Minutes, SDTC Conference Call, Friday, December 07, 2001
The call was convened at noon am eastern standard time.
Attending: Liora Alschuler, Bob Dolin, Rich Mushlin, Sandy Boyer, Fred Behlen
Future meeting times
Tuesday, Dec. 18, noon eastern
Agenda:
1. How to express requirements for CDA?
At the request of Rich Mushlin from IBM, we discussed the steps required to express and to execute requirements
for a clinical document within the CDA. Rich’s specific area of interestis protein/DNA sequences. Bob explained
that with the ORU/OBX framework developed for Version 2 (messaging), any observation can be expressed and
sent. The ORU/OBX construct includes the type of observation, value and for RIM-derived observations, the RIM
observation class. He noted that these cannot be constrained in an XML schema.
Rich noted that position, “nesting structure (containment)” also required. Bob responded that with Act_relationship
it is possible to nest observations.
The question of whether to use Act_relationship or nested document sections is not resolved.
Rich said that he needed clarification on which parts of the specification he would need to supply, which would be
hand-crafted and which would be supplied by the methodology.
Bob outlined this procedure: articulate requirements; see if met within current RIM; if Yes, build Refined Message
Inf Model (RMIM); if No, then express as item for RIM harmonization.
Rich needs to determine if the vocabulary he needs is already in the RIM. There are several potential vocabularies
including Lab Book, Biological Sequence Markup Language.
Rich will post a sample of the type of documents he is working on.
2. Funding work of the SDTC
Bob reported on the discussion the Board call on Monday, 12/3/01. He reported that the Board was willing to look at
a proposal and that funds required for certain key actiivities might get direct Board funding, other activiites would
be supported if outside funding available. The specific types of activities that need support are:
 translation of requirements to “RIM-speak”
 creation of a template architecture
 XML expertise
 travel to brign committee members to meetings, tutorials, to acquire skills needed to build RMIMs, HMDs,
CMETs. Such training would be predicated on a promise of work delivered
 Solicit requirements from domain experts
 Create training and documentation for specifications
Liora and Bob will continue to work a a specific proposal to put in front of the Board at the January meeting.
3. CDA Body RMIM
Bob posted the result of his initial attempt to create a CDA RMIM that would form the basis for a derived CDA
body. The RMIM and a summary of issues he identified is in the email of 11/21/01.
Bob provided a walk-through of the RMIM, starting with a small tutorial on the basic RIM classes.
Act class specializes to Observation, Procedure, Medication administration as well as to Patient encounter and
financial management.
Each Act is associated with people or things (Entity, which can be people, device,m pill, place…)
In RIM diagrams, Entity (person) is green; plays a Role (Patient, father, …) yellow; and has a Participation (of
record, primary surgeon…) blue; in an Act, which is pink.
Each of these four classes (Act, Entity, Role, Participation) has attributes which include ocde, type code which can
be constrained by constraining the code. Thus, an Act can be constrained to an appendectomy. This fosters a high
degree of dependence on vocabulary to constrain the model.
To build a specification, an RMIM is created which is the source of the implementable XML. The RMIM can have
specific values of type codes. Classes can be cloned for the RMIM. Example: Act (a) w/type code = foo; Act (b)
w/type code = bar. Thus an RMIM can have multiple specializations.
Act_relationship (light pink) defines the relationship between acts. Act also specializes to Act_context. There is a
special association from Act to Act_context. All CDA classes are specializations of Act_context.
4. Creating an RMIM for DICOM Structured Reporting
Fred will attempt to do so using Bob’s Visios as a model. The question was raised: how to model DICOM Template
2000? Fred will bring sample diagrams to San Diego for discussion.
5. Next meeting: December 18, 2001, noon eastern time.
 Please review the draft R-MIM posted by Bob.
 We will invite Mike and Stephen from New Zealand to explain their project and how CDA might meet their
requirements.
 We will continue our discussion of Amnon’s proposal for two stage validation of CDA level Two/Three
documents.
 Liora will give a brief report on XML ’01, particularly the issue of validation in various schema languages.
 We will discuss the Clinical LOINC report supplied by Calvin.
 Next meetings: we will make a time for another teleconference or will set our agenda for San Diego
The meeting was adjourned at 11:45 eastern.
Open Issues/Action Items:
1. Revisions to Level 1
schema: normative for next release; informative for existing (just post)
data types DTD :: after close of ballot, check and note issues
technical corrections, as needed
families of documents
2. Non-clinical document types. Use cases for the Pan-Canadian Client Registry Specification (Shari, Michael) and
other non-clinical document types (Dale, Mark)
3. Statement on implementation of digital sig/witness: LA to follow work within CQ
4. Followup with Clinical LOINC on document ontology: Calvin
5. Calvin offered to suggest ways in which the documents could conform more closely to the Level One CDA and
he will post his comments to the list prior to next week’s call. (Calvin)
6. Funding SDTC activitities
7. Rich to post sample sequencing/DNA document