PCC TC Face to Face April 31-May 3-2018

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April 31, 2018 F2F Meeting Day 1

Attendees: Steve Moore, MIR Tone Southerland, IQVIA Michael Clifton, EPIC Gila Pyke, Cognaissance Denise Downing, AORN Nemanja Mienkovic, ASIP Emma Jones, Allscripts Raffaele Giordano, Arsenal IT Celina Roth, HIMSS Yvonne, HIMSS Andrea Fourquet, eHealthsign Daniel Venton, Allscripts George Dixon, Allscripts Amit Popat, EPIC Chris Melo, Phillips Thomson Kuhn


Agenda Update : Switched CDA Document Summary to start at 9:30am so that PCS Summary can be moved to the afternoon

Workflow CP Loinc Codes

• Arsenal IT submitted 4 CPs proposing that we create our own TypeCode OIDs instead of waiting on LOINC to assign them, since LOINC does not manage non-clinical OIDs

• PCC will create 4 TypeCodes and update the consolidated IHE wiki where the formatCodes are with TypeCodes

• Gila will add this to the joint meeting agenda to help us understand how to assign typeCodes

CDA Document Summary

• Emma presented CDA Document Summary volume 2, and updated the Template ID OIDs in the PCC Wiki

• Emma will work with Tone offline to work out the Notes section and how to follow the CDA IG

Dynamic Care Plan (DCP)

• FHIR based profile meant to support the care planning process

• New actor, new transactions

• Task still needs to be profiled

• Gila to add “IHE Constraint Cardinality” column to the joint meeting agenda

IHE FHIR Profiles - Conformance (presenter John Moehrke)

• Process menu item from Wiki left hand menu

• FHIR Conformance Resource Templates contain guidance for profile writers who are using FHIR. What additional things can you do when profiling FHIR? This is just the current thinking, not the ultimate way we will profile FHIR as new IGs are published

• You have to do this step for any of the publication systems so far o Process is described under “Current Guidance on ‘use’ of FHIR o A conformance resource is a way to convey metadata about datatypes, resources and API features of the FHIR spec that can be used to create derived specifications o Uses CapabilityStatement, StructureDefinition(s)(called profiles in simplifier), OperationDefinition, SearchParameter at minimum. Other Conformance module resources are still in flux. o John recommends that we use the STU3 Conformance resource as a manifest of the required elements

• A capability statement is a definition of an actor

• An implementation guide in HL7 is equivalent to a profile in IHE

• A FHIR profile is a subset of StructureDefinition that puts constraints on a (single) resource, such as limiting the cardinality, defining the value set to be used, define fixed values, etc

• Why should we publish them? o They are machine readable o There is tooling that has been built to help create the conformance resources o Conformance resources can be used by servers to test whether an app request is compliant with an IHE profile o There is also tooling for application writers to import definitions into their tooling, which will force them to fill out all the required fields

• Wiki Profiles page really needs to be up to date!!!

• Index of ftp.ihe.net/TF_Implementation_Material/fhir/CapabilityStatement/ contains machine readable capability statements where you can publish them

• We then use “Simplifier” to publish them to the registry.fhir.org registry of conformance resources, which can point to the IHE wiki for the relevant profile. Anything mature should be updated to the FHIR registry

• Publish examples of messages in the IHE domain implementation guide section of the implementation material wiki, not in the fhir directory which is limited to capability statements

• Encourage IHE to get enterprise licenses to the Simplifier tool


All profile writers, upon completing their profile, to create a:

o Capability Statement

o Implementation Guide

o Structure Definition(s) where you add constraints on a resource

• Guidance on how to do this is on the wiki, and John is happy to help

• Zulip, at chat.fhir.org is a group chat with an IHE stream that you can discuss any IHE topic. John can also use the announcements stream to announce public comment for FHIR IHE profiles

PCS Summary

• Replace volume 2 with a statement “no new transactions” and delete everything

• Reviewed volume 4 and vol 6 content

May 1, 2018 F2F Meeting Day 2


Michael Clifton, EPIC Gila Pyke, Cognaissance Denise Downing, AORN Nemanja Mienkovic, ASIP Emma Jones, Allscripts Raffaele Giordano, Arsenal IT Celina Roth, HIMSS Yvonne, HIMSS Andrea Fourquet, eHealthsign Amit Popat, EPIC Thomson Kuhn


Agenda Update: Switched CDA Document Summary, PCS, and DCP

CP Discussions

• CP 222 has been applied to a version of RPM that is in the current published folder, but does not match the version on the IHE.net site.

• Current published TI is FHIR DSTU1, and Brian said that we cannot publish the DSTU2/STU3 version until HL7 has finished the device debate

• 4 things need to happen

o Apply the CP to the old version of RPM, IF it is worth updating o We need to reach out to Brian about updating RPM. If he can do it this year, we skip updating the old one. o Warn Mary that RPM will be republished this year. o The updated CP needs to be approved  Amit moved to approve the CP  Gila seconded  No objections

• Denise to move CP 222 to the Approved folder

• CP 228 – Emma is making the changes to DCP now as part of the Plan Definition updates to DCP

o Need to talk to Chris Melo about this one and then agree on this committee-wide going forward. o Gila added the question of pointing to base FHIR for base FHIR operations or to FHIR STU to the joint meeting agenda

FHIRPlanDefinition: DCP

• Discussed DCP and XDW interactions • John Moerhke joined us to discuss what to do about FHIR and testability

CPs Work continued

• Moved Andrea/PCS topics to Wednesday due to computer issues

• Discussed CP 228 with Chris Melo, will discuss it again at the joint meeting

o Will approve CP 228 after joint meeting discussions are complete, since everyone who had a stake in the ballot was present for resolution o Needs to be moved into the approved folder once approved

• CP 227 approved without changes. o To be moved to approved

• CP 267 assigned to Lori, needs to be moved to assigned

• CP 272 assigned to Gila o Gila to update with volume 2 content o Denise to warn Mary that volume 2 will be republished this year o Move to ready for ballot

• CP 224 has been incorporated into BED by Emma, Emma will send to Denise to put in CommitteeSubmitted and notify Mary that it will be republished

• We will do a May 2018 CP Ballot, with CPs 223, 224, 263, 266, 272 o Last ballot for this publication cycle o Ask Lori about 267

• Schedule 2 CP calls to get updates and do ballot resolution on May 25 and June 8 12-1:30pm CT

• Process for updating documents discussed

CDA Document Summary Section discussion

• Emma reviewed CDA Document Summary changes. The group discussed user/developer expectations and came to resolution with no changes.

• Gila moved to approve CDA Document Summary Section for public comment. Michael Clifton seconded. No objections, no abstentions, no further discussion. SO MOVED. PPOC, eNS, GAO deprecation discussion

• Notes taken direction on the PCC Deprecation page: http://wiki.ihe.net/index.php/PCC_Profile_Deprecation#Profiles.2FNational_Extensions_in_Intent_to_Deprecate.2FDeprecated_Status

• eNS post-mortem, why did this seem like a good idea to write the profile but didn’t get implemented? o Nurses were not EHR customers, so they weren’t buying o The nurses at the time who were writing the use cases in the nursing sub group were united in their belief that this was needed to solve their documentation problems and their care coordination problems, but nobody went through the vendors to see if they would implement something like this. There was no vendor interest at all because vendors were not listening to nurses at the time. And then meaningful use happened and anything not MU related stopped (so bad timing was part of it). o Exchanging the new care plans may help with the problem too. o 2 lessons for the planning committee:  Make sure the vendors are committed or there is no point going forward (we already started this last year)  No more surprised from the federal government!  Prioritize (US) federal priorities during planning. Bring this to the board as well.

• Tone and Amit to talk to DCC about the idea of a notice of intent to deprecate status on the wiki. Need to update the wiki, including creating a status/category page.

May 2, 2018 F2F Meeting Day 3



Michael Clifton, EPIC

Gila Pyke, Cognaissance

Nemanja Mienkovic, ASIP

Emma Jones, Allscripts

Raffaele Giordano, Arsenal IT

Andrea Fourquet, eHealthsign

Denise Downing, AORN

Amit Popat, Epic

Thom Kuhn, ACP

Cindy Levy

Tone Southerland

John Moehrke


Agenda Update:

Since CDA is ready for public comment, we will use the after lunch time slot to continue the Deprecation and CP discussion, and also possibly CPS if it needs it.

CP Discussion

• Started with the CDA portion of the CPS profile

• Need to make sure that we invite people to submit comments to the open issues

• Action: Andrea to forward public comment announcement to all possible reviewers and ask them to share it

• Added new open issue: For new sections and entries, do developers need an additional table for each HL7 section and entry, or is pointing to them enough?

• We need LOINC codes for this document. o Gila will email Chris Carr to find out what the process is o Andrea and Cindy will create list of codes needed and fill out form

FHIR PlanDefinition: DCP Update Reviewed Open Issues: Still have a few open issues, XDW is a new issue added to the list along with it being added to the profile Introduction section, mobile app and ATNA grouping is an open issue which may be answered later with implementations, Open Issue #3 – hopefully resolved by using the task Resource and it can contain CDA documents wanting comments from vendors if they will use this, #4 - HL7 DAM work 2.0 ensuring the model can support the technologies, #5 – resolved the open issue about initiator and moved to Closed Issue

Added explanation about XDW to the introduction as discussed yesterday and moved all the XDW to the Appendix

Added FHIR Implementation Guide section to the DCP wiki page In the profile fixed all the links to STU3 as defined in CP-228

Tom motioned to move DCP to Public Comment

Gila Seconded the motion



No discussion

To Do:

• Correct font color

• Take out highlighted areas

• Place profile on PCC CommitteSubmitted ftp folder

PCS Summary

Reviewed the LOINC mappings to clinical and quality data elements

Thursday, May 3, 2018 F2F Meeting Day 4


PCS Summary

Present: Present: Emma Jones, Thom Kuhn, Michael Clifton, Milenkovac, Cindy Levy, Lori Fourquet, Andrea Fourquet, Gila Pyke, Denise Downing

Putting data points back in that we discussed as business related yesterday and to take out of the table, those data elements will be put back into the table because they are needed for Emergency quality measures, discussed mechanism of injury and what FHIR Resource to use, reviewed possible Resources to use and noted there is a gap in FHIR, discussed the AHA Repurfusion Checklist because there weren’t mappings for this checklist, verifying this is still a standard of care, discussed status of profile

To Do:

• Complete mappings in table (header, data elements EMS vs VS,) (FHIR mapping [70] and CDA mapping [13])

• Make new Section for Mental Status (use C-CDA as a base model)

• Complete vol 4 (vocabulary and constraints)

• Develop Open Issue related to 1st Encounter (use the code in RIPT or HL7- report to HL7 the difference)

• Consolidating Open Issues (move some Open Issues to Closed Issues that have been resolved)

Resolution of the Profile:

• Profile authors complete the changes to the document

• Send the completed document with a detailed note about changes made to the profile and send to PCC Committee

• Review profile May 4, 2018 at 12pm Central Time

Tone Motion to Move the Profile to Public Comment pending the outcome of the profile review call May 4, 2018

Seconded by Chris Melo

  • 0 - Abstain
  • 0 – Rejection
  • 0 – Discussion

Will move the profile forward pending status of profile on Friday, May 4th 2018

T-Con Planning

T-con for Comments after June 18th, Tuesday June 26, July 10th 90 min call 12 - 1:30pm Central

CDA T-con Friday at every other week, Friday, June 29th and July 13th at 2pm Eastern (1pm Central, 12pm Mountain)

DCP will check with SME’s for best time, Wednesday, June 27th and July 11th

CP and Maintenance Work

Reviewed list of CP's to go to May 2018 Ballot

CP Spreadsheet updated with all CP's, decision to us the "Ballot" tab as the tracking site for IHE PCC balloted and resolution to CP's instead of placing them on the wiki as ITI does

CP-211 - PCC-1 Transaction change, will send the profiles affected by this change out with May 2018 ballot as an informative ballot so members know which profiles will have their PCC-1 Transactions changed due to CP-211

Outstanding Issues & To Do Tasks:

  • CP-242 - DRIV code, same as CP-265 or not, Gila sent submitter email to clarify
  • Develop list of CP's for May 2018 ballot, send to Nicole for ballot email
  • Develop list of profiles that need incorporation based on balloted CP's
  • Assign profiles needed to be changed based on balloted CP's
  • Wiki pages need to be developed for the following Profiles:
    • Newborn Discharge Summary (NDS) - assigned to Lori
    • Remote Patient Monitoring (RPM) - assigned to Brian
    • Retrieval of Clinical Knowledge (RCK) - assigned to Denise
    • Dynamic Care Planning (DCP) - assigned to Emma