)" (refer to provided slide set)

Terminology report/summary (cont' from Q3)

  •  Hoping for provisional numeric codes for events and alerts by end of Oct 2109

FHIR Tooling Discussion (in preparation for Q1 Thursday joint meeting)

  • John R. will build a slide from some items in past weekend's "Connectathon"...related to alerts
  • Other topics
    • Device Alerting
    • Performance challenges at server side (e.g., can output 200 per second per device w/o or including waveforms)
    • Localization
    • Large Data issues - Experience from FHIR Connectathon like event - 
      • SDC Patient monitor - 50 - 60 devices for example (which is not realistically much from a hospital setting) - would have to write ~7K observations per second. 
      • Writing into the repository was buffered and couldn't handle them...
      • So next the observations were bundled (which optimized) - led to 160-180 observations per second...
      • Then optimized the server and memory... 
      • Next write only every 10 or so seconds (i.e., 10 second blocking)... which worked better - achieved nearly 7K observations per second...  also don't get timestamps.  Note to display on a mobile phone would likely need to do every ~2 seconds.
      • Bottleneck was really at FHIR server... throughput of the network was not the problem...
      • So from Stephan S' perspective this will really not scale up.
      • Brian R. mentioned the large amount processing that has to occur at the FHIR server side, lots of overhead as well to set up.
    • Save two-dimensional data that is where one dimension is something other than a periodic time series
      • real time sample is able to display (value versus time)
      • power spectral density or probability distribution, for example, not supported
      • suggested remedy: allowing other units like Hz (1/sec), cumulative probability
    • DoF Road map - process for the next iteration of the IG + release 5
    • ACTION: a brief but complete proposal for changes to the data type allowing for these and other useful 2-dimensional data presentations

Todd also mentioned to WG about planning for Australia WG meetings and suggested thinking about perhaps having some introductory sessions throughout the week to help the newer folks in Australia to get more engaged with the HCD group.

  • Motion made to close the IEEE portion of WG meetings
    • Motion made by John Garguilo, second by Todd Cooper 
    • Motion approved 11-0-0
9/19/2019
Thursday, Q1

Welcome and Introductions

  • Joint with FHIR @ HCD
    • “Devices on FHIR” IG Roadmaps, R5, Resource Maturity, ...
    • DoF:  Alerting Strategies (incl. DeviceAlert)
    • DoF:  Server Performance re. Scaling for Patient Monitored data (e.g., SDC)
    • FHIR "Localization"
    • FHIR support for non-time-based sample arrays
    • Device Static vs. Dynamic Data in FHIR
    • HCD / FHIR Planning

Co-Chairs / Rick Geimer

Rhoads, Karl

Rhoads
Stefan Karl

Stefan Karl

Rhoads

Joint with FHIR @ HCD (FHIR Infrastructure Work Group Rep: Rick Geimer, room M103)

“Devices on FHIR” IG Roadmaps, R5, Resource Maturity, ...

  • Resource Maturity Level (ML): Rick noted when developing and working on IGs for trial use, FMG will be requiring attending/testing at a FHIR Connectathon Event or similar type of event.
    • Noted that IG of this group are ML STU
    • The requirement above (attending FHIR Connectathon/Test Event) applies to ML 0 or 1
  • O&O status for device
    • Device status is conflated depending on if device is implanted (vs. if for example if a device is implanted with a dead battery)
    • Looking at status of device and status of record of device...
  • Any resources planned on bringing normative (Level 4 or 5).  
    • HCD would likely bring forward DeviceMetric forward
    • Presently at maturity level 1, next is to fill out spreadsheet, do a testing event at FHIR Connectathon (or similar event if not at HL7 WG meetings)
  • Timing of R5 will likely be May 2021, and still targeting end of year 2021 (this may require an out of cycle ballot
  • ACTION ITEM : Device Metric needs to have maturity level spreadsheet completed (John Rhoads)

DoF:  Alerting Strategies (incl. DeviceAlert)

  • Todd Cooper provided a back drop for Alert
  • Rick noted that other folks are doing work on Alert resource (more FHIR Server)
    • Rick mentioned his mention is tied to subscription approach (e.g., DiVinici)
    • Todd noted alerting from/to devices are different and HCD intends to make this very clear (and in a way that is consistent and synergistic) 
    • Rick noted previously Subscription resource now split into 'Subscription' + 'Topic'
      • This was done so those using subscription would publish topic
  • DeviceAlert resource definition Review (John )
    • John showed spreadsheet providing Path, Type, Binding, Multiplicity, Definition, Comment, etc... providing informational and current state representation of alert.
    • Noted that IEEE has many alerts - embedded in the nomenclature
    • IEEE is a recognized, have an OID, and a FHIR page - tooling can expand 
    • John Garguilo mentioned to Rick about the RTMMS and nomenclature source
    • Todd mentioned the IG has two parts in which getting the solid "stuff" concrete and further cook
    • Topic is a new resource spun off from Subscription resource providing the topics allowed to subscribe to... (various channels to establish) EHR will predefine topic in which one can choose topic to "listen for"...
    • Rick mentioned and encourage folks in HCD to create a Device Alert Topic and test out in next FHIR Connectathon track...

DoF:  Server Performance re. Scaling for Patient Monitored data (e.g., SDC)

  • (Stefan Schlichting) provided background for Rick
    • High volume of data from many devices...
    • When testing with FHIR Server, the date was written but buffer was overloaded... 
  • Rick mentioned maybe trying bulk data, but no easy answer at this point...
    • May need some other folks from FHIR team who are on server side to hear about...
    • Todd asked if this could be a good topic at DevDays - and that we should give notification in the IGs
    • Rick mentioned some discussion in FIREi how to "page" the reading... also mentioned "Patch" feature
    • Rick suggested running this issue by and contacting James Agnew lead developer on HAPI 
  • ACTION ITEM: Rick suggested doing a write up and creating a GForge tracker item so the item would get a time to talk about it with FHIR team...  assign it FIREi team.  Stefan Schlichting Stefan Schlichting agreed to do the write-up against the HTTP.html page (description of FHIR use of REST) Reassign to Stefan Karl

FHIR "Localization" (issue brought forth by Paul Schluter)

  • Todd Cooper introduced topic for Rick
  • Localization: a display provides the overall 
    • How does one do the Localization in FHIR
    • There is a "text field" which could be used, but if you need to note a localization such as what language is used (e.g., Japanese, German, etc)... Rick was thinking this may have to be a unique resource for each language...
    • This might fall into an extension...
    • As a general construct, localization would include things like language, geographical info - but doesn't appear to be a place to do this...
  • Rick mentioned this seems like a common issue, but not aware of answer - so he will look into it and get back to HCD (will bring it up in Q2 today)

FHIR support for non-time-based sample arrays

  • Bjorn Andersen provided background...
  • Rick suggested getting a tracker issue in before R5 - to relax cardinality and propose the additional fields needed such as "basic science"

Done. Ticket can be found at #25034

Device Static vs. Dynamic Data in FHIR

  • This does appear to be a good use case for PATCH - perhaps HCD could participate in a Connectathon ; HAPI and ZONK both support PATCH but might not support the item 
  • ACTION ITEM: To do in parallel with Performance item above. (Stefan Karl)

HCD / FHIR Planning

  • End of Oct moving to JIRA (system will be down on a Friday and come back up on a Sunday) Lloyd will notifiy when NOT to file a new tracker...
9/19/2019
Thursday, Q2
  • IHE PCD Update
    • PCD "Reorganization" Proposals Update
    • Alerting:  ACM CPs for timing diag. and fatigue
    • SDPi Public Comment
    • DEC FHIR Option (deferred to another time)
    • Boston Agenda Review


  • NIST V2 Tool Update & Infrastructure


  • Review of Projects, Status


  • HL7 DEV General Roadmap and Planning


  • Carry-over DEV topics 
  • Adjourn 

Rhoads/Cooper






Garguilo



Co-Chairs/All



All

IHE PCD Update

PCD "Reorganization" Proposals Update

  • Device Enterprise Integration
  • Personal Connected Health Alliance (PCHA)
  • SDPi
    • OR High Acuity
    • Healthcare Enterprise
    • Home and/or Mobile

Alerting:  ACM CPs for timing diag. and fatigue

  • Diagram presented and discussed
  • More to come... summary is that the diagram shows a multi-domain approach

SDPi Public Comment

  • Please provide comments ASAP, deadline for open comments (Sept 23, 2019)

DEC FHIR Option

  • Initial draft sent by Todd Cooper (to IHE Chairs)

Boston Agenda Review

  • Pump work group meets on Tuesday - Terminology
  • Wed morning Q1 is joint with PCD and PCH, Launch Personal Connected Health
  • Action Item: John Rhoads to take a look at the IHE-PCD Wiki page for meeting and comb out things that no longer apply or more in the "parking lot"
  • Suggested to have an update to Agenda on next IHE-PCD TCon Wednesday at 11 am 
    • Update from MDIRA folks in Boston (possibly also from MDPnP?)

NIST V2 Tool Update & Infrastructure

  • See posted presentation from John Garguilo entitled "HL7_IEEE_HCD_NIST_Sept_2019_Atlanta" here 
  • Discussion about looking down the road (future) integrating the NIST Test Framework with additional HCD protocols...

Review of Projects, Status

  • 3-year plan now no longer needed 
  • Projects reviewed from HCD HL7 Projects wiki page
    • 1335: no update
    • 1277: Need to update the PSS for the steering division (and update dates)
    • 1153: Has not made it out yet
    • 898: Now at the next stage of usability (no needs for HCD from lead) - success!
    • 897: Now at the next stage of usability (no needs from HCD from lead) - success!
    • 850: Dependent on the DAM finishing
    • 773: 2.9 Messaging Standard: Going through normative ballot
    • 513: HCD has asked to remove, still shows up 

Carry-over DEV topics

  • No carry-over topics 

Motion to adjourn HL7 HCD

  • First Todd Cooper, second Michael Faughn
  • Motion approved 17-0-0

Action items