HL7 WGM Meeting, San Antonio, TX, January 2015

DRAFT EHR WG Meeting Attendance and Minutes

ATTENDANCE

Monday / Tuesday / Wednesday / Thursday / Electronic Health Records Work Group
Q1 / Q2 / Q3 / Q4 / Q1 / Q2 / Q3 / Q4 / Q1 / Q2 / Q3 / Q4 / Q1 / Q2 / Q3 / Q4
x / Angeles / Becky / ESAC/ONC /
x / Aschhett / Mattias / HL7 Germany /
x / Ayres / Elaine / NIH /
x / x / x / Baker / James / Sparx Systems /
x / Botts / Nathan / Westat /
x / Brancato / Chris / Deloitte /
x / Caden-Price / Chrystal / ACS NTDB /
x / x / x / x / x / x / Cangioli / Giorgio / HL7 Italy /
x / x / x / x / x / x / x / x / x / x / Cannady / Patrick / ADA /
x / Chen / Ken / CHI /
x / x / Coleman / Jonathan / ONC /
x / Datta / Gora / Cal2Cal /
x / Davis / Mike / VA /
x / Decouteau / Duane / VA /
x / x / x / x / x / x / x / x / x / x / x / Dickinson / Gary / Centri Health /
x / Donnelly / Michael / Epic /
x / Eichner / Steven / Texas Department of Health /
x / Friend / Danielle / Epic /
x / Friggle / William / Sanofi /
x / Gallego / Evelyn / ONC Contractor /
x / x / x / x / x / x / x / Gelzer / Reed / Provider Resources /
x / Gonzales-Webb / Suzanne / VA /
x / x / x / x / Goossen / William / HL7 NL /
x / x / x / x / x / x / x / x / x / x / Goossen / Anneke / HL7 NL /
x / Graham / Matthew / Mayo Foundation /
x / Haddorf / Richard / mayo / haddorff.richard @mayo.edu
x / Harbauer / Kevin / Healthwise /
x / x / Heermann Langford / Laura / Intermountain /
x / Helton / Edward / RCRIM/BRIDG /
x / Hirai / Masaaki / HL7 Japan /
x / Howell / Chuck / FamilyCare /
x / x / x / x / x / x / x / x / x / x / Janczewski / Mark / Medical Networks LLC /
x / x / Jones / Emma / Allscripts /
x / x / x / Khan / Hetty / CDC/NCHS /
Kiser / John / Abbot /
x / Kisler / Bron / CDISC /
x / Konishi / Yukimori / KIS Inc /
x / Kraft / Terry / EPIC
x / x / Kretz / Jim / SAMHSA/HHS /
x / x / x / Kunisch / Joe / Memorial Heimann /
x / Kush / Rebecca / CDISC /
x / Lyle / Jay / VA /
x / x / x / x / x / x / McKay / Tim / Kaiser Perm /
x / Mandel / Joshua / Boston Children's /
x / Martin / Michael / AAVCD /
x / x / x / x / x / x / x / x / Matsumoto / Koichiro / HL7 Japan /
x / Mense / Alexander / HL7Austria /
x / Miyohara / Hideyuki / HL7 Japan /
x / Moehrke / John / GE /
Moesel / Chris / MITRE /
x / x / x / Mulrooney / Jackie / JP Systems /
x / x / Murakami / Ray / HL7 NZ /
x / Nachimuthu / Senthil / 3M /
x / Nanjo / Claude / CDS /
x / Neal / Melanie / ACS NTDB /
x / x / x / Ott / Russell / Deloitte /
x / Padula / Michael / Chilldren's Hospital /
x / Park / Peter / DOD/TMA /
x / x / Pupo / Erik / Deloitte /
x / x / Pyke / David / Cognassante' /
x / x / Ravishandor / Ashu / Medfusion /
x / x / x / x / Reeves / Dianne / NCI /
x / x / Rhodes / Harry /
x / x / x / x / x / x / x / x / x / x / x / x / x / x / Ritter / John /
x / x / Rocca / Mitra / FDA /
x / Ryan / Sarah / MITRE /
x / Shafarman / Mark / Shafarman Consulting /
x / x / Shaw / Krystol / DOD /
x / Skapik / Julia / ONC /
x / x / x / x / x / x / x / Spiro / shelley / Pharmacy HIT Collaborative /
x / Suarez / Walter / Kaiser Perm /
x / x / Susanto / David / Accenture /
x / x / x / Tachwa / Han / KETI /
x / x / Takasaka / Sadamu / HL7 Japan /
x / x / Tanaka / Masato / HL7 Japan /
x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / Thompson / Sue / NCPDP /
x / Topping / James / Duke University /
x / x / x / x / Toyoda / Ken / HL7 Japan /
x / x / x / x / x / x / Van Dyke / Pat / DDPA /
x / x / VanderZel / Michael / UMCG /
x / VerHoef / Wendy / Samvit Solutions /
x / x / x / Walden / Anita / DUKE /
x / Walker / Mead / MWWC
x / x / Ward / Steven / Eli-Lilly /
x / x / Warner / Diana / AHIMA /
x / Welsh / Catherine / Acad of Nutrition&Dietetics /
x / Westheim / Rien / Furore /
x / Williams / Trish / HL7 Australia /
x / x / Woznica / Darek / Genoptix /
x / x / Yu / Pele / CHWG

MINUTES

------MONDAY, 19 JANUARY 2015 ------

MONDAY, 19 January 2015, Quarter 1 (0900-1030)

Lead: Mark Janczewski

Scribe: Diana Warner

SUBJECT(S): Kickoff Session Items

1. Introductions

2. WG Meeting Agenda Review for this Week

Wednesday – need to see if we can jointly meeting with OO for at least part of the quarter to discuss the LRI. Currently this does not confirm and what would need to be done to have this conform to the EHR FM.

Thursday

  • PHR FM has parking lot items that need to be addressed on how to handle these.
  • In addition have a 'Coming to Terms' white paper the needs to be reviewed to determine if we should update the various types of interoperability.
  • ISO/TC1215 21089 update on plans for revising this document and how it ties into EHR WG.

Agenda items – suggest reviewing Paris agenda for Monday and Tuesday Q3/Q4 to flesh out talking points. We will add to Q2 and bump until all co-chairs are available.

3. Ballot Updates:

  1. PHR FM profile set has been balloted and finalized. This has led to a list of items to bring back to the EHR WG FM for consideration in R3. Anticipate this will be published by 31 January 2015
  2. Meaningful Use FM has been balloted. This is the first functional profile using the tool. This is based on MU Stage 2 test procedures as defined CMS and NIST. This has been published. Plan to start a profile for MU Stage 3 when the final rule is published. Need to work with the certifying bodied to build in the MU into their certification process so the MU and EHRs may be certified against both for vendors.
  3. The Lab Results interface ballot just went through.

4. Project List Review:

  1. EHR FM R2 and PHRS FM have both been completed in HL7. Both are still in process at ISO, but we have dropped this off our project list as the work is completed at the HL7 level.
  2. Usability FM has been moving, but still needs a lot of work.
  3. RM&ES has been working on the FHIR resources to ensure the RI components are aligned in the work. We are reviewing the work and taking our findings back to the Friday FHIR workgroup.
  4. Italy is working to adopt the EHR FM – the Italian EHR FM. They are using the profile tool. They published the DSTU in December for ballot which ends 20 January 2015. This will be reconciled and plan to have this by the end of March (if they can solve the legal problem).
  5. Suggest moving PHR FM into the tool. This is a big project. Consider importing PHR FM R1 into the tool. Discussion ensued on what needs to be done and the time line. We need a strong foundation to be able to move forward.
  6. Phase III
  • Update for Translations. Right now have to create work arounds.
  • Upload PHR into the tool.
  • Implement the framework into the tool to build the functional profile.

Co-chairs need to discuss strategy for taking Phase III to HQ for review and budget approval. Seems that there is some miscommunication. We should reach out to other countries e.g. Italy, Japan, Finland, Mexico, Netherlands, Brazil, and possibly France. Discussions on how to move profiles forward are complex and yet we need to do this in a timely fashion.

5. Health Metrics – deferred.

MONDAY, 19 January 2015, Quarter 2 (1100-1230)

Lead: Gary Dickenson

Scribe: Mark Janczewski

SUBJECT: EHR System Functional Model Release 3

Gary led discussion on the Plan of Action and Milestones (POA&M) for the EHR-S FM R3. Going from EHR-S FM R1 to R2 meant going from 130 functions to 320 functions and 2,300 CCs. Now with 7 sections. Some of the concerns brought up by Gary and Steve Hufnagel in the development of a Release 3 were discussed per below.

  1. Baseline: R2 is the baseline for R3
  2. Tool: EHR-S FIM R3.0 Reference and Profiles will be Sparx EA tool based
  3. R2 deficiencies:
  4. R2 is too complex making it hard to use

1.)Too many and inconsistent CC: ACTION ITEM: Review the FM to build an Inheritance Hierarchy. Create a CC inheritance hierarchy within the tool (e.g. CC for orders vs. at pharmacy or lab level). Serves to reduce the number of CCs

2.)Remove conformance criteria for data elements. Add normative Information Model, associate FHIR to EHR-S functions. ACTION ITEM: Need the group to further review and consider.

3.)Inconsistentverb use:

  1. Discussed Verb hierarchy and possibly using Manage only in the FM and leave the subordinate verbs to FPs. Michael van der Zel suggested that we do this. Further discussion will be needed. There was also discussion to have all of the CCs in the FM be “MAY” and leave “SHOULD” and “SHALL” to the FPs. ACTION ITEM: Take a look at the “Manage” verb and how we will go forward with it for possible exclusive use in the FM and use subordinate verbs in FP.
  2. Separate configuration and operational related functions. Gary and Helen provided discussion. ACTION ITEM: Gary suggested developing guidelines.
  3. Add Core EHR within Infrastructure
  4. Separate policy related functions from Core EHR functions
  5. Where does usability, usefulness, utility belong as criteria?
  6. Profiles can refine verbs

4.)Move SHALL/SHOULD/MAY qualifiers to profiles (e.g., domain and realm, such as ED in Holland)

  1. Incomplete / Inconsistent “see also” indicators

1.)Include “see also” in Direct Care & Supportive Care; but, not infrastructure; distinguish

  1. Dependencies, inheritance, aggregation, composition
  2. Associations (“see also”)
  3. Information Model – R3 will remove incomplete/inconsistent data-element requirements/conformance-criteria; and, R3 will link functions to Information Exchanges (IEs) and the appropriate IE Fast Healthcare Information Resources (FHIR). Find an appropriate place to put the data requirements. FHIR might be the answer.
  4. Functional Updates – Concurrent with this effort, functional updates may be incorporated into the model by the main EHR WG; where, functional changes will be coordinate-with the Interoperability sub-work-group.
  5. Example Use-Cases / Scenarios - will be addressed by incorporating / formalizing Use-Case Simplification Tool concept into the Sparx EA Tool version of the model

1.)Standardized Common/managed set of actors/entities/concepts, their definitions, and their data elements

2.)Common/managed set of Actions/Activities,their input and their output entities

3.)Common/managed set of requirements / conformance criteria.

4.)Domain specific profile’s context should be defined by assertions,

5.)Map use-case events/actions to EHR-S functions and FHIR data modules (FHIR described below)

6.)Integrate “Use-Case Simplification Tool” [US Realm S&I Framework as exemplar] into Sparx EA

  1. EHR-S FM R2 is hard to navigate; that is, it is not intuitive (ACTION: Add categories, base, FHIR pictures)

1.)Leverage ‘2003 IOM Key EHR Capabilities & ‘2011 National Quality Strategy Priorities (7 categories)

  1. Decision Support, Results Management, Order Entry/Mgmt./CPOE, Administrative Processes, Patient Support/Education
  2. Health Information and Data, Reporting & PopHealth Mgmt., Communication and Connectivity
  3. Be careful to not be US specific

2.)Move Records Infrastructure under “Infrastructure”

3.)Move Trust Infrastructure under “Infrastructure”

  1. Consistent Conformance Criteria numbering across profiles

1.)Hierarchical numbering, like OIDs?

  1. Functional Model Management

1.)Provenance and contact information for model sections, profiles, within tool? Could use the tool to help.

MONDAY, 19 January 2015, Quarter 3 (1345 -1500)

Lead: AnnekeGoossen

Scribe: Mark Janczewski

SUBJECT(S) Tooling Update

Anneke presented a slide briefing on the progress of the Tooling effort in support of the EHR WG and development of FPs. Demonstrated some examples of functions and CCs using the EA tool and some of the particular features (such as term search) to allow for easier use of the FM. Anneke then showed how to start building a new FP.

MONDAY, 19 January 2015, Quarter 4 (1530-1700)

Leads: Michael van der Zel and Giorgio Cangioli

Scribe: John Ritter

SUBJECT:Tooling and Functional Profiles

[ John to provide ]

------TUESDAY, 20 JANUARY 2015 ------

Tuesday, 20 January 2015, Quarter 1 (0900-1030)

Led: Gora Datta

Scribe: Mark Janczewski

SUBJECT: Joint meeting with Mobile Health WG

[ John to provide ]

Gora Datta presented a slide deck about MHR-S Functional Framework (see separate Zip file for EHR WG

Problem:

There are over 200,000 mobile apps

“mobile, mobile everywhere … none talk to each other”

Options:

Given that mHealth apps can appeal to different users, they are looking at the following options.

  1. MH FP derived from EHR-S FM
  2. MH FP derived from PHR-S FM
  3. MH FP derived from both EHR-S and PHR-S FM
  4. MH FM

Discussion amongst attendees ensued talking about mHealth app environment from the perspective of different countries (e.g. US, Japan, Netherlands)

  • Mobile phone market: 1st billion in 20 years, 2nd B in 4 years, 3rd B in 2 years, 4ht and 5th B in 1 year (2013)
  • In 2013 over 1B “smart” phones sold globally, 100M in US
  • Sept. 15, 2014: 4M iPhone (6 & 6+) sold on Day 1
  • 80% of the world lives within range of a cellular network, up from 40% in 2000.

Gora showed bullet points of the WG Charter then a diagram of the different stakeholder communities. He followed with some Scenarios illustrating the scope and benefits of mHealth (provider-facing, patient-facing, caregiver-facing).

So, in Looking at Healthcare in the 21st Century we see:

  • Next generation “iPadTM” kids
  • Blurred line: Impact of Social Media
  • Are we there yet: I want it NOW
  • Take Charge: Consumer Health
  • Gene to genes: from Star Trek (Gene Roddenberry) to Genetic Health
  • Back to the Future: Longitudinal Health Record
  • Live long & prosper: from provenance to preservation
  • Emerging Areas: Internet of Things (IoT), Big DATA, Open Data
  • We live in a Global Village: Urban, Rural, Remote, Underserved

John Ritter discussed PHR-S FM work efforts related to mHealth

  • Moving PHR-S FM into EHR Profile Designer Tool
  • Enhancing interchange between Popn Health and Public health stakeholders
  • Social media
  • Attempting to accommodate Maturity Model Framework approach
  • Listed National PHR efforts.

Action Items:

Tuesday, 20 January 2015, Quarter 2 (1100-1230)

Lead: John Ritter

Scribe: Pat van Dyke

SUBJECT: Joint meeting to discuss Usability with Clinical Interoperability Council (CIC), Clinical Quality Information Work Group (CQI), Emergency Care Work Group (ECWG), and others.

  1. Peter Park– user input e.g. physician is very important. John questions how to achieve this input. Peter will provide documentation that might be available from work being done in the DOD
  2. More formal review of the literature resulting in a White Paper
  3. CDS and CQI - have a PSS out for review
  4. Requirements for an artifact authoring environment.
  5. Allow you to author a rule or a clinical measure
  6. Peer Review white paper status: expecting a draft the end of January
  7. Usability for the Human Actor; Usability for a System Actor
  8. Working on a second part of this. Candace, Rebecca, Mitra, a couple of interns (move in and move out) ---- Needing more help to work with the functions and descriptions
  9. Possible Glossary updates
  10. Types of usability ‘Contexts’: Patient-Context –Time Context—Workstation Context—Session Context---Provenance Context---Information Context—
  11. Indication Context
  12. Suggested paths from Walter----Usability for EHRs--
  13. finish the CC and white paper
  14. framework----creating the next state/artifacts----DAM
  15. outreach to clinicians ---other venues such as AMIA;
  16. Walter: Need to review the scope of work---review the PSS
  17. Usability of PHR’s would be a separate project---usability for consumers is a different area/
  18. Peter Park: Came up with 80 requirements User Interface--
  19. Lowhanging fruit: colors
  20. Other criteria that is not under User control
  21. Reed: Do I believe what I see on the screen: Data provenance?
  22. Group: This is a different matter
  23. Public Health:aggregation of data without having additional work to be done by the user
  24. Asking simple questions that are really complex questions

Tuesday, 20 January 2015, Quarter 3 (1345-1500)

Lead: Gary Dickinson

Scribe: Pat van Dyke

SUBJECT: Project Work: EHR Record Lifecycle / FHIR Project (FHIR=Fast Healthcare Interoperability Resources)

Gary presented an overview of FHIR, to include where to find information on the HL7 websites. He described the concept of “Resources” and then discussed the Record Lifecycle (LC) Events FHIR Profile development. The are some 27 Pre-/Post-LC events.

Gary continued with discussion on various aspects of Record LC Events, to include entity role categories, action and record entry metadata. He reviewed some Use Cases and provided links to various worksheets.

Tuesday, 20 January 2015, Quarter 4 (1345-1500)

Lead: Reed Gelzer and Gary Dickinson

Scribe: John Ritter

SUBJECT: Records Management and Evidentiary Support (RMES) Functional Profile planning for 2015

[Need minutes – John has 1 sentences and 2 PP presentations. Reed to also provider verbiage]

------WEDNESDAY, 21 JANUARY 2015 ------

Wednesday, 21January 2015, Quarter 1 (0900-1030)

Lead: Gary Dickinson

Scribe: John Ritter

SUBJECT: Joint Session to discuss Provenance and Use Cases with Security, CBCC, and FHIR WGs. Provenance Purposes and Use Cases: What is it and Why are we Doing It

  1. Clinical Reliability
  2. System Internal – representation, management
  3. Interoperability across clinical systems – exchange
  4. Authorship
  5. Security Enforcement – Authorization, Access Control
  6. Clinical Relevance
  7. Legal – non-repudiation
  8. Legal Defense
  9. Legal – reliability, authenticity
  10. Legal – jurisdictional
  11. Financial – billing/claims, audits
  12. Consumer Engagement – where data came from, consumer device, device captured vs. consumer-authored content
  13. External stakeholders – public/population health, surveillance, public health indicators
  14. Data Analytics
  15. Social networking
  16. Early warnings and indicators
  17. Minimal metadata necessary

Wednesday, 21January 2015, Quarter 2 (1100-1230)

Lead: Pat Van Dyke

Scribe: John Ritter and Mark Janczewski

SUBJECT: Joint meeting - Updates from BRIDG, Child Health Work Group, CIC, CQI WG, ECWG, Patient Care WG, Pharmacy WG, Public Health and Emergency Response Work Group (PHER WG), S&I Framework

[ For more detail see the Slide Decks from each group from the Zip file ]

  1. Care Coordination Services (CCS)
  2. Patient Care WG
  3. Working on reconciling 2ndBallot comments for the DAM (Informative)
  4. Looking at Allergies and Intolerances harmonization, involves DAM & Clinical Models in V3, C-CDA (R1.1 and R2.0), FHIR (Allergy Intolerance) and Open EHR.
  5. Developed new FHIR Clinical Resources
  6. Second HL7 FHIR Clinician connectathon this Friday, May. 23
  7. Patient Care WG
  8. Working on reconciling 2nd Ballot comments for the DAM (Informative)
  9. Looking at Allergies and Intolerances harmonization, involves DAM & Clinical Models in V3, C-CDA (R1.1 and R2.0) and FHIR (Allergyintolerance)
  10. Developed new FHIR Clinical Resources
  11. Second HL7 FHIR Clinician connectathon this Friday, May. 23
  12. Public Health and Emergency response (PH-ER WG) - not present
  13. Child Health Working Group (CH WG) – working on developing a new CH FP based on the EHR-S FM R2 as well as a Derived Domain Profile on Developmental Screening
  14. Emergency Care WG (EC WG)
  15. Digging into FP R2.0
  16. Fielding comments re: DEEDS and uses of it
  17. Publication submissions
  18. Finalization of DAM
  19. Considering DEEDs harmonization with FHIR and CIMI
  20. Biomedical Research Integrated Domain Group (BRIDG)
  21. Working on DSTU, plan to go to Normative ballot in September
  22. ISO has approved current standard data model, NCI at NIH is using it
  23. Met this AM with Clinical Genomics to enhance collaboration
  24. They meet every other Tuesday at 10 am ET.
  25. Pharmacy – not present
  26. CQI – Not present
  27. EHR WG
  28. EHR-S FM R3
  29. Solve structural issues
  30. Record Lifecycle Events on FHIR
  31. PHR-S FM: Working to move from R1 to R2 format
  32. EHR-S FM Tooling – a 1-2 year project using Sparx EA tool to assist Profile development
  33. Functional Profile development – There are now approximately 20 FPs now in development, based on the EHGR-S FM R2. Also several new national language profiles in development (e.g. Italian, Dutch, Japanese)
  34. EHR System Usability WG – Peer review White Paper nearing end; developing CC for including into the EHR-S FM
  35. Action Verbs / Glossary
  36. Record Management Lifecycle FHIR Resource developments
  37. Functional Model framework – Create protocols for naming and governing FMs, FPs, Versions, languages, etc.
  38. Multiple Parking Lot issues continue to be followed
  39. Public Health FP Purpose and Vision – conforms to EHR-S FM and includes a subset of functions relevant to PHER. Has 9 separate domains. Publication is scheduled for end of Jan. 2015.
  40. S&I Framework
  41. Data Provenance initiative – Joint meetings with EGHR, Security and Structured documents
  42. ESMD
  43. Clinical Interoperability Council (CIC)
  44. Developing several DAMs
  45. Working on a couple of CDAs
  46. Proposed new project on Bipolar and Generalized Anxiety Disorder (PSS needs approval by TSC)
  47. ACTIVE Projects
  48. Emer. Med. Svcs.
  49. MAX Tool
  50. Trauma
  51. TB Version 2.0
  52. Structure Data Capture
  53. Usability EHR (Co-Sponsor with EHR)
  54. Nursing Informatics
  55. BRIDG 4.2 Ballot in May
  56. Other topics
  57. NCIs caDSR
  58. User Groups for Other Domains
  59. Calendar for May 2015 WGM in Paris was discussed. This session is likely to be moved up to Monday Q3.

Wednesday, 21January 2015, Quarter 3 (1345-1500)