2011-05-15 TSC WGM SDO Activities Minutes

TSC Sunday Q4 Agenda - 2011 May Orlando FL, USA

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TSC HL7 activities with other SDOs Meeting Location: TBD		Date: 2011-05-15 Time: Sunday Q4
Facilitator	Austin Kreisler	Note taker(s)	Lynn Laakso
Opportunity for HL7 WGM attendees to review activities in collaboration with other SDOs such as IHE, OMG, and the JWG and JIC, and provide comment.
Attendees: see http://gforge.hl7.org/gf/download/docmanfileversion/6311/8369/2011_05_14_SDO_Attendees.pdf

Agenda

Welcome and Introduction - Austin Kreisler

HL7 Executive Report on Activities with other SDO's

Review of each JIC-sponsored event having HL7 engagement

SDO liaison activities

Comment period

Minutes=

Welcome and Introduction - Austin Kreisler

• Austin called the group to order at 3:50 PM.
• In Sydney the discussion on the future of this meeting indicated that there were people interested in continuing this session in its current format.
• Austin gave a slide presentation.

HL7 Executive Report on Activities with other SDO's

(JIC, ISO TC215, JWG, NQF, SCO, W3C, Continua)

• John Quinn

Review of each JIC-sponsored event having HL7 engagement

• ICSR: Mead Walker
  • Mead states that the joint ISO/HL7 ballot for ICSR involves reporting adverse events and product problems to regulatory agencies. Ballot has been approved through HL7, submitted to ISO early February. Pushing forward with ISO FDIS in the next couple of months.
    • Mead suggests the process of joint ballot with ISO should be re-examined. He recommends finish balloting in the SDO first so that people can start using it, then send it to ISO to finish at their leisure.
    • Rules of publishing in ISO are different from HL7. He’d like to see a better description of the rules in ISO for HL7 participants in the ISO process. E.g. wrappers are not being balloted in ISO; do we describe them as normative (as they are balloted in HL7) or informative in ISO?
    • Richard Dixon-Hughes notes that one driver is the European standards bodies. Publishing it and then throwing it over the fence to ISO doesn’t make it an international standard. Publishing it in ISO and then bringing it to HL7 doesn’t solve the problem either. Mead notes that comments received during the HL7 ballot were repeated during the ISO ballot and were not substantive in either case. John Quinn notes that the process has to do with the legitimacy of a ballot through the ISO process. ICSR has been an extreme example that has taken a long time.
    • Ann Wrightson notes that the discussion on the JIC though unrelated to the projects listed as activities by the TSC is very important and necessary to having this session. Austin suggests the attendees get out there and encourage others to participate. Keith Boone asks if it has to be on Sunday. Those that are not on the International Council may not arrive until Monday or Tuesday.
• IDMP: Tim Buxton reported in advance - Identification of Medicinal Products (IDMP) consists of five draft international standards that are under development: 11615, the medicinal product itself; 11616 the pharmaceutical product; 11238, substances; 11239, dose forms, routes of administration, units of presentation and packaging; and 11240, units of measurement. A set of HL7 messages that reference the Common Product Model are under development to implement these standards in the context of regulatory processes for the authorisation of medicinal products. IDMP supports the reporting of adverse reactions using the Individual Case Safety Report message. IDMP is a Pharmacy group project within HL7, and taken forward by WG6 within ISO TC215.
  • The five draft international standards were balloted at the enquiry stage in ISO and CEN between September 2010 and February 2011, and passed. A parallel ballot was held within CDISC, and IHTSDO contributed comments through the ISO process. The five standards were balloted within HL7 between February and March 2011, and did not reach the required percentage for approval. All comments have been examined, addressed and responses provided. Revised draft documents have been made available for the ISO TC 215 Working Group Meeting in Finland.
  • The linked HL7 messages were balloted within HL7 as part of the current, May 2011 ballot cycle and passed.

  Tim adds for the group, that the IDMP went through query ballot in ISO, ballot in HL7 was a month later so could not co-terminate. Passed in ISO but not so effectively in HL7 with a lot of comments to be resolved around both ballots. They hope to be through them next week. Transmission of messages using IDMP info also passed and will be looked at in Pharmacy group.

  • Both IDMP and ICSR were proposed NWIP in March 2007, and suffered all the teething pains of a new process. Tim feels that once we reach the end of ICSR and IDMP and look at the process to see how the plan should change. It has been very hard for all that have been involved so he suggests we should sit down and run through the lessons and put them through a grilling.

    John Quinn comments that many discussions that happened in JIC could have happened serially in HL7 and in ISO. Working through the nuts and bolts of the process took time to work out. Once Audrey and the HIMSS group no longer working as secretariat we may lose some of that knowledge as well. Advice received from ANSI is that they will take over that role for a year while evaluating the responsibility for it.

• CTRR: Becky Kush reported in advance - Clinical Trial Registration & Results, a CDISC-HL7 standard is also an approved JIC project. An ISO TC-215 New Work Items Proposal has been drafted for this. The JIC will be meeting at the ISO TC 215 meeting in Finland in late May.
  • Becky and Bron in China today proposing their standard from CDISC
• DataTypes: Grahame Grieve reported to Austin that “it’s done”.
• EHR-S FM: Don Mon is not available.
  • Gary Dickinson reports they passed the NWIP ballot in Feb for ISO. Joint ballot between HL7 and ISO at this point; no other groups indicated participation. The challenge is the ISO ballot is 5 months to close where HL7 is 30 days. Their challenge is to finalize the draft that will be balloted in both organizations in order to start the clock; it will be August or September.
  • RIM 1.0 in ISO is up for expiration after 5 years. Take current balloted version 3 and submit it to replace version 1.
• SKMT: Heather Grain
  • They have been asked to create harmonization process so the glossary can be more multinational and the work will be considered in Finland.
  • John asked about the link on the tutorial. Heather notes you have to register the first time to gain access to track international use and participation. To be able to add to the tool or modify entries in the tool, your organization must notify SKMT folks to grant access to edit entries for your organization.
  • Heather says Tuesday night tooling overview will also be showing SKMT.
• John refers to US TAG discussion, secretariat passing from HIMSS to ANSI. Oasis item has to do with their approach to HL7 to renew the MOU. They work closely with PHER on Homeland Security response.
• Attachments WG response to NCVHS Vital Statistics subgroup work has renewed interest in procedural things going on with CMS in US on resurrecting couple of items from 1996 in attachments for claims and authorizations. Keith Boone notes that Patient Care is involved by the end of 2012.
• Walter Suarez reports the national community advises the committee on the adoption. Trying to make sure we don’t have multiple standards for sending the same information. Two steps: first a hearing on attachments to get industry input on work towards the standards. In 2012 the second set of hearings to be held to understand what is needed to build them. John also feels it would be a good idea to map HL7 terms on normative, informative, DSTU, mapping what is a standard to other SDO materials and definitions.
• Patient ID: Christian Hay reported in advance: this JIC work Item has been given the following precise scope: "Automatic identification and data capture marking and labelling - Patient and caregiver Identification". The working group includes over 30 participants, follows GS1 GSMP rules and meets every 2 weeks. Ian Shepherd (ISO TC 215 WG 6 convenor, CEN representative) has been nominated co-chair beside Prof Christian Lovis (University Hospital Geneva, GS1 co-chair).

  The Business Requirements Analysis has been completed by April 2011. We are currently understanding the gaps and learning from users’ experience. To be noted, Caregiver ID is also addressed in that group. Vocabulary has been aligned to ISO TS 22220, so Patient ID = Subject of Care identification.

  • GS1 update slide show
• BRIDG: Becky Kush reported in advance: The BRIDG Model (RCRIM DAM for protocol-driven research) received comments from ISO Central that need to be addressed before it can be balloted as a DIS. These were discussed with the ISO TAG secretariat, leader and CDISC representatives. (The primary change is to put it into HTML.) BRIDG is already a CDISC and an HL7 Standard. This path via the JIC will develop it into an ISO/CEN standard, thus a true global standard for clinical research and safety.

SDO liaison activities

Keith speaks next on the IHE report.

• IHE PCC coming for public comment in next 30 days.
• IHE IT activities also being followed by John Moehrke of Security WG
• IHE QPHR seek out Lori Pacquet
• Recently IHE referencing some HL7 work on Web Services on use of communicating platform over web services.

Ken Rubin reports on OMG.

• Four areas of collaboration with OMG
  • Common Terminology Services R2 (CTS2) – HL7 did functional work and OMG doing the technical umbrella. June 20th week in Salt Lake City will be devoted to final touches. Encourage you to participate.
  • HCSPD – Healthcare and Community Services Provider Directory: normative HL7 standard completed and the technical work underway in OMG.
  • SOA WG approached by hData to sponsor two projects and the RESTful spec might be a better fit for OMG. RFC fast-track process may be employed – being explored.
  • HL7 and OMG collaborating on SOA in Healthcare conference, expanded to include BPM this year. July 13-15th in Washington DC.

John adds to his report on the NCVHS testimony. Unsolicited advice to CMS was request to coordinate with ONC.

Richard Dixon-Hughes has brief update on JWG/JIC meeting (see attachment), noting new work 5.1 in developing countries on enabling technology at low cost; 5.2 on safety in health software. New prelim item on Data Types Implementation guidance between ISO DT, DT R1.1 etc.

Austin proposes an email list of those members in attendance and forward emails in the future.

Adjourned 4:59PM.

SDO Liaison Reports (submitted in advance)

1. HL7 activities with CDISC
   • Becky Kush reports:
     • HL7 RCRIM co-chairs met with FDA representatives at White Oak on 20 April to discuss issues with the CDISC content to HL7 message standards.
     • The JIC will have a pavillion at the WoHIT Conference & Exhibition in Budapest, Hungary the week of 10-12 May. Bron Kisler, JIC Chair and CDISC VP of Strategic Initiatives is coordinating.
     • Clinical Trial Registration & Results, a CDISC-HL7 standard is also an approved JIC project. An ISO TC-215 New Work Items Proposal has been drafted for this.
     • The JIC will be meeting at the ISO TC 215 meeting in Finland in late May.
2. HL7 activities with DICOM
   • Helmut König reports for HL7 Imaging Integration / DICOM WG 20 Report May 2011

     DICOM Supplement 150 (Radiation Dose Summary Information in Radiology Reports)

     This supplement to the DICOM standard introduces a template for including radiation dose summary information and relevant section headings (medical content) in DICOM Structured Reports:

     • basic information about the current imaging procedure.
     • relevant medical history data, information on the current request (i.e. clinical question that is expected to be answered by the requested procedure) and impressions on the current imaging procedure that has been performed.
     • Summaries of the radiation dose for imaging procedures using ionizing radiation.

     This supplement also considers transformation into HL7 CDA documents.

     Individual nations may have legal requirements or local content standards that require specific information be present. In Europe the Euratom Directive specifies the general aspects of documentation of the radiation exposure of a person.The transcription of this directive to national German law requires written report for X-ray and nuclear medicine examinations, but the German X-Ray and Radiation Control Regulation („Röntgenverordnung“, „Strahlenschutzverordnung“) does not specify the content of the report. The German national standard DIN 6827-5, „Recording in medical application of ionizing radiation – Part 5: Radiological report“ specifies the medical content of the report and describes how to optionally document radiation exposure and protection content which can be entered manually or automatically populated from documents such as SR modality dose reports. This template is also intended to satisfy California SB 1237.

     The document has been accepted for DICOM letter ballot at the WG6 meeting in Pisa (April 5 and 6, 2011). Comments that were received during the public comment phase have been addressed and a section on the transformation to CDA R2 has been added to the document.

     HL7 CDA: WG20 will be meeting with the HL7 Structured Documents WG at the May HL7 meeting in Orlando to discuss the development of CDA Imaging Report Templates and imaging topics related to the CDA IG Consolidation Project.

     HL7 Messaging: WG20 will be meeting with the HL7 Anatomic Pathology WG at the May HL7 meeting in Orlando to discuss order entry workflow and specimen identification topics.

3. HL7 activities with GS1
   • Christian Hay reports: Since June 2010 (EFMI Special Topic Conference in Iceland), we are planning a round table at the Medical Informatics Europe, late August 2011 in Oslo, Norway. That round table should be more user-oriented. At the April 2011 GS1 Healthcare conference in Washington DC, we had a dedicated session to educate GS1 users to HL7, animated by Todd Cooper. That has been among the best rated sessions for that week.

     GS1 and HL7 still have to work on local collaborations. In Austria, GS1, HL7, IHE and other organisations have passed a Memorandum of Understanding a few years ago. Still there is space for improvement – even in Austria. In Switzerland, the relationship is closer due to the guys involved … thanks to Beat Heggli to be such an open friend.

4. HL7 Activities with the Health Story Project
   • Joy Kuhl reports:

     The Health Story Project is a non-profit, industry alliance of over three dozen member organizations that was founded in 2007. To support its vision of electronic records that offer a patient’s complete health story, the project sponsors development of HL7 standards for the flow of information between narrative notes and EMR systems. In May 2008, Health Story established an Associate Charter agreement with HL7. Since that time we have supported the development, ballot and release for publication of eight implementation guides based on CDA R2, including Consult Note, History and Physical, Operative Note, Diagnostic Imaging Report, Discharge Summary, Procedure Note, Unstructured Documents and Progress Notes.

     Recently, in collaboration with HL7 and IHE, Health Story launched an effort to consolidate these guides along with the Continuity of Care Document (CCD) standard into a single publication. This project, called the HL7/IHE Health Story Implementation Guide Consolidation Project, addresses critical industry requirements and is receiving recognition from ONC through its Standards & Interoperability Framework. It is going through the current HL7 ballot cycle.

     Since our previous board report, Health Story engaged in the following additional activities, bringing value to HL7.

     • Published two press releases with HL7 to promote the HL7/IHE Health Story Consolidation Project with coverage in the 2011 HIMSS Conference publications and other media, such as Healthcare IT News and CMIO Magazine.
     • Volunteers supported a Health Story booth at the HIMSS11 Convention Interoperability Showcase, and Bob Dolin, MD provided a presentation at the showcase theatre.
     • Collaborated with HL7, IHE under the umbrella of the ONC Standards & Interoperability Framework to publish for ballot, “HL7 IG for CDA Release 2: IHE Health Story Consolidation, Release 1.”
     • Health Story and HL7 co-promoted an educational webinar, “HL7/IHE Health Story Consolidation Project: How to Participate in the HL7 Ballot” presented by SDWG Co Chair, Liora Alschuler to encourage ballot participation.
     • Health Story wrote an article for May issue of Health Data Matrix, the business and technology journal of the Associations for Healthcare Documentation Integrity called, “Health Story: The Gentle Path to Meaningful Use.” The article highlights HL7.
     • Health Story received coverage in NHIN Watch with a column contributed by HL7 chair, Bob Dolin, “Preserving the Patient Story as we Progress to EHRs.” The article highlights HL7.
     • Health Story members are encouraged to become early adopters of the HL7 CDA Implementation Guides, and members are directed to participate in training at HL7 Working Group Meetings and Education Summits.
     • Health Story is working with HIMSS Analytics to analyze initial survey results showing adoption of Health Story-supported HL7 CDA Implementation Guides.

     We look forward to further collaboration in 2011, including, most immediately, completion of and advocacy for adoption of the HL7 IG for CDA Release 2: IHE Health Story Consolidation, Release 1.

5. HL7 activities with IHE
   • Keith Boone reports:

     - IHE PCC is developing a profile supporting the reconciliation of problems, medications and allergies. Data can come from systems using CDA and HL7 Version 3 Care Record Query messages. Results can be reported in CDA or returned by subsequent Care Record Query messages. PCC is also expanding upon its EMS Transfers of Care profile on CDA to include Interfacility Transport.

     - IHE IT Infrastructure is developing a profile supporting CDA encryption using S/MIME for content packaging. In March they published Cross Community Patient Discovery for Trial Implementation using HL7 Version 3 Patient Administration messages.

     - Quality, Public Health and Research is working on profiles supporting:

     • Early Hearing Loss Care Plan using CDA
     • Quality Case Reporting using CDA
     • Physician Reporting to Public Health Repository (focused on Cancer) using CDA.

     - IHE Cardiology has published the Cardiac Imaging Report Content Profile (CIRC) for public comment based on HL7 CDA

     - IHE Radiology is working with DICOM on CDA templates for imaging reporting.

     - Anatomic Pathology has published Anatomic Pathology Structured Reports (APSR) for Trial Implementation. This is a CDA based profile.

     - IHE Eyecare has published Basic Eyecare Workflow also for Trial Implementation, using HL7 Version 2 ADT and Order messages.

6. HL7 activities with IHTSDO
   • Russ Hamm reports:

     On Jan 28,2011 IHTSDO approved a policy permitting the international use of SNOMED IDs and terms by International Standards Organizations. This would permit HL7 to publish SNOMED CT IDs and descriptions in HL7 standards and implementation guides, as well as permit HL7 members to exchange SNOMED IDs and descriptions through value sets regardless of IHTSDO member status. Use of these terms requires prior approval by IHTSDO through a formal request and justification for use. A proposal has drafted by the Vocabulary WG and approved by FTSD, TSC and the Board, and forwarded to the IHTSDO.

     The IHTSDO Management Board has voted to support the query components of the HL7/OMG CTS 2 specification. The CST 2 Submission Team has worked to provide a formal mapping and examples of how SNOMED represented in Release Format 2 (RF 2) would be represented in CTS 2.

     A process for submitting HL7 proposed content changes to SNOMED to the IHTSDO is being developed. This process will define the key participants, change evaluation process, priority assignment, and submission format for any changes.

     Further work on the integration of HL7 vocabulary content into the IHTSDO Workbench has been delayed due to tooling budget constraints and volunteer availability.

7. HL7 activities with NAACCR
   • Betsy Kohler reports:

     In 2010 NAACCR completed a pilot project testing the HL7 CDA for cancer data transmission. A couple of the issues identified during the project are the CDA file size and the transmission of one file instead of batch submissions. NAACCR decided to continue to explore other transmission formats. The next project will use a NAACCR specific simplified XML that will have the ability to transform to CDA.
     The NAACCR Standards for Cancer Registries, Volume V, Pathology Laboratory Electronic Reporting includes implementation guidelines using HL7 2.x message to transmit pathology laboratory reports from pathology laboratories to central cancer registries. Standards Volume V, Version 4.0 (May 2011) expanded Chapter 3 Synoptic Reporting to include guidance on the transmission format of synoptic cancer pathology reports. (http://www.naaccr.org/StandardsandRegistryOperations/VolumeV.aspx).

8. HL7 Activities with NCPDP
   • Margaret Weiker reports on NCPDP – HL7 activity:
     • NCPDP WG2 – Product Identification has a task group, Structure Product Labeling Activities Task, which tracks the activities of the SPL, offers suggestions to improve access and usability of the FDA Structured Product Label and Electronic Drug Listings, and monitors the work of the Guiding Coalition for feedback to the WG. They have completed a letter on Kits that will be sent to the FDA and are working on letters in regards to Marketing Categories, Inner/Outer NDCs and Identifiers, REMS, SPL Vendors and Freeness. They continue to collaborate with the HL7 SPL Leadership Team/SPL Working Group regarding issues with “Last Marketing Date/Marketing End Date”, “June/December Updates of the SPL” and the “SPL Validation Process”. They are also investigating the process whereby the Billing Unit Standard can be added to the SPL Indexing Files.
     • NCPDP WG11 – ePrescribing and Related Transaction has a task group, NCPDP/HL7 ePrescribing Functional Profile, which is monitoring the finalization of NCPDP and HL7 processes on the pharmacist/pharmacy interface functional profile and the standalone profile.
     • NCPDP WG14 - Long Term and Post Acute Care (LTPAC) has 2 task groups that interface with HL7
       • EHR/HL7 Task Group - The task group has begun creating business use cases for additional information that needs to be added to electronic prescriptions by the facility.
       • Automation in LTPAC Task Group –This task group reported they are continuing working on the review of HL7 messages currently used in LTPAC setting automated dispensing systems. They have completed the review of the dispensing log and new/change/discontinue order messages.
9. HL7 activities with OMG
   • Ken Rubin reports on HL7 and OMG Activities

     Relations between HL7 and the OMG continue to remain very positive with no significant issues or risk areas. Senior leadership from among the two communities have a standing monthly teleconference call to surface concerns. Since the last WGM, a number of these calls were cancelled due to unrelated circumstances, but no issues have been surfaced either. The relationship has moved into “maintenance mode” and continues positively. The following are the four areas of most significant collaboration:

     1. Common Terminology Services Release 2 (OMG Spec) Technology Adoption. Activities on CTS2 are drawing to a close in the OMG, with a technology adoption vote expected in June 2011. The HL7 community has been given several opportunities to review and interact with the technical specification, and HL7 has a vote as part of the final adoption. The specification will be discussed and action taken in Salt Lake City the week of June 20-24. HL7 members interested are able to register and attend OMG events at OMG member rates (cite HL7 when you register). http://www.omg.org/news/meetings/tc/ut/info.htm
     2. Healthcare and Community Services Provider Directory RFP. The OMG has issued an RFP for the technical specification to correspond with the HL7 Healthcare and Community Services Provider Directory Service Functional Model (HCSPDIR) http://www.omg.org/cgi-bin/doc?health/2011-3-6. In effect, this is a “yellow-pages” service, allowing for the discovery of appropriate (human) services providers based upon search criteria. A community of parties interested in doing this work is beginning to form, and HL7 members are welcomed and encouraged to participate. Feel free to contact me at ken.rubin@hp.com. The deadline to express formal commitment to participate as “submitter” is 25-September-2011, with submissions due September 2012. RFP
     3. hDATA RESTful Specification. The HL7 SOA committee has been approached by the hDATA proponents about participating and/or hosting hDATA activities within HL7. Among the two hDATA specifications brought forward, it was collectively determined that the hDATA RESTful specification had a potential natural fit as part of the HSSP / OMG collaboration. Presently, procedural steps are being explored to determine the optimal path for consideration of this work within the OMG using an available “fast-track” mechanism. HL7 side of these activities will be hosted by SOA, with the remaining hDATA HL7 projects hosted by SOA in collaboration with MnM and ITS.
     4. 4th Annual SOA in Healthcare Conference. OMG and HL7 are collaborating on what will be the fourth annual SOA in Healthcare Conference. Both organizations are co-hosting the event as has been done since its inception. The conference is scheduled for 13-15 July in Washington DC. See http://www.omg.org/news/meetings/HC-WS/index.htm

10. HL7 Activities with TIGER
    • Pat Van Dyke reports:

      HL7 agreed to provide a ‘Breakfast for Nurses’ at each Working Group Meeting for four meetings. Even though the commitment ended in 2009, HL7 has continued to hold a breakfast on Tuesday mornings from 0700-0800. Nurses from the international community attend the breakfast and discuss their involvement in projects affecting the nurse communities in HL7 and other organizations such as HIMSS and IHE. A Wiki site has been created. The development of education courses is one of the key areas of interest.