PCC TC Face to Face Nov 16-17 2016

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Introductions & Agenda Review:

  • Present: Amit, Anne, Ioana, Andrea, Thom, Thierry Dart
  • Phone: George Cole, Tone, Laura, Elena, Steve Beller, Chris Melo, Brett Andriesen, Manual Metz

ASIP Sante’s Interoperability Framework - presented by Thierry Dart & Manuel

    • French gov agency, GIP-DMP for the dev of a national EhR, GIP-CPS agency for the prod of HC professional smartcards
    • Regulation for improving eHealth, Implementation of shared national services, Promotion and speeding up of use and innovation in eHealth
    • HIS-IF organized in 3 layers
      • Transport
      • Service
      • Content
    • Interoperability mission 1 for improving eHealth, organized in 3 layers (transport, Service, Content)
    • Uses IHE profiles: XDS, PCC MS-Medical Summary, IC – Immunization Content, antepartum, L&D, QRPH Mother & Child Health
    • Modeling tooling Modelio is used, terminology & value sets testing CTS2, mapping modeled data on CDA sections/entries don’t have a tool yet,
    • Search PCC profiles, search TF for section or entries, time consuming if none is found they create a specific section
    • Mapping between modeled data on CDA sections/entries using Art Décor
      • note made that they are not using Art Décor yet because it was slow and there were many issues, will re-evaluate it in 2 yrs
      • developed a mapping tool automation HIS-IF document production, need to parse PCC content modules (in progress)
    • Propose that we publish the tooling on the IHE website to evaluate it, get a better understanding of their process and how PCC can help, constraints with PCC templates for international use
    • Define the common data elements and represent it in the standard
    • Trying to implement a specific implementation, need assistance with tooling, provides end-user with a tool to export all the narrative content is preferable, common way to define where the data is for each standard (CDA v2, FHIR, etc.),
    • No immediate ask, at the board level there is discussion about CDA harmonization, explore other content efforts going on
    • Showed PCC the mapping tool France is using.

France CDA Mapping Tool.png

Result of the Devices profiles alignment meeting - Presenting by Denise and Ioana

    • Answered the following questions:

Device Profiles Allignment.png

    • RPM - creating a FHIR equivalent bundle to PCD1
    • Other device profile will use PCD01 as is.

Device Profiles Allignment Decision.png Device Profiles Allignment Decision2.png

    • PCD, Cardiology, VA are interested
  • Cross-paradigm
    • HL7 PC work group sponsoring what will be used in volume 4
    • IHE profiles looking at point-of-care tracking
      • Vote: Denise motion to combine, Ioana second, no further discussion - 0 abstain, 0 against, 17 for

360 Closed Loop Referrals - Presented by Vassil Peytchev

  • Present: Amit, Anne, Ioana, Andrea, Thom, Thierry Dart, Emma
  • Phone: George Cole, Tone, Laura, Elena, Steve Beller, Chris Melo, Brett Andriesen, Vassil Petychev, Rob Rose
    • 2012 initiative by ONC State Health Information Exchange Cooperative Agreement Program goal using MU 2 to enable provider exchange for referrals
    • Need a permanent home.
    • Need the national extension
    • Can be referenced in future rule making in CMS
    • Determine the best approach
    • Has a new wiki space with onc
  • Goal is to add value for clinicains
  • Scope limited to electronic exchanges
    • Pt Care Coordination is a national priority due to changing payment models
    • Gap in available standards to support the Use Cases
    • This is all depended on DIRECT - will DIRECT be around for some time? See it growing to include patients as well. Will see increased numbers of transactions as well. Relationship between XDM, XDR. In relations to FHIR services then this spec can be incorporated in a solution like that.
    • Goals:
      • Standardize the type of data exchange and how data is transported
      • Provide transparency to progress and/or gaps in care until the loop is closed
      • Design a process with a low bar of entry for implementation

    • Technical:
      • XDM
      • XDR/XDM for Direct Messaging Specification
      • XD metadata
      • HL7 v2.x Messaging; HL7 C-CDA (Summary of Episode Note, Consultation Note, or Referral Note preferred)
      • Two New Actors: Referral Initiator, Referral Recipient
    • Specific to the US.
    • Is unsolicited in scope? Only support the referral request that is accepted or declined
    • Exception requirements are considered but will be added at a later point.
    • Open Issue – Relationship with other Profiles, haven’t looked at the Actors in ROL, will do that
    • Get a vendor list who are interested in this profile, is DIRECT here to stay? Do we see it growing? Yes, there is additional pts and HCO signing up, interest is increasing with the number of transactions, and this **profile has a generic referral and for specific referrals can add additional content as an extension
    • Provider directory target for the referral, but not a requirement

Point of Care Medical Device Tracking - Presented by Denise Downing and Ioana Singureanu

  • Use of FHIR resources (i.e. RESTful services) to device record information acquired at the point-of-care and add it to the set of data maintained by enterprise information system (e.g. EHR systems, IMS systems, flowsheets).
  • The following use cases were discussed:
    • Tracking implantable, life supporting or life sustaining devices

Device Use Case 1.png

    • Vital Sign Monitoring and Charting

Device Use Case 2.png

    • Smart device programming and tracking

Device Use Case 3.png

RPM - Presented by Brian Reinhold

  • Present: Amit, Anne, Ioana, Andrea, Thom, Thierry Dart, Chris Melo, Emma
  • Phone: George Cole, Vassil Petychev, Rob Rose

    • Want to adopt it and there is a market demand, supporting it in PCHA and keep it consistent with RPM
    • PCD-01 replaced with a FHIR bundle
    • Semantically similar to PCD-01 and semantically similar to FHIR, use FHIR Resource for a Push
    • The profile adds different transactions using FHIR
    • Interested in the profile? Countries are interested, Scandinavian development work is being tested at FHIR Connect-a-thon, do not know the list of vendors for the IHE Connect-a-thon

HL7 Update Project Scope for Cross Paradigm IG for Medical Device Interoperability - Presented by Ioana Singureau

  • Present: Amit, Anne, Ioana, Andrea, Thom, Thierry Dart, Chris Melo, Emma
  • Phone: George Cole, Vassil Petychev, Bret Andriesen, Brian Reinhold
    • Project sponsored by HL7 Patient Care work group. This project need to be aligned with and it informs the Device profile work.
    • Plan on a HL7 May 2017 ballot for domain analysis DCM

Closed Loop Referral Whitepaper for EDHI - Presented by Xidong Deng

  • Present: Amit, Anne, Ioana, Andrea, Thom, Thierry Dart, Chris Melo, John Stamm, Ghia Gdong, Emma
  • Phone: George Cole, Vassil Petychev, Rob Rose, Serefina Versaggi, Nicohle, Lori Fourquet, Gila Pyke, Elena, Diana Warner, Tone
    • Discussed the proposed Whitepaper, suggested other PCC profiles to look at ROL, Dynamic CP, EDHI for reference
      • ROL focus on the linking and matching. EHDI can use that. However, the problem defined is more aligned with 360x. From public health angle, if the public health generates a care plan with a recommendation that is shared with the PCP, the PCP can make the referral.
    • Go forward plan - Xidong will work with the 360x Closed loop referral to see if this is a possible use case that can be included in their profile. If not, will look into create a white paper to discuss the specific needs for implementing an EHDI workflow.
      • Add it to the PCC volume 1 meeting schedule to discuss plans for it.

Pt Registration Content Profile - presented by Gila Pyke

  • Present: Amit, Anne, Ioana, Andrea, Thom, Thierry Dart, Chris Melo, Emma
  • Phone: George Cole, Nicohle, Lori Forquet, Gila Pyke, Elena, Diana Warner, Tone , Laura Hermann-Langford
    • Registration data not in a standardized format, only talking about content
    • Goal is analysis of the various registration data and come up with one common list

Discharge to EMS Transport - Presented by Andrea Forquet

  • Present: Amit, Anne, Ioana, Andrea, Thom, Thierry Dart, Chris Melo, Emma
  • Phone: George Cole, Nicohle, Lori Forquet, Tone , Laura Hermann-Langford, Dr. Greg Mears, Diana Warner

EMS Transport Problem.png

    • Discussed needing a standard way to exchange transport instructions, new functionality, embed into the workflow.
    • Will fit on the Zoll 2018 roadmap
    • Open Issue: Where is the value add for a business driver?
      • Care Team Management
      • Advertise it as a support for Direct, Support for Payers

Care Team Management: Presented by Emma Jones

  • The goal is to have a means of identifying providers and care givers who are providing or have provided care for the patient.
  • This information can be dynamically updated as the patient interacts with the healthcare system.
  • FHIR resources infrastructure and other specifications to support clinical, workflow, scheduling, etc, will be used as the back bone to provide the operational pieces needed for managing care team membership.
  • Need to explore Care Plan Driven Care Teams and Non-Care Plan Driven Care Teams
  • Explore how or if HPD relates
  • Risk: FHIR Resources are still in a state where further modifications will be made. Will need to keep up with FHIR resource changes.
  • Plan is that this work will inform/inherit from HL7 Patient Care Workgroup Care Plan DAM

Patient Centric Data Element Location Services (QED on FHIR) - presented by Charles Parisot

  • QED implemented by very few vendors. Are there vendors interested? There are people doing QED but in their own proprietary way
    • Plan in using QED grouping for the type of data that will be queried.
    • Value add is to standardized the queries instead of people starting from a different point
    • Thin QED - pick a subset of what is in QED
    • Use DSTU view of argonaut as a starting place
    • Volume one QED had a single transaction. In volume 2 the single transaction has multiple options.
    • Two ways of doing the profile: Could have a QED profile with a set of V3 options and a set of FHIR options or have 2 profiles - one with QED and the second for FHIR
    • QED is trial iimplementation
      • Could retire QED
    • Volume 2 work - page 46-81
      • Transactions were structured by function in the query. Uses V3 transactions.
      • Some of the QED returns are in FHIR, some are not.
    • Need PCC input for the search criteria in volume 2
    • Will use the argonaut list in volume 1 as the starting point.
  • ITI and PCC Alignment

ITI and PCC alignment.png

  • Updated ITI/PCC agreement from Charles (and ITI)

ITI and PCC updated agreement.png

PCC Tech House keeping Vote

  • Amit moved to move all profiles forward for the 2017-2018 profile year
  • Ann Diamond Second
  • No further discussion
  • 0 Abstain
  • 0 Negative
  • 12 Affirmative
    • PCC Tech with have a 'routine' touch base call for updates on where the profiles are with volume one
      • Action: Jeremiah will send doodle poll and schedule call
  • T-Cons scheduled for Care Team Management and Point of Care Medical Device Tracking profiles
  • Action: Jeremiah will send volume 1 template with T-Cons and schedule remaining T-Cons with profile editors
  • Board update - Tone completed the update and was well received.

Topic - presented by Amit

  • How to get the deployment committee engaged earlier so that they are not swamped during public comments. Suggestion:
    • Make sure profile synopsis is updated
    • Both Planning and Tech produces a summary of work items that is shared with the committees. Can use this information so the deployment committee can apporach possible vendors for testing. Charles will propose this with DCC.


  • Emma and Denise will complete existing outstanding CPs
  • Emma and Denise will meet and finalize publication documents and Schedule for Mary

Meeting Adjourn

  • Next F2F for Volume one completion is Feb 6-10, 2017