HL7 1999 Winter Working Group Meeting

HL7 1999 Winter Working Group Meeting

Government Projects SIG – Wednesday AM, Jan 27, 1999

Agenda

Governance

-Elect co-chairs

-Decision making process

Charter discussion
Project proposal discussion
Information exchange

Meeting attendees:

Denise Koo / CDC /
Steve Wagner / VA /
Ed Butler / Viscorp /
Terri Johnson / EDS /
Jeff Blair / Medical Records Institute /
Penni Hernandez / MICROMEDEX /
Sherry McKenzie / DOD/Health Affairs /
Nancy Orvis / DOD/Health Affairs /
Mary Kratz / U of Michigan /
Lloyd Anderson / DOD/Health Affairs /
Konstantin Beznosov / NHSSF /
Cedric Vessell / DOD JECPO/DISA /
Dav A. Eide / Group Health /
Roy Baker / VHA /
John Clemens / VHA /
Christine Chesney / VHA /
Ken Rubin / EDS /
Jim Demetriades / VA /
Robert Mayes / HCFA /
Jim McCain / IHS /
Pete Rontey / VA /
Susan Abernathy / CDC /
Jerome Soller / Cognitech /
Jerry Kirchner / SSA /
Karen Van Hentenryck / HL7 /
Dan Pollock / CDC /
Abdul Malik-Shakir / The Huntington Group /
Tom Culpepper / 3M /

Introductions – The meeting began with introductions. Denise Koo then briefly described the background and startup of the SIG, a summary of which follows. There was interest in the GCPR meshing with the HL7 RIM and thus that group initially approached HL7 in April. HL7 suggested that the group enlarge their scope beyond GCPR to include government projects in general.
Sherry McKenzie (DoD) gave some additional information about the DOD model, which they would also like to harmonize with the HL7 RIM, indicating that bringing their model to HL7 is a way to prioritize their work. Steve Wagner added that the different government organizations get funded for different projects. The DoD, VA, Indian Health Service and HCFA combined a large group of payers and providers with a need for a forum in which to exchange information related to their standards requirements. This SIG can provide such a forum and allow industry vendors to comment on and have input on government strategies and solutions. The SIG can also provide synergy for the various government agencies.
Discussion of SIG Scope - There was some discussion of whether the scope of this SIG is limited to US government. The UK and Australia have expressed interest in participating, and thus the scope is not limited. Susan Abernathy urged the SIG to ensure that its work gets folded into the RIM (i.e., compatible with the V3 work) and that it be included in the HL7 vocabulary work (i.e., ensure that it gets into the UMLS metathesaurus). Another suggestion was to examine implementation projects and extract them to a generic approach. Bob Mayes suggested that the group try to identify services or objects that are re-usable or adaptable across several implementations. The group should also be looking at government project SIG issues and how they apply to the larger world—the general adoption of standards. What comes out of this group should be usable by everyone and we should adopt solutions that can be widely used.
Elections – John Quinn joined the group for co-chair elections. Marco Johnson (DoD), Steven Wagner (VA) and Denise Koo (CDC) were elected.

Governance – The group reviewed the list of projects generated at the September 1998 meeting and grappled with how to triage them. Possible solutions were to develop use cases, which will help unveil areas where HL7 can collaborate with other standards groups to solve problems, and to focus on projects of interest to more than one group. There was general agreement that the group’s purpose falls into three main areas: 1) sharing information 2) promoting participation across government groups and supplying a forum for participation from other groups, and 3) coordinating efforts to avoid duplication. Steve Wagner reminded the group that any SIG work requiring balloting will need to go through a technical committee. Steve also reminded the group that some projects, GCPR being one, are open only to government groups. Susan Abernathy suggested that some of the group’s work is still V2.x work and that the group would limit itself if it focused solely on v3. Steve Wagner indicted that Karen Van Hentenryck can assist with submitting work specifications to the various and appropriate TCs. There was also a suggestion that this SIG ask HL7 to suggest the kinds of issues/work products that this group can bring to the table as well as the role the government group should play.
There was general agreement that those participating in the government projects SIG need to understand enough to know where there is overlapping work. Work is typically accomplished between meetings and brought back to this group for endorsement. Since not everyone participating in the SIG will have the skill set to endorse the various projects, documents and proposals should be distributed before the meetings so that the appropriate people at the agencies can review and comment prior to the SIG meetings.

Decision making process – Abdul Malik Shakir joined the group to address how work is accomplished and to summarize the “rules” of HL7. For example, HL7 meetings cannot be held unless they’ve been cleared with HL7 HQ, minutes are taken and submitted to HQ, attendance recorded, and the meeting is open. Abdul-Malik liked an earlier suggestion that the group split into subcommittees or working groups, which can petition for separate rooms at the working group meetings and for interim meetings. Abdul-Malik stressed that work will get through to the technical committees faster if the SIG endorses the work, although this does not preclude individual government groups going directly to the TCs. Abdul-Malik reviewed other rules such as reaching consensus and suggested that the group decide on how consensus will be reached soon (i.e., will it be one vote per agency or one vote per person). He also indicated that the group must provide an agenda before the meetings that list the items that will be voted on during the week.
A question was asked about submitting information to the RIM. Abdul-Malik explained that input to the RIM comes only through a TC or SIG. Someone from this group would have to present at the RIM Harmonization meeting and in a position to speak for the SIG to accept or reject any changes that might be suggested to the RIM proposal.
Bob Mayes moved that voting be open to all HL7 members attending the meetings and decisions be made by simple majority. Roy Baker seconded the motion, which passed with14 in favor, 1 opposed, 2 abstentions.

Charter discussion - Deferred until next meeting.
Project proposal discussion – The following project proposals were suggested. The person whose name appears in parenthesis volunteered to write the scope statement for the proposed project.

Immunizations (Susan Abernathy)
Security (Mary Kratz)
Work flow (Mary Kratz)
Defining a use case for defining reporting requirements (Bob Mayes)
GCPR models harmonization (patient identifiers, lab) (Sherry McKenzie)
Liaison (Bob Mayes)

public health data
Metadata consortium

Government Projects SIG 1/28/99

Meeting attendees:

Terri Johnson / EDS /
Sherry Mckenzie / DOD/ Health Affairs /
Cedric Vessell / DOD JECPO/DISA /
Jan Root / UHIN /
Dav A Eide / Group health /
Susan Abernathy / CDC /
Jim McCain / IHS /
Roy Baker / VHA /
Gregg Seppala / VA /
Ken Rubin / EDS /
Steve Wagner / VA /
Denise Koo / CDC /
Ed Butler / Viscorp /
Mary Kratz / U of Michigan /
Bob Mayes / HCFA /
Dave Riley / DOD/ Health Affairs /
Karen Van Hentenryck / HL7 /

Brief presentation from Mark Shafarman on central electronic lab reporting. Mark presented an approach based on clinical templates and which enables you to devise a re-usable interface strategy that is table driven. New implementations require only new tables or new table values. Mark suggests that this be the model for sharing data between agencies, although there would be a need to agree on vocabularies. If basic demographics are not available in the PID and PV1, you can either add another segment or add attributes to existing segments.
Review of project scope statements

Immunization (Susan Abernathy) –
Statement – The goal of the immunization workgroup is to update the immunization messages from 2.3 to be included in v3

Scope: To migrate the current immunization messages in v2.3 to incorporate the concepts and data elements in the HL7 RIM, then to establish v.3 immunization messages to allow query, responses to query, and unsolicited updates.

Susan reported that there is now a group of states that are interested in working together to eliminate the optionality in the messages. Susan suggested that these messages are a good starting place because they are simple.

Security (Mary Kratz) -
Information systems security, data protection and privacy provide the backdrop for Healthcare Information Technology projects implemented in today’s current environment. The HL7 Government Projects SIG Security workgroup serves to identify security requirements to address both technology and policy for Government Project initiatives. The deliverable value of this workgroup activity shall encompass:

Identify existing and upcoming government security policy that will impact the HL7 community
Catalyze the process for defining security requirements
Leverage content expertise of SIG Secure for applicability in Government projects
Coordination with other organizations

Mary also presented the following list of security services that one would expect an overall security framework to encompass, based on sound security practice that has been implemented in information technology applications for over twenty years:

Identification and Authentication – This service supports the definition of entities, also called principals, such as a person, an application or a system, and the corroboration that an entity is the one claimed.
Authorization and Access control – This service supports the granting of rights, which includes the granting of access based on access right and the prevention of unauthorized use of a resource.
Integrity – This service ensures that data or system software have not been undetectably altered or destroyed in an unauthorized manner or by unauthorized users.
Confidentiality – This service ensures that information is not made available or disclosed to unauthorized principals
Accountability – This service ensures the legal responsibility of a user for his/her actions
Audit – This service ensures that the the actions of a principal can be traced
Availability – This service ensures that information is accessible and useable upon demand by an authorized entity.
Non-repudiation – This service supports the provision of evidence, which will prevent a participant in an action from convincingly denying his/her responsibility for the action. Non-repudiation is regarded as a subgroup of the accountability service

Workflow Scope Statement

The HL7 Government Project SIG workflow workgroup serves to identify common requirements to address both the process, policy and technology for Government Project initiatives. The deliverable value of this workgroup activity shall encompass:

Identify existing and upcoming government process and policy requirements that will impact the HL7 community
Catalyze the process for defining workflow requirements
Leverage content expertise of the HL7 community for applicability in Government projects

Reporting Requirements Workgroup (Bob Mayes)

The purpose of this workgroup is to identify a set of common user requirements around the process of multiple institution reporting. Examples would be reportable disease requirements from CDC, adverse drug reactions from FDA, functional status assessments for long term-care residents from HCFA. Within this set of common user requirements, the workgroup will identify the services needed to meet those requirements and the mechanisms for providing those services. The workgroup will also identify a potential government project, which can be used to demonstrate this approach.

Other examples noted in yesterday’s meeting were electronic lab reporting, cancer registry, DEEDS.

Liaison Workgroup

The purpose of this workgroup is to develop and implement strategies to enhance collaboration among both SDOs and other federal workgroups, e.g., the Public Health Data Standards Consortium, for the purposes of increasing standards-based implementations, minimizing duplication of effort, leveraging existing work, and increased adoption by the vendor community. The workgroup will focus on development of strategies in two broad areas: increasing understanding of standards and their relationships, and increasing communication among interested parties. These strategies might include formal liaisons with other government collaborations, development of programs to increase and coordinate participation by government agencies in HL7 activities, and multi-agency demonstration projects based on the use of HL7 and other standards.

Health Information Model Harmonization (Sherry)

Background: In support of the Government Computer-based Patient Record (GCPR) project, the Department of Defense, Department of Veterans Affairs and Indian Health Service will develop common information models and terminology models for specific domains. The first two domains planned are master patient index and laboratory. The purpose of the models will be to document the requirements for a framework that will allow the sharing of patient information among the partners.

Proposed HL7 Project: As information models and terminology models are developed for the GCPR project and other health information-related projects, present them to the HL7 Government Projects SIG for review, comment and refinement, if necessary. After SIG approval, recommend changes or additions to the RIM, through appropriate technical committees or directly to the modeling and methodology committee.

III.Project resourcesa) Immunization – Susan Abernathy, Sherry McKenzie

b)Reporting requirements – Steve Wagner, Sherry McKenzie, Bob Mayes, HIS, CDC

The immunizations project will be used to demonstrate this approach

c)Security – Many individuals in the Government Projects SIG will need to create an instantiation of a security model for their projects. This group will act as a liaison since they will know, more so than most, what is going on legislatively. It will also keep the HL7 Security group apprised of what is going on and may use the technology knowledge of the HL7 Security SIG to develop its models. The Government Projects SIG should also ensure that the Security SIG work is meeting government requirements and should work to make government technologies publicly available (technology transfer).

d)Workflow – Tabled

e)Health Information Model Harmonization – Sherry McKenzie, Susan Abernathy, GCPR representatives. This will be an ongoing workgroup. Need to set up a process for harmonizing models. The following individuals volunteered to draft a list of topics for discussion at the next meeting: Jim McCain, Sherry McKenzie, GCPR representatives.

f)Liaison – Bob Mayes, Denise Koo

IV.Work items

Expand projects scope statements. Expand the description of each task so that it can then be taken to the agencies to get appropriate representation (Susan Abernathy=immunization, Mary Kratz=security, Bob Mayes=Reporting Requirments, Denise Koo=Liaison, Sherry McKenzie=Health Information Model Harmonization)
Draft harmonization process
Karen Van to post minutes to list server for comment
Karen Van to post charter on list server for comment

V.Agenda for Toronto meeting

Review minutes
Review charter
Review project status
Review harmonization process
Information sharing/updates from agencies

Meeting preferences: Monday PM, Tuesday PM

AV Requirements: Screen, LCD projector