PCCTech Minutes 2016 02 19

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Monday February 15, 2016

Agenda Review

  • Present: Emma Jones, Denise Downing, Thom Kuhn, Tone Southerland, George Cole, Elena Vio
  • Phone: No One

Performed by Co-Chair Emma Jones

CP 203: PCC “CodeStatus” – larger issue, difference of how “StatusCode” is represented in HL7 Implementation guide setting “Status Code” and PCC Content Profiles different between how “StatusCode” is done IHE – international HL7 – national Suggestion by Tone – feed into HSI work Difference where the items were different are noted in the CP HL7 marks “StatusCode” gives you access to the entire value set, IHE has “StatusCode” states to always make it “Completed” How are people using “StatusCode”? Medication/Problems became deprecated by HL7 – HL7 said it was deprecated on purpose, but in future versions it will be undepreciated CP – column C CCDA v1 and column D CCDA v2, reflects the observation of the thing, PCC has it as the observation is completed, but not how HL7 does it – look at effective times of the medication to see if it is active – this is conveying different information

HL7 v2.1 HL7 PC want it to come back, but want the value set to change

  • Next Step –
    • look at CDA 2.1 to see if anything has been redone and forget about v2.0,
    • align with v2.1,
    • see if there are anything in v2.0 that affect PCC
    • create a mapping
    • If “StatusCode” and “StatusObservation” present, in PCC should override the “StatusCode”
    • George will relook at it and make a version 4 of the CP

Board Sharing:

IHE doesn’t give guidance about how to select the Board Members – each domain does it differently, discuss as a committee about our process, election of a board member every year? Document how we select our Board Member

Next Steps:

    • Tone will take this on
    • Discuss with DCC

IHE doesn’t have a guideline, domain decides the representative, loosely defined didn’t know where the domains were headed,

FHIR Profiles: What is PCC doing about FHIR profiles

  • GAO
  • Discuss with other domains, e.g., ITI, bring this up at the Joint Meeting
  • How are we doing support for FHIR

Documentation Workgroup: This workgroup has started working again Document templates, trying to get all the domains to the new templates, currently domains are misaligned with the templates, PCC is especially misaligned with TF-1, and the workgroup should incorporated FHIR work also


  • Present: Emma Jones, Denise Downing, Thom Kuhn, Tone Southerland, George Cole, Elena Vio, Chris Melo, Jose xxx, Portugal Student
  • Phone: Keith Boone

Added new Open Issue about how the profile could be used in other settings e.g., surgery, recovery area

  • Transaction Diagram-

First transaction in BED is ITI PAM (Pt Adm Management), will note this in BED vol 2 Order Placer separate because it may be integrated with a systems EDIS, looks grouped, but not, does it need to be grouped? Add this to Open Issues and Questions, is not a function of EDIS as an Order Placer so it should be a subgroup of EDIS – no it should be grouped, Keith made the boxes touch now,

  • Bed Manager –

decides if there is a bed available based on the pt from the physicians order – added as an Open Issues about PAM – Address and clarify Admit for Observation (bed location) is a subset of the first added Open Issue – Clarify Billing is out-of-scope

No Optional transactions – ADT Tracker receives everything and bed notification – Bed Manager only sends beds it doesn’t receives bed notifications

  • Actors –
    • ADT Tracker – possibly needs a new name, have a Tracker Actor in PCC? It is a component in DS, not doing DS in the profile it needs to be hooked to a DS

Need to broaden the def to general tracking not just ADT

Haven’t completed X.1.1.1 – X.1.1.4 yet, will update about the transactions No “R” Required Actor Groupings

Some vendors sell Bed Management Systems with their EHR, Discussion about scheduled beds needed – out-of-scope for this year, but another profile for next year

  • Security Considerations –

protect demographic, clinical, and administrative info, secure it with ATNA and only authorized users and authentication use the data and ATNA would cover this, recommending actors be grouped with ATNA transaction not required

Tomorrow will look at Use Cases in detail, Wednesday do self work-cancel BED time, Thursday bring back updated draft


  • Present: Emma Jones, Denise Downing, Thom Kuhn, George Cole, Elena Vio, Chris Melo, Lisa Nelson, Jose xx, Tone Southerland
  • Phone: Paul Dow
  • Reviewed Actors & Transactions -
    • 3 Actors (Consumers, Manager, Contributor)
  • Scope

Make this an agenda item for the Joint Meeting on Wednesday

  • Transaction name of “Update” functionality – HL7 group labeled update and create separately, FHIR Restful separate update and create, does it imply a new version, update is a new version if there isn’t a new version, this will be volume 2 detail, have 1 update transaction in the profile for now
  • Transaction Actor Table -

Care Plan Manager optionality is an “R” but looks confusing and funny in Care Plan Consumer, make “R” in Care Plan Manager an “initiator” and “O” in Care Plan Consumer as a “receiver”

  • Have new Actors and need definitions for those actors

Care Plan update isn’t a replacement of the entire CP, but it amends/updates the CP, HL7 calls it synchronization, in Pharm used terms aggregation and then reconciliation of the content occurred

  • Reviewed text of the Use Case -

Reusing the Chronic Condition Use Case from HL7 Patient Care Workgroup Encounter(s) B tells you what occurred during each encounter

  • Appendix A -

Looked at the workflow, swim lane diagram

  • Outside the Scope is ensuring the CP is the latest, Care Plan Manager you chose to retrieve from may not have the latest data about the pt. You are only getting the latest version based on what the Care Plan Manager has – Open Issue #2: Discovering the patient points of care, FHIR does not profile this and the profile is only using FHIR Resource and must be written into the Resource

To Dos: Scoping and ramifications Term definitions Workflow Diagram


  • Present: Emma Jones, Denise Downing, Thom Kuhn, George Cole, Elena Vio, Chris Melo, Lisa Nelson, Jose xx, Tone Southerland
  • Phone: Paul Dow
  • Reviewed the Scope of the Profile, supported by XDS-b and XDS-I profiles
  • Reviewed Actor and Transaction diagrams

Describe the difference between workflow document and transaction is present in vol 2, but not vol 1, vol 1 only describes the transaction and not the workflow document

All Actors and Transactions are “R” required, is there a way to support a specific HT Requester was a question generated, the HT Manager invites the participants to join the HT and delivers a list of members for the HT, but can it identifies specific providers

  • Add an Open Issues: about HT requestor requesting specific providers
    • Send a list of the open questions to Jim Chang and Dave Swortzwiener for responses
  • XTW didn’t define the human transaction, may need to keep it general part human part automated (computer)
  • To Do – add in section X.1.1.2 add content about - how the decision process for the HT Manager (Requester) doesn’t decide the staff for the HT – better wording - the process for defining the list of participants for the HT is out-of-scope for this profile.
  • Table X.1-1 Actors/Transactions table HT Participant – why do we have Add Individual Eval Report? It is all part of the report not a separate transaction, or additional examination, table lists the tasks in the workflow.

ITI-PCC APPC Supplement: Reviewed Tone’s comments for APPC with ITI about Content Consumer and Options

Tuesday, February 16, 2016


  • Present: Emma Jones, Denise Downing, Thom Kuhn, George Cole, Elena Vio, Lisa Nelson, Tone Southerland, Chris Melo
  • Phone: No One

Worked on Open Issues and Closed Issues – we need to determine the version of FHIR we are going to use for this Profile, will use DSTU2, what do we do about future FHIR changes?

  • Closed Issues - #1 is Open Issue #2 –

Data and Synchronization – how does the CP Manager handle data, expected to synchronize when you update a FHIR Resource it is a complete update, to do more granular data managing you do your changes outside the Resource then retrieve the Resource you as the client are responsible to get it, update your CP, merge it, and push it back to the CP Manager– this is based on the FHIR Resource, the facility needs to make the business rules for the client.

  • Appendix A
    • Adding 3 new Actors

Discussed Actor Names and definitions why make it a CP Contributor instead of CP Creator? It is named this way because the CP is created once then it is updated after that, it is a new version but according to FHIR

Need to document in vol1 about the CP consumer and what they receive, they receive and push back the entire CP not just “content” of the CP

Within the document use Care Plan, but somewhere in the document state it is related to CarePlan FHIR Resource Discussion occurred around versioning of the CP, FHIR handles versioning, according to FHIR you’d test the retrieve conformance statement - query the server for versioning

Discussed about adding “search” in the diagram


  • Present: Emma Jones, Denise Downing, Thom Kuhn, George Cole, Elena Vio, Lisa Nelson, Tone Southerland, Amit Popit
  • Phone: Keith Boone
  • Review of Use Cases
  1. 1 – Ed Admission – needed to add about transfer/discharge being sent to the bed management system
  2. 2 – Dashboard – acuity and services discussed, all covered
  • Out-of-Scope transfer to another facility
  • Using PAM so the HL7 messaging version the profile will be using is v2.5
  • Reviewed Open Issues
    • Billing information – added a sentence about this in the profile
    • Admit for Observation – Use Case #3, discussed whether a new account is created, the profile addresses it within the section X. it is changing the patient class in ADT/Admit/Visit Notification Event A01
  • ADT Tracker or just Tracker Actor? Discussed that Tracker is the same as Auditor in other profiles? Tracker is from HL7 v3 message, suggested an update to the definition that the tracker receives all messages, resolution we are keeping the actor as “Tracker”


  • Present: Emma Jones, Denise Downing, George Cole, Elena Vio, Chris Melo, Tone Southerland
  • Phone: John Donnelly
  • Actors Reviewed
    • HT Requestor – question can you put a name to the HT Requestor – yes (e.g., the cardiologist) initiator of the workflow
    • HT Manager – who is this a system
    • HT Participant – member of the team

Figure X.1-1 Actor Diagram – discussed that we need to remove the PCC Y2 Accept/Reject HT Activity in the diagram because it is not a document exchange that is bond with an XDS document – it is a transaction so XDS Document Registry cannot be the vehicle to exchange this because it is between the HT Manager and HT Participant, need to delete the exchange between HT Manager and XDS Registry and make an arrow from the HT Manager and HT Participant

  • Transactions Reviewed

Resolved the open issue about aborting the workflow if the pt encounter changes – added HT Cancel

  • Need to word smith the Individual Preliminary Report – it’s not one document including all the HT Participants reports, instead it is the report from each individual HT participants
  • Discussed the document table – discussed the acceptance and rejection of the HT participants, it is not a document that is exchanged, but it is a transaction, the XDW document is displaying the acceptance/rejection from all the team members

The XDW will be the master document that shows all the HT Participants that accept/reject the request - Need to have this as an Open Issue – is XDW the path to use for acceptance or rejection of HT Participants (one document that all can see who has accepted or rejected the invitation) or keep it out-of-scope and just keep this profile as a workflow profile with the focus of assembling the HT and can, we can put this question back to the cardiologist.

Building the HT team from the IT perspective include or exclude use XDW of accept/reject or not.

PCC Work

  • CP – George has been assigned, refer to CPv6 (back and forth from HL7 to PCC and HIS)
  • PCC Profile Summaries – assigned to Tone to do, put on as an agenda item for next F2F

Wednesday February 17, 2016

  • Present: Emma Jones, Denise Downing, George Cole, Elena Vio, Thom Kuhn, Chris Melo, Charles Pensanoe
  • Phone: Laura Herman-Langford, Paul Dow

DCP: General Review Updated introduction, glossary, actor summary definitions, transaction list, and Issue – security issues haven’t been discussed, can borrow from DSTU2, George noted some risks

Security Considerations discussed Looked at other profile security consideration section - GAO doesn’t require groupings mentions ATNA, RECON has no security considerations, will borrow from GAO communications security and integrity – certificate nodes at each end, ATNA for unauthorized access and authentication, PHI query for search and other REST queries include PHI as query parameters take from PIXm

If the profile requires ATNA groupings it constrains the profile use on mobile devices – added as an Open Issue

What to do about mobile devices, wasn’t originally a consideration, profile lists the pt will get access to their CP, the profile doesn’t state how the pt gets it, a pt portal? via a mobile device? Consensus is yes include that in the profile, changing PIXm to DCP

Don’t need an update or create reference due to using the FHIR resource, it’s a FHIR resource Transactional Resource in the FHIR Resource liked that because CPlanning a single CP represents multiple specialties and each specialty is only interested in a view, piece, of the CP, the specialty makes the get, updates, creates the new, and sends back to the CP Manager, if the references are pointing to something (e.g, XDS) it would make the deployment easier, if you point to unknown FHIR resources who should the resource be under control of eg, the HCO? Can FHIR reference other things than resources – Yes. Can FHIR reference other documents such as other PCC profiles based on CDA or HL7 documents or Summaries of Care – don’t know? You can use the FHIR Composition Resource or transfer of care document

CP Contributor follows a CP (keeping up on changes that are needed for the CP in the CP Manager) as a contributor I merge my CP with the CP from the CP Manager, changes I’ve made to the CP that came off the CP Manager server the CP Manager accepts or rejects the CP pushed to the CP Manager, accepts good, rejects due to other changes to the CP by other CP Contributors since the time you downloaded the CP from the CP Manager, example of this should be placed in the Profile

Added another Open Issue about when profiling FHIR Resources making sure we reference existing documents

Interoperability at Connect-a-thon:

  • Present: Emma Jones, Denise Downing, George Cole, Elena Vio, Thom Kuhn, Chris Melo, Charles Perisot, Tone Southerland
  • Phone: Paul Dow

Discussion topic from testing and tool committee, an international committee for tooling and testing at connect-a-thon, clinical data content and level of testing in this area, the level of engagement and testing has been declining over the years and is low, poorly organized, and challenged with testing efforts due to national specifications

Documents in the PCC are based on HL7 CCD v1.0 and C32 for MU, these standards supply less definition, but missing some aspects of interoperability. Suggestions:

  • Bring all the national specifications and dev a volume 4 where they are all listed for testing
  • PCC introduced modules and level of content at this module level is based on CDAv1 of CDAv2.1, using the “Concept Modules” is organized, the link process
  • Other suggestion – a combination of both a link to the standard no matter what standard is being used

PCC had a project to move what PCC had created, the base content and national extensions, then the new template versioning developed, the PCC project Keith started was placed on hold until the template issue got dissolved, that issue got dissolved and figured out, PCC Content Module may not have any relevance in the world now due to FHIR, so thinking ahead for IHE PCC when doing sematic data exchange PCC TF way of merging standards and semantic definitions or semi-groupings based on models, so meeting somewhere in the middle – PCC takes the 10 most popular Use Cases for an Dx, Allergies, Med Adm, and map to EPSOS, CDAv1, CCDA, need tooling to do this, PCC needs the fragments to map, but you also need the standards to be able to define the bindings Start from the practical people, not the theoretical people, that are using the standards and implementing the standard

Next Steps:

  • Meeting next week with many international vendors, identified this is a process problem – Charles will meet with COCIR next week, then he will get back to the PCC Cochairs and PCC will setup a T-con to discuss this
  • Need a committed host for this project, PCC is top of their list
  • COCIR has developed a Whitepaper about this, publication date – early May-June
  • Need to identify all the stakeholders and if we need tooling for this
  • IHE needs to discuss this project – it’s a Planning – Technical decision
  • There is a need for this to be performed

Cardiology: Present: Emma Jones, Denise Downing, George Cole, Elena Vio, Chris Melo, Tone Southerland, Charles Perisot Phone: Paul Dow, Nick Gawrit

Based off of the XDW profile, not using documents, but transactions, reviewed the XCHT-WD Sequence Diagram, there were 121 transactions, suggestion was to make some of the queries to retrieve and accept-make it one transaction and explain it in more detail in volume 2, this will make the diagram less busy

4 Use Cases in the profile – reviewed the Use Cases and the composition of the HT Requestor and HT Participant, suggestion to state in the profile that there are 2 Use Cases – 1 simple, 1 more complex and 2 exception Use Cases, in section X.4.2 add an additional sentence or information simple stating the profile has a simple, complex and exceptions Use Cases then when you get into each individual Use Cases you can state the participants and roles for the Use Case

Resolved the issue about seeing HT Participants response for the request to join the HT Request

Issue: have many diagrams and which ones do we place in the profile? Process Flow Diagrams and Sequence Diagrams, as a committee we can agree to have both, but if we clean up the Sequence Diagram we may only need one, currently the Process Workflow Diagram is cleaner, but only shows actors, the Sequence Diagram displays the XDS transaction, put the Process Flow Diagram last, Swim Lane Diagram 2nd, and the other first, possibly making it an Appendix

Additional Discussions:

Future Agenda Items:

  • What to do about deprecating Supplements – need a strategy first prior to deprecating

Charles Issue – Managing interoperability between versions of CDA and FHIR, rebirth of PCC “Modules” need membership from each nation to find out who those individuals are first.

Thursday February 18, 2016


  • Present: Emma Jones, Denise Downing, George Cole, Elena Vio, Thom Kuhn, Chris Melo, Tone Southerland, Lisa Nelson
  • Phone: No One

Reviewed Security Considerations – identified risk due to some PHI will be exposed e.g., name, when using a mobile device

Cross profile considerations – discussed groupings - “Content Consumer in Pt Care Coordination” might be grouped with a Care Plan Consumer to enable filtering and display Care Plan content.

Discussed the Dynamic Care Planning picture, the existing picture looks like it references a document type of structure and not a dynamic process, need a picture to depict the process and then the artifact of the process which is the existing picture that was removed

What is the behavior of FHIR for “Subscribe”? - to discuss in volume 2

  • Encounter A & B Basic Process diagrams need to be updated, need to break up the boxes into multiple boxes
  • Appendix A Diagram – need to change the Dynamic Care Plan box to Care Plan Management System
  • Next Steps: TCon participation: Emma, George, Denise, Lisa Scheduled Time: Monday 3pm Central start March 7th after HIMSS (cancel existing series)

Vote: Motioned – Thom 2nd – Denise Opossed - 0 Abstain - 0


  • Present: Emma Jones, Denise Downing, George Cole, Elena Vio, Thom Kuhn, Chris Melo, Tone Southerland, Lisa Nelson
  • Phone: No One

Update Sequence Diagrams, TCon participation: Emma, Amit, Denise, Scheduled Time: Fridays Noon Central start after HIMSS March 11th

Vote: Motioned – Denise 2nd – George Opossed – 0 Abstain - 0

PCC Update:

  • BPMN:

Working with Order and Observations in several committees at HL7 for FHIR Workflow Resource, wanting it to look familiar for anyone who has implemented XDW, Task Resource combines task resources with task workflow documents, Task can have more sub-tasks, Task will be the thing we need to update in IHE profiles – have a parent Task that has the FHIR structure e.g., Task Priority, Task Status, Identifier, Inputs, Outputs, building the infrastructure for Task in HL7 Taskforce in Montreal who wants to test Task Resource, able to take a lot of the content from the BPMN Whitepaper for this HL7 work, the TaskResource will be ready sometime next year, this will address the challenges Radiology was having with XDW and Modality Worklist, this is competing with a messenging version action request and action response, no full project plan for how this will affect

Next Step is to convence ITI about the use of BPMN

  • FHIR based Profiles:

CMAP, GAO - Next Steps FHIR is going from DSTU1 > DSTU2 update the Trial Implementations to DSTU2 because we based them off of the DSTU2, 2017 release for DSTU3, Keith will update the profiles for summer publications, Keith - need to do a change proposal for these, John Moeke is working on a formal process, refer to notes from DSTU Meeting

    • Next Steps:
      • Let Mary know about summer publication for CMAP and GAO
      • Keith to do CPs for updating CMAP and GAO to DSTU2

  • CP 214 – StatusCode:
    • On hold for now until we decide what to do about document updates related to Charles proposal yesterday
      • C-CDA docs heading towards FHIR then use that as our opportunity to rework our IHE PCC TF instead of doing a crosswalk, use an HL7 Resource like that, George has been on calls for CDA and CCDA and doesn’t know how vocabularies(code systems and value sets) are going to be addressed

Mitre is proposing a Connect-a-Thon for clinical content but calling it a Connect-a-thon is not the proper term because they could come to IHE/HIMSS for this, look at IHE PCC Use Cases and see what they look like in FHIR

XCHT-WD – Cross Enterprise Cardiovascular Heart Team Workflow Definition

  • Appendix C.1
    • need to move the text to X.4 as second paragraph. Also add the Scope piece to X.4.
    • Get rid of the use case.
    • Keep the pictures in Appendix C but add a label

  • Transactions table in Appendix will be described in volume 2.
  • Vote: Tone: Moved pending the above changes; George Second; 0 abstain, 0 against,

  • T-Cons: Monday 10:00 AM EST (9 am CST) every other week - starting after HIMSS on March 7th