eDoC Workgroup & Additional Attachment Templates IG for HL7 Community Meeting
Date of Meeting: December 4, 2013 / 1:00pm EDT
Decisions
Leadership in Attendance
Name
Organization
Attendance
Status
Bob Dieterle
EnableCare
R
Dan Kalwa
CMS/OFM/PCG
R
P
Alcia Williams
CMS/OFM/PCG
R
X
Mike Handrigan
CMS/OFM/PCG
R
X
Kathy Wallace
CMS/OFM/PCG
R
X
Joyce Davis
CMS/OFM/PCG
O
X
Joy Sam
CMS/OFM/PCG
O
X
Mark Pilley
Strategic Health Solutions
R
P
Viet Nguyen
Systems Made Simple
R
P
Sweta Ladwa
ESAC
R
P
Zachary May
ESAC
R
X
Vaishnavi Rao
ESAC
R
P
Bob Yencha
RTY LLC
O
X
Tamiko Wilson-Coe
CMS/OFM/PCG
O
X
Johnathan Coleman
Security Risk Solutions
O
X
LLP User Story

Sweta discussed the LLP User Story E2E review comments submitted by Keith Salzman
with the community for input.

Sweta will post the updated version of the LLP User Story with all the E2E review
comments integrated within the document by 12/5. The User Story will be available
for consensus from 12/5-12/16. The round robin consensus process will be conducted
during the eDoC WG & SD SWG community meeting on 12/18. Only esMD committed
members can provide consensus for the LLP User Story. Community members can sign
up to become a committed esMD member through the esMD Wiki.
Additional Attachment Templates IG for HL7

Bob D. presented background information regarding the need for the Additional
Attachment Templates IG for HL7.

The leads specified that electronic signatures do not provide non-repudiation signatures
and hence digital signatures have several constraints. The overall goal is to migrate from
unstructured data (i.e., PDF) to structured data so that CDA and C-CDA’s can be
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produced. We want to create an environment in which an individual can refer to a third
party for validating a signature within a clinical document.

When a clinical document is signed and its contents have been attested to, the signature
that is a part of the document will exist on the document until the document no longer has
validity. In the current CDA document structure, the CDA header contains a signature
text element where all the artifacts of a digital signature and its delegation of rights are
stored. When a CDA is signed, a digest is created and the digest creates a more concise
and consolidated version of the clinical document.

The CDA signature and validation process serves multiple purposes: 1) To ensure that a
received document is signed and sent without any alterations 2) To ensure that the sender
has signed it and only the receiver’s public key can decrypt the signed digest 3) To ensure
the authenticity of the signer.

The benefit of using a digital signature process is using a non-repudiation signature
which will allow for the verification and integrity of a signed clinical document. We are
trying to provide an electronic vehicle that functions within the CDA by providing homes
for structured information through document types.

The AAT C-CDA R2 sections and entries spreadsheet outlines 5 new document types
which include every section that applies to each document type (for a single F2F
encounter).

There are 4 new constrained sections that can contain additional documents that are not
already specified within the C-CDA R2. The 4 new defined sections are: 1) Additional
Documentation Section 2) Externally Defined CDE Section 3) Orders Placed Section 4)
Transportation Section.
Action Items
Name
Sweta
Subject
Task
Post the updated version of the LLP User Story
LLP User Story with all the E2E review comments integrated within
the document,
Due Date
12/4