PCCTech Minutes 2015 02 23

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Monday 2015 02 23 thru Thursday 02 27


  • Keith Boone
  • Alex Lippitt
  • Isabelle G
  • George Cole
  • Mike Bohl
  • Tone Southerland
  • Thom Kuhn
  • Chris Lindop
  • Jesse Shiah
  • Emma Jones
  • Julie Dumons
  • Kevin McDermott
  • Jean Camille
  • John DeLong

  • On phone - Nagesh Bashyam (Dragon), Gayathri Jayalardena, Angelique Cortez, Glen Marshall, Brian Reinhold, Dave Stumpf, Teri Sippel, Lynn Felhofer, Kinson Ho


Intro/Agenda Review

  • Request to record and make available the DCB discussions for those unable to attend the sessions due to time zone differences


  • George/Emma led discussions, reviewed several sections, made some changes to document
  • may need interaction with IHE-HL7 Joint Workgroup (HSI), in relation to using the provenance FHIR resource. Need a PSS work item for HSI with PCC and Patient Care as co-sponsors. HSI will sponsor
  • discussion around using PCC-1 Share Content
    • will likely need a new transaction that provides more explicit/specific guidance
  • Options section need to be implementation agnostic (remove specific references to CDA, PCC TF and FHIR)
  • Next Steps - Get on HSI agenda with PSS questions (let Laura H. know). Update PC with Volume 1 progress - will not impact current DSTU. See what is needed to get this on the list for FHIR May Clinical Connecthathon. Plan for Volume 2.
  • T-Cons - Keep every other week on Tues at 11 EST (currently scheduled).

Remote Patient Monitoring (RPM)

  • Brian led discussion, reviewed actor/transaction diagrams
  • discussion resulted in clarity of actor/transaction definitions, and use of grouping
    • updated the actors - question around the required groupings
      • no new actors
      • 3 transactions - communicate PHCA - Data, PCD-01 communicate PCD data, PCC document sharing
  • Clean up of various diagrams
  • Clean up of Other dependencies section
  • Risk assessment - - Keith will provide spreadsheet of what is needed.
  • Security Considerations discussed - needed for volume 1 - Keith will add in the security considerations based on risk assessment.
  • Next Steps -
    • Section about H data (appendix)
    • PHCA data transaction referencing the Continuua work
  • T-Cons - Prefer mornings - Wednesday 9:00 EST - meeting invite to PCC tech and PCD.

Device Clinical Bridge - Name changed to Clinical Mapping (CMAP)

  • Alex led discussion, reviewed actors/transactions diagrams
  • actors and transactions we reworked based on committee feedback
  • next action: Alex to apply changes to DCM document for follow up session
    • - updated 2nd use case - clinical to billing use case.
    • Clarification of Transaction (multiple back and forth until it is done - multiple activities can occur. Will be a complete business request)
      • 2 actors with one required transaction
    • Clarification of options - limited to device mapping and problem mapping
    • Security considerations discussed
  • Next Steps - clean up volume 1, complete security matrix
  • T-Cons - Every other Thursday at 1:00 PM CT (2:00 PM EST) - Start March 12 -catch up meeting, start volume 2 meeting on March 26

Workflow Definition

  • Keith led discussion, reviewed selection of BPMN as the standard of choice
  • Dave Stumpf/Jesse Shiah from AgilePoint discussed reasons for using BPEL and/or XPDL
  • next action: for Dave to bring details to next session on market penetration levels for XPDL/BPEL vs BPMN
  • Reviewed BPMN structure and process flow
  • Need Feedback
    • May need to have a white paper with a high level explanation.
  • Next Steps
  • T-Cons- Fridays at 8:00 CT (9:00 am EST) weekly starting March 6


  • Keith led international discussion
    • decision made to not proceed further with international DAF efforts as there really does not seem to be much to do
  • Alex/Dragon led IHE USA extension discussion
    • DAF US extension is mostly complete
    • Need to identify ITI SMEs to review the DAG IG and provide examples
    • next steps - develop testing tools
    • would like to test at Connectathon 2016 (CAT16)
  • Next Steps - IHE USA will move forward with DAF. Nothing further needed from PCC Tech except publishing the National Extensison in conjunction with IHE USA. IHE USA will work with IHE publication on getting the IG and National Extensions published.

Content Creator/Consumer change discussion

  • Led by Tone Southerland
    • Discussion
      • Need a better way to keep track of the Content creator/content consumer actors, actor options and transactions.
      • Suggestion of doing a framework update
      • Recon 3.1.1 - need to do a little bit more cleaning up. View option is CDA specific but can be fixed - "when the document is CDA, do this". Will set this up as part of the joint discussion - Need to confirm what the transaction number is and how we will fix it.
      • Original issue about CC/CC raised by DSG - need to make the option not bound tightly to CDA. Generic framework will describe the options and profiles will specify how the options are used. Content creator/consumer is about "document" sharing. (will need a new transaction for RECON on FHIR because it's about resources - not document)
    • CP 211 - created and edited by Keith.
      • Plan
        • Discussed CP 0211 at joint meeting
        • Going forward, will need the following - CPs to TF - IC, XDS, XPHR; CPs to fix other individual supplements
        • Tone created a google spreadsheet that will be used to track changes
        • Awaiting discussion with John M and Charles - Need to list out transport and talk about bindings.

Remote Read WD (RR-WD)

  • Discussion lead by Chris Lindop
  • Volume 1 discussion - clean up of RR workflow definitions.
    • Double read workflow - need to clarify if over-read or double-read. The rest of it is part of the workflow.
    • Clean up of workflow scenarios - removed administrator function because it's pre-condition of the profile.
    • Discussed actor option grouping from various workflow definition profiles
    • Concurrent update of BPMN workflow definition by Keith
  • Next Steps
    • IHE Rad F2F meeting March 31-April 3 - goal of this meeting is to release volume 2 of remote read.
    • Need to complete the standards assessment. Propose a discussion about this the week of march 9 - Friday 3/13 at 9:00 CT
    • Plan to have profile ready for public comment may 2015 and TI August 2015 (via PCC)
  • T-Cons - Weekly for 3 weeks starting Friday 3/13 at 9:00 CT (13, 20, 27) - need invite to IHE RAD and IHE PCC

Imaging Clinical Decision Support - ICDS

  • Discussion led by John DeLong
    • Imaging CDS profile -
      • PCC Profile - interaction between the EHR and the CDS so that CDS can provide clinical based guidelines (patient data, lab data, allergy data, problem list, etc)
        • Mechanism (technology piece)
      • IHE RAD - deals with the ordering
      • PCC to deal with Content set
        • PCC has done a number of Decision Support work with little implementation -
        • Info button is working and may be a option
        • In the US - ICDS is required to become mandatory Jan 2016
        • Discussion about the payload and the contracts to use - RFD Form Filler and form processor, look at CRD - (QRPH profile) for some of the data usage of session ID, etc) - CRD in the Quality Domain discusses Clinical Research as a content profile on top of RFD.
        • George provided an overview of RFD
        • Keith provided another possible solution
        • Keith provided review of ITI security cookbook white paper to drive security section of volume 1
          • Discussion about providing digital signature as an option as well as dealing with ATNA
  • Next Steps
    • FHIR approach need to be considered
    • Have to do the standard selection matrix.
    • Nail down use cases
      • No Question
        • include propose alternative
      • Question
        • include propose alternative
      • Propose alternative
      • Need to support pre-auth in the use cases
      • Response will include
        • Questions
        • Score
        • Advice
        • Alternatives

T-cons -

    • no Fridays - Wednesday at 10am CT
    • IHE Rad F2F -March 31-April 2 at RSNA
    • IHE PCC F2F - April 27-30 at RSNA

Change Proposal Discussions

  • CP 203 Status Code of Completed
    • CDA V3 have all the ActStatus codes.
      • Need to go back to HL7 SDWG about acts that have been nullified
      • Medications - Need to wait for hl7 to come to resolution.
      • Put the CP into held state for now
  • CP 208 LOINC code used for plan of care section 61145-9
    • In TF under immunization recommendation has 18776-5 is the treatment plan - which is what is intended for immunization treatment. Will leave LOINC as is
    • - Need to change this back but need to get approval from nursing sub-committee.
  • CP 210 - use of SDTC extension for sdtc:patient. This came from HITSP C83
    • Need to go back to SDWG to not deprecate because in C83 4.1.3 as a role for patient.
  • CP 211 addresses CP 204. To address further concerns of CP 204, created CP 212 to fix QED transaction numbering change.