PCD PC&TC 2011-10-18 to 21 F2F

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Meeting Objectives

These face-to-face meetings have a number of objectives depending on the committees involved:
  • Planning Committee: Review, plan and initiate PCD activities; contribute to planning of the HIMSS Interoperability Showcase and other Showcases and events; recruit vendors and users.
  • Technical Committee: Review and adopt brief profile proposals; contribute to Connectathon test tools, tests, and procedures.

Suggested Agenda Items/Topics

The agenda is available at ftp://ftp.ihe.net/Patient_Care_Devices/FaceToFaceMeetings/2011-KansasCity/. Documents are available without a password.

Agenda Suggestions Received in Advance:

  • How do we handle WCM? Profile, Required, Option? (Ken Fuchs)
  • Integration Statements - Is the current content adequate? (Ken Fuchs)
  • Discussion concerning Volume 3 content and Content Profiles (Todd)
  • Final discussions and ballot concerning Cycle 7 proposals (Ken Fuchs)
  • Close Brief Profile Proposals ballot at 5 pm Tuesday; analyze and discuss Wed. am
- Organize work for Detailed Profile Proposals (TC) (follow up to the PC ballot)
- ITI/PCD joint efforts (e.g., cybersecurity, alarms, events)
  • Pharmacy/PCD pump joint efforts
(see work item proposal for joint white paper)
  • Change Proposals
- to discuss, ballot (Todd):
o Security Harmonization
o ACM Sync w/ v2.8 Proposal
o (TBD) Add "RAS" to Infusion Administration Reporting (from Rx)
- Change proposals to post as required for the Connectathon (Manny)
  • High Level Architecture (Cochairs)
  • NIST Test Tools
  • Detailed Clinical Models for Medical Devices (Ioana)
  • Roadmaps, with reference to roadmaps in IHE, HIMSS; add new workitems in appropriate locations
  • Address specific Action Items (both PC, TC)
  • Connectathon
  • Showcase

  • Technical Committee - some suggested topics
Coordination updates
IEEE 11073 / TC 215
HL7 Health Care Devices
HL7 "Fresh look" activity
Ongoing project updates
Event Comm
Point of Care Identity Management: use case review, technical approach discussion
Detailed review of technical approach and resource needs for this cycle's proposals, and leftover resource needs from present ongoing work
MEM Device content to CMMS
Pulse Oximetry Integration with Clinical Applications
Enterprise ACM
Cross Enterprise TeleHomeMonitoring Workflow Definition (XTHM-WD)- Valentina Ferrarini (Consorzio Arsenàl.IT)
Device Cybersecurity - Axel Wirth (Symantec)
Device Specializations - General Content Profile - Todd
Device Specialization - Infusion Pump - Todd
Medication Administration Clinical Integration White Paper - Todd
Long term: Technical philiosophy and strategy for realizing road map


Meeting Location:Cerner, in Kansas City
10234 Marion Park Drive, Kansas City, MO 64137

Attachments / Materials

Documents related to the meeting are found at ftp://ftp.ihe.net/Patient_Care_Devices/FaceToFaceMeetings/2011-KansasCity/ unless otherwise noted. Documents are available without a password.


Those attending via Webex are identified.


Cochairs: Ken Fuchs, Steve Merritt
Participants: Dominick Anggara, Sam Carello, Anupriyo Chakravarti, Todd Cooper, Bikram Day, Paul Elletson, Al Engelbert, Robert Flanders, Ken Fuchs, Jeff Gaetano (CareFusion), John Garguilo, Chad Hays, Sarah Hopkins, Sandra Martinez, Steve Merritt, Monroe Pattillo, John Rhoads, Jeff Rinda, Paul Schluter, Erin Sparnon, Richard Swim, John Zaleski, Khalid Zubaidi
Webex participants: Manny Furst


Cochairs: Ken Fuchs (PC), John Garguilo (TC), John Rhoads (TC)
Participants: Dominick Anggara, Sam Carello, Anupriyo Chakravarti, Todd Cooper, Bikram Day, Paul Elletson, Al Engelbert, Robert Flanders, Ken Fuchs, Jeff Gaetano, John Garguilo, Chad Hays, Sandra Martinez, Monroe Pattillo, John Rhoads, Jeff Rinda, Paul Schluter, Erin Sparnon, Richard Swim, John Zaleski, Khalid Zubaidi
Webex participants in the morning: Steve Merritt, Greg Staudenmaier, Manny Furst
Webex participants in the afternoon: Khalil Maalouf (guest), Manny Furst


Cochairs: John Garguilo (TC), John Rhoads (TC)
Participants: Dominick Anggara, Anupriyo Chakravarti, Todd Cooper, Bikram Day, Paul Elletson, Al Engelbert, Robert Flanders, Ken Fuchs, Jeff Gaetano (CareFusion), John Garguilo, Chad Hays, Sandra Martinez, Monroe Pattillo, John Rhoads, Jeff Rinda, Paul Schluter, Erin Sparnon, Richard Swim, Khalid Zubaidi
Webex participants in the morning: Mike Goulet (Welch Allyn), Manny Furst, Khalil Maalouf (guest)
Webex participants in the afternoon: Steve Merritt, Ioana Singnureanu, Greg Staudenmaier, Manny Furst, Khalil Maalouf (guest)


Cochairs: John Garguilo (TC), John Rhoads (TC)
Participants: Anupriyo Chakravarti, Todd Cooper, Bikram Day, Paul Elletson, Al Engelbert, Robert Flanders, Ken Fuchs, Jeff Gaetano, John Garguilo, Chad Hays, Sandra Martinez, Monroe Pattillo, John Rhoads, Paul Schluter, Khalid Zubaidi
Webex participants: Axel Wirth, Steve Merritt, Khalil Maalouf (guest), Manny Furst

Schedule & Agenda

Detailed Agenda

Note: Additional evening working sessions may be scheduled as needed.


Discussion Summaries do not require formal approval, while minutes of meetings where votes are taken do. Participants are encouraged to review and bring up significant issues with discussion summaries of previous meetings. Votes will be taken to approve meetings where votes took place; these may be email ballots.

Tuesday Morning May 10

Item Topic Discussion
1 Introductions & Agenda Review
- Chair

Participants introduced themselves.

The IP Management Process was discussed. Slides were provided.

The agenda was reviewed. Todd suggested adding strategic planning and marketing PCD (publications, membership, deployments, success stories). ONC was also added. Steve noted that the Brief Profile Proposal Ballot closes tonight and participants were encouraged to vote. Decisions on priorities will be made tomorrow. Steve indicated the work to date on Integration Statements laying the ground for discussion this afternoon.

Decisions/Issues: Agenda approved


2 Discussion Summary or Approval of Minutes
- Chair

Decisions/Issues: Discussion Summary of previous meeting was deferred


3 Agenda Items
- As Noted

Roadmap Ken led discussion as we transition from Cycle 6 to Cycle 7. There are requirements that won’t be met until HL7 v.2.9 is available in Cycle 8 (assuming 2.9 will be available in this time frame). Todd noted that 2.7 has been published and 2.8 which will be available for Cycle 7 will not have significant changes for PCD.

- It was noted that Cybersecurity is related to web services as well.
- The DOF should be available for Final Text in Cycle 7. ACM PCD-05 and subsequent were delayed one cycle (Alarm Archiver to Cycle 8 (however it may just be a specialized archiver conforming to ADQ), smart alarms to Cycle 9) and Coordination with HL7 2.8 was accomplished in Cycle 6. ITI-PCD may address Enterprise ACM in Cycle 7.
- ADQ will be continued in Cycle 7 and Data Mining is delayed to Cycle 8 – and Erin later asked if ADQ the only venue for data mining; will it be sufficient, in relation to pumps? Multi-component admixtures was added in Cycle 9. Collaboration with the Pharmacy Domain was added in Cycle 7 – a joint PCD/Pharmacy WP addressing workflow.
- PCIM will also be continued in Cycle 7.
- RFID was added to Cycle 8. Todd noted that barcode and RFID will be considered within PCIM.
- Event Communication was added to Enterprise Communications to assure that events beyond pump applications are addressed in Cycle 8, with IPEC leading the way.
- The Pump WG will address PCA pumps in Cycle 7.
- MEM will address Operation Status/Monitoring, Device Communication Management in Cycle 7, Device Configuration Programming and RTLS in Cycle 8 rather than Cycle 7.
- DPI was delayed until Cycle 8 (needs further discussion concerning mission and strategy). Other Point of Care workitems were delayed until Cycles 9, 10. Todd suggested adding AAMI/FDA/MDPNP interoperability coordination to the agenda to further discuss device control workitems.
- RTM Vent Terminology and IDC terms should be ready in Cycle 7. The full set of PHD terms will be folded in within Cycle 7. Paul summarized current and planned status of RTM. Events and Alarms were added to the roadmap. RTM migration to RTMMS was accomplished in Cycle 6.
- Coordination Effort: REST-ful style architecture (to suit cell phones) and PHD Alarms were added to Cycle 8 with Continua. Paul described the effort related to exploring REST-ful, with Continua and ITI. Items in Cycle 6 were moved to Cycle 9 and modified slightly (Smart Home, LTC, Physician Office, Sub-Acute Care). ICE-PAC was moved to this section of the roadmap and is a component of SHARP (type of grant).
- Regulation: Alarm 60601-1-8 appendix was added and IEC80001 was modified for Cycle 7.

Connectathon More companies, more systems, more profiles: Accent on Integration, Fresenius, iMDsoft, Nihon Kohden, Philips (more systems), ScottCare, Vocera. We have three AC actor systems (Nuvon, Vocera added to SIS). We will test IPEC. We will test WCM if any are interested, but this will be unofficial, off the record. We lost three companies from last year, including Polycom. Testing the PIV profile is in doubt.

- Pre-Connectathon: NIST has done a great job, adding Isolated System Testing, available for most tests. Tests will be available 24 x 7; will not be posted separately. NIST is hoping to provide sample messages based upon experience after the testing is over. Gazelle will indicate which type of test – Instance or Isolated for each test. Steve Moore will announce the availability of Pre-Connectathon testing, possibly today. There is a Wiki page that points to tests.

Showcase Largely unchanged from the last update. There are four Use Cases, Jack Hoffman and perhaps others have offered suggestions to John Donnelly. The HIMSS12 site is presenting issues for the structure(s). Defining them will now be done after the Use Case systems are allocated next week in Chicago.

AAMI Alarm Summit Todd summarized the meeting, noting that John Garguilo, Erin, , Monroe, John Zaleski and he were among the participants. It was an open forum, with about 300 people and well organized. He described the agenda and discussions. Erin noted that alarms are generally designed for the person in the room, rather than the clinician who is not present. Todd noted John Zaleski’s suggestion that “remote alarm” would be preferred over “secondary alarm”. However, on the second day there was a focus on the primary alarm and not much good material on the secondary alarm. On the second day there was good discussion of best practices. Todd’s observations are available on the ftp site. He noted that nothing related to PCD was reflected in the balloted final list. Todd described the next steps.



- Ask Elliot for an update on ONC and CONNECT.
- Todd to draft a communication to Mary Logan/AAMI to help understand the priorities coming out of the Alarm Summit and the various PCD activities that relate.:- Monroe to draft an article for publication in AAMI outlets to help educate the marketplace on ACM and how standards exist and contribute to interoperability.

Tuesday Afternoon October 18

Item Topic Discussion
1 Agenda Items
- Chair

IHE International – Update Todd presented a summary of the work and organization of IHE International. Todd is a Board member, representing PCD. His report is available at ________ . Among the notable items:

- The DCC is intended to provide opportunities to make coordination/collaboration between domains a higher priority.
- Steve described the strategic planning initiative. The second item in the required PCD plan is cross-domain opportunities. The PCD plan will be based upon a shorter version of the roadmap and include the collaborative efforts discussed this morning. John Garguilo noted the customers’ needs to have complete array of profiles. Among the priorities are the cross-domain work with Pharmacy and Alarm Management. Todd suggested that clinical integration profiles, meaningful use and _________ should be included. Reference was made to the Joint Initiative Council – Joint Initiative on SDO Global Health Informatics Standardization, with a meeting in Chicago. IHE is increasingly focusing on deployment – and an interest in utilization.
- John Garguilo provided an update on the Testing and Tools Committee that is primarily focused on Gazelle and related items. He noted that Steve Moore is open and working with NIST. He anticipates integrating NIST tool results directly into Gazelle at some time.
- The DCC also focuses on ONC.

HIMSS - Opportunities

- Steve extended HIMSS’ invitation to submit papers for the HIMSS journal’s issue on interoperability. Abstracts are due the end of October.
- Survey: Steve reviewed the survey that will go to HIMSS members regarding each individual’s/ organization’s interest in PCD and PCD’s work to help PCD set its priorities. Surveys will go to clinicians, IT and other users, and to vendors. Suggestions were offered and the survey was edited.
- Crystal will post a PCD Webex for the clinical informatics members.

Review ITI-PCD Joint Work: See morning notes.

Marketing: Publications, membership, deployments, success stories: discussion stressed the importance of developing a strategy which can include: publicizing the commercially available systems, identifying devices/systems commercially available in the Showcase, finding and publicizing implementations, the Nashville demonstration site, a demonstration by successful hospitals in the Showcase with some PCD devices/systems, expanded use of the AAMI venue, video. Telehealth/Home Monitoring: John Donnelly informed Todd that PCC is interested if PCD will work with them. Todd suggested that the initial effort be a WP. Todd asked how the group wants to respond. Steve suggested that the recent PCD/ITI meeting might be a model for this collaboration. Todd suggested that a WP include a “grouped actor”, identify the requirements and where the actor would reside.

ITI/PCD Joint Meeting Sept. 23: Ken summarized the discussion and outcomes. A detailed list of potential areas of collaboration was shared afterward. The meeting focused primarily on cybersecurity. The groups agreed to meet 4 times per year. A list of joint tasks was developed and prioritized. The Cybersecurity whitepaper will be the first joint work effort developed with the intention of creating supplements in year 2.

IEEE 1073 Copyrights: John Garguilo led this discussion with the goal of an MOU permitting use of various elements of the standard. There are important elements of 11073 that are used by PCD in RTM. A meeting was held Friday with several IEEE staff. PCD representatives provided PCD’s point of view within the context of what PCD is trying to accomplish. A follow up meeting will be held early in Dec. An element is the coordination between ISO and IEEE on this standard. John then described how NIST and IEEE might work together in the future when NIST’s efforts are ready to be turned over to another organization – NIST’s role is to do the research that establishes the solution, not to continue indefinitely.

WCM - What is it?: Ken described the issue as WCM evolved from a profile to something else. The issues are primarily: it is not a profile because it doesn’t have actors in its present form, cannot stand alone because it is an object, not a complete message. Alternatives include making it a profile (adding actors) and making it an option (it has issues including the lack of reporting results by Gazelle and assuring that DOCs don’t crash). Another option is to make WCM required like RTM and submit to HL7 as a replacement for the deprecated waveform data type. Vendors are able to market an option, include it in the Integration Statement even without Gazelle reporting the results. The consensus is to proceed with making WCM an option, addressing the issue of assuring that receiving systems don’t fail when these messages are received, and taking the issue of non-reporting of results to the Testing and Tools Committee. WCM may be one of many similar PCD efforts, e.g., event communications. Ken’s slides are available at ____ .

Integration Statements Ken displayed product-registry.ihe.net/ and follow on pages. Discussion followed to determine if PCD should provide additional information on the ISs. Additional information, such as profile version (maturity), if/when last tested, and other details were suggested.



Manny to ask Erin how to coordinate on deployment marketing effort by DCC.
Develop a strategy for publicizing IHE PCD.
- Find some sites which would be willing to prototype PCD compliant integration use cases..
- Manny to explore with Sandy: videotaping, identifying commercially available systems.
- Erin to explore commercially available testing opportunities with Mario @ Kaiser, Ted Cohen at UC-Davis and other large facilities that may already have test-beds.
- Erin to find out how to get onto the IHE “news blasts”
- Manny to explore opportunities for a “COMMERCIALLY AVAILABLE TODAY” sticker at the Showcase.
- Cochairs to explore opportunities with Elliot and Joyce on how to encourage reference implementation sites of PCD profiles, grants/awards/etc
- Todd to respond to John Donnelly regarding collaboration with PCC on telehealth.
- John G to take the issue of non-reporting of results in Gazelle to the Testing and Tools Committee. This needs to be a priority for Gazelle.
- John Rhoads to explore how to (or if) volume 2 needs to explicitly reflect that consumers need to gracefully process unknown (but properly formed) data. In other words if a DOC receives WCM OBX’s and doesn’t know how to process them it should continue on and not bomb out.

Integration Statement improvement - add to integration statements:
- Version of profile (John Gargiulo to dig up the Profile maturity index to see if it applies)
- Was the product tested at Connectathon and a link to connectathon results page

Wednesday Morning October 19

Item Topic Discussion
1 Introductions & Agenda Review
- Chair


Agenda reviewed by John Garguilo and revised
John reviewed the IP policy by reference to the posted materials.


2 Agenda Items
- As Noted

Alarm Management Continued: John Zaleski added to yesterday’s discussion, emphasizing the need to consider context, focus on the clinician and not technology, and the need for alarms to provide the right alarm to the right person at the right time. He noted that there is no good regulatory framework to address alarms.

AAMI/FDA/MDPnP Interoperability Coordination: Todd observed that interoperability has not achieved the goal of improving patient care.

Roadmap Continued: Ken asked if ADQ was sufficient to address data mining. Discussion elicited the belief that ADQ was the first step possibly followed by a WP.

Device Point of Care Integration (DPI): Ken asked what the role of DPI is when implemented within a device? Is DEC sufficient? Todd suggested that DPI has applications, such as with ICE. Progress with DPI depends upon a number of standards, some of which are being more or less actively pursued, and regulations. These include control, format, plug and play, _________ . He suggested asking PCD’s sponsors to help address the issues, and including the FDA. He suggested that reference to DPI in the roadmap include a WP. Ken suggested that we need a better understanding of how DPI and DEC differ in terms of requirements and whether DEC can be used in certain DPI Use Cases or can it be modified to meet the needs of certain DPI Use Cases.

Planning Committee Action Items

71. Recruit Clinicians: Ken suggested that asking clinicians to participate in PCD meetings is not productive. Rather, to invite participation in specific items, such as workitem proposals. Jeff suggested periodic standing meetings with a clinical contingent. Erin suggested that the greatest need for clinical input is to learn what their needs are. Ken suggested that they will be of greatest value when they understand what PCD wants to accomplish. He also suggested that we establish a Clinical Advisory Board and recruit clinicians in patient care and IT integration as well as in PCD vendor organizations. John Zaleski suggested that we can also recruit physicians.

Action Item: Erin to discuss with Christal to see how to build Clinical Advisory Board (primarily non-physician) Action Item: JZ to explore recruiting physicians to a Clinical Advisory Board.

72. Press Release: Manny to complete the Commercial Availability press release. John Zaleski suggested physicians who reported at the AAMI Medical Device Alarm Conference. John will take action to contact these individuals in regard to their interest acting a advisors to PCD.
78. Stakeholder Survey: Draft was updated yesterday and will be sent to Christel.
105: Implementation Guide: The ITI IG was cited as an example. John Garguilo offered to develop a similar Wiki page.
107: Clinical System Integration: no change
111: Recruit WCM Vendors: Close.
116: Integration Statement: Change date to end of November.
123: Recruit CMMS Vendors: Manny to ask Steve to update or close.
128: Promote RTM: Manny to ask Ioana to provide an update.
130: Clinician Recruiting: Close.
131: Recruit ACs: Close.

Brief Profile Proposal Ballot: All but two passed. The results are posted in the meeting's folder on the ftp site. For the two that failed to pass, these will be led by other domains and PCD will provide support. All that passed may proceed if leadership is available. The next steps are development of the Detailed Profile Proposal and then ballot by the TC.



Erin to discuss with Christal to see how to build Clinical Advisory Board (primarily non-physician)

John Zaleski to explore recruiting physicians to a Clinical Advisory Board.

Wednesday Afternoon October 19

Item Topic Discussion
1 Introductions & Agenda Review
- Chair

Decisions/Issues: Participants in attendance this afternoon were present in the morning; it was not necessary to repeat the IHE IP policy discussion.

John Garguilo reviewed the agenda for the TC meeting and minor changes were made. Agenda was approved.


2 Discussion Summary
- Chair

Project Updates:

ADQ: John Zaleski described the ADQ profile beginning with the proposal. ADQ addresses the need to obtain data having a common time. It is a patient specific query to align the data. Retrospective data is the primary focus. A variety of data would become available, including physiologic, alarm, device data. Data to the Device Data Archiver (DDA) could be proprietary or via PCD transactions. A variety of DDA transactions have been 9dentified, with two defined so far. In response to a question, John indicated that they have not addressed the question of whether multiple DDAs would be permitted. He noted that there could be multiple sources of the same information and that is a concern. Other questions that had been identified earlier or during the meeting are reflected in Comments within an updated ADQ document. The last meeting was in September and they plan to meet after the F2F. They want to complete the profile by the end of 2011. Todd suggested that an accompanying WP would be desirable.

HL7 messages: Todd described the desired changes to the messages. __________

Waveform Content Message (WCM): Ken provided the update. Discussion of the choice of implementing WCM as an option included how to incorporate the technical material in the TF. Content in Volumes 1 is understood, but perhaps portions would go in both Volumes 2 and 3 – or just in Volume 2. Manny to ask Steve Moore. Manny to ask John Donnelly about New Directions and the ability to include WCM in PCD or New Directions if we have off-the-record testing in advance of HIMSS.

PCIM: Robert provided an update of PCIM. He began with a review of the Detailed Workitem Proposal. The new transactions, PIM-01,-02 will become PCD-nn when the document is complete. A variety of Use Cases were discussed. The diagrams are available on the ftp site (zipped file).

- John Rhoads provided a discussion of the importance, approach to, and requirements for identity management. This addresses the questions of the accuracy, reliability of various elements in establishing the patient’s identity for use in associating the demographics with device data. The diagram is available at _________ . John Zaleski suggested adding other factors related to the patient’s history that can be used to verify the patient’s identity. He added the common example of sleep deprived residents assembling data for clinical rounds and therefore making errors. He stated that these errors are more likely than the device/patient association issues. For ICU patients, especially those with questionable identities, nursing staff and physicians will know the patient, even John Does and carefully address the association issues.

Detailed Clinical Models for Medical Devices: John Rhoads then discussed the subject using various diagrams. The diagrams are available at _______ .

Change Proposals: Manny noted that CPs that affect Connectathon testing must be published by November 1. Manny to discuss the date with Steve Moore and the TC will consider how to address this tomorrow.



- Manny to ask Steve Moore for guidance on how to document options in Volumes 2 and 3 of the TF.
- Manny to ask John Donnelly about New Directions and the ability to include WCM in PCD or New Directions if we have off-the-record testing in advance of HIMSS.

Thursday Morning October 20

Item Topic Discussion
1 Introductions & Agenda Review
- Chair

Those attending were present yesterday.


Agenda approved as revised.


Manny to change 60104 to optional, check that WCM tests are Optional and post the Connectathon tests in ftp and share links.

2 Agenda Items
- Chair

NIST Tools: John Garguilo began the update and overview with a slide presentation that is available on the ftp site. Manny will post the table of tests. Sandra provided an update on the tool. Discussion drilled into the changes in, and remaining questions in the details of the tests. Sandra's slides are available on the ftp site. IPEC tests are not yet available. WCM poses implications for RTM, to distinguish waveform from other data for the same parameter.

RTM and RTMMS: Status: Paul provided a status update. Parameters have been relatively stable with additions primarily to enumerated values. There are approximately 575 parameters. He would like to include IEEE descriptions and that remains to be negotiated. A large number of terms are in ventilator terminology. Todd noted that Rosetta has not only brought vendors together, it has made a major contribution by bringing 5 standards groups and very high level expertise to develop a computer based vendor-neutral representation. Paul noted that this is a similar approach that was used by IDCO with competing vendors developing a robust set of terminologies. Waveform Attributes and Device Management (PCD MEM), events and alarms and their content models, and more extensive containment modeling (VMDs define content) are open items. Todd noted that a significant question in the general content model is to assure how the model assures that the correct parameters are included. Paul’s slides are available on the ftp site. RTMMS: Sandra described the web application to support RTM. Accomplishments, work remaining/planned and issues were discussed. Todd reiterated the need to obtain vendor data. Slides are available on the ftp site. John Garguilo then demonstrated how RTMMS adds vendor data. John described how the tool will promote adoption of standardized terminology – shortening the time it takes for IEEE to add a term from years to months. It will also enable vendors to map between proprietary and standard terms. In response to John Zaleski’s suggestion that LOINC and SNOMED are more common clinical standards, John Garguilo noted that RTMMS focuses on devices and in the future NIST is planning to accommodate these others.

Pharmacy/PCD Joint Effort: Todd described the opportunity for PCD-Pharmacy Domain collaboration. Slides show how the Pharmacy’s Hospital Medication Workflow (HMW) may work. While the first slide shows one sequential story, in actuality the steps may not flow this way. The second slide shows how PCD IOP may obtain the order information and how the pharmacy system would get data from a DOC. The value add is grouping these PCD profiles with the pharmacy. He then described an Excel spreadsheet defining the data required. Erin added to the description of the discussion with the Pharmacy Domain in September. A number of open issues are described in that document. Documents are available on the ftp site.



- Manny to post list of Pre-Connectathon tests.
- Manny to change 60104 to optional and check that WCM tests are Optional.
- Manny to post the Connectathon tests in ftp and share links.

Thursday Afternoon October 20

Item Topic Discussion
1 Agenda Items
- Chair

The meeting continued.

Device Specialization – Infusion Pump: Todd began with a discussion of the role and content of the TF Volume 3 that applies to pumps, devices, etc. The document presented is available at ____ . Volume 3 addresses semantic content (terms and information model).

With regard to Rosetta, Volume 3 of the TF will contain

- The original Appendix D
- the RTM document and continue to leave the actual RTM technical data in the tables. John Garguilo noted that reference to other standards (e.g., SNOMED) might need to be added.
- Content specializations, general and device specific
- Additional as well.

Pulse Oximetry Integration with Clinical Applications: Include link to TC Detailed Profile Proposal Template here.

Ioana indicated that the VA is attempting to standardize on LOINC and SNOMED. They need the ability to map IEEE terms to these. Paul noted that work in Continua revealed that SNOMED doesn’t have all the corresponding terms and Ioana indicated that the VA will address this with SNOMED. She indicated that Meaningful Use criteria settled on a small set of standards. Todd responded that experts who have looked at developing the mapping between standards indicated this is a very difficult issue. Ioana indicated that mapping won’t be required for all parameters (e.g., data sent only to EMRs), only a small subset (required for enterprise communication).

Security References Harmonization – CP: Todd presented the CP developed in response to the disparate references to security in PCD documents. Security in PCD profiles defers to ITI documents, but the elements are inconsistent. A single CP is proposed to address various PCD documents. He presented the proposed wording developed by John Moerke. The rationale and need for the paragraph was discussed in detail and changes were made. Todd then reviewed the proposed changes to documents that refer to cybersecurity.

ACM Update: Monroe provided an update (see slides on the ftp site). Monroe described multiple changes and emphasized the need to pull multiple transactions in order to move ACM to FT. Among these are the previously described items (transactions with the AA actor) and indicated that no ARs are interested in PCD-05. He went on to describe differences in the Japanese desires. The Japanese will lose three important elements: priority, physiologic condition, space. Todd will respond and address implications including local extensions, calling the result something other than ACM. Monroe cited the differences in the use of R40 and R41 for alarms (R41 is for guaranteed delivery, R42 is not; the real world won’t permit this). The proposed resolution is to drop R41, use that number to hold the text currently in R42. R42 would then be used for pump events. Additional discussion elements are in the slides, including advice to ACM implementers.

- Enterprise ACM: ACM should be of interest to other domains and therefore PCD is attempting to interest ITI in supporting a version for wider use and therefore commonality among domains.
- ACM and HL7 v2.8 Harmonization: Todd described issues before HL7 and led discussion of the needs and the way forward. Issues include the need for a new message (PID must be required). The entire analysis is available at _________ .

IPEC CP: Jeff Rinda presented the Pump WG's CP. It was balloted among those present and a quorum was met. The CP passed. An email ballot may be provided to enable those not present to add their input and maintain or obtain voting privileges for the future.

Next meeting: Joint PC/TC followed by TC

Next F2F: Khalil offered CareFusion for the May meeting.



Friday October 21

Item Topic Discussion
1 Introductions & Agenda Review
- Chair


Agenda approved. All present have been present and there was no need to review the IP policy.


2 Discussion Summary
- Chair

CP Ballot Manny indicated the ballot passed. A one week email ballot will be conducted to provide the opportunity for those not present to express their opinion and help keep or become eligible for their vote to count in the next ballot.

Brief Profile Proposal: Device Management Infrastructure (White Paper) Axel led discussion of a joint workitem proposal with ITI. Due to low interest from ITI, high interest from several ITI members, PCD will take the lead. Axel noted that ITI has expertise and that the subject remains a high priority for PCD. ITI will review the PCD WP. John Rhoads will attempt to set up a call sooner than the quarterly coordination call already scheduled. Axel noted that there are three aspects in addition to Security that need to be addressed to protect the device and its connections. These are management, privacy, access control. Discussion elicited aspects within several of the items such as assuring the device user was qualified and permitted to use the device; Axel indicated that these were exactly what the WP is to address. The WP will rely upon existing documents and best practices (e.g., 80001). Todd asked if the WP would discuss how these other documents apply and not merely cite them. Axel indicated that this is intended. He noted that there may be issues with the application of standards that were not intended to apply to PCD’s circumstances and it will be necessary to avoid going too broadly. Todd noted that there will be coordination with ITI and he congratulated Axel and the others involved in establishing the relationship. Axel noted that many of the same issues apply to other domain efforts (e.g., Radiology) and the need to develop communication with them. Todd indicated that coordination with ITI should accomplish this coordination. The document is available at ____ .

Device to CMMS Messages Steve Merritt met with several CMMS vendors to learn of their interest in the proposal and in pursuing development and implement the resulting technical profile. Those CMMS vendors responded favorably to the development and are willing to add HL7 to their development efforts. The next step, now that PCD’s ballot passed, is to flush out data types and data desired. This may be a content profile, but Todd suggested that alarms and alerts may be of interest as well as managing their customer’s work. The two highest priorities appear to be PM and battery management. A WG will begin meeting regularly. Steve will establish a Google Group. Axel noted there are synergies between this effort and the WP described above.

Device Specialization – Infusion Pumps Todd described the effort to develop the Detailed Profile Proposal, adding to the discussion yesterday about the General Device Specialization. He cited section 5 of the Brief Profile Proposal as direction for developing the technical material that will be added. A significant question is how to address specific types of pumps – are these constraints on the more general profile or a separate profile? John Garguilo noted that this may be another distinction of PCD vs. other domains. Some of this may be a workflow option. The Integration Statement will become an important communication vehicle. The goal is to be finalize after HIMSS12 and be able to test in January 2013. The document is available at ___ .

RTM – Event and Alarm Identifiers Paul’s discussion addressed the content models that will describe these events and time point vs. interval events/alarms (start and end times, e.g., how long did the AFib last). Other transitions such as silencing an alarm need to be addressed. Later discussion provided the suggestion that a special “tpoint” be defined to indicate an event with unknown end. He indicated that VMD or MDS should always be required to provide context and he prefers the VMD to consistently identify the device. He noted that some events include a discriminator that indicates start, etc. vs. needing another OBX to indicate the interval item. He noted that there are also transition and other event types. The optimum approach is to provide greater consistency in identity and content models, with flexibility for vendors that encode data differently. Other items include handling multiple simultaneous events, and if the OBR can handle some of this information. Note the blue items and the Discussion list at the end of the document available on the ftp site.

In the Afternoon

Continua Update Paul provided an update, indicated an active discussion is underway as Continua evaluates a second message transport layer – RESTful – more of an architectural style.

Achieving Interoperability John Rhoads described a number of obstacles to achieving interoperability.



- Manny to send Todd a draft email asking Erin about how these issues are seen by the AAMI infusion pump WG.
- Todd, Al: Consider change in TF Vol. 2 to include examples of containment sequences.

Decisions Summary

Next Meetings

Joint Planning and Technical Committee: PC and TC October 26, 2011 PCD PC&TC 2011-10-26 Webex

Planning Committee: PC November 2, 2011 PCD PC 2011-11-02 Webex

Technical Committee: TC November 9, 2011 PCD TC 2011-11-09 Webex