PCD PC&TC 2008-04-21 to 23 F2F

The Planning Committee met Monday morning, April 21, 2008;
the Planning and Technical Committee met Monday afternoon;
the Technical Committee met Tuesday and Wednesday, April 22 and 23

Overall Meeting Purpose

Develop Year 3 Technical Framework Supplements for Trial Implementation - Resolve Remaining Issues
Finalize Stable Year 1,2 Technical Framework, Options and/or Supplements (was not addressed)
Test Tooling
Begin Year 4 Profile Development (was not addressed)
Plan for WHIT, Education Workshop
Review Roadmap, Calendar

Meeting Information

The meeting was held at RSNA offices in Oak Brook, IL

Attachments / Materials

NIST Update, from John Garguilo, found at ftp://ftp.ihe.net/Patient_Care_Devices/Tools/NIST-Tools/NIST-UpdateF2F200804
PIV, Point-of-Care Infusion Verification draft supplement developed during the meeting, found at ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/PIV/
ACM, Alarm Communication Management draft supplement developed during the meeting, found at ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/ACM/
MWB file with ACM transactions developed during the meeting, found at ftp://ftp.ihe.net/Patient_Care_Devices/Profiles/ACM/MWB/

Minutes Monday Morning, April 21

Planning Committee Meeting

Objectives Review of current status, begin planning Year 4, including Year 4 Profiles
Develop Volume 1 of Year 3 Technical Framework Supplements - Resolve Remaining Issues

Attending Terry Bettis, Jon Blasingame, Steve Borchers, Todd Cooper, Al Engelbert, Robert Flanders, Ken Fuchs, John Garguilo, Joel Halle, John Hotchkiss, Ken Marks, Monroe Patillo, John Rhoads, Jeff Rinda, Paul Schluter, Iona Singureanu, Steven Staats, Kristina Wilson, Ray Zambuto, Manny Furst

Discussions
Update PCD Status, Progress
Ray - Many compliments were received on PCD Showcase; congratulations to all who participated.

Wiki
Rosetta terminology project – Paul, Todd making use of Wiki for Rosetta Project profile development. Todd introduced the Wiki profile pages for the various domains which have links to documents on the ftp site. He noted that the TC215 liaison arrangement requires sharing the information contained on these pages with TC215. The Rosetta |Project group has found that using the Wiki has advantages, but does present difficulty when developing a supplement. Documents are posted on the ftp site, while |collaborative work is done on the Wiki. Advantages of the Wiki are ability to search Wiki pages and track the collaborative effort. The Wiki does not permit uploading .zip ||(can alter the document type and users can then download and change) files and does not provide all editing functions of Word or prevent further editing without extra effort can record final version, can note the date of the final version, can refer to PDF, can use ftp site).

Google Groups
IHE is moving to Google Groups which domains can manage. Iona suggested exploring HL7 GForge which provides version control and other features and permits linking to Google Groups.

John Garguilo mentioned that Gazelle will provide for releasing test versions.

Flyspray may be used to track responses in the public comment period.

WHIT
No new information.

Education Workshop
Format may change, likely use Webex. PCD will have a specific session. It will have sufficient detail to convey the transaction level and a level beyond.

Rosetta Terminology Mapping
Paul summarized the current status. Companies that are DORs have submitted their mapping from common term to the vendors’ terminology and units of measure. The key benefit is availability of the standard terminology and each vendor’s terminology, and visibility of each vendor’s measurements that are supported. The effort also will help resolve differences and periodically update the table. The table will help each vendor map to 11073 and to have a set of allowed units of measure. In addition, the table provides grouping by physiologic system. Eventually the normative table will be XML.

Review of Profile
This is a Content Profile; this will become part of the DEC TF, volume 3. Paul reviewed the current version, posted on the Wiki in detail. He stressed the need for scientifically valid units of measure, and that this supports development of decision support systems.

Roadmap and Calendar Review/Update
The Roadmap was discussed in detail. Some changes were made on April 22 to clarify descriptions and change the due dates consistent with the evolution of the discussion.

Parameter coding is moved to Year 3.

Subscribe to Patient Data - Paul will add ACK message to SPD; SPD will remain a supplement.

Barcode profile awaits HIBCC actions and will be integrated into existing profiles. Ray noted that it remains essential for interoperability in the clinical environment, and that the profiles need to be broad enough to avoid having multiple, incompatible instances. Jeff noted that bar code readers are available that can read multiple formats. Year 4.

Patient Identity Binding needs extensions – point of care local binding, recovery from communication interruption, association of multiple devices. Recommendation was to include Year 4, while PIB in its current form will be part of the final Year 2TF.

Discussion followed regarding necessity of ADT cf. local use of the patient wristband for patient ID binding. Possible complication if wristband has multiple bar codes. Todd will ask the cochairs to determine what should be done and which IHE committee should be responsible for incorporating bar code into ADT implementations.

Plug and Play (PnP) Year 3 or 4.

Alarm Communication Management This supplement is under development.

Device Document Template is the new name for Small Data Element Exchange (CDA HL7 v3). Year 3 or 4.' Point of Care Infusion Verification is the new name for Bedside Infusion Verification or earlier, Infusion Pump Medication Management. This supplement is in development.

Security and Privacy is moved back a year. Need to learn what is required when PCD data is sent beyond the facility. Ken Marks provided this link to the ISO 27000 series of standards documents for information security matters as a place to start: http://www.27000.org/ . User authentication and device authentication is especially important with wireless connections. Other issues include compliance when crossing international borders. Ken Fuchs will talk with ITI (June 1) about how best to approach the security issue.

Remote Monitoring PCC referred this to PCD last year. HITSP has begun working in this area, based upon AHIC detailed use case for Remote Monitoring. HITSP currently working on a portion of a multi-year effort where some standards are in development. Continua’s presentation included both wellness and health care devices. PCD effort is based upon a CDA type message while Continua’s is lighter weight. Continua is focused on gathering data from within the home.

Todd described how PCD profiles could support the RM effort. Ken Fuchs expressed concern that their focus on a specific use case can interfere with later, broader applications. Steve Staats volunteered to work with Todd in determining the PCD documents’ relevance to HITSP Remote Monitoring use cases and vice versa.

Medical Equipment Management Todd described the MEM profile, available on the Wiki. Please see the Wiki for details. Use cases include (1) device configuration management, (2) location tracking services, (3) battery management, (4) operational status monitoring, (5) periodic maintenance, (6) software patch management. Year 4.

Synchronous Data Cross Enterprise Sharing (waveforms) (1) Transmission and (2) Storage and Retrieval Todd noted that ACM and Rosetta Project ventilation coding have a need for waveform snippets. ACM is looking at inclusion in HL7 v2 message, possibly having something for the New Directions area in 2009, and not for testing; even that is unlikely. Todd posted the ECG snippet issue on Flyspray.

Real Time Location Systems - RTLS This is an active issue in HL7, appearing on the current ballot in a different form (Service Delivery Location). Year 5.

Device Interrogation Query a device for retrospective data or device condition. Include the ability to issue request that retrospective data be deleted at that time. This may be an extension of SPD.

Wireless Transport ISO 80001 and other standards are under development.

Transport – Pre-Hospital Waveforms Follows on waveform transmission in Real Time Storage and Retrieval. This is not dependent upon Remote Monitoring. The HITSP RM effort is not real time. PCD needs a champion for the Transport effort.

12 Lead ECG Follows on waveform transmission in Real Time Storage and Retrieval. Paul noted that this will include transmission of annotations and comments as well as waveforms. Ray will inquire about coordination with the Cardiology domain.

Decision Support Remains in Year 5.

Associations This refers to the ability to associate patient identity with multiple devices at one time. This might take place when the equipment is in one location for a specified period of time (e.g., an RFID application) or in other ways.

Device to Device Integration Communication of data from one device to another – including open loop control. E.g., adjust blood pressure for bed height.

PCA Pump Safety Moved to 2010, to follow on PIV.

PIV Extension Enhancements will be delayed until 2011 cycle to permit response to the initial supplement and to receive feedback, recommendations for extensions and priorities.

Data Mining No change.

Device Control Closed loop, e.g., ventilator pause and resume to synchronize with x-ray.

Wellness, Fitness Combine Fitness with Wellness in Year 4 (moved).

Smart Home Move to Year 5.

Minutes Monday Afternoon, April 21

Joint Planning and Technical Committee Meeting

Objectives Preliminary results of market survey
Test Tooling
Year 3 Supplements Prepared for Public Comment – Resolve Remaining Issues

Attending Terry Bettis, Jon Blasingame, Steve Borchers, Todd Cooper, Al Engelbert, Robert Flanders, Ken Fuchs, John Garguilo, Joel Halle, John Hotchkiss, Ken Marks, Monroe Patillo, John Rhoads, Jeff Rinda, Paul Schluter, Iona Singureanu, Steven Staats, Kristina Wilson, Ray Zambuto, Manny Furst

Discussions
NIST Test Tools Inventory
John Garguilo provided an update. The tools include Device Communication – X73 and Enterprise Communication

NIST Cypress Wiki
http://collaborate.nist.gov/twiki-cypress/bin/view/Cypress/WebHome The Cypress effort is open and available; all participants have agreed to this.

NIST Support of PCD Testing
John Garguilo provided a list of Key Objectives for HIST’s efforts in support of PCD, as well as integrate it with NIST’s efforts in support of IHE and HITP. See John’s documentation on the ftp site at ftp://ftp.ihe.net/Patient_Care_Devices/Tools/NIST-Tools/NIST-UpdateF2F200804/ [the following was added and approved 5/14/08] and for NIST V2 validation web site is http://xreg2.nist.gov:8080/HL7Web/index.html. The site provides/lists our IHE-PCD actors (DOC, DOF, DOR) and some transaction/profiles. We can further develop the profiles as we go through this year and become more mature.

To facilitate developments to support PCD, PCD needs to develop tests cases earlier, with sample use cases. PCD-01 is included. Users have the potential for tests to be configured for their needs.

Todd noted that existing tests don’t test for content, future tests should be more rigorous. Schematron tool will test more of the messages. Peter Hendler’s discussion tomorrow illustrates how this can be accomplished.

Supplement: Alarm Communication Management
John Rhoads and Monroe Patillo reviewed the information contributed by the Task Group. Five Use Cases were described, including patient/no location and location/no patient identification. Discussion included: not allowing an alarm to be turned off except at the source; acknowledgement of receipt of an alarm can permit preventing the alarm from escalating; unsolicited alarms are required while solicited alarms are optional.

Supplement: Point of Care Infusion Verification
Jeff Rinda described the Use Cases, noting that PIV focuses on the interaction between the bar code system and the pump. Iona recommended using “Placer” instead of “Sender”, and “Filler” instead of “Receiver”. The WG consulted with Pharmacy Order and Filler experts and agreed on the use of the RGV^015^RGV_015 message. The required ACK message is essentially a mirror and permits sending the actual rate which may differ slightly from the amount requested due to device limitations. An optional ORU transaction would be required if the patient weight has changed – because the RGV message cannot include an OBX. Discussion of the need for a separate message for the OBX for PIV and ACM followed. Iona suggested that a request be made for change in the specification of the ACK message to include an OBX. Monroe observed that for ACM, the two messages (received and action) may go to different TCP/IP addresses, so the ability to send two messages have this benefit.

Recruiting
Clinicians – Planning Committee – to contribute to the interesting part – identifying needs, conceiving of the requirements and perhaps reviewing volume 1. At least one cochair of PC must be a user. Most PCD members belong to both committees, but we need some users to help assure real needs are being met. Iona suggested that IHE develop a brainstorming environment for clinicians who have wider interest. Iona suggested that there are physician meetings elsewhere and some may only be interested at a high level.

Minutes Tuesday, April 22

Technical Committee Meeting

Objectives Development of Supplements
DELETED: Edit Technical Framework in preparation for public comment period June 15 – July 14

Attending Terry Bettis, Jon Blasingame, Steve Borchers, Todd Cooper, Al Engelbert, Robert Flanders, Ken Fuchs, John Garguilo, Colin FX Garstka, Joel Halle, Peter Hendler (via Webex), John Hotchkiss, Ken Marks, Monroe Patillo, John Rhoads, Jeff Rinda, Paul Schluter, Iona Singureanu, Steven Staats, Kristina Wilson, Vaughan Zakian, Ray Zambuto, Manny Furst

Discussions Year 3 Vol 2 Supplements: Alarm Communication Management, Point of Care Infusion Verification
Participants worked on one or the other of the documents for most of the day.

Device Document Template (previously Small Data Element Exchange
Peter Hendler and Chip Furniss joined the meeting via Webex. Peter discussed his efforts. He has written demonstration code for CDA. He noted that he is using CDA because vendors in the US are unwilling to use messages other than CDA or CCD for HL7 v3 messages. CCD is a constrained subset, and is being used by Continua and HITSP. Peter believes that the Clinical Observation is all that is necessary. These are overkill for PCD, but are therefore necessary.

There was concern that the human readable segment of the CDA may not match the actual coded value – errors may be introduced because these are independently generated. Peter asked about the level of interest of the participants at the meeting. There was a lack of interest. Peter noted that an SQL query is possible if coded data is accompanied with the text.

This will be a two year effort, with demonstration in Year 3, a supplement in Year 4.

Technical Framework Finalization and Publication
Todd, Ray spoke with Chris Carr for guidance on how best to publish the final version of the TF (for Year 1 alone or Year 2) and whether to include PIB. Chris recommends that a document not become final unless all parts are final. For PCD this choice is a final TF with DEC and PIB or wait to finalize until SPD has also become finalized following a Connectathon. SPD was not fully tested due to lack of DOCs implementing this option.

Consensus was reached to postpone issuing the TF as a final document for public comment and publication. No objections were expressed.

Minutes Wednesday, April 23

Technical Committee Meeting Continued

Attending Steve Borchers, Todd Cooper, Al Engelbert, Robert Flanders, Ken Fuchs, Colin FX Garstka, Joel Halle, Ken Marks, Monroe Patillo, John Rhoads, Jeff Rinda, Paul Schluter, Kristina Wilson, Vaughan Zakian, Ray Zambuto, Manny Furst

Discussions Year 3 Vol 2 Supplements: Alarm Communication Management, Point of Care Infusion Verification
Participants worked on one or the other of the documents during the morning.

PCD Wiki
Todd described the organization of the Wiki pages and requested comments and suggestions.

Year 3 Vol 2 Supplements: Alarm Communication Management, Point of Care Infusion Verification
Participants worked on one or the other of the documents until adjournment.

Action Items Summarized

Paul will add ACK message to SPD.

Todd will ask the cochairs to determine what should be done and which IHE committee should be responsible for incorporating bar code into ADT implementations.

Ken Fuchs will talk with ITI (June 1) about how best to approach the security issue.

Steve Staats volunteered to work with Todd in determining the PCD documents’ relevance to HITSP Remote Monitoring use cases and vice versa.

PCD needs a champion for the Transport effort (and others).

Ray will coordinate about 12 lead ECG with the Cardiology domain.

Cochairs will address recruiting of clinicians, possibly in creative ways.

Todd is updating the Wiki pages and will update the ihe.net/pcd page, clarifying the link to the Wiki.

Next Meeting

The next meeting will be a Technical Committee Webex meeting, April 30 at the usual time, 11 am EDT

These minutes were approved by both the Planning and Technical Committees

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