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Meeting InformationHL7 Clinical Interoperability Council BR&R and CIC Meeting Minutes Location: Madrid/ Marseilles Conference Room Date: 2017-05-09Time: Q1 | 10:00-11:30 am Facilitator Anita Walden Note taker(s) Amy Nordo Attendee Name Affiliation .X. Amy NordoDuke University .X. Anita WaldenUniversity of Arkansas Medical SciencesQuorum Requirements Met: (yes/No) NoConfusion about the meeting time led to the meeting not being held. HL7 Clinical Interoperability Council CIC – Trauma Reconciliation Location: Madrid/ Marseilles Conference Room Date: 2017-05-09Time: Q1 | 02:45-4:00 pm Facilitator Amy Nordo Note taker(s) Anita WaldenAttendee Name Affiliation See attendee list Quorum Requirements Met: (yes/No) YesRow 29 is missing from the spreadsheet. Need to determine if it is a consolidation error.Negative votesVote Jay Motioned to accept ballot dispositionsSecond – Jim Lynch Comments # - 24,25,28,32,34,35,36Abstains - 0Against - 0Approves - 4Vote: Jay Motioned to accept the dispositionSecond - Jim Lynch Comment # 38 & 39Abstains - 0Against - 0Approves - 4Vote: Jay Motioned to accept the dispositionSecond - Jim Lynch Comment # 59, 60, 62Abstains - 0Against - 0Approves - 4Vote: Jay Motioned to accept the dispositionSecond - Jim Lynch Comment # 44, 45Abstains - 0Against - 0Approves - 4Vote: Jay Motioned to accept the dispositionSecond - Jim Lynch Comment # 48, 47, 46, 49, 50, 53Abstains - 0Against - 0Approves - 4Other VotesJay Motioned to accept the dispositionSecond - Jim Lynch Comment # 65, 77Abstains - 0Against - 0Approves - 4Other VotesJay Motioned to accept the dispositionSecond - Jim Lynch Comment # 52, 76, 6Abstains - 0Against - 0Approves - 4Other Votes TyposJay Motioned to accept the dispositionSecond - Jim Lynch Comment # 1,2 3, 4, 5, 7, 8, 10, 11, 12, 13, 14Abstains - 0Against - 0Approves - 4Other Votes typosJay Motioned to accept the dispositionSecond - Jim Lynch Comment # 15, 16, 17, 20, 21, 22, 23, 26, 27Abstains - 0Against - 0Approves - 4Other Votes typosJay Motioned to accept the dispositionSecond - Jim Lynch Comment # 30, 31, 37, 40, 42 Abstains - 0Against - 0Approves - 4Other Votes typosJay Motioned to accept the dispositionSecond - Jim Lynch Comment # 51, 54, 55, 56, 57, 58, 59 Abstains - 0Against - 0Approves - 4Other Votes typosJay Motioned to accept the dispositionSecond - Jim Lynch Comment # Abstains - 0Against - 0Approves - 4Actions Jay will contact Mitra to set up ballot reconciliation HL7 call and will include Amy Nordo.Jay will contact Jenny Steve CIC to follow up on questions about several proposed dispositions.Jay will check with Are there substantive changes that will require another ballot?HL7 Clinical Interoperability Council CIC – CCRF (Registry Project) Location: Madrid/ Marseilles Conference Date: 2017-05-010Time: Q3 | 02:45-4:00 pm Facilitator Russ Leftwich Note taker(s) Amy Nordo and Anita WaldenAttendee Name Affiliation See attendee list Quorum Requirements Met: (yes/No) YesRegistry DiscussionBelgium PresentationHealthdata.be“Only Once” Belgium – Second Use DataGoals:Clearly defined business process for setting up a registry Catelogue – of data definitionsTranslates definitions into interfaces.Open SourceHow did you start? A Insurance organization initiated the project and started with 40 registriesUsed DCM and created a concept (building blocks) based on the CCR (CCD).How much is available in CCD…mapped Registries to clinical 42 building blocks. 2/3 were in the CCD. Others may be research specific.No solution for the 1/3 of the items that don’t map to CCD.Three Project Phases Map existing registries to CBBAdjust questions to CCB StructureCBB-Based RegistriesCBB may be similar to DAMInterfacing with CBBUse API (Simple Rest) XML Message – Belgium standardQuery Interface for each registry based on rolesRegistry DAM Ballot UpdateMost of the voters voted affirmative.Only 2 Negative votesReview of the Use Cases, Sequence Diagram and the DAMFlush out data flows Common across registries.How to enable add the registry of the future to this Model – Argunut has examples. Start to envision the future.How to set up validation to make sure it is complete and accurate before it is submitted to the Registry.Next Steps:Identifier (Inner circle)Make Life simple …Conform to a common interface for pulling dataNo common models yetMaybe a subscription service for each registryThere are 167+ US Registries, where to start to facilitate interoperabilityThose who are not getting dataMeaningful useNeed to have this worked out before July 12th in time for the CIIC meeting Vendors get them aligned on a common processMeeting InformationHL7 Clinical Interoperability Council Themes Meeting Minutes Location: Madrid/ Altea Conference Room Date: 2017-05-09Time: Q4 | 16:30-18:00 pm CEST Facilitator Anita Walden Note taker(s) Amy Nordo AttendeeNameAffiliation.X. Amy NordoDuke University .X. Anita WaldenUniversity of Arkansas Medical Sciences.XAbdul Malik ShakirHi3 SolutionsQuorum Requirements Met: (yes/No) NoSuggestions/Additions to Agenda: NoneApprove Minutes: None to approve Discussion on agenda topic 1; Ballot comments reconciliation: “A list of permitted values should be provided. This occurs multiple times within the domain.”(AMS comment numbers# 1- 6)If voting on ballot reconciliation item: Motion to accept AMS comment numbered #1-6 as persuasive and adjust the DAM to have a list of permitted values. Agenda business is ballot reconciliation? Yes Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheet“Element name should be organizational role. A list of permitted values should be available.” (AMS comment numbers# 7)If voting on ballot reconciliation item: Motion to accept AMS comment numbered #7 as persuasive and adjust the DAM to have a list of permitted values. Agenda business is ballot reconciliation? Yes Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetDo you mean EHR (MR comment # 1) If voting on ballot reconciliation item: Motion to accept MR comment numbered #1 as persuasive with modification and adjust the DAM to specify the Medical Record to include digital and non-digital records. Discussion: Not all medical record systems are electronic and in addition not all data is documented electronicallyAgenda business is ballot reconciliation? Yes Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetUse the term EhR and the ISO definition (MR comment #2) If voting on ballot reconciliation item: Discussion: This reference is to a single medical record and not an EhR Agenda business is ballot reconciliation? Yes Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetClass diagram (MR Comment 3#)If voting on ballot reconciliation item: Discussion: This is a question. This information is in the class diagram under the exercise stress test section. It is a derived data and is denoted by a slash in front of the naming convention. Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheet(GS Comment #1) If voting on ballot reconciliation item: Discussion: Discuss the changing of the name. Would this cause confusion? Discuss: clarify that future expansion is needed. Need to defer to subject matter expert before making a determination. Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheet(GS Comment #2) If voting on ballot reconciliation item: Discussion: Examples of the discrepancies would be helpful. The PDF is the authoritative version. Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheet(GS Comment #3) If voting on ballot reconciliation item: Discussion: similar to comments from AMS Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheet(GS Comment #4) If voting on ballot reconciliation item: Discussion: Coded attributes are bound to an enumeration but we did not have any values for them. Answering comment #3 will impact this comment. Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #5If voting on ballot reconciliation item: Discussion: Medical Record is an actor not a class. There is no class called EMR. Unclear what the intention of this comment means. Discussed possible interpretations. Determined that this relates to the report.Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #6If voting on ballot reconciliation item: Discussion: agreed this needs alignmentBallot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #7If voting on ballot reconciliation item: Discussion: It is a device and the model has it as such. It doesn’t appear on the class diagram. Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #8If voting on ballot reconciliation item: Discussion: Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #9 If voting on ballot reconciliation item: Discussion: Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #10 If voting on ballot reconciliation item: Discussion: Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #11 If voting on ballot reconciliation item: Discussion: Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #12 If voting on ballot reconciliation item: Discussion: Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #13 If voting on ballot reconciliation item: Discussion: Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #14 If voting on ballot reconciliation item: Discussion: Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #15If voting on ballot reconciliation item: Discussion: This is persuasive and will need permitted values. Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #16If voting on ballot reconciliation item: Discussion: Yes to all. That is the main objective of the project. Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #17 If voting on ballot reconciliation item: Discussion: They are semantic. Possibly this refers to concept classes. They will be removed from the model. Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetGS Comment #18 If voting on ballot reconciliation item: Discussion: Agreed. Ballot reconciliation posted to ballot desktop? Yes Vote on Motion: Unable to vote because lacking quorum. Disposition motion documented in the spreadsheetAdditional comments still to be reviewed. Adjourned 18:05 pm> CEST. Meeting OutcomesActions (Include Owner, Action Item, and due date) . Anita and AM will review the remaining comments with the SMEs. Next Meeting/Preliminary Agenda Items. Meeting InformationHL7 Clinical Interoperability Council CIMI and CIC Meeting Minutes Location: Madrid/ Frankfort Conference Room Date: 2017-05-10Time: Q2 | 12:00-13:30 pm CEST> Facilitator Anita Walden Note taker(s) Amy Nordo Attendee:see attachement Name Affiliation .XAmy NordoDuke University .XAnita WaldenUniversity of Arkansas Medical SciencesXRachel RichessonDuke UniversityXAbdul Malik ShakirHi3SolutionsXJay Lyle JPSysXSusan Matney IntermountainXStan Huff Intermountain XRichard EsmondPenRadXChris HoeftAS NTDBXSteve Hufnagel FHAXMark KramerMitreXGalen MulrooneyVHAXMichael VanDer Zel UMCGXDaniel VreemanRegenstrief Institute XPlease refer to the scanned version for handwritten attendees. Quorum Requirements Met: (yes/No) YesSuggestions/Additions to AgendaApprove Minutes: None needed Discussion DAM to CIMI ModelDevelopment of new data points into the EHRCIMI will send slides that are being sharedJuly 13, 2017 at NIH in Washington DC –Clinical Information Interoperability Council MeetingThis meeting was attempted in the past but it did not move forward. HL7 and HLPC are sponsoring this meeting. But many other groups are invited. Trying to engage the clinical experts. Frist meeting intended to get buy in from leadership. No modeling will be done at this meeting. Identify problem and gain agreement that this is the problem. Set priorities. (See slides for more accurate goals of the meeting)Interoperable App Development Process CIMI and CIC both have projects that require input from the other group See slides for diagram Using SOLOR terminology server Could this be used to inform CCD as well as FHIR? Yes Discussed Assertion examples See conclusion slide for proposed process to develop from DAM to FHIR What if the item isn’t in LOINC or SNOWMED? CIMI has had experience with this. It could be put in the extensions. Is this clinical concepts or non-clinical concepts? Discussion on whether non-clinical concepts should be captured. LOINC is interested in capturing anything that is clinically useful. Is the syntax expandable to collect metadata? i.e. to capture the source of the data- patient reported, outpatient….Yes this can be captured. Some assumptions are captured. How do we go from the DAM to what is a data element? Discussed optional solutions. Underlying principle in CIMI is to do the most post coordinated. Time points would that be a CIMI model or LOINC code? That is a rule that derives the time value. The system calculates the result. Dive deep into an example of how to make O2 uptake as expressed in THEMES DAM into a CIMI model. Review an example that is pending from Intermountain Health. Additional questions remain but the time allotted is complete. Next steps: next meeting walk through the process from CIMI to FHIR. Need more information for investigators to show them how the process works from DAM to CIMI to FHIR/CCD. Susan is the CIMI facilitator. Can we assign the CIMI facilitator to a CIC project to assist with the process? Discussed tools available. Adjourned 13:30 pm CEST Meeting OutcomesActions (Include Owner, Action Item, and due date) . Anita Walden to schedule meeting in San Diego on Wednesday Q2. Next Meeting/Preliminary Agenda ItemsCIMI to FHIR process. Meeting InformationHL7 Clinical Interoperability Council Registry Meeting Minutes Location: Madrid/ Frankfurt Conference Room Date: 2017-05-10Time: Q3 | 14:45-hh:mm pm CEST> Facilitator Anita Walden Note taker(s) Amy Nordo Attendee Name Affiliation See scanned sign in sheet Quorum Requirements Met: (yes/No) YESSuggestions/Additions to Agenda: Agenda reviewed. Approve Minutes: None needed Start with an Overview of the work being done with Registry in CIC: Common Clinical Registry Framework (CCRF)Review of purpose: see slides Discussed secondary use of Ehr data Discussed growth of registries in US based on government incentiveReview use cases Discussed the variabilities of registries with in the US and NetherlandsGoal is to establish the interoperability framework for Registries Introduced DAM model project Introduced CCRF white paper – available on the Wiki. Comments are appreciated. This is a working draft. Initial ballot of Registry DAM this May. This will most likely be reballoted. Presentation by Guest Speaker from Belgium: Marten Landuyt See slides “Only once” conceptHealthdata.be is Open source and available on the web Live with 20 registries, goal is >100 Question: Information architecture- how has that evolved? See next section of presentation for responseQuestion: For the different registries is there overlap of data elements? There is overlap between different registries. This has been standardized. Question: Around the scope of the project and how it progressed. Initial scope was a limited set of registries. See slides on Information Architecture Question: Where does the 1/3 of the data go? No solution at this moment. Manual or CSV files can be used. Question is the CBBs? It is a mapping that is happening in the middleware. Question CBB is similar to the CCR. How does this DAM relate to these clinical building blocks? This is the next conversation. Question Do you have query interface that can pull data from multiple registries? There is a dedicated reporting warehouse that is SAS based and allows to query across multiple data environments. The permission to pull this data is more of the concern. The technical capability exists. What if data element changes and how can you track the version? If the mapping remains the same, there will be no change. Otherwise this is something to consider going forward. Abdul Malik Shakir review the CIC DAMMost of ballot responses are affirmative158 people reviewed, only 19 abstained (87%) 2 negative votes- with comments. Each comment will be reviewed at a future CIC meeting. Definition of registry per the DAM reviewed Focused on behavior that are common among registries by identifying use cases. Review of DAM (projected for visualization during the meeting)Next step is to look at the observations. Suggested to use the CMS common data set. Discussion about the shared data elements. Registries have not shared their individual data points. AHRQ has a list of registries as we do not know the number of all the registries. Start from key quality for meaningful use is one option. Making a conformed way to make it easier for sites to share data and a single way to share data back to the registry owner. Next step per Russ is how do we enable the registry of the future? Registry of the future won’t be a submission it will be a query. Discussion about the need to validate data before it is submitted.Discuss data use agreement model need. Discuss Duke RADaptor project with American College of Cardiology (ACC) Additional discussion necessary. Adjourned 16:15 pm CEST Meeting OutcomesActions (Include Owner, Action Item, and due date) . Next Meeting/Preliminary Agenda Items. Next week but Anita is not available for the call. If one person could volunteer the conversation on the absence. Laura volunteered to facilitate. HL7 Clinical Interoperability Council CIC – Education Discussion Location: MadridDate: 2017-05-11Time: Q2 |Facilitator Anita Walden/ Diego KaminkerNote taker(s) See Education committee notes Attendee Name Affiliation See attendee list Quorum Requirements Met: (yes/No) YesEducation Q2 ThursdayCourse OfferingsClinicians on FHIRHow to be a Smart HL7 Consumer of EMR SystemsDiscussion – Which Options Option 3 – Talkathon. Bring a bunch of clinicians. Think of a new world where I can do whatever I want. What I would do? What do I need. A Fresh Look from the other side.CEUs, CME’s with Duke.Meeting Q2 Thursday – In San Diego. Discussion : Which options of tutorialsOption 1 : Introduced by Virginia Lorenzi, presented by DKOption 2 : Idea by Amir, presented by DKOption 3 : Clinician Talkathon, presented by Dr Ed.W.Hammond OPTION 1 (Virginia Lorenzi’s Plan – modified by the joint WG) Lecture 1: The Case for Interoperability with HL7 – This class will present the use cases for interoperability with real-world healthcare scenarios. It will then explain why solving interoperability problems with HL7 standards-based solutions is so critical. Introduce what Interop is about. A broader view of stakeholders, issues involved, semantics, definitions of common terms.Lecture 2: An Introduction to HL7’s primary standards Focus on case studies. Present 1-5 case studies involving more than one institution, using different standards, including challenges and how to overcome them or not.Cover Data Standards: FHIR / SMART ON FHIR / FHIR IGs, CDS-Hooks, CCD, HL7 V2 MUCDS-hooks Clinical Decision SupportPatient Portal AppManaging Your Patients’ HealthThe Olympics. Disaster ManagementThese lectures will provide high level introductions to the problems at hand, the challenges, and which primary standards were used, It should then cover V2, CDA, FHIR, Standards used in EHR communication (ADT, orders, results, public health, CCDA, and info-button). (Fernando) For one case, follow one case from beginning to end : 1) radiology order (v2), 2) , Identify problem (FHIR terminology server), etcLecture 3: Be a savvy customer of HL7 interoperability solutions. Know the opportunities and limitations. This class uses common real-world problems caused by lack of interoperability and then discusses approaches to implementation including opportunities and limitations of the technologies. You will be more prepared to ask effectively for robust interoperability solutions. Lecture 4: The clinician’s role in solving interoperability problems While vendors and IT professionals are able to develop, install, and configure systems, they often miss a critical factor needed for success – you. You understand your workflow and your problems. You know the data and how it might need to be mapped and translated. And most importantly, you understand the vision. Successful interoperability requires integrating and improving your clinical workflows. This class will describe this process and how to work effectively with the technologists to get this done.Lecture 5: HL7 interoperability projectsThis class will describe the steps involved in implementing interoperability from requirements analysis to building to testing to training to production cut over. It will also describe how to be prepared for disruptions in interoperability and what to do when problems occur. Learn how to oversee or ensure that an interoperability project is executed following best practices and how to cope with and minimize production issues when they occur.Lecture 6 - Hands-On FHIR Workshop for Healthcare Providers(David Hay - Clinfhir)This workshop will provide an overview of HL7’s fastest moving standard for interoperability called Fast Healthcare Interoperability Resources or FHIR. Many developers are learning FHIR through hands-on coding experiences called FHIR Connect-a-thons. This class provides a similar opportunity for non-technical professionals a hands-on learning experience that exposes the technology without requiring programming. Clinicians and other non-technical professionals will use a hands-on tool to build test cases of patients, medication lists, care plans, and laboratory results using the FHIR standards. Students will be able to envision how FHIR can be used to solve their interoperability problems.OPTION 2 (Dr. Amir Mehrkar - NHS) The ‘Don?t BS me course’6 twenty minutes video for clinicians covering from the inception of the idea to the implementation on how to be a savvy interop consumer.Action Items for Options 1 and 2(DK) Send the details to Virginia and Amir(Virginia/Amir) Identify potential speakers / content developers. Volunteer teaching?(Sharon) Oversee content (style, tooling, etc.), manage speakers and content developers.(Ed W Hammond) Confirm that this will be freely available - free webinars!OPTION 3 (Dr. Hammond’s Plan)Talkathon. Bring a bunch of clinicians.Think of a new world where I can do whatever I want.What I would do? What do I need?A fresh look from the other side.Action Item: For Melissa and Ed to follow up with this idea. ................
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