Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
IT-014 Health Informatics Committee
Executive Summary
HL7 Working Group Meeting
9th - 14th September, 2012 (Baltimore, USA)
Version: FINAL 1.0
Date Issued: 11/10/12
Lead Author: Dr Patricia Williams
Collated by: Standards Australia
With input from Australian Delegation and other employer funded Australians at the meeting:
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Dr Trish Williams, Ph.D. (Delegate and Report Coordinator)
Heather Grain (Delegate)
Richard Dixon Hughes (Delegate)
Dr Hugh Leslie, MB BS, FRACGP, FACHI (Delegate)
Dr David Rowed, MB BS, BEng, FRACGP (Delegate)
Dr Vincent McCauley, MB BS, Ph.D. (Delegate)
Nat Wong (Delegate)
Amy Mayer (Mentored Position Delegate)
Dr Andy Bond (NEHTA) Ph.D.
Dr Stephen Chu (NEHTA)MB ChB, Ph.D.
Vin Sekar (NEHTA)
Meya Achdiat (Standards Australia)
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
TABLE OF CONTENTS
1.
Introduction ......................................................................................................................... 3
2.
Objectives of the Meeting ................................................................................................... 3
2.1.
Relevance to NEHTA programs........................................................................................ 5
3.
Meeting Logistics ................................................................................................................. 5
4.
Recommendations Arising from the Meeting ..................................................................... 9
5.
Funding Sources Summary and Australian Attendance .................................................... 25
6.
Australian Leadership Positions ........................................................................................ 26
7.
Acronym List ...................................................................................................................... 27
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Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
1. INTRODUCTION
HL7 is an international organisation with its origins in the USA, and an expanding
group of international users participating in its standards development processes. HL7
provides international standards for inter-system and inter-organisation messaging,
decision support, clinical text documents mark-up, user interface integration, EHR/PHR
systems functionality as well as for a health data model and message development
methodology. It produces global health informatics standards through a process of
collaboration, which involves its local affiliate, HL7 Australia.
HL7 International Working Group Meetings (WGMs) are held three times per year at
varying locations. These WGMs serve two important purposes: giving the HL7
International work groups a chance to meet face-to-face to work on standards, as well
as the opportunity to network with industry leaders from around the world; and
providing an invaluable educational resource for the healthcare IT community.
HL7 standards are the dominant health-messaging standards in the USA, Canada,
Germany, Holland, Finland, Japan, Korea, Taiwan, New Zealand, and Australia, and
are being adopted as health-messaging standards by many other countries.
The September 2012 HL7 International Plenary and Working Group Meeting was held
in Baltimore, Maryland, USA, with activities scheduled over 6.5 days. There were 507
attendees at this meeting.
The main activities ran from Sunday, 9 September to Friday, 14 September, 2012. On
weekdays formal meetings were scheduled from 9am to 5pm; however, some
meetings were scheduled from 7am and ran as late as 10pm. Over the last nine
months, HL7 has been examining its priorities and principles. This period has seen
significant changes and growth and has culminated in the announcement of HL7 free
access to Intellectual Property (IP)1. This meeting welcomed the new membership
‘caregivers’ category and saw the Mobile Health Work Group, established in May,
realise more interest and engagement with the community. The plenary session that
focused on “HL7 in the Era of Patient Empowerment” was held on Monday, 10
September and is reported on separately in the HL7 September Final Report.
It should be noted that the HL7 International standards work is not structured as "Work
Items" that are put forward to the HL7 body for approval; rather, most projects arise
from the work within the many domain specific and specialist committees. However,
these proposed projects need to be well-defined and documented and require approval
by the relevant Steering Division and the Technical Steering Committee to ensure
appropriate internal (HL7) and external (international standards development
organisations) harmonisation.
This report summarises the committee proceedings, issues and actions for
consideration by Australia arising from this HL7 International Standards and Education
Meeting.
2. OBJECTIVES OF THE MEETING
HL7 meetings are true working meetings, not conferences, with many experts and
individual groups meeting to develop, discuss and improve HL7 standards, processes
and implementation guides and to determine the most effective way to meet the needs
1
Further information can be found in the HL7 September Final Report.
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Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
of the stakeholders – both those present at the meeting and those in the wider
community of interest. While HL7 engagement with stakeholders in other forums is
also strong (through regular, often weekly, teleconferences), the ability to influence the
work program, outcomes and strategic direction requires physical presence at working
group meetings.
The overarching objectives of HL7 meetings are to benefit the Australian health system
and wider community by:

Improving Australian capacity to implement health informatics standards and ehealth systems, through expanding local knowledge and expertise based on
international best practice;

Promoting free trade and its benefits to health ICT, by lowering the cost of
integrating and implementing local health information systems, many of which
are imported, and by reducing costs to Australian exporters; both of these
outcomes require Australian requirements to be embedded in global standards
so that they can be adopted in Australia, rather than having different standards
across domestic and international markets; and

Improving Australian health information systems by facilitating a standardsbased approach to development and implementation, and achieving
interoperability between systems.
Other more specific objectives for Australian
standardisation via HL7 International include:
engagement
in
international

Monitoring and influencing HL7’s strategic positioning as a global SDO,
encouraging its collaboration with other international and global SDOs and
assessing and contributing to the strategic positioning of its key products (HL7
V2.x, V3, CDA, EHR, etc.) so as to encompass Australia’s health information
interchange and related requirements.

Negotiating the inclusion of Australian healthcare messaging requirements into
HL7 V2.8, CDA and V3 specifications for:

Patient administration;

Diagnostics (pathology, radiology); and

Collaborative care initiatives, such as, but not limited to, e-discharge
and e-referral, so that Australian requirements become a formal part of
these Standards.

Negotiating the inclusion of Australian health sector requirements in the HL7
Standards so that Australian EHR developments are supported by the
upcoming HL7 and related ISO EHR Standards.

Negotiating the harmonisation of ISO, HL7, CEN and other established
standards development organisations (SDO) to achieve progressive inter-SDO
e-health standards, with the long-term goal of a unified set of global health
informatics standards.

Monitoring, and influencing as necessary, new initiatives for standardising
clinical data content so as to improve Australia’s ability to unambiguously and
safely exchange semantically interoperable clinical data.
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Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)

Assessing and influencing HL7’s work on service oriented architectures (SOA),
as required by Australia’s national direction setting, and negotiating the
inclusion of Australian health sector requirements (in particular, those described
by NEHTA) into service specifications being jointly developed by HL7.

Assessing and influencing the positioning, development, implementation, utility
and effectiveness of CDA (including CDA Release 3), to support Australia’s
interest in CDA in its national eHealth program.

Assessing, exploring and proposing approaches to the embedding and
transportation of archetypes in HL7 V2.x messages for referral, diagnostic
results and collaborative care to support Australian interest in the use of
archetypes for the exchange of clinical information.

Progressing the international harmonisation of common data types and
vocabulary for healthcare information that will meet Australia’s identified
requirements.
Additional Australian interests may be pursued opportunistically as and where formally
agreed upon by the community, Standards Australia and the Department of Health and
Aging (DoHA). Additional specific objectives may arise from time to time as a result of
the development of Australia’s national eHealth agenda and other national interests.
2.1
RELEVANCE TO NEHTA PROGRAMS
NEHTA has endorsed a range of Australian Standards derived from international
standards work by including them in the National e-Health Standards Catalogue. As
the implementation of NEHTA’s domain-specific initiatives are based on many of
these standards, it is important that Australia continues to be involved in the
international forums that develop, manage and maintain these, and other potentially
relevant, health informatics standards.
3. MEETING LOGISTICS
The table below shows the meeting schedule for all of the meeting groups. Most USA
based meetings have more than 60 separate working groups and committee meetings.
In addition to the working groups listed, members also attended tutorials and project
specific workshops.
The Australian delegation is denoted as follows in the table below:
AB – Andy Bond
HG - Heather Grain
SC – Stephen Chu
AM – Amy Mayer
MA- Meya Achdiat
TW - Trish Williams
DR - David Rowed
NW - Nat Wong
VM - Vince McCauley
HL - Hugh Leslie
RDH - Richard Dixon Hughes
VS – Vin Sekar
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Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Working Group
Sat
Affiliate Due Diligence
Committee
Ambassador Presentation
Anatomic Pathology
Architecture Review Board (ArB)
Arden Syntax
Board of Directors’ Meeting
Sun
Mon
Tue
AB
AB
DR
RDH,
MA
Clinical Decision Support
HL7/OMG Joint Meeting
Health Care Devices
Imaging Integration
Implementation Technology
Specification
Infrastructure and Messaging
International Council & Affiliate
Chairs
AB
AM,
DR,
MA
SC
TW,
VM
HL,
RDH,
TW,
VM
TW
VM
Electronic Health Records
Fresh Look Taskforce
Governance & Operations
GS1 Education Session
HL7 Activities with other SDOs
Fri
HL
Community Based Collaborative
Care
Conformance and Guidance for
Implementation/Testing
Detailed Clinical Models
Education (&marketing)
FHIR Project
Thu
DR
AM,
DR
Clinical Genomics
Clinical Interoperability Council
Clinical Statement
Co-Chair Information Session
Electronic Services
Emergency Care
FHIR Connectathon
Wed
RDH
HG
HL
HG
HL
HG
HL
AM,
NW,
RDH
AM
AM,
TW,
SC
HL
HG,
NW
RDH,
MA
NW
SC,
VS
DR
DR
VM,
VS
VS
RDH
NW
NW
MA
RDH,
TW,
MA
VM
VS
VM
VM
AM,
DR,
HL,
NW,
RDH,
TW,
VM,
HG,
MA,
VS,
SC
RDH
International Membership &
Affiliation Taskforce
RDH
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Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Working Group
Joint Initiative Council (JIC)
liaison
Marketing
Mobile Health
Sat
Sun
Mon
Thu
Fri
AB,
MA
DR
HL
RDH
AM,
TW,
VM
Orders and Observations
OO/Lab/Composite Order
Patient Administration
NW
SC
Patient Care
HL,
SC
Patient Safety
Plenary Session
SC
AM,
NW,
MA
HL,
SC
AM,
NW
HL,
SC
AM,
NW,
MA
HL,
MA,
VS,
SC
AM,
AB,
DR,
RDH,
TW,
VM,
MA,
NW,
HG
SC,
VS
Pharmacy
Physician’s Meeting
Public Health Emergency
Response
Publishing
Regulated Clinical Research
Information Management &
CDISC/BRIDG
Services Aware Interop
Architecture
Security
SC
SC
DR
SC
NW
NW
HG
NW
DR
Services Oriented Architecture
Templates
Terminfo Project / Terminology
Tooling
Vocabulary
Wed
RDH
Modelling and Methodology
(MnM)
Open Health Tools
Steering Divisions – Domain
Expert, Foundations & Tech,
Structure & Semantic, Tech
Services
Structured Documents
Tue
VM
VS
AB
TW
TW
AB,
VM
AB,
VM
VS
AM,
VS
TW,
VM
TW,
VM
TW
VS
VS,
SC
VM
HG
HG
HG
7
AM,
HG,
VM,
MA
VS
HG
VS
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Tutorials are also offered and these are of great value, both to newcomers and to older
hands, to bring them up to date on generic changes made that may not be discussed
in their individual committee areas. At this meeting 30 tutorial sessions were held
concurrently with 56 work group and task force meetings. Additionally, there were
meetings for the Ambassador Program, Co-Chairs, Board of Directors, First Time
Attendees, GS1 Education session, and HL7 Activities with other SDOs.
The number of concurrent sessions makes it difficult for a small delegation to
effectively follow all the issues and to influence change. It is noted that delegates
funded by their employer, or individually, to international meetings have no obligation
to work with or relate information back to the Australian delegation, though some have
done so in the past. It is clearly desirable that there be a cohesive Australian position.
Given the participatory natures of the HL7 committee work, it is vital that Australians
are present, and participate in the committee work. Intensive work is done in the
committees, and often two or three Australian subject matter experts are required to
get the Australian requirements into the consensus-based processes. In most cases,
preparation beforehand of "Australian positions" on the matters to be worked on is not
effective, as the discussions and views often substantially change during the
consensus-building process. Most of the work done in committee is "leading edge"
standards development work that often cannot be locally previewed, assessed and
commented on beforehand. As a result, the selection process of the funded
participants focuses on their expertise and interests as well as their ability to effectively
communicate complex technical issues and achieve the desired outcomes for Australia
in a collaborative, consensus-based committee environment.
As is customary, the Australian participants met on a daily basis to plan and monitor
their involvement, identify any additional sessions and/or activities that should be
covered and identify emerging issues, particularly those that are relevant to Standards
Australia IT-014 and/or NEHTA work plans. Australian participants also coordinate
their activities through Skype.
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Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
4. RECOMMENDATIONS ARISING FROM THE MEETING
The principal issues/actions and recommendations identified by the Australian
delegation at the September 2012 HL7 Meeting are summarised in this section. The
alignment to the IT-014 Committee Structure is also listed.
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Advisory Council
input:
Issue: Application and investigation of Fast Health Interoperability
Resource (FHIR) in the Australian context.
HL7 Australia
FHIR
Action: Discussion and investigation of the application and
development of FHIR in the Australia context.
IT-014
Action: Investigate the possibility of establishing a FHIR interest
group.
Action: Continue to monitor and contribute to the development of
FHIR resources through active participation and support of the
Patient Administration work group.
Action: Monitor the Healthcare Community Services Directory to
inform decisions about code set use.
Affiliate Due
Diligence Committee
Issue: Continuing support by HL7 Australia of the work of the ADDC
through Richard Dixon Hughes as an active member.
Action: HL7 Australia to note progress with ADDC activity at HL7
International and assist with follow up in Indo-Pacific region
where requested.
HL7 Australia
Richard Dixon
Hughes
Architecture Review
Board (ARB):
Issue: Governance of HL7 International Products and Product Lines.
Business
Architecture Model
(BAM)
Action: Monitor development of BAM so that HL7 governance of
products meets Australian requirements.
Arden Syntax:
Issue: Arden 2.9 is an extremely comprehensive standard for
knowledge representation as well as procedural processing with
workflow support and clear identification of integration points for
external applications. Its utility is not well understood across the health
informatics community.
IT-014-013
Action: Review Arden 2.9 and identify and support new
requirements for version 3.0, particularly:
- Transition from its informative to normative XML
representation; and
- Development of simplifying, task-suitable reduced sets of
Arden covering its operators as well as declarative
representations and work-flow functionality.
Other professional
colleges
Version 3.0
Action: Contribute to the new Arden Implementation Guide Project
and monitor the ‘Why Arden’ authoring.
9
NEHTA
IT-014
RACGP NSC for
eHealth
MSIA
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Arden Syntax:
Issue: Arden has capability to provide standards-based CDS as
currently needed in immunisation, Drug-Drug Interaction, (DDI) and
clinical guidelines by Australian primary care and nursing practitioners.
IT-014-013
Version 3.0
Action: Identify and engage Knowledge suppliers in high priority
areas including immunisation, DDI, pathology ordering,
therapeutic guidelines, and travel health, and encourage them to
consider Arden representation for interoperable knowledge
deployment and application workflow integration.
Arden Syntax:
Version 3.0
Issue: To date there has been inadequate input of Australian
requirements and validation of the Arden Standard against Australian
needs.
Action: Circulate and take part in ballot for version 3.0.
Arden Syntax:
Version 3.0
Issue: Arden is not aligned with the HL7 v3 RIM, although this has
often been explored. Such alignment is under consideration as is
alignment with FHIR, the latter appearing to offer more promise for
Australia, but being untested in CDS applications.
IT-014
RACGP NSC for
eHealth
Other professional
colleges
MSIA
IT-014-013
IT-014
FHIR Project Lead
(Australian)
IT-014
Action: Advocate for thorough assessment of FHIR for Arden and
CDS generally by standards working groups and the FHIR project.
HL7 Board:
Free IP
Issue: Access to HL7 IP has normally been available only to HL7
members. This has been the primary driver for many organisations and
individuals joining a local Affiliate. Free access to this HL7 IP will likely
impact Affiliate membership, and may impact on HL7 Australia’s
corporate documents and contractual relationships.
HL7 Australia
Action: HL7 Australia to analyse the impact of free IP on its
membership model.
Action: Provide a statement on the impact of this announcement
to the IT-014 community noting under which circumstances free IP
can be used.
Action: HL7 Australia to review its Governance and Operations
documents and MoUs to assess the impact of free HL7 IP.
HL7 Board (CEO
Report):
Formation of HL7
Asia
Issue: HL7 International has entered into negotiations with North Asian
countries about the formation of HL7 Asia. It is proposed that it be
based in Japan and include HL7 China, HL7 Hong Kong, HL7 Japan,
HL7 Korea and HL7 Taiwan. The North Asian countries had previously
extended to the Chair of HL7 Australia the courtesy of advising him of
their plans to do this on a local basis, and there is some interest among
the Australian, NZ and Singapore Chairs on forming an Indo-Pacific or
South East Asian grouping.
Action: HL7 Australia to note the proposed establishment of HL7
Asia, with an initial focus on North Asian affiliates, and consider
the potential for greater collaboration among affiliates in Southern
Asia and Oceania.
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HL7 Australia
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
HL7 Board:
Issue: HL7 International has announced that it will make all of its
standards and some other selected intellectual property available
without charge from early 2013. This is a significant change from the
current position where anyone using HL7 Standards in developing
systems or delivering product was required to be a paid-up member of
HL7 International or one of the affiliates. The change therefore has
potential significant impact on the business models of both HL7
International and the affiliates (including HL7 Australia). The Chair and
CEO have invited a small group of leading HL7 members to assist in
redefining HL7 International member benefits. Richard Dixon Hughes is
among that group, and will participate.
HL7 Australia and
Standards Australia
Making standards
and other IP available
without charge
Action: HL7 Australia is aware of the change and has publicly
supported it. The sub-licensing arrangement between Standards
Australia (SA) and HL7 Australia for use of parts of HL7
intellectual property in SA publications still requires action.
CDS:
Clinical System
capabilities to enable
Services Oriented
CDS operation
Action: Richard Dixon Hughes to participate in HL7 International's
Membership Task Force, advising HL7 Board on restructure of
member benefits following HL7 decision to make its standards
available without charge.
Richard Dixon
Hughes (in
progress)
Issue: CDS deployments must work-in with point of care systems both
at the levels of standardised data interchange and the more difficult
area of workflow integration. The CDS WG has researched and
identified the key services and capabilities of clinical information
systems to enable this deployment. This is in the form of a paper for
presentation at American Informatics Association (AMIA) and not yet a
HL7 publication. It needs to be a HL7 product.
IT-014-13
MSIA
Action: Support and facilitate the development of this work as a
HL7 publication, preferably a DSTU. Circulate the current WG’s
paper to the Australian CDS community where it aligns with one of
the proposed IT-014-13 projects that it will facilitate.
CDS:
Current standards for
Order Sets, vMR and
Infobutton
Issue: These standards are in varying stages of development
(normative and DSTU in later releases). They are ready for purpose
and adoption by implementers but need to be better understood and
assessed for different purposes.
IT-014-13
Action: Monitor uptake and further work. Consider comparatively
in the CDS implementation Guide project and the related IT-014-13
project proposal.
CDS:
Issue: Coordination with existing HL7 publications and ISO work items.
Harmonisation with
HL7 Standards and
ISO work items
Action: Identify how this harmonisation is to occur and who has
responsibility.
CDS:
Issue: To identify and harmonise standards that facilitate the
emergence of systems and services whereby sharable CDS
interventions can be implemented.
Health e-decision
Standards and
Interoperability
Framework Initiative
Action: Monitor this project for potential application to an
Australian context.
11
IT-014
IT-014
HL7 Australia
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
CDS:
Issue: HQMF is relevant to CDS in population-based applications and
knowledge development that affects pro-active care and resourcing.
EHR systems need to be appropriately structured to represent quality
measures, especially to support queries around these. The implications
for Australia include that HQMF could provide input to EHR
requirements for quality and CDS.
Standards Australia
Health Quality
Measure Format
(HQMF) Release 2
Implementation Guide
IT-014
IT-014-13
Action: Alert Safety monitoring groups to this work and offer
engagement. Monitor the project to gain a clearer picture of how
process and outcome based quality measures are queryable when
represented in EHRs and used for CDS.
CDS:
Implementation Guide
(IG) for CDS
Issue: There are several unrelated HL7 CDS standards with
overlapping functionality and task suitability, making it difficult for
knowledge authors and vendors to adopt the best for their purposes.
The ONC has recently specified very comprehensive requirements to
be met by a unified approach. Australia is greenfield with respect to
CDS standards adoption and stands to benefit from a CDS roadmap
and Implementation Guide
IT-014-13
Professional
Colleges
Knowledge Authors
MSIA
Action: Review and contribute to the IG Project Scope Statement
and actively take part in the consequent project. Engage industry,
professional colleges, and academic stakeholders.
CDS:
OpenCDS
Issue: OpenCDS uses standards, with a modern services approach,
and is aligned to MU3. It provides a low cost entry to interoperable CDS
for vendors whether they are established or new to CDS. It
accommodates different knowledge bases and can be used for a wide
variety of clinical needs. It is being used successfully with immunisation
CDS.
IT-014-13
MSIA
Action: Review OpenCDS at IT-014-13 and advice implementers.
Monitor the immunisation implementation.
CDS:
OpenCDS –
Immunisation
Calculation Engine
(ICE)
CDS:
Virtual Medical
Record (vMR) for
Clinical Decision
Support
Issue: The Immunisation Calculation Engine (ICE) is an immunisation
evaluation and forecasting engine using openCDS. This project informs
the needs of CDS standards and facilitation of systems design and
deployment.
HL7 Australia
IT-014
Action: Monitor project development.
Issue: CDS systems rely on data in EHRs and on inputs and outputs in
different formats. Standards for content are required to bridge this gap.
The vMR forms the basis of one project proposal coming through IT014-013. This project is important in ensuring that Australia’s initiatives
across messaging, CDA, EHR can be brought together to enable
improved care and safety through standardised CDS.
Action: In light of recent proposals concerning clinical content of
v2 messages to HL7, and the work of IT-014-13 on v2 messaging,
review the CDS vMR HL7 specification to access impact on
Australia’s v2 messaging requirements for clinical content.
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IT-014-06-06
IT-014-13
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
CDS with Patient Care
and SOA:
Issue: Care planning is an important process in Australian primary
care, where it attracts significant government funding both at GP and
allied health levels; however, current implementations are not
standards-based and rarely employ electronic communications. There
is a need for functional modularity via services at the point of care and
integration with CDS. Australia does not use v3 messaging so
deliverables as abstract models are important.
IT-014-06-06
Health Care
Coordination Project
IT-014-13
HL7 Delegates to
PC, CDA, SOA WGs
Action: Monitor this project via members (including Co-Chairs) of
PC, CDA and SOA, the 3 WGs sponsoring the project, and ensure
our Care Planning work takes this into account. Ensure the project
has useful deliverables at the DAM level.
Action: Engage IT-014-06-06 and IT-014-13 in the Patient Care
Services co-ordination project to leverage it for our projects and
ensure it meets our requirements.
CDS/SOA:
Cross-paradigm
interoperability
implementation guide
for Immunization
Issue: Immunisation is monitored and recommended by GP point-ofcare systems, but the underpinning knowledge is complex and
expected to be difficult for general system vendors to provide.
Jurisdictions and health advisory bodies provide guidelines for this and
some have in the past provided on-line recommendations including
those in the problematic areas of catch-ups. A group of standardized
services available to point-of-care applications could improve overall
achievement of immunisation targets. Australia could benefit from
international resources being committed here.
IT-014-013
MSIA
Jurisdictions
Immunisation
Guideline
Authorities
Action: IT-014-013 to continue consideration of a project in this
area to bring Australian requirements into this work with view to
deployment into point-of-care systems, immunisation registries,
and knowledge source applications.
CDS/SOA:
Cross-paradigm
interoperability
implementation guide
for Immunization
Conformance and
Guidance (CGIT):
HL7 V2 table content
quality review and v3
/ CDA harmonisation
Issue: As there is no decision support in v2 standards, this raises the
question of whether v2 referral messages may be a candidate for
decision support in Australia, and how international developments
relate to this.
IT-014
HL7 Australia
Action: Discussion on and possible development of decision
support for V2 referral messages within the Australian context.
Issue: During a harmonisation review and comparison with v3 data
model and content, there were some errors found in existing v2 tables.
Consistency is required to support migration and integration with legacy
systems as well as information exchange. Problems identified include
actual errors as well as poor data structure and content.
Action: Review of the problems identified in the spreadsheet (this
was provided to Heather Grain at the WGM) should be undertaken
by the IT-014-06 and HL7 Australia to identify appropriate actions
required for updating Australian standards. Consideration should
also be given to whether Australia specific existing standards
require review. It is noted that this may require some assistance
with vocabulary expertise.
13
IT-014-06
HL7 Australia
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Conformance and
Guidance (CGIT):
Issue: New segment proposals for v2.9 will be finalised at the May
2013 WGM.
IT-014-06
HL7 v2.8/2.9
Conformance
Requirements
Conformance and
Guidance (CGIT):
HL7 V2 table content
quality review and v3
/ CDA harmonisation
Education and
Marketing:
Communication and
development of
understanding and
skills
Action: Consider submission for signature segment and display
narrative segment by the January 2013 WGM. Submit Standards
Australia ATR on HL7 v2 signatures as part of documentation.
Issue: Need for alignment of code sets, value sets and vocabulary
models used in v2 and v3/CDA to facilitate interoperability.
HL7 Australia
IT-014
Action: Australia to obtain master spreadsheet (this was provided
to Heather Grain at the WGM) to track v2 errors and resolve where
necessary.
Issue: Quality of HL7 education. Education is being recognised as
different to presentations or information sessions in that it aims to
develop a specific set of skills. HL7 Australia provides many
presentation and information sessions, but if considering moving
towards education provision, should consider how to ensure the skills
of presenters. Heather Grain is happy to provide the free tutorial in
Australia if this is seen as helpful.
HL7 Australia
IT-014 (community
to consider priority
for Australia)
Action: Consider the needs to develop educator skills within the
HL7 community in Australia to support improved education
provision.
Education:
Issue: Tools for use when training.
HL7 Australia
Strategic Plan
Action: Identify and inform the next HL7 delegation (January
Meeting) through Standards Australia or Heather Grain (member
of Education WG) the tools required for training about HL7
standards in Australia and our priorities for their use.
NEHTA
Education:
Issue: The development and offer of an Australianised version of
HL7 International e-Learning courses.
HL7 Australia
Strategic Plan
Education and
Marketing:
Communication and
development of
understanding and
skills
Electronic Health
Record (EHR):
Personal Health
Record System
Functional Model
(PHR-S FM)
Action: Decide whether to proceed with e-Learning for HL7 and
determine method and partner/s to achieve this.
Issue: Education requirement specification.
HL7 Australia
Action: Identification of the roles and related competency
requirements in the Australian health messaging environment
need to be determined in order to prioritise the development and
availability of educational materials, courses and competencies.
Heather Grain is able to assist HL7 in this activity.
Consideration by
IT-014, DoHA and
NEHTA
Issue: Privacy and security direction and advice are needed by HL7
International as part of the Personal Health Record System Functional
Model development. Other issues identified to date include:
Jurisdiction-specific legislative issues regarding privacy and
security.
Storage, management and retrieval of extremely large
amounts of data generated by a life-long PHR.
IT-014
Action: Monitor the lessons learnt from the PCEHR development
to support progress of the international standard.
14
HL7 Australia
NEHTA
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Electronic Health
Record (EHR):
Issue: Despite the presence of Australian Co-Chairs driving this
project, its visibility to Australian Software Developers is limited.
HL7 Australia
Allergies and
Intolerances
Electronic Services:
HL7 CRM System
management of
members of affiliates
Governance &
Operations:
Documents
MSIA
Action: Increase awareness of this Domain Analysis Model.
Issue: HL7’s International electronic services platform is not
sufficiently flexible to retain the details of members of affiliates when
they are nominated as voters for HL7 Australia.
HL7 Australia (Nat
Wong)
Action:
HL7 Australia to participate in HL7’s International
Electronic Services working group and seek resolution on
problems affecting voting members of international affiliates.
Issue: Changes to the HL7 International Bylaws and Governance
documents may impact the equivalent documents of International
Affiliates.
HL7 Australia
Action: Pending receipt of the updates to the GOM and Bylaws,
HL7 Australia needs to review this in relation to its Constitution
and other Governance documents.
International Council:
IHIC 2013
Issue: HL7 Australia explored International Council interest in
conducting IHIC 2013 in Sydney in a time period either prior to or
preceding the ISO/TC215 meeting planned for October 2013. This
suggestion was considered and strongly supported by the International
Council, with agreement that HL7 Australia should develop the concept
and formally request funding support of up to US$5,000 from the
International Council toward running the event.
HL7 Australia
Action: HL7 Australia to proceed with consideration of running
IHIC 2013 in Australia in October 2013 either prior to or preceding
the proposed ISO/TC215 meeting and to submit request for
International Council budget submission.
International Council:
Leadership
Issue: Heather Grain has been requested by a number of the current
members from different countries (Canada and UK in particular), to
stand as a Co-Chair of the International Council to represent the
interests of improved process, education quality and overall
governance.
HL7 Australia
IT-014
Action: Identify priority and provide guidance on proposal to
stand for Co-Chair of the International Council.
International
Membership &
Affiliation Task Force
(IMATF):
International Council
Membership rights
survey
Issue: Richard Dixon Hughes to submit updated final version of
International Council membership/customer survey.
Action: Richard Dixon Hughes to submit updated final version of
International Council membership/customer rights survey on
behalf of HL7 Australia and assist in compiling results.
15
Richard Dixon
Hughes
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
International
Membership &
Affiliation Task Force
(IMATF)
Issue: Given the extent of changes brought about by the HL7
International decision to make its standards and related IP available
free of charge and the formation of a Membership Task Force at HL7
Board level, the IMATF resolved to recommend to the International
Council that the IMATF be disbanded, which was done.
Standards Australia
Action: Standards Australia to delete IMATF from list of activities
for future delegations.
Joint Initiative
Council (JIC):
IHE
Modelling and
Methodology (MnM):
FHIR
Issue: The establishment of IHE as an SDO now puts the IHE
specifications on the same international level as HL7.
IT-014
Action: IT-014 should examine IHE specifications and consider
their relevance and applicability in the Australian context e.g. CDA
content for ETP, referral care planning as well as, infrastructure
such as XDS.b and XDR.
Issue: Emergence of FHIR as a disruptive modelling and technical
approach.
HL7 Australia
NEHTA
Action: Australia needs to invest in some early R&D support
behind the FHIR initiative both to grow recognition of the
Australian origin of FHIR and to prepare itself for the emergence
of FHIR commercially.
Modelling and
Methodology (MnM):
FHIR Project –
Collaborative Care
Messaging
Issue: HL7 v2 is implemented widely in systems deployed in Australia
where we have Australian Standard Implementation Guides for Referral
and Discharge. Its messaging capabilities, and implied dynamic model,
with defined sender –receiver responsibilities, is adequate for our
existing use cases in Collaborative Care Communications. It is
inadequate for Clinical Content representation and no agreed solution
has been found.
IT-014-06-06
Action: Assess FHIR messaging capabilities and content
solutions at the level of segment mapping against our
collaborative care requirements, particularly for concepts of
Problem-Diagnosis, Goal, Pathway, and their contexts and
relationships.
Modelling and
Methodology (MnM):
FHIR Project –
Clinical Decision
Support
Issue: Clinical Decision Support needs Clinical Data Mapping for its
access to health information in the EHR, most notably through the vMR
Standard and the Arden curly braces inter-operation path as well as
resources in the form of data structures such as Medical Logic
Modules. Much of this is greenfield, as HL7 RIM-based models have
made limited inroads into Arden and other HL7 CDS, with the resulting
need for harmonisation across CDS standards.
Action: Assess FHIR for CDS needs and ensure that, if it is to go
forward as a major representation in HL7, that CDS is wellcovered.
16
IT-014-13
HL7 Delegates to
CDS, Arden Syntax,
and MnM WGs
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Modelling and
Methodology (MnM):
Issue: Clinical resources need to be developed as soon as possible to
prove FHIR’s capability and to ensure an early switch over to FHIR, if it
this turns out to be the way forward. There has been some clinical
engagement to date but work has been initiated for some resources
and needs to be picked up by a wider group of experts.
HL7 Delegates to
PC, CDS, and Arden
Syntax WGs
FHIR Project –
Clinical
Requirements
FHIR Project Lead
Action: Influence HL7 Clinical WGs, particularly PC, Arden Syntax,
and CDS to engage with the FHIR project (via. joint sessions) to
identify their clinical resources needs and jointly develop these
resources. This engagement should begin with Condition, Health
Issue, Health Asset, Problem, Diagnosis, Goal and Care Plan.
Modelling and
Methodology (MnM):
Orders &
Observations (OO)
Issue: Australian is not actively represented in the Orders &
Observations WG, resulting in Australia requirements for Pathology
and Radiology Ordering and Reporting not being advocated for.
Standards Australia
Action: Increase focus on the OO WG through future Australian
delegations to HL7 WGMs. Standards Australia to be aware of this
gap in expertise.
Modelling and
Methodology (MnM):
Issue: Australian participation in development of FHIR Resources is
limited to Grahame Grieve.
FHIR – Resources
Action: Encourage Australian representation in WGs developing
FHIR resources.
Orders and
Observations:
Issue: Need to ensure that the contents of the laboratory order and
reporting model and specifications can be profiled into templates for
use in CDA implementation guides for use in Australia to avoid
retrofitting Australian work into the new HL7 International standards
downstream.
Laboratory Order
Specification
Future HL7
delegates
HL7 Australia
MSIA
Standards Australia
IT-014-06-05
IT-014-06-06
NEHTA (through
Stephen Chu)
Action: IT-014-06-05 and IT-014-06-06 to work closely with NEHTA
and provide inputs to the ongoing work on this new Laboratory
Order modelling and specification project.
Patient
Administration:
FHIR
Patient Care:
Allergies and
Adverse Reactions
Issue: FHIR Patient Administration resource development needs
Australian participation.
Standards Australia
IT-014-06-03
Action: Notify IT-014-06-03 committee members of FHIR resource
development, and encourage participation in HL7 PA
teleconferences and mailing lists.
Issue: The HL7 allergy/intolerance model is likely to become a
standard way of sharing this critical clinical content.
Hugh Leslie &
Stephen Chu
IT-014-06-04
Action: Australia should continue to be involved in development
of this clinical model for use in sharing allergy information. IT014-06-04, IT-014-06-06, IT-014-13 and NEHTA should monitor
progress of this project closely and contribute actively to the
development of the allergy/intolerance model and related
contents.
IT-014-06 should consider taking on a cross
subcommittee coordinating role.
17
IT-014-06-06
IT-014-13
IT-014-06 to
consider cross
coordination role
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Patient Care:
Issue: HL7 DCM representation for CIMI models.
Hugh Leslie &
Stephen Chu
Detailed Clinical
Models
NEHTA
IT-014-06-04
Action: Australia to contribute and be involved in this task. IT014-06-04, IT-014-06-05, IT-014-06-06, IT-014-13, and NEHTA
should provide Australian representatives with inputs for active
contributions to CIMI modelling works.
IT-014-09 should
consider taking on a cross subcommittee coordination role.
IT-014-06-05
IT-014-06-06
IT-014-13
IT-014-09 to
consider cross
coordination role
Patient Care:
Issue: International involvement is required.
Stephen Chu
Care Plan Topic
Action: Australia to continue to be involved in developing this
standard. This project has high relevance to care plan projects
initiated and currently underway in Australia jurisdictions (e.g.
North Territories and Victoria). IT-014-06-06 and IT-014-09 should
take on coordinating roles to coordinate inputs from Australia and
inputs via Australian delegates to this international project.
IT-014-06-06
Issue: Clinical content for FHIR needs a process for clinical review
that is unlikely to be met by the HL7 ballot process.
Hugh Leslie
Patient Care:
FHIR clinical content
IT-014-09
Action: Australia to work with the FHIR working group to develop a
better way to develop clinical content.
Pharmacy
Issue: Alignment between Australia’s medication management
programs and HL7 / IHE pharmacy model, technical specifications
and profiles are required.
IT-014-06-04
IT-014-06-06
Action: Australia should stay highly engaged with HL7 and IHE
Pharmacy project works. They are extremely important to IT-01406-04
development
of
national
electronic
medication
management programs. IT-014-06-04 and IT-014-06-06 should
collaborate closely to provide coordinated inputs to international
pharmacy projects.
Pharmacy:
ISO WG6
Issue: Almost complete disconnect between ISO WG6 projects and
new project proposals from other international works in this domain,
resulting in duplication or even divergence of work with highly counterproductive outcomes.
Action: IT-014-06-04 and IT-014 must liaise more closely with
Australian ISO delegates to prevent such counter-productive
divergence between the groups.
Pharmacy:
R2 Ballot
Issue: Pharmacy topics R2 (Jan 2013) ballot requires Australian
inputs.
Action: IT-014-06-06 should collaborate with NEHTA to provide
ballot comments to Pharmacy topics R2 ballot.
18
IT-014
IT-014-06-04
Future ISO
Delegates to WG6
NEHTA
IT-014-06-04
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Pharmacy:
Issue: Substantial international development is taking place within the
realm of HIT for nutrition and dietetics.
NEHTA
V3 Nutritional Order
Clinical Message
Action: Introduction of HL7 work on nutrition to Dietetics
Association of Australia (DAA) via Allied Health Professions
Australia (AHPA) may support development in Australia. AHPA
to be made aware of this work.
Allied Health
Professions
Australia
HL7 Australia
Action: HL7 Australia to monitor the ongoing developments of
nutrition models internationally and consider application to
Australia.
Pharmacy:
Patient Medication
Profile
Physicians Group:
New group
Issue: Medication Profile modelling direction
international inputs to ensure universal usability.
needs
broad
Action: This project is highly relevant to Australia / NEHTA
electronic medication management program. Australia should
play a leadership role. IT-014-06-04 and IT-014-06-06 should work
with NEHTA to provide significant contributions to the HL7 and
IHE work on this topic.
Issue: The mutual benefits of HL7 and non-technical clinicians coming
together are not adequately realised. HL7 needs to promote its benefits
to non-technical clinicians and to gain their input via its clinicianfocused standards.
NEHTA
IT-014-06-04
IT-014-06-06
IT-014
HL7 Australia
Standards Australia
Action: All future HL7 delegates who are physicians to be
encouraged to attend the Physicians WG session at the next
meeting. Standards Australia to be aware of this in order to assist
logistically.
Action: Advocate for greater pre-registration promotion of the
meeting by HL7 HQ. Identify HL7 products that might be of
interest to Australian physicians, such as Functional Profiles, with
a view to alerting the communities to their availability. Promote
local Care Giver membership of HL7.
Policy Advisory
Committee
Issue: The HL7 Policy Advisory Committee is seeking input from
Affiliates on security and privacy issues as well as governance of
secondary use of data from Affiliates.
DoHA
Action: Provide a briefing document on Australian policy in these
areas
Richard DixonHughes
HL7 Australia
IT-014-04
Security Workgroup:
Data Segmentation
for Privacy (DS4P)
Issue: Whilst Australia is not yet in a position to embrace data
segmentation in the national eHealth system, as the system evolves it
will become increasingly important due to privacy concerns relating to
the sharing of patient healthcare and personal information.
Action: NEHTA should review the DS4P pilot project to anticipate
the use of its concepts for the Australia eHealth system.
Action: Standards Australia should note that the DS4P is being
developed through HL7 and taken to ISO with a view to being
formulated into an international specification in the future.
19
NEHTA
Standards Australia
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Security Workgroup:
Issue: The Australian healthcare and health informatics community
should be made more aware of the issues and potential solutions of
both primary and subsequent data sharing, and the data segmentation
terminology and concepts being developed worldwide.
NEHTA
Data Segmentation
for Privacy (DS4P)
Action: NEHTA should consider an awareness and education
program on DS4P concepts and potential impacts for the
healthcare community.
Security Workgroup:
Security and Privacy
Ontology - Project
No: 646
Security Workgroup:
e-measures and
Quailty.
Issue: Recommencement of the project and international input
requested.
IT-014-04
Action: IT-014-04 to be advised of the project status and to provide
feedback through the HL7 Security WG Co-Chair or though HL7
Security WG List.
Issue: In Australia, e-measures and quality measurement is not being
addressed.
NEHTA
IT-014-04
Action: NEHTA and IT-014-04 to review the e-measures project for
consideration of adoption and input to international work in this
area.
Security:
Issue: New Co-Chair position recording.
IT-014
New Co-Chair
Action: Standards Australia and IT-014 to note election of Dr Trish
Williams to HL7 Security WG Co-Chair.
Standards Australia
SOA:
Issue: This project provides both a generalised guide to implementing
SOA for legacy systems and a specific demonstration of how to apply
the approach to immunisation use cases.
HL7 Australia
Cross Platform
Interoperability
Implementation
Guide for
Immunisation.
(Sponsor SOA, CoSponsor PHER &
ArB).
SOA:
Cross Platform
Interoperability
Implementation
Guide for
Immunisation.
Action: Seek wider Australian comment on the next ballot cycle
from Government and e-health industry. This will need to be
coordinated by HL7 Australia.
Issue: Commence discussion of how immunisation data should be
aggregated and managed with this project as a potential guide to
doing this in the Australian context.
Sponsor SOA, cosponsor with PHER,
ArB.
Action: Circulate balloted
discussion at IT-014-06-04.
SOA/Pharmacy:
Issue: This DSTU is now complete and provides a useful mechanism
for accessing medications. Additionally, potentially, it is a servicebased approach to medication management.
Medication Statement
Service
document
for
information
and
Action: Circulate to IT-014-06-04 for discussion and potential
adoption.
20
IT-014-06-04
Standards Australia
IT-014-06-04
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
SOA:
Issue: ELS needs to be submitted to the OMG.
NEHTA
Healthcare and
Community Services
Provider Directory
Service (HCSPD)
Action: NEHTA and Standards Australia to provide the ELS
specification to OMG.
SOA:
Issue: HCSPD needs to be adopted as an Australian Standard.
Healthcare and
Community Services
Provider Directory
Service (HCSPD)
Action: IT-014 to consider the adoption of the HL7 HCSPD DSTU
as an Australian ATS.
SOA:
Record Locate
Update Service
(RLUS)
SOA:
SOA Service
Ontology
Standards Australia
Issue: This HL7 standard is now available and provides a general
service based capability for managing Health data. It should be
considered for local adoption.
IT-014
IT-014
Action: IT-014 to consider adoption of the HL7 RLUS Standard.
Infrastructure services such as the RLUS Standard do not, at
present, have a natural ‘home’ within the IT-014 structure.
Consideration may need to be given to forming a new Services
Committee to mirror the HL7 SOA committee.
Issue: This important white paper will pave the way for the
development of a rich set of discoverable and interactive electronic
services. When balloted it needs to be explained, discussed,
socialised and commented upon by a wide audience within the health
standards and software community. NEHTA is a co-author of this
paper.
HL7 Australia
NEHTA
Standards Australia
Action: Plan a seminar to present this paper in December to
prompt feedback and comment. This may be best managed by
establishing a new committee or task force to mirror the HL7
SOA committee. IT-014 to review how best to approach this task.
HL7 Australia to manage a seminar in conjunction with NEHTA,
as part of its education program and marshal ballot response.
SOA:
PASS
Issue: Expertise in security required to review the SOA Audit project
within PASS. Decision to be made on progression or removal of
project.
IT-014-04
Action: Trish Williams is reviewing the SOA Audit project on
behalf of IT-014-04 to ensure that the project is not relevant for
Australia or not catered for elsewhere.
SOA:
PASS
Issue: Advanced access control features using metadata tags that
move with the data would provide a rich mechanism for maintaining
data privacy following download from shared data stores such as the
PCEHR.
Action: IT-014-04, NEHTA and DoHA need to be aware of this work
and its potential ramifications for Australian healthcare data
security and privacy.
21
Trish Williams, HL7
Security WG CoChair & IT-014-04
Co-Chair, to report
to IT-014 on this
work
Standards Australia
to organise an
educational
seminar for
NEHTA/DoHA on
this topic
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
SOA:
Issue: CCS Project statement to be finalised and potential
implementers engaged.
IT-014-06-06
Patient Care Services
Co-ordination Project
Structured
Documents:
CDA R3
Action: IT-014-06-06 to request expressions of interest from the
Australian community in contributing to this project.
Issue: CDA R3 is logical successor to CDA R2, retaining the tight focus
on patient centric document requirements which supports participation
CMETs (Common Message Element Type) such as subject,
participation, informant assignedDevice, accreditedLocation etc. to
satisfy exchange of financial, veterinary, public / population health,
medical device, and credentialing requirements.
NEHTA
IT-014
Action: NEHTA and Australia should monitor the development of
CDA R3 closely to ensure that the known Australian requirements
are catered for. Especially the new project for consolidated
clinical templates for CDA R3; this new project may serve the
upcoming requirements for financial, veterinary and Medical
devices.
Structured
Documents:
CDA R3
Issue: The CDA R3 includes many use case specific (RIM) ACT
classes / attribute like Container and Non Person Living Subject. This
will cater the requirements of capturing of fine-grained structured
information for some use cases without the need for Australian
Extension (Ex: like Pathology Investigation information).
NEHTA
IT-014
Action: The adoption of CDA R3 specification will eliminate the
drawbacks experienced in the current CDA R2 model. Australia
should actively contribute to the CDA R3 CCD templates
development and perform a R&D work around applying CDA R3
and its templates to the existing / new use cases.
Structured
Documents:
CDA R3
Structured
Documents:
Implementation
Guide for CDA
Release 3 anaesthetic record
Structured
Documents:
Patient Authored
Note
Issue: Australian extension included in CDA R3.
NEHTA
Action: CDA R3 includes some of the Australian CDA extension
added to CDA R2; thus the adoption of CDA R3 will enable eHealth system across the world to syntactically and semantically
recognize Australian CDA R2 extensions.
IT-014
Issue: Development of Anaesthetic Implementation Guide.
NEHTA
IT-014
Action: Monitor project development and implementation guides
for CDA Release 3 and their relevance to Australia.
Issue: Capacity for recording and capturing provider vs. patient
authored information. The existence and process of developing
Australian unique health identifiers and health provider IDs may
contribute to this discussion.
Action: Potential incorporation of patient authored data in
Australian e-health programs.
22
NEHTA
IT-014
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Structured
Documents:
Issue: Capacity for recording patient authored information like
neonatal and child health record.
NEHTA
Patient Authored
Note
Structured
Documents:
Patient Authored
Document
Structured
Documents:
Quality criteria for
CDA Implementation
Guides
IT-014
Action: Australia and NETHA should continue to closely monitor
the development of Neonatal CCD templates to align the
upcoming Australian requirements with HL7 International
standard. Australia and NEHTA should also contribute its
upcoming Antenatal requirements to the HL7 international
standards committee.
Issue: Australian EHR (PCEHR) includes patient author documents
like ‘Consumer Entered Notes’, ‘Consumer Entered Health Summary’
and ‘Advance Care Directive’.
NEHTA
Action: Australian delegates should work towards getting these
existing requirements incorporated into the HL7 ‘Patient
Authored Document’ Implementation guide. This will provide an
opportunity to align Australian Consumer Entered documents
with HL7 International standards.
Future HL7
delegates to SD
Issue: Quality criteria list for quality assessment of normative and
informative and reference-set parts of a CDA Implementation Guides
in navigational, and implementation perspective.
NEHTA
IT-014-06-06
IT-014
Action: Standards Australia and NEHTA need to pay close attention
to this project. Some of these quality criteria can be utilized to
produce quality criteria specific for Australian CDA Implementation
Guides. The inclusion of following checklist will increase the
readability and consistency for CDA documents and end users.

OID and value set references and the URL of the publically
available OID registers.

Minimum requirement of a standalone complete XML
examples file for each CDA document.

Minimum requirement
section/template.
of
a
narrative
text
for
each
Structured
Documents:
Issue: Inclusion of section / entry level templates and versioning of
template IDs.
CDA Template
versioning
methodology
Action: Inclusion of section and entry level template for CDA IG
will increase the re-usability of CDA sections (vendor code,
schematrons / conformance libraries) across various Health Story
specifications.
Structured
Documents:
Issue: Inclusion of template ID versioning will increase the re-usability
of CDA artefacts for old and new specifications.
CDA Template
versioning
methodology
Action: Australia and NEHTA should continue to closely monitor
the Templates versioning project to procure the benefits of
sustainable (forward and backward compatible) CDA template,
Schematron packages and vendor library across all domain
packages. The incorporation of the versioning methodology into
the Specification development tool chain should be considered to
align NEHTA template versioning methodology with the HL7
international standard.
23
IT-014
NEHTA
IT-014
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Structured
Documents:
Issue: Development of tools for remote patient monitoring and
potential application to similar projects in Australian domains.
IT-014
Continua Health
Alliance
Action: Monitor development of tools.
Vocabulary:
Issue: CTS2 in the past has not been used extensively in Australia.
Given the significant review and update it would be appropriate to
reassess its utility and priority for involvement of Australian resources in
the project.
Common
Terminology Server
(CTS2)
IT-014
NEHTA
Action: Monitor this work and determine the impact, relevance and
priority of this project for Australia.
Vocabulary:
Vocabulary
Facilitators
Action: Note that this guidance is being developed and provide
information to the HL7 Vocabulary WG if there are issues Australian
members would like covered or included.
HL7 Australia
IT-014-06
Action: Inform HL7 delegate to Vocabulary WG of any specific
Australian requirements.
Vocabulary:
Use of IHTSDO
workbench for HL7
Content
Issue: If HL7 progress to using the workbench for live data, it is hoped
that Affiliate members of HL7 will maintain their own submission of
content requirements. This will require skills in both HL7 models and
the IHTSDO workbench.
IT-014-02
IT-014-06
Action: Monitor progress in this area.
Vocabulary:
TermInfo Project
Vocabulary/SOA:
Clinical Terminology
Service (CTS2)
Issue: Lack of resources for the TermInfo Project.
NEHTA
Action: Identify the priority of this project to Australia and
consider resources which might be provided to support the
activity.
Issue: The software industry and government need to become aware of
this service and its potential for unifying and simplifying access to, and
management of, Health reference vocabularies including SNOMED,
LOINC, HL7 tables, and MBS/PBS items.
HL7
Standards Australia
MSIA
Action: Hold an educational seminar for industry and government
on CTS2 to demonstrate the benefits that can be easily realised by
leveraging the work already completed at PHAST and the Mayo
Clinic.
Clinical Information
Modelling Initiative
(CIMI)
Issue: CIMI is an important national and international initiative
Action: Australia should continue to support and develop the CIMI
work.
24
Hugh Leslie
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
5. FUNDING SOURCES SUMMARY AND AUSTRALIAN
ATTENDANCE
Twelve Australians attended as representatives for the duration of this HL7 meeting,
nine of whom were in the formal delegation. The funding source for these delegate
numbers is indicated in the table below.
DoHA provided funding assistance for the following delegates:

Heather Grain

Patricia Williams

Vince McCauley

Richard Dixon Hughes

Hugh Leslie

Amy Mayer

David Rowed

Nat Wong

Meya Achdiat
Funding Source
Number
Change from
Previous meeting
Full funding by employer: Private
0
0
Full funding by employer: States/Territories or National Initiatives (NEHTA)
3
+1
Funding assistance – DoHA through Standards Australia contract
9
no change
Total:
12
+1
There was a team of delegates from NEHTA who attended the HL7 meeting; these
NEHTA delegates are listed below:

Andy Bond

Stephen Chu

Vin Sekar
25
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
6. AUSTRALIAN LEADERSHIP POSITIONS
The table below lists leadership positions held by Australians at the HL7 meeting in
September 2012.
Attendee
Position (held at
the meeting)
Funding Source
Work Group or Committee
Andy Bond
ARB Member
Co-Chair
NEHTA
Standards Australia via
the DoHA Funding
Agreement
Standards Australia via
the DoHA Funding
Agreement
Standards Australia via
the DoHA Funding
Agreement
ARB
Vocabulary
Heather Grain
Invited Member
Dr Hugh Leslie
Richard Dixon
Hughes
Co-Chair
Co-Chair
Policy Advisory Committee
Patient Care
Advisory Council to the Board of HL7
International
Non-Voting Member
HL7 International Board of Directors
Chair
HL7 Australia
International Council and Affiliate Chairs
Meetings,
International Membership & Affiliation Task
Force (IMATF)
Invited Member
Affiliate Due Diligence Committee
(of HL7 International Board)
Invited Member
Policy Committee (of HL7 International Board –
invited by HL7 Chair)
Invited Member
HL7 Membership Task Force – to define new
rights of HL7 members post free licensing HL7
standards - invited by HL7 CEO)
Chair-elect
Joint Initiative Council (JIC) for Health
Informatics SDO Harmonisation
Service Oriented Architecture
Vincent McCauley
Co-Chair
Patricia Williams
Co-Chair
Stephen Chu
Co-Chair
Standards Australia via
the DoHA Funding
Agreement
Standards Australia via
the DoHA Funding
Agreement
NEHTA
26
Security
Patient Care
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
7. ACRONYM LIST
Abbreviation
Meaning
ACCC
Australian Competition and Consumer Commission
ACMA
Australian Communication and Media Authority
ACSQHC
Australian Commission on Safety and Quality in Health Care
ACT
Action
ACTUG
Australian Clinical Terminology Users Group
ADA-JDA
Australian Design Award James Dyson Award
ADL
Archetype Definition Language
AG
Advisory Group
AGDA
Australian Graphic Design Association
AHIEC
The Australian Health Informatics Education Council
AHIMA
American Health Information Management Association
AHMAC
Australian Health Ministers' Advisory Council
AHML
Australian Healthcare Messaging Laboratory
AIDA
Australian International Design Awards
AIHW
Australian Institute of Health & Welfare
AIIA
Australian Information Industry Association
AMT
Australian Medicines Terminology
ANSI
American National Standards Institute
ANZCTR
Australia New Zealand Clinical Trials Registry
ArB
Architecture Review Board
AS HB
Australian Handbook
AS/NZS
Australian/New Zealand Handbook
AS/NZS ISO
International Standards adopted by Australia and New Zealand
AU
(Australia abbreviation in the Int'l comment form)
AWI
Approved Work Item
BAU
Business As Usual
BCA
Building Codes of Australia
BRIDG
Biomedical Research Integrated Domain Group
BRIDG is a collaborative effort of CDISC, the HL7 RCRIM WG, the (US) National
Cancer Institute (NCI), and the US Food and Drug Administration (FDA).
BRS
Business Requirements Specification
Cal-X
The California Exchange (Cal-X) is a data and information exchange to support
healthcare, medical, public health, and homeland security needs in a collaborative,
shared, secure, and cost-effective manner.
COPOLCO
Consumer Policy Committee [ISO]
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Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Abbreviation
Meaning
CASCO
Conformity Assessment
CBCC
Community Based Collaborative Care [HL7 Workgroup]
CCD
Continuity of Care Document
CCS
Care Coordination Service
CCHIT
(US) Certification Commission for Health Information Technology
CD
Committee Draft (third stage in developing an ISO or IEC standard)
CDA
Clinical Document Architecture
CDC
Centre for Disease Control (US Government agency)
CDISC
Clinical Data Standards Interchange Consortium
CDS
Clinical Decision Support [HL 7 Workgroup]
CDV
Committee Draft for Vote
CEN
European Committee for Standardization (Comité Européen de Normalisation)
CENELEG
European Committee for Electrotechnical Standardisation
CEO
Chief Executive Officer
CGIT
Conformance and Guidance for Implementation and Testing Committee
CIC
Clinical Interoperability Council [HL7 Workgroup]
CIMI
Clinical Information Modelling Initiative
CIS
Clinical Information Systems
COAG
Council of Australian Governments
COM
Comment
conHIT2011
European Health Informatics Conference 2011
ContSys
System of Concepts for Continuity of Care
COR
Corrigendum [to a Standard]
CRM
Customer Relationship Management
CTO
Chief Technical Officer
CTR&R
Clinical Trials Registration and Results
DAFF
Department of Agriculture, Fisheries and Forestry
DAM
Domain Analysis Model (comprehensive model of a domain) [HL7]
DAM
Draft Amendment [Standards Australia]
DCM
Detailed Clinical Model
DCOR
Draft Corrigendum
DEVCO
Developing country matters
DIA
Design Institute of Australia
DICOM
Digital Imaging and Communications in Medicine
DIISR
Department of Innovation, Industry, Science & Research
DINZ
Design Institute of New Zealand
DIS
Draft International Standard (fourth stage in developing an ISO or IEC standard –
28
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Abbreviation
Meaning
the main opportunity for public input)
DMP
Dossier Médical Partagé (Shared Medical Record) (France)
DoHA
(Australian Government) Department of Health and Ageing
DSTU
Draft Standards for Trial Use (HL7 and ANSI)
DTR
Draft Technical Report [ISO and Standards Australia]
DTS
Draft Technical Specification [ISO and Standards Australia]
EC
European Commission [the administrative arm of the EU]
ECCF
Enterprise Compliance and Conformance Framework
EEC
European Economic Community
EFMI
European Federation of Medical Informatics
EHR
Electronic Health Record
EHR-FM
EHR Functional Model
EHRS or EHR-S
Electronic Health Record System
ELGA
Austrian CDA Implementation Guide in Development
ELS
End Point Location Service
EMEA
European Medicines Agency
EN
European Standard (Européen Norm)
ENA
Energy Networks Association
EPM
Enterprise Project Management
epSOS
European Patients Smart Open Services.
A European initiative (23 countries) to exchange pharmacy and EHR information,
including prescriptions, across the EEC using IHE profiles and local standards. See
www.epsos.eu
ETP
Electronic Transfer of Prescriptions
EU
European Union
EudraCT
European Union Drug Regulating Authorities Clinical Trials
FCD
Final committee draft
FDAM
Final Draft Amendment
FDIS
Final Draft International Standard (for vote to publish) [ISO]
FHIR
Fast Health Interoperability Resources [HL7]
FRS
Functional Requirements Specification
FYI
For your information
GCM
Generic Component Model
GDP
Gross Domestic Product
GP
General Practitioner
GS1
An international SDO – primarily in the supply-chain domain
GVP
Good Pharmacovigilance Practices
HCD
Health Care Devices Committee
29
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Abbreviation
Meaning
HDF
HL7 Development Framework
HI
Health Identifiers
HIE
Health Information Exchange
HIMSS
Healthcare Information and Management Systems Society
HISC
Health Informatics Standing Committee
HITSP
Health Information Technology Standards Panel
HL7
Health Level Seven (International)
HL7 ELC
HL7 E-Learning Course
HPI
Healthcare Provider Identifier
HPI-I
Healthcare Provider Identifier for Individuals
HPI-O
Healthcare Provider Identifier for Providers
HQMF
Health Quality Measure Format
HSSP
Healthcare Services Specification Project [joint HL7/OMG]
IC
International Council (HL7)
ICD10AM
The Australian NCCH modification of ICD-10 code set for the coding of diseases
and procedures
ICD10-AM
International Classification of Diseases, Version 10, Australian Modification
ICD9CM
International Classification of Diseases 9 Clinical Modification
ICH
International Conference on Harmonisation (of Technical Requirements for
Registration of Pharmaceuticals for Human Use)
ICHPPC
International Classification of Health Problems in Primary Care
ICNP
International Classification for Nursing Practice
ICOGRADA
International Council of Graphic Design Associations
ICPC2+
International Classification of Primary Care 2
ICSID
International Council of the Societies of Industrial Design
ICSR
Individual Case Safety Report [related to Medicines/Devices]
ICT
Information & Communications Technology
IDA
International Design Alliance
IDEA
Industrial Design Excellence Awards
IDMP
Identification of Medicinal Products
IDSA
Industrial Design Society of America
IEC
International Electrotechnical Commission (an international SDO)
IEEE
Institute of Electrical & Electronic Engineers (US) (also an SDO)
IF
International Forum of Design
IFI
International Federation of Architects/Designers
IG
Implementation Guide
IHE
Integrating the Healthcare Enterprise
IHI
Individual Healthcare Identifier
30
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Abbreviation
Meaning
IHTSDO
International Health Terminology Standards Development Organisation
IMATF
International Membership and Affiliation Task Force
InM
Infrastructure and Messaging [HL7 Workgroup]
IP
Intellectual Property
IS
International Standard
ISO
International Organization for Standardization
ISO/CS
ISO Central Secretariat
ISO/TC 215
ISO Technical Committee (Health Informatics)
IT
Information Technology
IT-014
Standards Australia Committee IT-014 (Health Informatics)
ITS
Implementable Technology Specifications
ITTF
ISO/IEC Information Technology Task Force
ITU-T
International Telecommunications Union – Standards Division
IXS
Identity Cross Reference Service
JI
Joint Initiative on SDO Global Health Informatics Standardization
JIC
Joint Initiative Council (responsible for governance of the JI – with current members
being ISO/TC215, CEN/TC251, HL7 International, CDISC, IHTSDO and GS1)
JIDPO
Japanese Industrial Design Promotional Organisation
JSC-HIS
Joint Standing Committee on Health Informatics Standards
JSON
Java script Object Notation
JTC
Joint Technical Committee
JTC 1
ISO/IEC Joint Technical Committee 1 Information Technology
JWG
Joint Working Group
KPI
Key Performance Indicator
LB
Letter Ballot
LIC
Low Income Country
LMIC
Low and Medium Income Countries
LOINC
Logical Observation Identifiers Names and Codes
LPO
Local PCEHR Officer
MBS
Medical Benefits Scheme
MBUA
Member Body User Administrators (Person who maintain the ISO Global directory
in each country)
MDA
Model Driven Architecture
MDMI
Model Driven Message Interoperability – see www.mdmi-consortium.org
MIC
Medium Income Country
MM
Maturity Model
MnM
Modelling and Methodology [HL7 Workgroup]
MOR
Monthly Operational Report
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Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Abbreviation
Meaning
MOU
Memorandum of Understanding
MSIA
Medical Software Industry Association
MT
Maintenance committee (IEC)
NASH
National Authentication Service for Health
NATA
National Association of Testing Authorities
NEHIPC
National E-Health and Information Principal Committee
NEHTA
(Australian) National E-Health Transition Authority
NH&MRC
National Health and Medical Research Council
NHCIOF
National Health Chief Information Officer Forum
NHIN
(US) National Health Information Network
NHISSC
National Health Information Standards and Statistics Committee
NHS
(UK) National Health Service
NIH
(US) National Institutes of Health
NIST
National Institute of Standards and Testing (USA)
NMB
National Member Body [of ISO or CEN]
Normapme
European Office of Crafts, Trades and Small and Medium sized Enterprises for
Standardisation
NP
New Work Item Proposal (current ISO/IEC abbreviation)
NPACC
National Pathology Accreditation Advisory Council
NPC
National Product Catalogue
NQF
National quality (measures) framework
NSO
National Standards Office
NWIP
New Work Item Proposal (obsolete ISO/IEC abbreviation – see "NP")
O&O
Orders and Observations [HL7 Workgroup]
OBPR
Office of Best Practice Regulation
OCL
Object Constraint Language
OHT
Open Health Tools Foundation (www.openhealthtools.org)
OID
Object Identifier
OMG
Object Management Group
ONC
Office of the National Coordinator for Health Information Technology (within US
Department of Health and Human Services)
OSI
Open Systems Interconnection
OTF
Organisation Task Force [ISO TC 215]
OWL
Web Ontology Language
PA
Patient Administration [HL7 Workgroup]
PACS
Picture Archive Systems
PAS
Patient Administration Systems
PASS
Privacy Access and Security Service
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Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Abbreviation
Meaning
PBS
Pharmaceutical Benefits Scheme
PC
Patient Care [HL7 Workgroup]
PCEHR
Personally Controlled Electronic Health Record
PDAM
Proposed Draft Amendment
PDF
Portable Document Format
PDTR
(Proposed) Draft Technical Report
PHDSC
Public Health Data Standards Consortium
PHER
Public Health and Emergency Response [HL7 Workgroup]
PHM
Powerhouse Museum
PHR
Personal Health Record
PHTF
Public Health Task Force
PIM
Platform Independent Model
PIP
Practice Incentive Payment
PIR
Post Implementation Review
PKI
Public Key Infrastructure
PM
Project Manager
PMBOK
Project Management Body of Knowledge
PMO
Project Management Office
PMP
Project Management Plan
PMS
Practice Management System
PMTL
Project Management Team Leader
PoC
Point-of-Care
PSM
Platform Specific Model
PSS
Project Scope Statement [HL7]
PSUR
Periodic Safety Update Report
PWG
Pharmacy Working Group [HL7 Workgroup]
RACGP
Royal Australian College of General Practice
RCPA
Royal College of Pathologists Australia
RCRIM
Regulated Clinical Research Information Management [HL7 Workgroup]
RFID
Radio Frequency Identification
RHIO
(US) Regional Health Information Organisation
RIM
Reference Information Model
RIMBAA
RIM Based Application Architecture
RIS
Radiology Information Systems
RLUS
Resource Locate Update Service (HSSP)
RMIM
Refined Message Information Model
RM-ODP
Reference Model of Open Distributed Processing
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Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Abbreviation
Meaning
RO
Responsible Officer
SA
Standards Australia
SAIF
Services Aware Interoperability Framework
SC
Subcommittee
SD
Structured Document [HL7 Workgroup]
SDO
Standards Development Organisation
SHIPPS
Semantic Health Information Performance and Privacy Standard
SIG
Special Interest Group
SKMT
Standards Knowledge Management Tool
SLA
Service Level Agreement
SMB
Standards Management Board (IEC only)
SME
Subject Matter Experts
SMTP
Simple Mail Transfer Protocol
SNOMED
Systematised Nomenclature of Medicine
SNOMED CT
Systematised Nomenclature of Medicine - Clinical Terms
SOA
Service Oriented Architecture
SOAP
Simple Object Access Protocol
SP3
Standards Professional Project Practitioners
STC
Technical Steering Committee
T3SD
Technical and Support Services Steering Division
TC
Technical Committee
TCM
Traditional Chinese Medicine
TCP/IP
Transmission Control Protocol/Internet Protocol
TEAM
Traditional East Asian Medicine – This term, though inadequate, is used to
represent Traditional Chinese Medicine, Traditional Korean Medicine, and
Traditional Japanese Medicine.
TF
Task Force
TM
Traditional Medicine
TMB
Technical Management Board (ISO only)
TOGAF
The Open Group Architecture Framework
TR
Technical Report (an informative ISO or IEC standards publication)
TS
Technical Specification (a normative standards publication having a lower level of
consensus than a full international standard)
UAT
User Acceptance Testing
UCUM
Unified Code for Units of Measure [Regenstrief Institute]
UHI
Unique Healthcare Identifier
UML
Unified Modelling Language
UN
United Nations
34
Executive Summary of HL7 Meeting – Baltimore, USA (Sept 2012)
Abbreviation
Meaning
VMR
Virtual Medical Record
VOC
Vocabulary Committee [HL7 Workgroup]
W3C
World Wide Web Consortium
WCM
Web Content Management
WD
Working Draft (second stage in developing an ISO or IEC standard)
WG
Working Group or Work Group
WGM
Working Group Meeting
WHO
World Health Organization
WI
Work Item
WTO
World Trade Organisation
XDS
(IHE’s) cross enterprise Data Sharing protocol
XML
Extensible Markup Language
35