PCC TC Face to Face July 18-22-2016

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Monday July 18, 2016

Attendees: Present: Emma Jones, Denise Downing, George Cole, Thom Kuhn, Chris Melo, Steve Moore, Elena Vio, Celina Roth, Kristen Boyd, Andrea Forquet (student)

  • Introductions
  • Agenda Review
  • Updates from IHE International: Celina Roth
    • IHE International Announcements – call for new co-chairs, ballot closes on Friday, July 22, term begins September 1st , Co-chair meeting Wednesday & Joint Meeting, Celina introduced Kristen Boyd IHE USA Assoc Manager (new Sarah), Sept 12-Oct 7 system registration for Connect-a-Thon
  • Updates from IHE International Board: George Cole
    • Board meeting - end of April 2016. IHE Board is discussing IHE work and uptake of profiles
      • Business focus on SWOT strategy with emphasis on Priorty and Threats, opportunities
      • Formation of Task Forces
        • 1. Innovation - with focus on the Internet of Things - IHE do not want to be left out
        • 2. Use Cases group
        • 3. Understanding Adoption - Plan on providing a presentation to the board at the Sept meeting
          • Focus is on cataloging things that have gone to implementation and not yet final text
          • Need metrix for what makes a successful profile
          • Provide advice to planning on how to approve profiles
          • Need to determine the key to success
        • 4. Inbound marketing - in line with start-up companies and entrepreneurial companies (current start-up companies/entrepreneurs listening instead of shouting’s, doing marketing in a way that entices your audience)
        • 5. Restructuring IHE - a lot of members, several ideas talked about, joining or merging several groups, not HL7 - HL7 is a separate list, HL7 FHIR & IHE Connectathons Celina presented
      • September meeting need to present to the Board about what profiles are in trial implementation, developing metrics for what makes a successful profile/themes for advice to the planning committees
      • Proposal for professional certification - GASQ -Global Assoc for Software Quality – IHE will contract with, will go forward with for professional individual certification
        • No discussion about product certification that is HIMSS conformity assessment for the international community, International Community get organizations ready for testing or conformity assessment, Charles Persot is very knowledgeable about this
        • Question asked about product certification - HIMSS uses conformity assessment to get orgs ready for cert testing
        • Link to the [IHE Board meeting minutes][1].

DCP Comments review: Led by George Cole

Present: Emma Jones, Denise Downing, George Cole, Thom Kuhn, Chris Melo, Steve Moore, Elena Vio, Celina Roth, Kristen Boyd, Andrea Forquet (student), Lisa Nelson, Keith Boone

  • Reviewed comments –

Already took care of typos, groupings in the text were taken out, did change actor names, but wasn’t completed consistently throughout the document Theme of comments related around confusion about if there was a structure about one shared care plan, reworded/added content to row 155 (first paragraph) of profile Will show work for Actor diagram deleting Actor Care Plan Consumer and keeping Actor Care Plan Contributor, will need to change other areas of the profile swim lane diagram, section 3Y2.2, etc. the other issue is what to do about Governance – closed issue?? Review row 345 – 350

BED Comments review: Led by Keith Boone

Attendees: Present: Emma Jones, Denise Downing, George Cole, Chris Melo, Steve Moore, Elena Vio, Celina Roth, Kristen Boyd, Andrea Forquet (student), Keith Boone, Tone Southerland

  • Reviewed comments:

There is a new Actor Definition Glossary from July 14, 2014 on IHE.net website which deleted several terms in the profile’s Appendix A – Actor Summary Definitions

  • Voting:
    • George motioned to move the profile to Trial Implementation
    • Emma seconded the motion
    • Discussion - none
    • Abstain - 2
    • Opposed – 0
    • Profile moved to Trail Implementation
  • Transaction numbers assigned to the profile: 23, 24, and 25

Profile Summaries

Present: Emma Jones, Denise Downing, George Cole, Chris Melo, Steve Moore, Elena Vio, Celina Roth, Kristen Boyd, Andrea Forquet (student), Keith Boone, Tone Southerland

  • Tone discussed about updating wiki summaries by profile authors, Keith will update BED for the wiki, Elena will update XCHT-WD

CP Discussion Present: Emma Jones, Denise Downing, George Cole, Chris Melo, Steve Moore, Elena Vio, Celina Roth, Kristen Boyd, Andrea Forquet (student), Keith Boone, Tone Southerland, Thom Kuhn

  • CP 222 - RPM transaction numbers wrong, the transaction numbers in RPM had already been used in RCK Supplement, will use the following new numbers: 15, 21, 22. Need to update the CP and the RPM profile, Denise will update all

Profile proposal for ED transport. Problem presented by Andrea (student and EMS provider in the Rhode Island and Boston)

  • Andrea Forquet (student) wants to solve an EMS discharge issue – EMT transfers from one facility to another (i.e., rehab hospital) the transfer of care document is electronic or can be paperwork that is in a sealed envelope for transfers, EMTs do not have access to the electronic record to gather the information needed during the transport, the EMT spends approx. 30 minutes collecting all the needed information prior to transporting the pt, current IHE profile-Transport Record Summaries Profiles (this has 2 profiles with 3 supplements) the profile doesn’t address the EMT transport and worker needs, need to review NEMSIS.org and see how it relates to the issue trying to resolve.
    • Suggestion by Tone to look at Interfacility transport - IHE Profile
    • Possible Workflow profile

Sequoia Project - eHealth Exchange Content testing Evolution Update provided by Tone Southerland and Didi Davis

Present: Emma Jones, Denise Downing, George Cole, Elena Vio, Celina Roth, Kristen Boyd, Andrea Forquet (student), Keith Boone, Tone Southerland, Thom Kuhn, Didi Davis, Matt Blackmon, Steve Moore

  • US scope, using IHE profiles, pilot testing 3 tools to collect various documents C32 CCDA 1.1, 2.1, wanting to get feedback for pain points from users trying to produce documents - CCDA documents and sharing, developed 24 pain points from the feedback, took the issue to HL7 Structured Documents Work Group, HL7 didn’t want to get into the Implementation Issues, ongoing discussion around where certain content (narrative content – Operative, Progress Note, etc.) should be placed, HL7 Structured Documents WG had 2 meetings about this, they will provide clinical guidance about where to place narrative content,
  • Brought to IHE - do we do a national extension or white paper-open for discussion, there is a lack of support from vendors for unstructured documents, it doesn’t support MU requirements, it does meet customers need, IHE could develop some Use Case and provide guidance for unstructured content,
  • This project could provide education about guidance for testing, need a valid XML, displayed with a style sheet, and show to clinicians and add security around the output,

The project is going to raise the bar with suggestions and how people are implementing this with an Implementation Guide, pilot has ended, good cross-section of documents majority are 2.1, identified gaps in modeling efforts and showing some of the errors in the tool

  • HL7 Scorecard – the testing data wasn’t PHI, had test pts (Obama, Mickey Mouse), maintain static data from product testing and program testing
  • Metadata Query Response problem – 1/3 of the 24 pain points were this issue (from providers when you query for data the query fails because the metadata is bad) need guidance on the metadata
  • Is IHE involved with the EU Trillion Bridge Project? George has been a little involved
  • Topic for discussion for the IHE PCC Planning Meeting put on agenda next F2F meeting
  • Summary: Pilot Content Testing - an introduction and update from the project group
    • Validation Tools Evaluation
      • Creating CCDA documents
      • Pilot was geared towards C32, CCDA 1.1 and CCDA 2.1
      • Majority of the documents received are 2.1 documents
      • Tools evaluating are Gazelle, Diameter Health, SITE
      • Goals are to capture what implementers are experiencing - what are their pain points? 24 pain points that are being tracked
        • schema issues
        • implementation issues
        • Took list of pain points to HL7 SDWG. Feedback - they were interested in tackling the schema issue but not the specific "where does this piece of data go"
        • SDWG discussed for 2 minutes now has moved onto Example Task force
        • SDWG will add additional guidance and linkages from the example task force.
    • Input from PCC
        • Suggest providing Support for the use of XDS-SD to support providers workflow. ONC MU cert has caused decreased use of XDS-SD
        • Suggest providing guidance on the point of exposure for providers is that some folks are standing up the validator and rejecting documents before providers get to see it.

XCHT-WD Present: Emma Jones, Denise Downing, George Cole, Elena Vio, Celina Roth, Kristen Boyd, Andrea Forquet (student), Tone Southerland, Chris Melo, Claudio Sa

  • No comments received during the “Commenting” period, the IHE Cardiology Domain didn’t have any comments, they aren’t interested in doing workflow definition profiles now
    • Vendors interested in this profile – Italy GE and 2 other Italian vendors, Arsenal planning to implement this profile next year 2017
    • How is this profile different from Tumor Board Profile? Cardiology more related to Use Case and involves only providers in Cardiology, Tumor Board encompasses several different specialties and is dynamic
    • Question – do we put out for another public comment or just publish it
    • 11 transaction – the transaction numbers are: 26 - 36
    • Tone motioned to move the profile to Trial Implementation
      • Denise seconded
      • Discussion - none
      • Abstained – 2
      • Opposed – 0
      • Moved to Trial Implementation

Meeting Recessed until tomorrow morning at 0930

Tuesday July 19, 2016

DCP Present: Emma Jones, Denise Downing, George Cole, Thom Kuhn, Steve Moore, Celina Roth, Kristin Boyd, Andrea Fourquet (student), Lisa Nelson, Tone Southerland

  • Comments reviewed –
    • 2 actors now not 3 - CP Contributor & CP Service in the Actor Diagram x.1-1
    • Discussions:
      • Links or hyperlinks for HL7 references – decision to put the links in the profile text
      • Versioning by the CP Service Server – FHIR Server Resource supports versioning with “meta.versionId”
      • CP Concepts table – deleted the table entirely due to the CCDA column concepts not matching to the DAM or mapping to FHIR, the table was confusing and will clear up several comments
      • Security questions
    • Profile needs 5 transaction numbers: transaction numbers will be 37-41

QRPH Antepartum Summary (APS) Discussion

Attendees: Emma Jones, Denise Downing, George Cole, Steve Moore, Celina Roth, Kristin Boyd, Andrea Fourquet (student), Lisa Nelson, Tone Southerland, John Stamm, Lori Lemieux, Amit Popit, Michelle Williamson, Eric Larson, Laura Bright, Claudio Paclavini, Thom Kuhn Phone: Anne Diamond, Nichole Drye-Mayo

  • Looking at adding an option on the form filler to be able to import antepartum information from the antepartum summary
  • No pregnancy history nor infection history in the antepartum summary - Ask to be added via a CP.
  • Background: Last year the QRPH Fetal Death Reporting was updated for vital records reporting, but pregnancy history not part of LDS, added optionality for preg history data, this year adding an option for the form filler to consume (import) the Antepartum Summary populate the L&D Summary which populates the Fetal Death form, add the preg history and infection summary into L&D Summary, there isn’t a preg history or history of infection section in the Antepartum Summary as an optional data, but would like to capture this in the Antepartum Summary,
  • Discussion around taking a history section out of history section and putting it in a summary section, need to add some text about this in the
    • What would we put into the Pregnancy Hx – went to LOINC to see what is coded, would like to add data elements such as: date of last menses, STDs, Birth Outcomes
    • APS was used to match the ACOG forms and was meant to be used as a suite of templates, using the same template sections in two different profiles is this a problem? We need to look at the uptake of Antepartum Profiles, there’s been some uptake, the summary profile has been tested
    • Question raised do we try to put a section level conformance on the section could use an Import option, which would make it so PCC profiles don’t need to be touched and have the population profile Birth and Fetal Death add an option as that includes the APS section, need discrete data import
    • Turn the list in Preg History Observation Codes into a value set, get an OID
    • Request to do a CP to APS to constrain the profile,
      • Date of Last Menses – within the Review of Systems if developed into a template separate from the Review of Systems needs a template ID in the CDS Content Modules
      • Next Steps:
        • QRPH will do a CP that includes:
          • Discovery where all the Preg History Observation is used
          • Write up the value list for Pregnancy History that is needed for population health
          • Figure out which spot Pregnancy History should live in –AP H&P has a Review of System that contains the Menstrual History, but the Menstrual History doesn’t have a template ID
  • Let Menstrual History have its own section that can be used by AP Review of Systems, with its own ID, observation entries for antepartum Menstrual History

Wednesday July 20, 2016

Attendees: Present: Emma Jones, Denise Downing, George Cole, Celina Roth, Kristin Boyd, Andrea Fourquet (student), Tone Southerland Phone: no one present

Change Proposals

    • CPs that went out for ballot met quouram
    • CP 221 – Recon & CMAP profile documents were updated, moved CP to “Integrated”
    • CP220 – LOINC code “Reason for Visit” fix code error in Physician and Triage Note, Emma updating documents now, once updated she’ll move to “Integrated”
    • CP 203 - status code rejected, Emma moved to the “Rejected” folder
    • CP 222 - RPM – assigned to Denise, will place row numbers where the changes were made in the CP as reference
    • Discussion - Balloting Process: need to announce the vote for 2 weeks, then send the CP out for Ballot


Attendees: Emma Jones, Denise Downing, George Cole, Celina Roth, Kristin Boyd, Andrea Fourquet (student), Tone Southerland, Thom Kuhn, Lisa Nelson Phone: No one present

  • Profile updates.
    • Explored publishing the IG in Simplifier
    • All transaction numbers have been incorporated
    • Added a new sentence for Subscribe transaction - the two transactions if you subscribe have now become required
    • Fixed all the references to FHIR in the profile
    • X.1.1.3 added text about versioning the CP Resource and the deletion of subscribing the CP Service in vol 1 of the profile, vol2 39.1 added content about supporting RESTful delete
    • Open Issues section #8 deleted reference to the Table and issue still remains that the DAM and CCDA do not have clear mappings to FHIR
    • Attempted to put the Resource in SIMPLIFIER, received an error back, submitted the error to be fixed, will put the Resource in when able so the FHIR community has access to what IHE has done
  • Thom motioned to move DCP to Trial Implementation
  • Emma seconded the motion; Discussion – none; Abstain – 0; Opposed - 0
  • George will setup a meeting with PCC when he receives a response from SMPLFR
  • Meeting Adjourned

Joint Meeting (QRPH, PCC, ITI)

See ITI Minutes [for joint meeting minutes][2]