HL7 Working Group Meeting Jan. 2014 SDWG Minutes

(Daily Attendance Sheets are at end of this document)

Monday Q1 Business Meeting

Agenda Review Update SDWG 3 Year Plan – updated – one item removed Update on current ballot - number of comments and planned ballot

reconciliation SWOT - Updated Expiring Standards (e.g. PHMR)

Proposal to request a vote to extend the C-CDA 1.1 DSTU To extend to the maximum allowed Keith, Lisa - Against: 0 Abstain: 0 For: unanimous

Review PBS metrics and work group health

Discuss with CQI – the two QDM Release 1 Quality Reporting

The three year plan items must be moved into project insight Idle ballots – needs some corrections, we will request that Dave Hamill to come to the SDD-SD Pick a time to work through the metrics that we are measured prior to the meeting ( after the meeting)

Upcoming ballots the next cycle for SDWG In May timeframe Cancer Reporting IG HAI ballot

Presentation on any new projects Two projects were discussed

Co-chair availability Q2 CDA R2.1 Project Proposal The committee discussed the CDA R2.1 project reviewing the project scope statement and seeking participants that would be interested in working on the refresh of the CDA R2 standard. The current list of participants from previous meetings were: Lisa Nelson Calvin Beebe Patrick Lantana has also offered to provide up to 4 hours / week

C-CDA Companion Guide Ballot Reconciliation 211 – Lisa comment – Requesting that the Role Codes be SHALL. SHOULD with a value set specified. Persuasive w/ mod - need to validate that we bind to a value set. Binding of all role codes in the header. 411 – Lisa reason for Referral Section Change to the referred to person #147 & #148 – Lisa comments Both approved as documents – 19 for, 0 against, 0 abstain Q3 Business C-CDA companion guide A number of items from Lisa were discussed and acted upon. Votes are recorded in the ballot spreadsheet. Q4 Reconciliation HOST PHER Cancer Registry Reporting to Central Cancer Registries – moving towards consolidated CDA. Need to resolve the IHE based IP issues to bring this to HL7. There are two options that need to be considered, should SDWG host this project, will depend on having this be a part of the C-CDA document. If it only uses parts of the C-CDA standard, then SDWG can be a co-sponsor of the ballot and PHER would likely be the sponsor. The committee also reviewed a number of other PHER projects: Vital Records - PHER Death Report – also passes Birth Report – also passes IG – Co-sponsor – CDA IG These documents are based on the MDHT tools. These documents have gone through a number of updates, and have added standard vocabularies. Made the corrections and made up full sample documents. They are currently missing a LOINC code in birth IG and missing a couple of LOINC codes for the Death IG. Vocabularies are being worked out. Approve publication of these two documents and move forward. Some comments were noted that need.

Tuesday Q1 Joint with CQI Joint w/CQI Transitioning a number of projects/standards from Struc Docs to CQI

So far CQI has taken on management and development HQMF v2.0. When new projects are in that space going forward, project will be primarily owned and sponsored by the CQI WG. Update QDM, need a new PSS and CQI will be primary sponsor Outstanding (not transitioned)

QRDA cat1 and cat3 has not transitioned yet so topic of discussion for today

DSTU period is expiring for QRDA III R1, need to determine if we want to extend At future WGMs, Struc Docs and CQI will continue to meet jointly Considering a monthly joint call Two unpublished DSTU ballots

QDM based HQMF, needs DSTU pub request Quality Reporting Document Arch (QRDA III), DSTU R3, needs DSTU pub request Intent is to create pub request and seek approval for publication from both CQI WG and Struc Docs. Action Item for CQI: Research what’s going on with QRDA III releases, what’s published, not published, and if release is expiring.

Presentation from Michael – How HQMF is being used (presentation attached)

Going forward to create a standard for study design, suggest primary sponsor is CQI, co-sponsoring Struc Docs and RCRIM. Michael will create a PSS and talk to co-chairs of RCRIM.

Struc Docs will follow up with HQ for extension of QRDA III, R1 CQ Metadata Conceptual model reconciliation (ballot reconciliation spreadsheet attached)

John’s comments, Keith will review with him next week since he’s not here today Clem requested in person resolution, so not today

Motion to approve the dispositions as captured in the ballot recon spreadsheet (attached) whose Column N value = either DUP or OK Keith Boone/Patrick Loyd:

Vote: For: 28, Against: 0, Abstain: 0

Motion to approve disposition for item 66 as captured in the ballot recon spreadsheet (attached): Keith Boone/ Thomas Khun item 66

Vote: For: 33, Against: 0, Abstain: 0 Q2 LOINC Clinical Ontology Reconciliation There is a hot topic What does base conformance with the clinical ontology look like? Should your system be able to do anything about the Document Codes or only provide limited support? Preferred subset – for the general document types vs. other meta-data that is explicit in the header. Need to look at the Complete CDA IG coming from attachments The VA document titles are not specific enough to perform research. LOINC and Inter-Mountain The number of different Document Type Codes used within organizations can range from 150 – 200 to up to 5000. Lots and lots of documents – the use of codes can support focused queries requirements. Insurance Companies Vs. Very Large Practices Is it realistic that HL7 might propose that the codes selected from document types codes be limited in some fashion, and not be the full set defined by LOINC? It was noted that there are rather specific codes for the radiology exams in LOINC. Allowing LOINC to incorporate the codes into the ontology to support documents HL7 SDWG guidance to support LOINC codes in documents. The LOINC solution For the DIR report, suggested generalizing the code to a single code. Liora encouraged the group to continue to support the limited set of LOINC codes in the ontology solution. VA document types – 2600 document types ( 600 are large ) – the last year only 25 CMP documents were used. The use case for the guide, there is a different use case to mapping the local document type to the LOINC. What we are trying to say as best practice is that we should include a general codes or add specific codes.

Translations – general codes and support to specific For base conformance – is there some constraint that we want to place on how the codes should be used. How do we want to use the value set definition. There are two specific use cases. The general and more specific. An implementation could choose to implement either a simple vocabulary or the more specific solution. If we can create best practice that are useful for these. There might be approx. 200 more codes. We cannot assume that we should not keep it simple. Adopt a simpler approach When they publish – Universal Realm Motion: Exclude the VA specific attributes in the tree as they are US specific. 8 against 10 abstains for: 6 – motion fails LOINC Specific C-CDA R2 comments Votes on the C-CDA IG Block vote – from last week 56 block votes were submitted – posted last week None were pulled Motion to approve the block Made: Sharah Second: Diane Opposed: 0 Abstain: 10 for: 15 motion passes Another block vote Lisa requested that 5 be pulled, and one was added back in based on discussion yesterday Q2. There are currently 11 items in the block. Referred to Person change. 11 items in the block – none were pulled out. Made by second Diane Second Sarah Opposed: 0 Abstain: 12 For: 13 motion passes LOINC comment to discuss #113 Wound measurements – the observable codes should be drawn from LOINC, and Observation values in SNOMED. Changing Wound measurements to LOINC codes. Motion to approve: Made by: Sarah Second Diane Opposed: 0 Abstain: 8 for: 16 motion passes

#237 – pulled form a previous block The discussion was to add APT to the value set. Persuasive Motion to approve – opposed: 0 Abstain; 6 For: 17 - motion passes 841 – comment about two volumes The previous volume included – the one that summarized the document. Or manually add it back in. Request that it be added to the contents. Is there any reason that we cannot volunteer adding at the end of the process. In previously releases. Let it for now, and look at doing it. Now we will have to do an extra step. Persuasive – work with Brett to make the change. Motion to approve made by Sarah, Second Brett Opposed: 0 Abstain:0 For: 23 – motion passes 846 – Please add back the xpath – the Properties heading might need to be removed on the empty entries. Look at possibly move out or add more explaination on itl Q3 Joint meeting with ITS/MnM/Publishing/Tooling Review of Agenda. Reinvigorate the CDA Publishing Quality sub group (Andy/Sarah) We have not met at all during the last cycle. Need to reinvigorate the group and come up with some action items and assistance to keep this going. Sarah has items to work on for C-CDA. Sarah can commit to putting things on the wiki by 2/7/14. We “refer people to Publishing”. This is a valuable process. Andy will send out a doodle poll to struc doc list to find interested participants and available meeting times. Frequencies and use of IVL_TS Implementers may misinterpret its use. Consider a med taken 4 times a day from 1/1/14 to 1/3/14. This includes 1/1 and 01/02 and just the first “instant” of 01/03. There is confusion on which days are included. (look at this in numeric value – 1 through 3 does not include 3.1) Solution: Add in time stamp precision to the second (midnight) to include the end of the day on <high>. Pad <low> out to zeros. Using inclusive flag rejected as a solution because this is not commonly known or understood. Add narrative guidance to the IG and “force folks to include seconds on the time stamp” to capture the “intent” of the prescriber in the machine language. All intervals of time in the guide SHALL be precise to the second. PROPOSAL--“ If range is to full day, SHALL include precision to the second.” Exact wording of the IG will be finalized in a later session. EXAMPLE: <effectiveTime xsi:type=”IVL_TS”> <low value=”20140101000000”/> <high value=”20140103235959”/> </effectiveTime>

MOTION by Brett to accept the proposal/Seconded. Against: 0, 0 Abstain: 0, For: 23 PASSES Brett will add this to the DSTU page. BALLOT RECONCILLIATION Sarah CDA R2 CCDA Clinical Notes #93 Language communication question Suggestion to make languageCommunication SHALL, which will make languageCode SHALL can we have nullFlavor? YES Item disposition is Persuasive. Sarah calls vote: Against: 0, 0 Abstain: 0, For: 23 PASSES

TUESDAY Q4 Rick Geimer – FHIR Connectathon Summary Rick and Dale Nelson and others from Lantana participated. Focused on two document tracks. Documents Track Scenarios –

Submit doc to FHIR Server Query and Retrieve Decomposition – break into elements

They created an app on local machine to take a CCDA/CCD document and loads the doc to view and then convert to FHIR mark up with a stylesheet. (ATOM feed)

Sent the doc to a FHIR server (Submit document) Was then able to query the server and find the document.

o Viewed in as FHIR and round-trip-back to CDA Discoveries

o FHIR is a bit “lossy” in transformation Standard display stylesheet is missing Stylesheet they wrote to render the doc is under 80 lines long and

was easy to write. FHIR uses HTML so it makes it easy to capture the XHTML (query for the resources and build from the pieces)

Level 2, or 3 with minimal coding (narrative heavy) documents are not as easy to display. FHIR falls down here.

Rick suggests giving sections a little more attention. There is not a narrative data type in a section to stick an extension

to. Sections are missing explicit title, although one could go code

and text to get a description. Possible creation of a section resource suggested.

Need to work on use cases with FHIR o Overall a positive response.

Robert Worden – More Meaningful Use of CDA: the CDA-FHIR Bridge Presentation sent along with the minutes. General overview is that FHIR can be used as a bridge to query an application database and manage C-CDA data. Tooling demos this evening, or RIMBAA Q4

Wednesday Q1 HOST CDS & CQI HQMF R2.x modularization and related topics Tacoma Project ONC / CMS – Mita Unify CDS and eCQMs

Create data models with A review of the timeline -

Expression models

1. QDM Transition and Evolution Mitre assumed responsibility Enhancing the QDM for MU3 Future replacing with unified standards

Review of the status of standards work MITRE and others are involved Follow-on to HeD and Query Health S&I eCQM Consolation and Review Formalize CQM HQMF R2.1 Updates Modularization - separate the expression logic and the data models Make the generic and come up with implementation guides Identify the expressions Looking at supporting a relatedDocument concept Defining Data in HQMF is related to the modeling in HQMF Limit some capabilities in the data elements How would this be model this for an observation? The criteria Reference will identify the returned class expected from the evaluation. How do you access the data in the data model. Episode of Care - ITNCNT – CD data type Need counted and non-counted items of the same type. Use the value set – to define what you want to count.

If you are going to count encounters, then you need to count the numerators and denominators. You need a reference to a criteria for the selection, and proposed, we need to have the value set specification for what is counted. Look at changing the CD data type in his reference to an ED to support a link reference. Composite Measure Metadata A wellness exam that uses other individual measures and come up with a scoring as an example. The current structure does not currently support this, but the new expression language will support this. RPLC XFRM HQMF R2.1 - Looking at relationships USE – for this one uses that relationship. This measure uses part of that measure. Providence or not? – what is the purpose of the reference. Policy needs to be considered There needs to be a phrase that can be used to reference other measures Propose that this be an XML include Vs. modeling the Providence Question about – pulling in composite rules that can be used together Ballot Reconciliation (as needed)

QI DAMv- Keith will followup at Q4.

Metadata

Comments

Expression Logic A lot of comments – proposed dispositions were sent last night Expression Logic DateDiff – its based on a floor How do you deal with contiguous intervals??

Define the boundaries are understood. Keith #47 – 2.1.1 Clinical Context How to reference the RIM via the expression logic. – withdrawn by Keith #66 – The Strict capability is nice to have maybe, but not a requirement.

It gives the author of the artifact the ability to specify behaviors. #66 was withdrawn by Keith

vMR Prospective later

Setting up calls in the interim and will hold a joint meeting at the next WGM. Q2 Reconciliation med Host Pharmacy

C-CDA Ballot Reconciliation #155 Single Medication Administration (Ben’s Comment) How to represent medications that are administered at a single time? Support another effective time that is a should C83 – only said that you need to say HIGH XSI:type TS – it should simple be included as an effective time. Should this be an errata for C-CDA 1.1 Two main topics: 1) fixing best practice guidelines based on recent discussions and 2) determining the process for further work group cooperation. As for 1, the following issues have been discussed (I’ve gone back to old e-mails, because I wanted make sure we don’t lose items we agreed on): • effectiveTime for single administrations Consensus was reached, but never

formally documented I think. • maiden name representation in C-CDA Not really Pharmacy-specific, but another

loose thread I believe. • total life-time dose Ended with a suggestion for an

extension, but never followed up. Modeling of the total life-time dose – there is a RIM class that can be used in medication March 2013 – incorporate the dose check quantity - Clinical Oncology Guide

• no immunization administered Another tread that ended with an (undocumented) suggestion.

• uncoded medication Should be a no-brainer, but again not sure if it was documented.

•

• RxNorm code unavailable Actually an extension of the previous discussion, more nuances.

• relationship doseQuantity-rateQuantity Ended with a question to StrucDoc co-chairs, without a response.

Continuously dosed medication – requiring two intervals Medication should include Dose quality or Rate Quantity and duration of medication

The Rate and the Dose need to be used together. Allow the rate of administration, along with Dose and period of administration. July 2013 – the validator rule needs to updated. Need to consider updating the text for both the Companion Guide and the C-CDA. Adding “A or B or both” – Should

May A May B Is there a use case for expressing the duration of an IV drip. Should contain at least 1

• interpretation of repeatNumber Reached consensus, but I’d like to make sure it was documented.

• several issues related to EIVL_TS I answered a bunch of questions, but there was no real feedback.

• use as directed I answered an e-mail, but I don’t think it was picked up after that.

Need sample – use a null flavor on the LOW to make this week. / How to represent “Use as directed” - use as directed

• maxDoseQuantity I answered an e-mail, but I don’t think it was picked up after that.

Example request

• drug vehicle (compound medications) One of many threads dealing with compound meds. Open issue.

• diseased indicator Not really Pharmacy-specific, but another loose thread I believe.

• interpretation of <high> in time intervals This is an overarching issue, but urgently needs follow-up action.

• variable dosage A recent discussion. Conclusion reached, but was it documented?

• PRN dosage instructions (see other e-mail) Last but not least. Conclusion reached, documentation needed.

Can co-chairs from a committee cross post to another committee list-serv or does the co-chair need to be a member? Posting to the SDWG – C-CDA Comment Page or Submitting to the Examples Work Group The Pharmacy work group is looking at setting up a pharmacy templates (FHIR / C-CDA…)

The length of this list makes it clear that discussion of process is needed. It

also makes it clear that we need more time than just Wednesday Q2! Cross posting is working on the Lists OK Examples taskforce

Wednesday Q3 - Brad Chair / Diana Scribe EU/US Patient Summary Project Project Scope Statement presented by Anna Langhans There is an ONC initiative based on memorandum of understanding between EU (epSOS) and US (C-CDA CCD) to figure out a solution for exchanging patient summaries between the two. They are ready to develop the solution. Presented as a mapping effort but they are developing a harmonized template to say certain data elements with constraints are shared between the two. In parallel is the Trillium Bridge project. They have the same goal but different ‘drivers’ and deadlines. Trillium is a transformation project, but there is over lapping work. Keith suggests that there be a universal realm guide that is consistent with both to enable harmonized exchange. Change project name to reflect what they are doing (Harmonize) not how they are doing it (mapping). TITLE CHANGE: Harmonized EU-US Patient Summary Would like to ballot by September. Potential joint ballot with ISO but they haven’t approached them yet. Will carry discussion over to Q4. C-CDA R2 Ballot Reconciliation Sarah – CDA R2 CCDA Clinical Notes R1 Comment 602 Negative Major. Comment 602 refers to the disposition for #411, which was already voted on. Sarah moves to open 411 for discussion / Keith seconds For: 16 / Against: 0 / Abstain: 0 Comment is reopened and modified. Original Text:

Agree with comment. Type of Referral will be primarily modeled in CDA header, whereas Reason for Referral will be left in existing section (within the Patient Referral Act template). Specifically: HEADER - Intended recipient of referral (e.g. "cardiology") will be a participant, with typeCode of REFT. - Add a value set reference to NUCC Health Care Provider Taxonomy for specialities (for use in the Role Code) - Modify description in 1.1.21, to clarify that the type of referral and the target of the referral are specified via the participant (and not via the author).

PATIENT REFERRAL ACT - Act/code is fixed to SNOMED 44383000 (patient referral for consultation); - Conformance 31635 is changed by replacing the reference to Act Reference with a contained link to the Indication (V2) template (and remove containment to Act Referrence).

See Updated spreadsheet for changes Sarah will take recommendations back for review and will return with 411 and 602 at a later date. Wednesday Q4 - Brad Chair / Diana Scribe Wrap up PSS review for EU-US Patient Summary Anna Langhans presenting Further background: Bulk of the work will be Analysis, so there is another title change: Suggested Title: Analysis for harmonized EU-US Patient Summary exchange. Longer term goal is to reconcile the differences between the formats. This should be better described as an Informative Guide for now. Keith suggests timeline of Analysis, and Transformation Guide, leading to future UV Realm Template for CCDA and identification of the common vocabulary value sets. Approval for this PSS will be given on a future (next week) Structured Documents Conference Call. ISO involvement will change the timeline for this project. Anna will contact Lisa Spellman and update the PSS after they correspond. C-CDA R2 Ballot Reconciliation Sarah – CDA R2 CCDA Clinical Notes R1 Comment 592 on raceCode Negative Minor Open for suggestions to reconcile. Extension is already allowed. Do we bind to a small value set for the raceCode and point to the full value set for the extension? Motion by Sarah / Ken seconds Against: 1; Abstain: 0; For: 13 Added Agenda Item for tomorrow Q1. Brett will update the wiki

Thursday Chair Scribe Room THURSDAY Q1 Lead: Brett, Scribe: Diana LOINC Clinical Ontology Reconciliation Russ Presenting: LOINC implementation Guide Comment #134 on Classification of Document types. Establish a document value set for a minimum as a SHALL but also allow a MAY support for all document type LOINC codes. VA representative expressed acceptance of this disposition. Liora moves to accept as written/Seconded Against: 0, Abstain: 0, For: 11 C-CDA R2 Ballot Reconciliation Sarah Presenting: Comment 314 by Lisa Nelson and 315 by David Tau on Rendering Header information David focuses on mis-matched patient and Lisa’s focus is on changed information. Disposition for both is to add a bullet item in volume one to “good practice list” in section 3.3 amd remove the statement that “therefore, there is no strict requirement…”. Sarah moves to accept the disposition for both comments, Lisa Seconds. Against: 0, Abstain: 0 For: 8 Comment 415 by Lisa Nelson on removal of data element “name” column. Was pulled from block vote. Disposition: This has been referred to tooling/publishing. Sarah moves to accept. Lisa seconds Against: 0, Abstain: 0 For: 8 Comment 760 by Lisa on serviceEvent PCPR / effectiveTime on Care Plan Disposition: Not Persuasive. Discussion of definition of PCPR Change to disposition to add code to serviceEvent for “care plan” (same as top level of the document). Discussion of effectiveTime – What does effectiveTime mean in this case? Do we need low/high? What is the service event in the case of a plan? (what would be an appropriate <high> time? Do we need to record the time that the plan was authored? When was the care plan implemented/done?) Sarah suggests we take this to S&I for further review/answers. Comment 572 by Lisa on the use of Author Participation Template being available everywhere. Disposition: Persuasive with Mod. and will add a statement to indicate why some templates use it and that it can be used anywhere, in other templates. Sarah moves to accept. Lisa seconds Against: 0, Abstain: 0 For: 8 Comment 281 and 505 by Brett and Lisa on value set recommendations Disposition: Persuasive with mod

Will add guidance in the text if SHALL, and if the value is cast to CD or a code, then bind to valueSet…. Sarah moves to accept. Lisa seconds Against: 0, Abstain: 0 For: 8 Comment 608 on Care Plan entryRelationship – progress toward goal. Disposition: Persuasive with mod Reviewed Figure 25 Care Plan Relationship Diagram in Volume 1 Will add explanation in both descriptions of template and above conformance statement about what the Progress toward goal observation is and how it relates and add clinical example. (see spreadsheet) Sarah moves to accept. Brett seconds Against: 0, Abstain: 0 For: 6

THURSDAY Q2 – Joint with PC/Templates. PC Hosting – See PC minutes and attendee list

Ballot Rec on V3-Template specification Allergy and Intolerances Project Update presentation Care Plan DAM Health Concern concept

LUNCH MEETING with PC Determined that Lisa will act as Liaison between PC and SD. PC is encouraged to use our DSTU comments page and work with the examples task force. Brett will keep PC updated with potential items of interest.

THURSDAY Q3 Reconciliation ( 6 – 7 items) FHIR held a final round of QA on the ballots In that there were several comments about the resources, however a few were brought back to the group. 3 are of interest to review Composition.instant

- When the composition was edited changed by the author - Full time stamp – no date must be down to the second

The requirement that it be known to the date level for CDA. Loosen the data type from instant – to date time

(year, year – date, year – date – time)

Date – change of name

2. Composition Resource Section Content

- Code - Subject - Content

Title – as a string attribute

Title is part of the resource it self. The challenge is that sections must have specific titles. Putting the title inside the narrative makes it un-useful for reuse. Narrative as being derived from the entry List resource html table – how do you name it in such way. Come up with a list of things that you have seen that would not fit. Is it one thing or two or three categories. For this DSTU – use resource.text - Other It does say when you render the document, you step. If they should call it out more.

If a section has content of any sort, coded or narrative – Find the appropriate resource; if you can not find the appropriate resource then use Other. Resources – are independent of each other There are some resources Profile of composition / document You can say in the profile that then must be contain an all or nothing for the narrative. Last one – Why there is no text on section There is no ability to have narrative information Always appears on the resource that is on the context

Calvin noted that CDA supports a distinct duality with regards to its narrative and entries. Within the Clinical Document Architecture, the narrative is to be consumed safely only on the whole, as the authentication spans the whole and narrative can be, when composed or dictated contradictory in parts or portions. The entries or clinical statements contained with a document on the other hand are presumed to be accurately constructed and contextually defined to be extractable and machine processable, for secondary uses as needed. This separateness is not currently supported within the FHIR solution, as it tends to think of documents solely as extraction artifacts, where the whole of the narrative is constructed from the contained parts narrative.

We will need to look at FHIR – and see what needs to be done to better support documents into the future.

Planning for the next DSTU 5-10 minutes - Time lines / Content

C-CDA R2 (FHIR Profiles) FHIR DSTU should be published next week. Timelines: Looking for groups to identify profiles/ resources to include in the next release (by end of Feb) QA by end of August; review during working group and ballot opening end of Nov through Jan. TASK: Identify content to bring forward and profile the resources that are owned in CCDA. DECISION: Target 1.1 as priority but also look at items that are new in 2. A Profile can contain 0..* structures . Could do a profile containing all of CCDA or break this out with each template for each section being a distinct profile.

Tools are available to help construct the profiles but are not quite ready. Tutorials on the tool will be made available. Lloyd will post information to the list. Lloyd will send out a templates spreadsheet to SD. Digital Signature is there for signing a document using XML. Consent – Security WG is interested in taking that on.

THURSDAY Q4 CHAIR: BRETT, SCRIBE: DIANA C-CDA Examples Task Force Brett updates on history of/status of the Examples Task force. ACTION taken to update the Wiki

o Updated the guidelines for submitting a sample o Bullet point for “Known Bad example” was removed and we will put bad

examples in their own section. Rules of the Road for going forward (Approval Process)

1. Time box the review of each sample. 2. Try to manage 2 samples per call. 3. No vote necessary. 4. Consensus categories

a. Mostly perfect b. Needs more off line modeling c. Needs input from another work group or SDWG

5. Update “approved by” to “status” and assign status categories 6. Heuristics for review

a. If a proposed sample does not achieve “mostly perfect” on a second call or after a third call of presentation to SDWG, it will be put on hold; Sample will include note on why it’s on hold for 3 weeks.

b. Samples for presentation in SD will be announced a week in advance with an email to the list with a link to the sample on the wiki.

c. When ready to present a sample to SDWG (status= ‘mostly perfect’), a block vote will immediately be called. If pulled, commenter must provide justification and if possible, alternative proposal via email.

d. Document any recognized modeling imperfections in the sample. Question: Will this wiki stand the test of time to maintain many, many samples. Note: Review the wiki for community requests for examples. Use of IDs in CDA R2 Question from Lisa. We use IDs in the role but not in the entity. Once these are set in the header, can we reference these by ID rather than repopulating classes in the body of the document? IDs identify the individual (SSN, NPI). Why is address and telecom pushed into the role?

Creating Classes without IDs was more of a tooling artifact rather than a conscious decision. This is a good topic for further discussion on R2.1 Friday. negationInd Rob and Lisa discussion Questions on usage and lack of clarity. Application of negationInd to code or to value can be declared for each template. We need to review how this is done/declared for each required section. Continue the discussion 30 minutes early tomorrow. Friday Q1 Technical med.gif MEETING 3 Year Plan update CDA R2.1 How difficult will it be for implementers? The discussion focused on whether or not we should be adopting the Data Type R2 for CDA 2.1. After some discussion, the group decided to review Graham’s write up on the topic and bring it back for consideration. Knowledge base – the industry has a set of people that understand the models. Revisions were made to the Project Scope statement, included within the attachments for these meetings. Q2 NO MEETING Regency East #1

Monday’s backside of attendance sheet.

Tuesday’s Attendance Sheets

Tuesday’s backside of the attendance sheet

Wednesday’s backside of the attendance sheet

Additional attendee, Calvin Beebe Mayo Clinic cbeebe@mayo.edu Q1 only.