Ballot SubmissionTriage & Committee ResolutionBallot Comment Tracking
Comment NumberBallotChapterSectionPage #Line #Artifact IDResource(s)HTML Page name(s)URLVote and TypeSub-categoryTracker #Existing WordingProposed WordingBallot CommentSummaryIn person resolution requestedComment groupingScheduleTriage NotePubsDisposition WGDispositionDisposition Comment or Retract/Withdraw detailsDisposition/Retract/ Withdrawal DateMover / seconderFor AgainstAbstainRetracted / WithdrawnDisposition External OrganizationResponsible PersonChange AppliedSubstantive ChangeSubmitted ByOrganizationOn behalf ofCommenter EmailSubmitter Tracking IDReferred ToReceived FromNotes
1PCFull CIMI (Mitre)NEGFull CIMI is not an accurate representation of the CIMI model. It seems to represent another model and this needs to have been clearly described earlier in the document.CIMI alignmentClaude NanjoUniversity of Utah
2Full CIMI (Mitre)NEGThe cimi-entity-Person-model does not match the CIMI Person and DetailedPerson model. For instance, it contains an attribute called 'headShot' which does not exist in CIMI. FHIR logical models must be generated from the CIMI model faithfully. It does not appear to be the case here.CIMI alignmentClaude NanjoUniversity of Utah
3Full CIMI (Mitre)NEGIn sw-WoundAssessmentPanel-model there is an attribute called personOfRecord which is named differently from the CIMI Reference model. In the CIMI Reference Model it is called subjectOfInformation and does not appear in this model.CIMI alignmentClaude NanjoUniversity of Utah
4Full CIMI (Mitre)NEGThe sw-WoundAssessmentPanel-model has lost the topic and context composition. It is a flattened model which has lost its hierarchy (Element is the parent). This represents a divergence from the CIMI model as it is represented today. If full-cimi aims at creating a logical model translation of CIMI, the translation should be faithful to the model. Variants should be labeled as iso-semantic variant but would also need to demonstrate 1:1 alignment with the CIMI preferred model.CIMI alignmentClaude NanjoUniversity of Utah
5Full CIMI (Mitre)NEGFixed Value should show the display name in addition to only the code.presentationClaude NanjoUniversity of Utah
6Full CIMI (Mitre)NEGIn sw-WoundAssessmentPanel-model topicCode has an extension attribute. It should not appear in a logical model.FHIR adaptationClaude NanjoUniversity of Utah
7Full CIMI (Mitre)NEGIn sw-WoundAssessmentPanel-model it seems that many attributes are not relevant to a panel so I am not sure what compositional pattern was used to create this class. It differs from CIMI in important ways. For instance, why does precondition appear in the panel? In CIMI, PanelTopic inherits from FindingTopic and not EvaluationResultTopic. Also, I am not sure where category comes from and it should probably be best handled at the terminology level. The logical profiles presented here thus do not faithfully represent the current CIMI model and should not be used as a base for comparison for other logical profile approaches.CIMI alignmentClaude NanjoUniversity of Utah
8Mini-CIMINEGEntities in Mini-CIMI are observations (e.g., they have a findingStatus, findingMethod, etc…). However, there is a conflation between the real-world ontological entity and observations you can make about that thing. I recommend deconflating the two.entity vs resultClaude NanjoUniversity of Utah
9Mini-CIMINEGpresentOrAbsent is a single attribute much like negation indicator. In CIMI, we moved away from this for two reason: (1) it is risky to have an attribute that can reverse the semantics of the class. (2) often the set of attributes is different when asserting presence vs absence. Also, presence and absence is modeled differently in PatientWoundSummary which is confusing.presence Claude NanjoUniversity of Utah
10Mini-CIMINEGIn Mini-CIMI, attributes are statements and these statements have subjects which may be the statement they are qualifying. Thus, a child knows its parent and the parent does not know its children. This is very different from most UML modeling approaches where the parent class specifies its children attributes. In other words the navigation goes in the other direction. While the proposed approach can be taken, it represents an important departure from our current modeling approach and still fairly immature at this time. I would not recommend its adoption for CIMI.association directionClaude NanjoUniversity of Utah
11Mini-CIMINEGThe definition of clinical statement in this model is not the same definition of a clinical statement in either CIMI or ISO-13606. I would recommend a different name be used. Perhaps - Data Element?clinical statement definitionClaude NanjoUniversity of Utah
12Mini-CIMINEGThe definition of composition in this model is different from the definition of composition in CIMI and ISO-13606. I would recommend another name be used to represent such a collection.composition definitionClaude NanjoUniversity of Utah
13Mini-CIMINEGEvery model represented as a clinical statement in mini-CIMI specifies attributes such as finding status and finding method. While at times the value for these attributes may vary for the subject of the clinical statement, often they are the same for the entire observation. This adds potentially more baggage than necessary.redundant overheadClaude NanjoUniversity of Utah
14Mini-CIMINEGThe qualifier (0..*) attribute seems very much like an extension. That is, any number of these may be defined for the class. Furthermore, I am not sure I fully understand its purpose as it has a coded value but no place to put the code for the qualifier itself. So if I have a qualifier for qualifier = 'rest', what does qualifier represent? Precondition, body position, etc...qualifier scopeClaude NanjoUniversity of Utah
15FHIM-CIMIA-CThis Implementation Guide (IG) is part of a demonstration project showing how different groups, with different tools, approach CIMI modeling.In this submission, we are presenting four models: CIMI, Full-CIMI, Mini-CIMI, FHIM-CIMI. This is very confusing. Rather than using different goups, tools, etc… to build CIMI models we are really showing how different groups, tools, etc… build different models. In other words, we are not really converging nor are we showing for instance isosemantic models and how they relate to one another.many models in this ballotClaude NanjoUniversity of Utah
16FHIM-CIMINEGfsw-ObservationStatement-model appears seems to be a panel rather than an observation. Suggest renaming the class in the FHIM and not combining panels and observations into one class.observation definitionClaude NanjoUniversity of Utah
17FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-PanelMembers-model.htmlNEGfsw-PanelMembers-model definition shows a cardinality of 0..*. Not sure that makes sense.panel cardinalityClaude NanjoUniversity of Utah
18FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-PanelMembers-model.htmlNEGNot sure why you need this structure. Why not make panelMembers be of type fsw-ObservationStatement-model.Claude NanjoUniversity of Utah
19FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssertion-model.htmlNEGfsw-WoundAssertion-model defines a value[x] attribute. Existence/Presence/Absence should not be expressed (1) as a quantity and (2) a code.assertion valueClaude NanjoUniversity of Utah
20FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-IsUnderminingPresent-model.htmlNEGfsw-IsUnderminingPresent-model seems to coordinate presence in the name of the model. Also, this structure presents a topicCode stating whether it is a finding or an action and a value for the finding or action. I thought we were moving away from this pattern (remember previous assertion discussion) and letting the class specify what it is and the topicCode represent the type of finding and observation. This form seems very close to the ANF information model approach and is very different from the current CIMI approach. I recommend we don't conflate ANF and CIMI. ANF is an isosemantic representation of CIMI.presenceClaude NanjoUniversity of Utah
21FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlA-QWhat is the difference between datetime and datetimeissued?datetimeClaude NanjoUniversity of Utah
22FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlNEGWhat is purpose of topic code if value[x] represents the LOINC panel? How can a quantity represent a LOINC code? assertion valueClaude NanjoUniversity of Utah
23FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlNEGThis class seems to be a hybrid between a evaluation result (topicCode paired with value[x]) and Panel (panelMembers, etc…). The panel has three types of attributes: Those under evaluationComponent, those under panelMembers, and first level attributes. It also makes use of Reference for some of them (independent statements vs dependent statements) when such a notion probably does not belong in a logical model.entity vs resultClaude NanjoUniversity of Utah
24FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-IsExudatePresent-model.htmlA-SThe name should be changed from isXYZ which implies a type of boolean. BooleanClaude NanjoUniversity of Utah
25FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-IsTunnelingPresent-model.htmlNEGThis structure indicates whether tunneling is present/absent but does not provide other attributes such as direction, etc… Thus, I am not sure how the case where attributes relevant to presence vs absence are handled in this model.presenceClaude NanjoUniversity of Utah
26FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundSize-model.htmlNEGIf value is a loinc code for Wound Size Panel, what goes in the topic code? Also why is there a Quantity type for value? It seems that the function of topicCode and value[x] is not consistent across models. Sometimes value indicates presence/absence as a quantity, sometimes this is done by value[x] as a code, sometimes value holds a LOINC code for the thing it represents, etc...entity vs resultClaude NanjoUniversity of Utah
27FHIM-CIMIhttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundArea-model.htmlNEGWhat goes in topicCode?entity vs resultClaude NanjoUniversity of Utah
28NEGI strongly recommend that in the future, all ballot submissions done under the auspices of any WG that pertain to represent CIMI must be completed at least 2 weeks before the ballot submission deadline. One week should be provided for review by the community (submitted on the listserv) and one week to make final adjustments before CIMI can vote to approve the submission. Any model that claims to represent CIMI should demonstrate that it is a valid CIMI model. full-cimi is not a valid CIMI model and thus not a good point of comparison for the other two variants. Any model that is not a valid CIMI model should demonstrate that it is a valid isosemantic variant of a CIMI model and that it adheres to our principles. As mentioned in a previous comment, for this ballot cycle, we submitted a ballot after the closing date that no one had a chance to review, that contains four different models - CIMI, the Mitre full-cimi SIMPL model, mini-cimi, and FHIM-cimi. If I were to review this work as an interested party I would be very confused as to what is CIMI. Such bakeoffs should be done internally and the lessons-learned incorporated into the preferred CIMI model which we ballot.ballot presentationClaude NanjoUniversity of Utah
29FHIM-CIMIApproach to Skin and WoundNEGApproaches to deal with the hierarchical nature of wound assessment include using sub-observations that are nested inside a parent observation, or a panel approach, where independent observations are grouped under panel observation.This statement is not entirely correct. Both are compositional approaches.compositional approachClaude NanjoUniversity of Utah
30SDCurrent Infectious Disease Diagnosis (ID)(CONF:3378-32884)NEGSHALL contain exactly one [1..1] value, which SHOULD be selected from ValueSet Problem urn:oid:2.16.840.1.113883.3.88.12.3221.7.4 DYNAMICSHALL contain exactly one [1..1] value, which SHOULD be selected from ValueSet Infectious Disease Problem urn:oid:xxx DYNAMICPlease constrain to SHOULD be selected from value set that is intensionally defined by SNOMED CT terms descending from Infectious disease (disorder) SCTID: 40733004There may also be some terms that are appropriate from the situation with explicit context hierarchy, you could look for those - or be satisfied with the SHOULD binding to the new value set where likely you will find all/most the terms neededYesintensional bindingGay DolinIntelligent Medical Objects
313.13.2 Differential Diagnosis (ID) CONF:3378-32920 (and children)NEGThis code SHALL contain exactly one [1..1] qualifier (CONF:3378-32920). i. This qualifier SHALL contain exactly one [1..1] name (CONF:3378-32930). 1. This name SHALL contain exactly one [1..1] @code="106229004" Qualifier for type of diagnosis (qualifier) (CONF:3378-32931). 2. This name SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.96" (CodeSystem: SNOMED CT urn:oid:2.16.840.1.113883.6.96) (CONF:3378-32932). ii. This qualifier SHALL contain exactly one [1..1] value (CONF:3378-32921). 1. This value SHALL contain exactly one [1..1] @code="47965005" Differential diagnosis (qualifier) (CONF:3378-32924). 2. This value SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.96" (CodeSystem: SNOMEI don't think that this meets the rules of snomed CT and R1 data types: and from R1 data types: http://www.hl7.org/v3ballotarchive_temp_90020D03-1C23-BA17-0C4E2B704F8175F4/v3ballot/html/infrastructure/datatypes/datatypes.html#prop-CD.qualifier: "It is important to note that the allowable qualifiers are specified by the code system." "Use of qualifiers outside the boundaries specified by the code system is a non-conformant use of the CD data type." Also, this a differential diagnosis is a MODIFIER, of a diagnosis, it changes the meaning, as opposed to a qualifier - which makes something more granular.Suggest not conforming to Problem Template and creating a new "Differential Diagnosis template using your LOINC requested code -- or maybe en entry relationship Yesprobably wrong specGay DolinIntelligent Medical Objects
32(CONF:3378-32895)NEGSHALL contain exactly one [1..1] value, which SHOULD be selected from ValueSet Problem urn:oid:2.16.840.1.113883.3.88.12.3221.7.4 DYNAMICSHALL contain exactly one [1..1] value, which SHOULD be selected from ValueSet Infectious Disease Problem urn:oid:xxx DYNAMICPlease constrain to SHOULD be selected from value set that is intensionally defined by SNOMED CT terms descending from Infectious disease (disorder) SCTID: 40733004There may also be some terms that are appropriate from the situation with explicit context hierarchy, you could look for those - or be satisfied with the SHOULD binding to the new value set where likely you will find all/most the terms neededYesprobably wrong specGay DolinIntelligent Medical Objects
333.13.3 Infectious Disease Carrier Diagnosis (ID)NEGConforms to Problem Observation (V3) template (identifier:I don't think this is conformant to the problem observation template since it doesn’t have a code from ValueSet Problem Type @observation/codeYesprobably wrong specGay DolinIntelligent Medical Objects
343.13.3 Infectious Disease Carrier Diagnosis (ID)CONF:3378-33019SHALL contain exactly one [1..1] value with @xsi:type="CD" (CONF:3378-32977). Note: Infectious disease carrier diagnosis a. The code SHOULD be selected from CodeSystem SNOMED CT (urn:oid:2.16.840.1.113883.6.96) DYNAMIC or CodeSystem ICD10 (urn:oid:2.16.840.1.113883.6.3) DYNAMICWhy such a broad value set?Yesprobably wrong spec
353.13.5 Past Infectious Disease Diagnosis (ID)CONF:3378-32885SHALL contain exactly one [1..1] value, which SHOULD be selected from ValueSet Problem urn:oid:2.16.840.1.113883.3.88.12.3221.7.4 DYNAMICSHALL contain exactly one [1..1] value, which SHOULD be selected from ValueSet Infectious Disease Problem urn:oid:xxx DYNAMICPlease constrain to SHOULD be selected from value set that is intensionally defined by SNOMED CT terms descending from Infectious disease (disorder) SCTID: 40733004There may also be some terms that are appropriate from the situation with explicit context hierarchy, you could look for those - or be satisfied with the SHOULD binding to the new value set where likely you will find all/most the terms neededYesprobably wrong spec
36PCFHIM wound assertion profileassertion profile A-SFor this and all profiles, there is so much inherited overhead on the page it's difficult to read. Investigate ways to a) constrain out elements not necessary to the model (e.g., method, for wound identification), and b) background elements that are necessary to the FHIR specification but are inherited infrastructure, not focal content for implementers (meta, language, etc.)redundant overheadGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
37FHIM wound assertion profileassertion profile A-SWhy is site 'related' while other properties are 'component's?FHIR adaptationGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
38FHIM wound assertion profileassertion profile A-SWhy is wound assertion an Observation? It seems like a Condition. Impact: we have code and value properties that are not specified.FHIR adaptationGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
39FHIM wound assertion profileassertion profile A-SFor initial and recurrent, WoundEpisode seems to belong on the Assertion, but Chronic and Acute seem to belong on the Assessment, as they may be expected to change.Assertion boundaryGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
40FHIM wound assertion profileassertion profile A-SCodes are specified at the coding.code level, rather than as constraints on CodeableConcept. This prohibits the use of additional, more specific codes. Can the property not be bound to a single code without doing this?FHIR adaptationGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
41FHIM wound assertion profileassertion profile A-SRepeating resource properties that are sliced (e.g., component) remain in unspecified form as well, but without cardinality constraints. They should not appear.Greg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
42FHIM wound assertion profileassertion profile A-SWoundType code value set not in VSACvalue set not specifiedGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
43FHIM wound assertion profile detail assertion profile detailA-SIf the code is specified, the display should be as well.presentationGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
44FHIM wound assertion profile detail assertion profile detailA-SPublication tool should group component properties visually, label them consistentlypresentationGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
45FHIM wound assertion profileassertion profile A-SObservation.category should be constrained to examconstraintGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
46FHIM wound site identification profilesite profileA-SPerhaps this should be an extension on body site rather than a parallel structurebody siteGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
47FHIM wound site identification profilesite profileA-Slaterality not in vsacvalue set not specifiedGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
48FHIM observation statement Profileobservation statemetnA-SSeems to be designed for physical exam observations; should be named ExamObservation.FHIR adaptationGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
49FHIM wound assesment profilewound assessmentA-Sthis should be a bundle, not an observation. If it were an obs, the the assertion should be Focus V3 has related in some views and hasMember in others, so if hasMember is the future, that sounds right. But if Observation doesn't get it together, this is a bundle.FHIR adaptationGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
50FHIM wound assesment profilewound assessmentA-SClinical semantics should have citations to support value choicesmetadataGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
51FHIM wound bed profilewound bedA-SLike assessment, this is a collection of observations and might better be a bundle than an observation. Constrain out code and value.FHIR adaptationGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
52FHIM wound bed profilewound bedA-SCan't put these together; need to pair percentage with observation, and allow multiple pairs of each. OR, make the bed profile 0..* and only populate two values in each instance.subassertionsGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
53FHIM wound edge profilewound edgeA-SConfirm edge observation cardinality. If these are both 0..1 for the assessment, they don't need an intermediate component.subassertionsGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
54FHIM wound exudate profile wound exudateA-SSee comments on bed profile regarding resource choice and compositionsubassertionsGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
55FHIM wound size profilewound sizeA-SSee comments on bed profile regarding resource choice and compositionsubassertionsGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
56FHIM wound size profilewound sizeA-SThis could be constrained to a 0..* observation with a coded question value set (length, width, etc.)measureGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
57FHIM wound tunneling profiletunneling presentA-SClarify semantics. Property name: tunneling presence. Values: 410516002 |Known absent (qualifier value)| 410515003 |Known present (qualifier value)| Ditto for undermining, exudatepresenceGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
58FHIM wound assertion logical modelassertion logicalA-SBasis for design pattern choices unclear - evaluation component, panel membersFHIR adaptationGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
59FHIM wound assessment logical modelassessment logicalA-Sassertion might should be focus rather than another panel memberpanel compositionGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
60Mitre wound assertionwound assertion A-SReason for using extensions rather than related observations unclearpanel compositionGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
61A-Stoo much techical detail to assess clinical validityIn any information model construction effort, there are two steps: requirements definition and solution design. CIMI has been conceptualized as a way to document requirements in a way that can be reused when technology regimes change. Most of the effort, however, has been focused on designing computable solutions to support pattern reuse and automated transformations. This work is very difficult - in fact, one of its goals seems to be to prove that it's possible - and it's interfering with the work of capturing requirements. CIMI should build analysis models first. They can be detailed. But analysts should not waste time debating patterns for modeling before the requirements are agreed on.CIMI strategyGreg Staudenmaier US Department of Veterans Affairsjay.lyle jpsys.com jay.lyle@jpsys.com
62PCWoundPresenceAssertionProfilehttp://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundPresenceAssertion.htmlA-QWhat value set is used for wound staging, this? 2.16.840.1.113883.1.11.20.2.6 Is the staging based on NPUAP language?NPUAP stagesKanwarpreet SethiLantana Consulting GroupZabrina Gonzagazabrina.gonzaga@lantanagroup.com
63PCOverallNEGThe ballot content posted on the HL7 CIMI website contains a collection of wound related information components organised as a list Readers are required to wade through the Ancester list to understand how the different components are related, and plough through the Field Summary to try work out what data elements are included by what structure The complete absence of diagrammatic representation of relationships make almost impossible to discern what is related to what and how The whole ballot content presentation is very much unusable to readers ballot presentationStephen Chu Patient Care WG
64Wound areaA-SThe "Documentation" statement contains this description: "area of the wound""measurement of the wound region"The statement - "area of wound" - is circular with reguard to the name "wound area", provides no more claritydefinitionStephen Chu Patient Care WG
65Wound areaNEGWound area inherits a number of properties from EvaluationComponent, which include:ExceptionValue Descripiton of ExceptionValue = Reason that a value associated with a test or other finding is missing It is unclear what use case /requirement this element is intended to satisfy If it is for indicating missing finding, how is it different from WoundAbsenceAssertionredundant overheadStephen Chu Patient Care WG
66Wound assessment panelA-QThe structure excludes Laboratory Observation It is common for laboratory or even imaging results to form part of wound assessment panel Why are they excluded?Clinical requirementsStephen Chu Patient Care WG
67WoundEpisodeNEGWoundEpisode = wound episode refers to a period of the wound, an incident in the course of a woundChange to: a period to time during which the condition and/or management of the wound may evolveThe defintion/description is extremely confusing - describes the episode as both a time period and an incident/event The structure of this concept provides no clarity to what this concept should be The concept of "episode" means an event or group of events occuring within a specified time duration. For example, an episode of care represents a time period during each care events occurdefinitionStephen Chu Patient Care WG
68WoundIdentifierA-QDescription/definition = A human-readable identifier for the lesion; e.g., a letter or integerWhat is the rationale/purpose for this identifier to be human readable? Human-readability is not a requirement of identifier, except for cases such as Patient Identifier, which is may be used as one of the disambiguation variablesClinical requirementsStephen Chu Patient Care WG
69Wound Periwound DescriptionNEGDescription/definition = A description of the skin around the wound (periwound)Periwound description -> change to -> "a description of the tissue (i.e. skin or muscous membrane) around the wound" WoundEdge Description -> change to -> "The state of tissue at edge and within the perimeter or boundary of the wound"This description/definition and that for WoundEdge Observation (= The state of the tissue at the edge of the wound) - do not provide sufficient distinction for the two and potentially cause confusion Also, tissue around the wound is not always skin, as a wound can be sited on mucous membranesdefinitionStephen Chu Patient Care WG
70WoundExudate PresentorAbsentA-QWhy is this element not a child of WoundExudate Observation?presence Stephen Chu Patient Care WG
71WoundPressure Ulcer AssociationNEGDescription/definition = Is the wound associated with a device or pressure point?Change WoundPressureUlcerAssocation to: WoundPressureEffectAssociation Change definition/description to: "Is the wound associated with result of pressure?"The name of the element is incorrect: Pressure Ulcer is itself a type of wound The description/definition is semantically incorrect ** There should be no need for this element as this can be adequately supported using the WoundTypeEtiology elementPU associationThe association is with a device or pressure point.Stephen Chu Patient Care WG
72WoundTypeEtiologyNEGSuggest change to: WoundEtiologyThe element name is semantically incorrectdefinitionStephen Chu Patient Care WG
73WoundTypeEtiologyNEGDescription/definition = Is the wound associated with a device or pressure pointThe defintion/description excludes risk factors that may contribute to wound formation, e.g. malnutrition, edema, immobility … Suggest add a new element to support capturing of risk factorsClinical requirementsStephen Chu Patient Care WG
75NEGsee Claude Nanjo comments comment referenceBruce Bray
76NEGPlease see comments submitted by Claude Nanjo comment referenceGuilherme Del Fiol MD, PhD
77NEGPlease refer to Claude Nanjo's comments comment referenceKensaku Kawamoto MD PhD
78NEGPlease see Negative Comments by Claude Nanjo, University of Utah comment referenceDavid E Shields
79NEGPlease refer to comment submission by Claude Nanjo. comment referencePhillip Warner
80NEGThe vote is negative to bring attention to the following points: 1. It is not clear what the purpose for the different approaches are. If we have a clinical model as the underlying information source, then I would assume the FHIR representation would be used for information exchange. Since there is no discussion of the actual exchange beyond profiling some resources, it is not clear how these resources are to be used, and what the positive and negative sides of the different approaches. 2. It seems that the FHIR representation is just an agglomeration of resources, and the different approaches don't provide a coherent structure on how these resources work together to represent the clinical model. Use cases requiredVassil Peytchev
81A-SElement WoundExudateAmountNo data in https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1181.10/expansionvalue set not specifiedGary Dickinson
82A-SElement WoundExudatePresentOrAbsenthttp://hl7.org/fhir/us/sw/ValueSet/shr-core-PresentAbsentVS Link gives a 404 errorvalue set not specifiedGary Dickinson
83A-SElement WoundPressureUlcerAssociationhttp://hl7.org/fhir/us/sw/ValueSet/shr-core-YesNoUnknownVS Link gives a 404 errorvalue set not specifiedGary Dickinson
84A-SElement WoundTunnelClockDirectionhttp://hl7.org/fhir/us/sw/ValueSet/shr-core-ClockDirectionVS Link gives a 404 errorvalue set not specifiedGary Dickinson
85A-SElement WoundTunnelingPresentOrAbsenthttp://hl7.org/fhir/us/sw/ValueSet/shr-core-PresentAbsentVS Link gives a 404 errorvalue set not specifiedGary Dickinson
86A-SElement WoundUnderminingClockDirectionhttp://hl7.org/fhir/us/sw/ValueSet/shr-core-ClockDirectionVS Link gives a 404 Errorvalue set not specifiedGary Dickinson
87A-SElement WoundUnderminingPresentOrAbsenthttp://hl7.org/fhir/us/sw/ValueSet/shr-core-PresentAbsentVS Link gives a 404 errorvalue set not specifiedGary Dickinson
88CIMI Wound AssessmentIG Home Page http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/index.htmlApproachA-SHeaders confusing. “Dealing with Nested Observations” vs “Nested” should be a lower level header than “approach”presentationStan HuffIntermountain Healthcare
89CIMI Wound AssessmentIG Home Page http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/index.htmlApproachA-STwo approaches…Using FHIR subcomponents called “subextensions” is a third approach that should be considered.FHIR adaptationStan HuffIntermountain Healthcare
90CIMI Wound AssessmentIG Home Page http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/index.htmlDealing with nested operationsA-SOne of the key features of wound assessment is "nestedness", a hierarchical structure of containment with 1-to-many relationships at each level.Remove "with 1-to-many relationships at each level."Not always 1:*editStan HuffIntermountain Healthcare
91CIMI Wound AssessmentIG Home Page http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/index.htmlFlattening the topic-contextA-SFlattening the context reverts back to CIMI version one which is CIMI’s first model. The current model topic/context is CIMI version two. CIMI v1 is a small reference model vs. a well described reference model. The tradeoff with CIMI v2 is more work at the beginning which is less work for compilers and tools where CIMI v2 depends on people to do it right because you don’t have the consistent core reference model. Flattening topic-context is being conflated with mini CIMI and they are different things. context compositionStan HuffIntermountain Healthcare
92CIMI Wound AssessmentAll Logical ModelsNEGQualifying observations e.g. wound tunneling observation, wound exudate, etc. should not include recorded, signed, relevant time, interpretation, encounter, delta flag, category, redundant overheadStan HuffIntermountain Healthcare
93CIMI Wound AssessmentAll Logical ModelsAssessment timeA-SRename relevant to Assessment time and constrain to a dateTime data typedate timeStan HuffIntermountain Healthcare
94CIMI Wound AssessmentAll Logical ModelsFinding methodNEGShould be a constrained value set containing methods used to assess a wound (observed, mobile app….)Clinical requirementsStan HuffIntermountain Healthcare
95CIMI Wound AssessmentAll Logical ModelsCategoryNEGShould not be includedclassificationStan HuffIntermountain Healthcare
96CIMI Wound AssessmentAll Logical ModelsOfficial URL linkA-TAll the links for the official URLs for each logical model are dead.value set not specifiedStan HuffIntermountain Healthcare
97CIMI Wound AssessmentAll Logical ModelsMissing topic codesNEGwoundAssessmentInterpretation, woundEpisode , woundTrend, woundPeriwoundDescription, WoundVisibleInternalStructure, woundPressureUlcerAssociation woundTunnelingPresentOrAbsent, woundUnderminingPresentOrAbsent, woundExudatePresentOrAbsent, photographicImage, WoundBedAppearancetopic codesStan HuffIntermountain Healthcare
98CIMI Wound AssessmentWoundAbsenceAssertionModelHeaderA-TWoundAbsenceAssertionModelWoundAssertionAbsenceModelCIMI needs a consistent nomenclature for model names. Suggest putting "Presence" or "Absence" after "AssertionpresenceStan HuffIntermountain Healthcare
99CIMI Wound AssessmentWoundAssessmentPanel Wound assessment - http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundAssessmentPanel-model.htmlLogical modelNEGNeeds a wound identifierClinical requirementsStan HuffIntermountain Healthcare
100CIMI Wound AssessmentWoundAssessmentPanel Wound assessment - http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundAssessmentPanel-model.htmlWound InterpA-TDead linkvalue set not specifiedStan HuffIntermountain Healthcare
101CIMI Wound AssessmentWoundAssessmentPanel Wound assessment - http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundAssessmentPanel-model.htmlRelevant timeNEGConsider slicing to relevant time to wound assessment time and wound assessment relevant time.Clinical requirementsStan HuffIntermountain Healthcare
102CIMI Wound AssessmentWoundAssessmentPanel Wound assessment - http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundAssessmentPanel-model.htmlPreconditionNEGDon't need preconditionClinical requirementsStan HuffIntermountain Healthcare
103CIMI Wound AssessmentWoundAssessmentPanel Wound assessment - http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundAssessmentPanel-model.htmlDelta flagNEGDon't need delta flagClinical requirementsStan HuffIntermountain Healthcare
104CIMI Wound AssessmentWoundAssessmentPanel Wound assessment - http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundAssessmentPanel-model.htmlCategoryNEGDon't need delta categoryClinical requirementsStan HuffIntermountain Healthcare
105CIMI Wound AssessmentWoundPressureUlcerAssociationModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundPressureUlcerAssociation-model.htmlModel NameNEGIs the wound associated with a device or pressure point?Consider revising this concept to remove the "or". User would not know if the wound is associated with a device or pressure point.PU associationStan HuffIntermountain Healthcare
106CIMI Wound AssessmentWoundTunnelingPresentOrAbsentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundTunnelingPresentOrAbsent-model.htmlNEGLogical model does not match up to the profile - Present/absent In the logical model but not the ProfilealignmentStan HuffIntermountain Healthcare
107CIMI Wound AssessmentWoundTunnelingPresentOrAbsentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundTunnelingPresentOrAbsent-model.htmlNEGTrue panels should be “related observations” and not component observations because they are sister observationsFHIR adaptationStan HuffIntermountain Healthcare
108CIMI Wound AssessmentWoundTunnelingPresentOrAbsentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundTunnelingPresentOrAbsent-model.htmlNEGThere is no association between wound tunneling present/absent and wound tunneling observation suggest make wound tunneling assertion, different than the high level assertion, different than the high level assertion with present/absent values. (not wound tunneling present, wound tunneling absent)subassertionsStan HuffIntermountain Healthcare
109CIMI Wound AssessmentWound Undermining http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundUnderminingPresentOrAbsent-model.htmlNo association between wound undermining present/absent and wound tunneling observation suggest make wound tunneling assertion, different than the high level assertion with present/absent values. (not wound undermining present, wound undermining absent)subassertions
110CIMI Wound AssessmentWound Undermining http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundUnderminingPresentOrAbsent-model.htmlA-SNeed to determine if there is an identifier for wound undermining (need to ask SME)Clinical requirementsStan HuffIntermountain Healthcare
111CIMI Wound AssessmentWound Undermining http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundUnderminingPresentOrAbsent-model.htmlNEGNo association between wound undermining present/absent and wound tunneling observation suggest make wound tunneling assertion, different than the high level assertion with present/absent values. (not wound undermining present, wound undermining absent)subassertionsStan HuffIntermountain Healthcare
112CIMI Wound AssessmentWound Undermining http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundUnderminingPresentOrAbsent-model.htmlA-SNeed to determine if there is an identifier for wound undermining (need to ask SME)Clinical requirementsStan HuffIntermountain Healthcare
113CIMI Wound AssessmentWoundBedAppearanceObservationModel and WoundBedAppearancePercentageModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundBedAppearanceObservation-model.html NEGWound appearance percentage should be child or qualifier of appearance in order to associate specific appearance with the percentage (e.g 60% granulation, 40% necrotic)subassertionsStan HuffIntermountain Healthcare
114CIMI Wound AssessmentWoundBedAppearanceObservationModel and WoundBedAppearancePercentageModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundBedAppearanceObservation-model.html NEGThere is no association between wound undermining present/absent and wound tunneling observation suggest make wound tunneling assertion, different than the high level assertion. subassertionsStan HuffIntermountain Healthcare
115CIMI Wound AssessmentWoundSizeObservationModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundSizeObservation-model.htmlNEGThere are individual models for each measurement. These need to be grouped together in some way. (collection, panel?)panel compositionStan HuffIntermountain Healthcare
116CIMI Wound AssessmentWoundSizeObservationModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundSizeObservation-model.htmlQuantityModelA-SQuanityModel is a recreated quantity dataType – don’t need a quantity model, just reuse the Quantity datatypetypesStan HuffIntermountain Healthcare
117CIMI Wound AssessmentWoundSizeObservationModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundSizeObservation-model.htmlAll measurementsNEGDon’t need reference range redundant overheadStan HuffIntermountain Healthcare
118CIMI Wound AssessmentWoundSizeObservationModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundSizeObservation-model.htmlAll measurementsNEGDon’t need interpretation redundant overheadStan HuffIntermountain Healthcare
119CIMI Wound AssessmentWoundSizeObservationModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fullcimi/site/StructureDefinition-sw-WoundSizeObservation-model.htmlAll measurementsNEGDon’t need data absent reason redundant overheadStan HuffIntermountain Healthcare
120CIMI Wound AssessmentFHIM Primary local models http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/logical.htmlAll coded items with value setsNEGThere is not a standard code binding for topicCode. topic codesStan HuffIntermountain Healthcare
121CIMI Wound AssessmentFHIM Primary local models http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/logical.htmlAll coded items with value setsNEGThe value set binding description contains the topicCode LOINC code and should countain the value set description. (this can be found as a definition description on the SOLOR concept or in the VSAC description).binding?Stan HuffIntermountain Healthcare
122CIMI Wound AssessmentWoundAssessmentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlNEGWoundAssertion member of WoundAssessmentModel under "Panels" and should be the highest level.panel compositionStan HuffIntermountain Healthcare
123CIMI Wound AssessmentWoundAssessmentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlWound AppearanceWound appearance percentage should be child or qualifier of appearance in order to associate specific appearance with the percentage (e.g 60% granulation, 40% necrotic)subassertions
124CIMI Wound AssessmentWoundAssessmentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlWound ColorNEGWound color percentage should be child or qualifier of appearance in order to associate specific color with the percentage (e.g 60% red, 40% blacksubassertionsStan HuffIntermountain Healthcare
125CIMI Wound AssessmentWoundAssessmentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlPanel MembersNEGPanel members don’t need date time, interpretation, method, dateTimeIssuedredundant overheadStan HuffIntermountain Healthcare
126CIMI Wound AssessmentWoundAssessmentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlPanel MembersNEGMissing wound IDClinical requirementsStan HuffIntermountain Healthcare
127CIMI Wound AssessmentWoundAssessmentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlmethodNEGMissing method topicCode and value set.topic codesStan HuffIntermountain Healthcare
128CIMI Wound AssessmentWoundAssessmentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlEvaluation component isExudatePresentNEGNo relationship to woundExudate panelmissing relationshipStan HuffIntermountain Healthcare
129CIMI Wound AssessmentWoundAssessmentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlEvaluation component isTunnelingPresent NEGNo relationship to woundTunneling panelmissing relationshipStan HuffIntermountain Healthcare
130CIMI Wound AssessmentWoundAssessmentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlEvaluation component isUnderminingPresentNEGNo relationship to woundUndermining panelmissing relationshipStan HuffIntermountain Healthcare
131CIMI Wound AssessmentWoundAssessmentModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssessment-model.htmlEvaluation component periwoundDescriptionNEGMissing periwoundDescription panelmissing relationshipStan HuffIntermountain Healthcare
132CIMI Wound AssessmentWoundTunnelingModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundTunneling-model.htmltunnelingClockPosition DescriptionsNEGNo Values and id in SNOMED - LOINC 72297-5 (Tunneling clock position of Wound)This should contain the description and not the codes (or whether one is missing).value set not specifiedStan HuffIntermountain Healthcare
133CIMI Wound AssessmentWoundUnderminingModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundUndermining-model.html underminingClockPosition DescriptionsNEGNo Valueset and id in SNOMED - LOINC 72294-2 (Undermining clock position of Wound)This should contain the description and not the codes (or whether one is missing).value set not specifiedStan HuffIntermountain Healthcare
134CIMI Wound AssessmentWoundAssertionModel http://cimi.hl7.org/submissions/september_2018/skinwoundig/fhimsw/site/StructureDefinition-fsw-WoundAssertion-model.htmlvalueNEGNo way to determine presence or absence. No value set givenvalue set not specifiedStan HuffIntermountain Healthcare
135PChttp://hl7.org/fhir/us/sw/StructureDefinition/sw-WoundAbsenceAssertion-modelA-C... or using the Snomed code #181469002 (Entire skin (body structure))or using the SNOMED CT code CTID: 119181002 (Skin part (body structure) I think with using 181469002 (Entire skin (body structure)) for negation - you are saying there is not A wound over the entire body, whereas what you want to say is there is no wound on any PART of the skin on the bodyYesGay DolinIntelligent Medical Objects
136http://hl7.org/fhir/us/sw/StructureDefinition/sw-WoundAbsenceAssertion-modelA-CDocuments the absence of a wound at a given body siteDocuments the absence of a wound at a given skin site on the bodyYesGay DolinIntelligent Medical Objects
137NEG.. coding Σ 1..1 Coding …..throughout modelsPlease do not limit CodableConcept/coding. This prevents the use of and sending of local codes and /or interface terminology codes along with the publically defined code system code. See CodableConcept data type: http://hl7.org/fhir/STU3/datatypes.html#CodeableConcept: "A typical use of CodeableConcept is to send the local code that the concept was coded with, and also one or more translations to publicly defined code systems such as LOINC or SNOMED CT. Sending local codes is useful and important for the purposes of debugging and integrity auditing." I would also add it is important in EHR Implmentations' systems terminology maintenance operations. YesGay DolinIntelligent Medical Objects
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