esMD AoR L2 Harmonization Community Meeting
Date of Meeting: November 6, 2013 / 10:00am EDT
Decisions
Leadership in Attendance
Name
Organization
Attendance
Status
Bob Dieterle
EnableCare
R
P
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
P
Joy Sam
CMS/OFM/PCG
O
X
Mark Pilley
Strategic Health Solutions
R
P
Viet Nguyen
Systems Made Simple
R
X
Sweta Ladwa
ESAC
R
P
Zachary May
ESAC
R
P
Vaishnavi Rao
ESAC
R
X
Bob Yencha
RTY LLC
O
P
Tamiko Wilson-Coe
CMS/OFM/PCG
O
X
Johnathan Coleman
Security Risk Solutions
O
X

The leads discussed the negative CDA R2 IG ballot comments with the community.
An overview of the comments discussed and proposed dispositions are outlined in
the table below:
Contributor
Rita Scichilone on behalf of
Diana Warner
Comment
Table 4.2 Signature Policy- Specify
when this may be used
Lisa Nelson
How is the vocabulary established for
the SignerRole, ClaimedRoles, and
CertifiedRoles? How does it align
with the vocabulary established for
role codes in the C-CDA?
Lisa Nelson
What are the assumptions around
Disposition
Proposed Persuasive with Modclarify that these are policy issues and
out of scope for this guide.
Persuasive with Mod- We clarify
SignerRole/ClaimedRoles/Certified
Roles in the document signature data
set, which expand to 5 signer roles
(ClaimedRoles) and 5
SignaturePurpose.
Persuasive with Mod.
registration authority?
When digitally signing a CDA
document, the Digest of the Signed
Data Object is the entire document
contents starting with and excluding
clinical documents with all
occurrences. Can you explain why you
are proposing to exclude all
occurrences (tags for authenticator and
legal authenticator)?
Figure 3-1: Why wouldn’t this
diagram with the other process
descriptions for the alternate Use Case
where delegation of rights is needed?
How do co-signatures and counter
signatures play into section 3.30?
If someone receives a signed
document, how do they know who the
original authenticators and legal
authenticators are?
Suggest providing link to the product
brief when C-CDA R2 is published.
Lisa Nelson
Lisa Nelson
Lisa Nelson
Lisa Nelson
Bob Dolin
Persuasive with Mod.
Persuasive with Mod. (Defer to
11/20).
Persuasive with Mod. (Defer to
11/20).
Reviewed and Accepted
Persuasive with Mod. (Link will be
posted to the HL7 site).
Brett Marquard
Section 1.2.1- Strike or add additional
references.
Persuasive with Mod- Delete
Statement
Brett Marquard
Please update the HL7 Keywords- See
Volume 1 of C-CDA.
Brett Marquard
The digital signature goes after the
signature code and Sdtc. Signature
text in the C-CDA ballot.
Specify when the signature policy
implied is used.
Persuasive with Mod. - Zach and Bob
Y. will harmonize this with the CCDA document.
Persuasive
Rita Scichilone on behalf of
Diana Warner
Persuasive with Mod. – (Reference
back to item 2).

The leads specified that an authorized signer is authorized to affix a digital
signature to a clinical document. Lisa Nelson suggested clarifying that the
authorized signer (by policy) is an author and has the author participation declared
in the header.

Bob D. will e-mail Lisa Nelson the proposed wording for SignerRoles for
review and she will send it back to Bob D. with alternative wording.

Lester Keepper asked if the ClaimRole depends upon the signer. Bob D. clarified
that it does depend upon the signer since we are enforcing a CertifiedRole.

The leads discussed John Moerke’s ballot comments and specified the alternative
wording for ClaimRole/SignerRole.

Zach clarified if the role of the CertifiedRole is foreclosed (because when the
SignerRole is indicated within the actual tag, either a ClaimRole or CertifiedRole
has to be used and since we made CertifiedRole optional, we need to further clarify
this to avoid confusion).
Action Items
Name
Bob D.
Subject
C-CDA R2
IG Ballot
Comments
Task
E-mail Lisa Nelson the proposed wording for
SignerRoles and she will review it and send it
back to Bob D. with alternative wording.
Due Date
11/06