Final Report HL7 Meeting—Atlanta, USA (May 2013)
IT-014 Health Informatics Committee
Final Report
HL7 Working Group Meeting
5–10 May 2013 (Atlanta, USA)
Date Submitted: 30 July 2013
Lead Author:
Dr Patricia Williams
Collated by:
Standards Australia
With input from Australian Delegation and other employer funded Australians at the meeting:
Richard Dixon Hughes (Delegate)
Amy Mayer (Mentored Delegate)
Dr Zoran Milosevic (Delegate)
Dr Trish Williams (Delegate and Report Coordinator)
Nat Wong (Delegate)
Dr Stephen Chu (NEHTA)
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
Contents
1.
INTRODUCTION
6
1.1
OBJECTIVES OF MEETING
6
1.2
RELEVANCE TO NEHTA PROGRAMS
8
1.3
MEETING LOGISTICS
8
1.4
RECOMMENDATIONS ARISING FROM THE MEETING
12
1.5
FUNDING SOURCES SUMMARY AND AUSTRALIAN ATTENDANCE
20
1.6
AUSTRALIAN LEADERSHIP POSITIONS
20
2.
WORKING GROUP REPORTS
22
2.1
ADVISORY COUNCIL
2.1.1
PROGRESS AT THIS MEETING
2.1.2
ACTIONS FOR AUSTRALIA
22
22
22
2.2
AFFILIATE AGREEMENT TASKFORCE
2.2.1
PROGRESS AT THIS MEETING
2.2.2
ACTIONS FOR AUSTRALIA
23
23
24
2.3
AFFILIATE DUE DILIGENCE COMMITTEE
2.3.1
PROGRESS AT THIS MEETING
2.3.2
ACTIONS FOR AUSTRALIA
25
25
25
2.4
ARCHITECTURE REVIEW BOARD
2.4.1
PROGRESS AT THIS MEETING
2.4.2
CURRENT PROJECTS
2.4.3
ACTIONS FOR AUSTRALIA
26
26
26
28
2.5
HL7 BOARD
2.5.1
PROGRESS AT THIS MEETING
2.5.2
CURRENT PROJECTS
2.5.3
CEO REPORT
2.5.4
OTHER NON-PROJECT WORKING GROUP DISCUSSIONS AND PRESENTATIONS
2.5.5
ACTIONS FOR AUSTRALIA
29
29
30
34
37
42
2.6
CHILD HEALTH
2.6.1
PROGRESS AT THIS MEETING
2.6.2
ACTIONS FOR AUSTRALIA
43
43
43
2.7
CLINICAL DECISION SUPPORT
2.7.1
PROGRESS AT THIS MEETING
2.7.2
CURRENT PROJECTS
2.7.3
ACTIONS FOR AUSTRALIA
44
44
44
49
2.8
CLINICAL STATEMENT
2.8.1
PROGRESS AT THIS MEETING
2.8.2
CURRENT PROJECTS
2.8.3
ACTIONS FOR AUSTRALIA
50
50
50
50
2.9
COMMUNITY BASED COLLABORATIVE CARE
2.9.1
PROGRESS AT THIS MEETING
2.9.2
CURRENT PROJECTS
2.9.3
OTHER NON-PROJECT WORKING GROUP DISCUSSIONS AND PRESENTATIONS
51
51
51
55
2.10 EDUCATION WORKING GROUP AND MARKETING COMMITTEE
2.10.1 PROGRESS AT THIS MEETING
2.10.2 CURRENT PROJECTS
2.10.3 OTHER NON-PROJECT WORKGROUP DISCUSSIONS AND PRESENTATIONS
2.10.4 ACTIONS FOR AUSTRALIA
58
58
59
61
61
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.11 ELECTRONIC HEALTH RECORDS
2.11.1 PROGRESS AT THIS MEETING
2.11.2 CURRENT PROJECTS
2.11.3 ACTIONS FOR AUSTRALIA
62
62
65
72
2.12 ELECTRONIC SERVICES
2.12.1 PROGRESS AT THIS MEETING
2.12.2 CURRENT PROJECTS
2.12.3 ACTIONS FOR AUSTRALIA
74
74
75
75
2.13 HEALTH CARE DEVICES
2.13.1 PROGRESS AT THIS MEETING
2.13.2 ACTIONS FOR AUSTRLIA
76
76
76
2.14 HL7 ACTIVITIES WITH OTHER SDOs
2.14.1 PROGRESS AT THIS MEETING
2.14.2 ACTIONS FOR AUSTRLIA
77
77
79
2.15 HL7 ARCHITECTURE PROGRAM AND SAIF
2.15.1 PROGRESS AT THIS MEETING
2.15.2 CURRENT PROJECTS
2.15.3 ACTIONS FOR AUSTRALIA
80
80
80
81
2.16 INTERNATIONAL COUNCIL—GENERAL SESSION
2.16.1 PROGRESS AT THIS MEETING
2.16.2 CHIEF TECHNOLOGY OFFICER (CTO) REPORT
2.16.3 TECHNICAL STEERING COMMITTEE (TSC) REPORT
2.16.4 REGIONAL REPORTS
2.16.5 HL7 AROUND THE WORLD
82
82
84
85
86
86
2.17 INTERNATIONAL COUNCIL—AFFILIATE CHAIRS SESSION
2.17.1 PROGRESS AT THIS MEETING
2.17.2 ACTIONS FOR AUSTRALIA
87
87
91
2.18 JOINT INITIATIVE COUNCIL LIAISON
2.18.1 PROGRESS AT THIS MEETING
2.18.2 ACTIONS FOR AUSTRALIA
92
92
92
2.19 MEMBERSHIP TASKFORCE
2.19.1 ACTIONS FOR AUSTRALIA
93
93
2.20 MOBILE HEALTH
2.20.1 PROGRESS AT THIS MEETING
2.20.2 CURRENT PROJECTS
2.20.3 OTHER NON-PROJECT WORKING GROUP DISCUSSIONS AND PRESENTATIONS
2.20.4 ACTIONS FOR AUSTRALIA
94
94
94
96
97
2.21 MODELLING AND METHODOLOGY
2.21.1 PROGRESS AT THIS MEETING
2.21.2 CURRENT PROJECTS
2.21.3 ACTIONS FOR AUSTRALIA
98
98
98
99
2.22 PATIENT ADMINISTRATION
2.22.1 PROGRESS AT THIS MEETING
2.22.2 CURRENT PROJECTS
2.22.3 ACTIONS FOR AUSTRLIA
100
100
100
101
2.23 PATIENT CARE
2.23.1 PROGRESS AT THIS MEETING
2.23.2 CURRENT PROJECTS
2.23.3 ACTIONS FOR AUSTRALIA
102
102
102
105
2.24 PHARMACY
2.24.1 PROGRESS AT THIS MEETING
2.24.2 ACTIONS FOR AUSTRALIA
106
106
108
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2.25 POLICY ADVISORY COMMITTEE
2.25.1 PROGRESS AT THIS MEETING
2.25.2 ACTIONS FOR AUSTRALIA
109
109
109
2.26 SECURITY
2.26.1 PROGRESS AT THIS MEETING
2.26.2 CURRENT PROJECTS
2.26.3 OTHER NON-PROJECT WORKING GROUP DISCUSSIONS AND PRESENTATIONS
110
110
110
114
2.27 SERVICES ORIENTATED ARCHITECTURE
2.27.1 PROGRESS AT THIS MEETING
2.27.2 CURRENT PROJECTS
2.27.3 ACTIONS FOR AUSTRALIA
117
117
117
120
2.28 STRUCTURED DOCUMENTS
2.28.1 PROGRESS AT THIS MEETING
2.28.2 CURRENT PROJECTS
2.28.3 ACTIONS FOR AUSTRALIA
121
121
122
127
2.29 TEMPLATES
2.29.1 PROGRESS AT THIS MEETING
2.29.2 CURRENT PROJECTS
2.29.3 ACTIONS FOR AUSTRALIA
129
129
129
133
2.30 VOCABULARY
2.30.1 PROGRESS AT THIS MEETING
2.30.2 CURRENT PROJECTS
2.30.3 ACTIONS FOR AUSTRALIA
134
134
134
138
3.
ACRONYM LIST
139
4.
REPORTS FROM HL7 AFFILIATES AROUND THE WORLD
151
4.1
HL7 Argentina
151
4.2
HL7 Australia
152
4.3
HL7 Austria
152
4.4
HL7 Brazil
152
4.5
HL7 Bosnia and Herzegovina
153
4.6
HL7 Canada
153
4.7
HL7 China
154
4.8
HL7 Colombia
154
4.9
HL7 Croatia
154
4.10
HL7 Czech Republic
154
4.11
HL7 France
154
4.12
HL7 Germany
155
4.13
HL7 India
156
4.14
HL7 Italy
156
4.15
HL7 Japan
157
4.16
HL7 Korea
157
4.17
HL7 Luxembourg
157
4.18
HL7 New Zealand
157
4.19
HL7 Netherlands
158
4.20
HL7 Norway
158
4.21
HL7 Puerto Rico
159
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
4.22
HL7 Pakistan
160
4.23
HL7 Singapore
160
4.24
HL7 Spain
160
4.25
HL7 Switzerland
160
4.26
HL7 Taiwan
160
4.27
HL7 UK
160
4.28
HL7 US
161
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
1.
INTRODUCTION
HL7 International is a Standards Development Organisation (SDO) originating from the USA. It provides
international standards for inter-system and inter-organisational messaging, decision support, clinical text
documents mark-up, user interface integration, EHR/PHR systems functionality, a health data model, and
message development methodology. HL7 International produces global health informatics standards
through a process of collaboration that involves its local affiliate, HL7 Australia.
HL7 International Working Group Meetings (WGMs) are held three times a year. These WGMs serve two
important purposes: giving the HL7 International work groups a chance to meet face-to-face to work on
standards, and giving attendees the opportunity to network with industry leaders from around the world.
Both of these outcomes provide a valuable 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 May 2013 HL7 International WGM was held in Atlanta, Georgia, USA, with activities scheduled over
seven days. There were 370 attendees at this meeting. The main activities ran from Sunday 5 May to Friday
10 May 2013. On weekdays formal meetings were scheduled from 9:00am to 5:00pm, however as is
common for HL7 meetings, some were arranged from 7:00am and ran as late as 10:00pm.
Over the past 12 months HL7 has been examining its priorities and principles. This has been a period of
significant change and growth that culminated in the announcement of HL7 free access to Intellectual
Property (IP) at the Baltimore WGM in September 2012. This meeting announced the commencement of a
project to re-image HL7 products that will be based on the Product Line and Product Family Strategy.
Additionally the recently completed Tooling Strategy findings were presented to the Technical Steering
Committee (TSC), and a Risk Assessment Project that will develop a formal risk assessment process for HL7
International was initiated.
It should be noted that the HL7 International standards work is not structured as "Work Items" put forward
to the HL7 body for approval; rather, most projects arise from the work within the many domain specific
and specialist committees. The 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 before
being commenced.
This report summarises the committee proceedings, work progress, issues and actions for consideration by
Australia arising from this HL7 International WGM.
1.1
OBJECTIVES OF 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 of the stakeholders—both those present at the
meeting and those in the wider community of interest. Although 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 WGMs.
The overarching objectives of HL7 meetings are to benefit the Australian health system and wider
community as follows:
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
improve Australian capacity to implement health informatics standards and e-health systems by
expanding local knowledge and expertise based on international best practice.
•
promote 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 the 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.
•
improve Australian health information systems by facilitating a standards based approach to
development and implementation, and achieving interoperability between systems.
Other more specific objectives for Australian engagement in international standardisation via HL7
International include the following:
•
Monitoring and influencing HL7’s strategic positioning as a global SDO encourages 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.
•
•
Negotiate the inclusion of 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.
Negotiating the inclusion of Australian health sector requirements in the HL7 Standards to ensure that
Australian EHR developments are supported by the upcoming HL7 and related ISO EHR Standards.
•
To achieve the long-term goal of a unified set of progressive inter-SDO e-health global health
informatics standards, Australia is negotiating the harmonisation of ISO, HL7, CEN and other established
standards development organisations (SDOs).
•
Monitoring and influencing new initiatives for standardising clinical data content improves Australia’s
ability to unambiguously and safely exchange semantically interoperable clinical data.
•
Australia’s national direction setting requires assessment and influence of HL7’s work on service
oriented architectures (SOA), and negotiation of 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) supports Australia’s interest in CDA and the 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 supports Australian interest in
the use of archetypes for the exchange of clinical information.
•
Progression of the international harmonisation of common data types and vocabulary for healthcare
information 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 Ageing (DoHA). Additional specific
objectives may arise occasionally as a result of the development of Australia’s national eHealth agenda and
other national interests.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
1.2
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.
1.3
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 per the following table:
RDH – Richard Dixon Hughes
ZM – Dr Zoran Milosevic
SC – Dr Stephen Chu
TW – Dr Trish Williams
DH – Daniel Henzi
NW – Nat Wong
AM – Amy Mayer
Working Group
Sat
Sun
Mon
Affiliate Agreement Taskforce (AATF)
RDH
Affiliate Due Diligence Committee
RDH
Tue
Wed
Thu
Fri
RDH
Ambassador Program
Anatomic Pathology
Anaesthesia
Architecture Review Board
ZM
ZM
Arden Syntax
Attachments
Board of Directors’ Meeting
RDH
Clinical Context Object
Clinical Decision Support
AM
AM
Clinical Genomics
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
Working Group
Sat
Sun
Mon
Tue
Wed
Thu
Fri
Clinical Interoperability Council
Clinical Statement
SC
Co-Chair Information Session
RDH
TW
Community Based Collaborative Care
TW
TW
Conformance and Guidance for
Implementation/Testing
DICOM WG-10
Education
AM
Electronic Health Records
RDH
AM
RDH
Electronic Services
RDH
NW
Emergency Care
FHIR Connectathon
FHIR Project
NW
NW
NW
Financial Management
Foundation Taskforce
Fresh Look Taskforce
Governance and Operations
GS1 Education Session
HL7 Activities with Other SDOs
RDH
TW
HL7 Product Line Architecture
Health Care Devices
TW
Imaging Integration
Implementation Technology Specification
Infrastructure and Messaging
International Council – General Session
AM
NW
RDH
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
Working Group
Sat
Sun
Mon
Tue
Wed
Thu
Fri
SC
TW
International Council – Affiliate Chairs
RDH
International Mentoring Committee
ISO TC215 WG-2
ISO TC215 + IEC SC62A JWG7
RDH
Joint Initiative Council (JIC) Liaison
RDH
Membership Taskforce (MTF)
Marketing Council
Mobile Health
SC
TW
TW
TW
Modelling and Methodology
NW
Orders and Observations
Patient Administration
NW
Patient Care
SC
NW
NW
SC
SC
Patient Safety
Pharmacy
SC
SC
Physician’s Meeting
Policy Advisory Committee
RDH
Process Improvement Committee
Project Services
Public Health Emergency Response
Publishing
Regulated Clinical Research Information
Management
RIM Based Application Architecture
SAIF Architecture Program Update
Security
ZM
TW
TW
TW
TW
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
Working Group
Sat
Sun
Services Oriented Architecture
Mon
Tue
Wed
ZM
ZM
TW
Steering Divisions – Domain Experts,
Foundations and Technology, Structure and
Semantic Design, Technical and Support
Services
Structured Documents
Thu
Fri
ZM
ZM
TW
ZM
AM
SC
RDH
ZM
ZM
Technical Steering Committee
Templates
RDH
Tooling
Vocabulary
AM
AM
AM
AM
AM
Tutorials are also offered and are of great value to newcomers and older hands alike, and help attendees
with generic changes made that may not be discussed in their individual committee areas. At this meeting
41 tutorial sessions were held concurrently with 40 work group and 9 taskforce meetings. Additionally,
there were meetings for the Ambassador Program, Co-Chairs, Board of Directors, First Time Attendees, GS1
Education session, HL7 Product Line Architecture Program, CIMI and Nurses, and HL7 activities with other
SDOs.
The large number of concurrent sessions makes it difficult for a small delegation to effectively follow all the
issues and influence change in all areas of interest to Australia. It is noted that delegates self-funded or
funded by their employer to go to international meetings have no obligation to work with or relate
information back to the Australian delegation, although 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. Intensive work is done in the committees, and often more than one Australian subject matter
expert is required to integrate 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 or 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 or activities that should be covered, and identify emerging issues—
particularly those that are relevant to Standards Australia IT-014 and NEHTA work plans. Australian
participants also coordinate their activities through Skype.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
1.4
RECOMMENDATIONS ARISING FROM THE MEETING
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Architecture Review
Issue: Business Architecture Model (BAM) is optimising HL7
processes to meet Product Line and Product Family expectations.
NEHTA
Board (ARB):
Business Architecture
Action: Evaluate BAM model to ensure use cases for HL7 products
meet Australian expectations.
IT-014
Issue: Infobutton standards address relatively simple interactions
with EHR based applications, and address both patient and provider
knowledge needs. US implementation is required for Meaningful
Use 2. These needs are universal, and the standards offer benefits to
Australian healthcare providers, consumers and vendors.
IT-014-13
Model (BAM)
Clinical Decision
Support:
Infobutton
Action: Ongoing development of Infobutton standards in the
Australian context to be informed by international developments.
Clinical Decision
Support:
Virtual Medical
Record (vMR) for
Clinical Decision
Issue: Standards Australia’s CDS project HL7 V2 Virtual Medical
Record Profile is feeding into HL7 International’s CDS and V2 work
and vice versa.
IT-014-13
Action: International development in the vMR work and IGs to
continue to inform HL7 V2 Virtual Medical Record Profile project in
Australia.
Support
Clinical Decision
Support:
Virtual Medical
Record (vMR) for
Issue: Incorporation of nutrition and diet specifications is included in
the vMR from the Diet Order DAM. Such requirements are
important for decision support and patient safety for dieticians,
speech pathologists, physicians, nurses and their patients in
Australia.
Support
Action: It will be important for take up in the Australian context that
these specifications for decision support are included and modelled
on international Diet Order specifications. Other allied health and
ancillary provider requirements should also be explored for decision
support.
Child Health:
Issue: These potential projects are relevant to Australia’s PCEHR
Child eHealth Record.
Clinical Decision
EPSDT Milestone and
Anthropometrics
Template
Clinical Statement:
OWL-based HL7 v3
model-model
validator
Action: The Australia e-Health community, specifically IT-014-06-06,
IT-014-13 and NEHTA, should observe these closely, and provide
input to the development of these templates.
Issue: This tool may be useful for validating the conformance of
patterns of detailed clinical models to CDA, as well as Pharmacy and
Patient Care RMIMs.
Action: It will be useful for IT14-06 subcommittees, NEHTA and
PCEHR groups to keep a close watch on the development and
maturation of this OWL based tool, and to evaluate its
appropriateness and adequacy for adoption.
IT-014-13
Allied Health
Professions
Australia (AHPA)
IT-014-06-06
IT-014-13
NEHTA
IT-014-06 and its
subcommittees
NEHTA
Australia eHealth
communities
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Clinical Decision
Issue: A relaxation of the amount of content of HL7 International
Intellectual Property included in Standards Australia Implementation
Guides may be required for this project, or in the absence of such a
relaxation a review of the manner in which this Australian
Implementation Guide will be structured.
Standards Australia
Support:
VMR v2
Implementation
Guide
Action:
Review proportion of original HL7 content in CDS
implementation guides.
Community Based
Issue: Increased involvement of Australia in input/feedback on HCS
as a foundation for information sensitivity labelling and secure
handling.
Collaborative Care
(CBCC)/Security:
Healthcare
Classification Scheme
HL7 Australia
SA
IT-014-04
Action: Notification by SA to IT-014-04 balloting of HCS, and
IT-014-04 to review and comment on this to provide feedback to HL7
Australia on next ballot.
(HCS)
Education:
Certification Project
Education:
e-learning Plan
Issue: There is agreed and inherent value in building varying levels of
certification for an advanced practitioner level as distinct from base
level certification. Previously a certification project was active with
the Education Work Group, however the project leader was no
longer available and the project is no longer active.
HL7 Australia
Action: HL7 Australia to consider taking up leadership of this project
to reinstate as an active project.
WGMs
Issue: An e-learning course for Australia could be established. The
course can be set up for the HL7 Australia Board to review. (This
issue was reported by Heather Grain at the Phoenix 2013 WGM and
continues to be relevant.)
Future Education
representative
delegations to
HL7 Australia
Education Council
Action: HL7 Australia Education Council to review e-learning course
materials.
Electronic Services/
T3SD
EHR WG
Re-ballot of R2 EHR-S
FM
Issue: Work in Australia on update of its electronic services may be
complementary to other HL7 work.
HL7 Australia
Action: Keep the Technical and Support Services Steering Division
updated with the progression of the ‘Affiliate in a Box’ concept being
developed by HL7 Australia.
Issue: There is a mismatch between the HL7 and ISO re-ballot
requirements in relation to the next round of normative balloting to
finalise the ISO/HL7 10781 EHR-S FM R2 standard. The leaders of
EHR WG have sought advice and assistance on managing the
potential issues through the JIC Chair (Richard Dixon Hughes), the
ISO/TC 215 Secretariat (Lisa Spellman) and the ISO/TC 215/WG1
Secretariat (Naomi Ryan).
ISO/TC 215 WG 1
Secretariat
(Naomi Ryan)
Richard
Dixon Hughes
Action: Naomi Ryan (WG1) and Richard Dixon Hughes to consider
issues relating to harmonisation of DIS2 ballot of ISO/HL7 10781
with HL7 N3, and assist HL7 EHR WG Co-Chairs and ISO/TC215
secretariat in finalising a joint publication in the most effective
manner.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
EHR WG:
Issue: An Australian review and response to these two ballots of the
ISO/HL7 PHR-S FM will be required in coming months. This was
previously covered by IT-014-09, but now falls under IT-014-13 with
its broader responsibility of ‘Clinical workflow and care systems’.
The HL7/N2 ballot through HL7 Australia is likely to close much
earlier than the ISO/DIS2 ballot. A consistent approach is desirable.
IT-014
HL7/N2 and ISO/DIS2
ballot of PHR-S FM
HL7 Australia
Action: IT-014-13 and former members of IT-014-09 to be invited to
prepare ballot responses to HL7/N2 and ISO/DIS2 ballots in
collaboration with HL7 Australia.
EHR WG:
Proposals for R3 of
EHR-S FM
Issue: While preparation of Release 3 of the EHR-S FM is still some
time away, the preparation of the PSS for this work is already being
progressed by Functional Information Model (FIM) Sub-Group, who
are recommending a fundamental re-engineering based on
incorporation of their current approaches. Although this may or may
not have merit, the preliminary work on the FIM is strongly US based
and there is a risk that the International applicability of the EHR-S
FM as an international standard will be prejudiced or lost in this
process. It is desirable that this move be closely monitored and if
necessary addressed at an early stage to ensure that any outcomes
are internationally applicable.
IT-014
HL7 Australia
Australian
delegations to HL7
WGMs
Action: Future delegations, IT-014 and HL7 Australia monitor the
proposals and scope statement for R3 of the EHR-S FM to ensure
that future revisions are likely to remain relevant as an international
standard. As the HL7 process for approval of Project Scope
Statements is an internal function of the TSC without external input,
raising early harmonisation of this work through JIC should be
considered.
EHR WG:
Usability Sub-Group
Issue: Participation in the work of the new Usability Sub-Group of
the EHR WG by Australians with interest and expertise in usability of
systems would be welcome. The project is commencing with a
literature review and white paper, with a view to identifying
relevant usability criteria and incorporating them into the EHR-S FM.
Australian and related ISO/TC 215 guideline documents on user
interfaces and the application of clinical decision support are among
the key references identified to date.
IT-014
HL7 Australia
Action: IT-014 and HL7 Australia to circulate information on the HL7
EHR Usability Project among relevant experts with an invitation for
them to participate in the activities of the Usability Sub-Group of the
EHR WG.
Health Care Devices:
Ventilator
Nomenclature
Issue: Standardisation of measurement points and variables.
Action: Advise Standards Australia Health Care Devices mirror group
HE-003 of revisions and canvas for potential members or
manufacturers to engage in this work.
Standards Australia
(HE-003)
14
Final Report HL7 Meeting—Atlanta, USA (May 2013)
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
HL7 Board:
Issue: Changes to the HL7 membership model, membership benefits,
education and certification services, and IP licensing policies have
potential consequences for the HL7 affiliates, including HL7
Australia. Although generally positive for worldwide adoption and
acceptance of HL7 standards, these changes may impact the
perceived benefit of being an HL7 Australia member and its
contractual relationships.
HL7 Australia
Changes to HL7
International
membership model,
services and licensing
policies
HL7 Board:
IP Licensing Taskforce
Action: HL7 Australia to continue monitoring, analysing and
responding to the emerging changes in the HL7 International
membership model, services and IP licensing policies.
Issue: HL7 international has formed an IP licensing taskforce to
provide advice through the Membership Committee on IP licensing
issues that arise from free licensing of HL7 standards. The IP
licensing taskforce also takes note of potential interactions with the
new membership model, including possible difficulties in the
different treatments accorded to ‘derivative works’ under various
contractual arrangements. Richard Dixon Hughes has been
appointed to the taskforce based on his legal qualifications, his
current role as Chair of HL7 Australia, and his knowledge of
agreements between Standards Australia and HL7 Australia in
relation to the use of HL7 International IP in Australian Standards
and lower consensus publications.
Chair of HL7
Australia.
Action: Richard Dixon Hughes to participate actively as an appointed
member of the HL7 International IP Licensing Taskforce, with a view
to ensuring consistency between the various types of IP licenses, the
affiliate agreement and other contractual arrangements for use of
HL7 International’s intellectual property.
HL7 Terminology
Authority (HTA)
Issue: The HL7 Board has accepted a recommendation to form an
HL7 Terminology Authority (HTA) under the agreement between
IHTSDO and HL7 International to act as a gatekeeper to ensure that
content from HL7 is submitted to IHTSDO in a controlled manner. Of
the five members of the Authority, two must come from within the
HL7 affiliates, be appropriately qualified and experienced, and be
prepared to participate regularly in required teleconference calls. A
call for nominations is to be issued. Appropriate Australian
candidates should be given the opportunity to nominate.
HL7 Australia
Standards Australia
Action: The HL7 call for nominations of suitably qualified persons to
serve on the HTA to be circulated to IT-014-02, IT-014-06 and NEHTA
(Terminology Services).
International Council:
Staging of IHIC 2013 in
Sydney
Issue: HL7 Australia is organising the International HL7
Interoperability Conference (IHIC 2013) in Sydney in a time slot
adjacent to the ISO/TC215 meeting being planned for October 2013,
and has received $US5 000 support toward this end from the HL7
International Council. There is a lot still to be organised.
HL7 Australia
Action: HL7 Australia to progress the organisation of IHIC 2013 in
Australia in October 2013 and get calls for papers and publicity in
progress by end of June 2013.
15
Final Report HL7 Meeting—Atlanta, USA (May 2013)
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
HL7 Architecture
Issue: It is not clear at present how Product Line/Product Family
concepts from the ARB BAM project are related to the SAIF
Architecture Program.
HL7 Australia
Program and SAIF:
SAIF Artifact
Definition
Mobile Health:
Action: Contribute to and influence product line/product family
developments while linking it with the experience and deliverables
from the SAIF Artifact Definition project.
Issue: Benefits and opportunities for mobile health include
extending provider mobility especially for community clinics, rural
and remote and more mobile workforces (e.g. district nurses),
improving safety through identification standards, record keeping,
and identification of devices for supply chain management
IT-014
Standards Australia
Future delegations
Action: Integrate mobile health within Australian context and work
programs.
Modelling and
Methodology &
Patient
Administration:
FHIR Resources
Patient Care:
Allergy/Intolerance
and Adverse Reaction,
Care Plan DAMs; CCS
FM; and FHIR
resources models
Pharmacy:
HL7/IHE Medication
Profile
Issue: FHIR Resource development requires ongoing Australian input
to influence the inclusion of data elements that would be considered
core for Australia
Action: Continue to support and engage Australian subject matter
experts in the development of domain specific resources, including
Encounter resource for community contexts.
Issue: Ongoing work on allergy/intolerance and adverse reaction in
Care Plan DAMs needs to be noted by relevant IT-014 groups and
considered for incorporation into relevant Australian activities.
NEHTA
Standards Australia
Future HL7
delegations
IT-014-06-04
IT-014-06-05
Action: Allergy/Intolerance, Adverse Reaction, and FHIR resource
Models are of interest to and should be monitored by IT-014-06-04,
IT-014-06-05, IT-014-06-06 and IT-014-13.
IT-014-13
Care Plan and CCS are of interest to IT-014-06-06, IT-014-09 and
IT-014-13.
Australian eHealth
IT-014-06-06
All these projects are of interest to NEHTA and PCEHR projects.
Communities
Issue: The medication profile work is of high importance to Australia.
IT- 014-06-04; IT-014-06-06 and IT-014-13, NEHTA and PCEHR
projects in particular should monitor and provide relevant input to
this activity.
IT-014-06-04
IT-014-06-06
IT-014-13
projects
Action: The ISO WG6 activities remain a concern to other
international groups. There needs to be a closer link between the
Australian delegate to ISO WG6 and IT-014-x groups to ensure
visibility of the ISO projects.
Australian eHealth
Security:
Issue: The development of the Security implementation guides
needs wider than US input.
HL7 Australia
ISO/TC215 WG 6
HL7 DS4P IG
Action: It is important that Australia contribute to the development
of this project to ensure its companion work is suitable for Australia
in the future.
communities
IT-014-04
16
Final Report HL7 Meeting—Atlanta, USA (May 2013)
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
SOA:
Issue: The OMG MDMI standard can support many types of
information mappings but is not sufficient to support general
behavioural mapping.
IT-014-09
Cross Platform
Interoperability
Implementation
Guide for
SOA Ontology WG
Action: Continue analysis of alternative approaches to support
behavioural mapping, including the use of an MDMI standard and
other MDHT components as well as new SOA Ontology concepts.
Immunisation
SOA:
SOA Service Ontology
Issue: The ontology paper included on the SOA ontology wiki page
(http://hsspinfrastructure.wikispaces.com/HSSP+SOA+Service+Ontology)
provides the basis for the development of a rich set of discoverable
and interactive e-Health services. When balloted it needs to be
explained, discussed, socialised and commented upon by a wide
audience within the health standards and software community.
HL7 Australia
IT-014-09
NEHTA
Action: Develop and present a brief paper for Standards Australia
that outlines the approach, and consider the application of SOA
ontology for Australian e-Health (e.g. National Health Services
Directory, the ELS and PCEHR). Note that the SOA Ontology is
directly related to the e-Health Interoperability Framework
developed within IT-014-09, and thus this group is a natural home to
progress this work.
Action: Communicate SOA Ontology work to other relevant
organisations and encourage the use of the ontology in SOA oriented
solutions.
SOA:
Patient Care Services
Issue: This seems to be well-defined project and the only issue
would be feasibility of executing it in sync with other projects of the
SOA or other WGs.
IT-014-09
Future delegates to
Co-ordination Project
Action: Investigate how the PCC service can be expressed using the
concepts proposed by the SOA Ontology project.
SOA Ontology WG
SOA/Patient Care:
The SOA/Patient Care ordering services interface specification
project is relevant and of interest across the IT-014 and the wider
eHealth standards community.
IT-014-06-04
Ordering Services
Interface Specification
Action: SOA/PC work on ordering services interface specifications to
be reviewed by IT-014-06-04, IT-014-06-05 and IT-014-13 as basis for
wider discussion and need for complementary Australian activity.
IT-014-06-05
IT-014-13
Australian eHealth
communities
Structured
Documents:
CDA R3
Issue: CDA R3 will be submitted for ballot in September 2013.
Action: Monitor new CDA R3 developments, and understand
industry acceptance and impact on Australian specifications that are
based on R2. NEHTA and IT-014 committees are to monitor the
progress on this item.
NEHTA
IT-014
HL7 Australia
Also monitor interplay of R3 with FHIR specification that will be
published in the same balloting period.
17
Final Report HL7 Meeting—Atlanta, USA (May 2013)
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Structured
Issue: The Patient Generated Document (PGD) IG is intended to
provide implementation guidance on the CDA header and body
elements for documents authored by patients or representatives of
patients. The PGD header now includes international inputs based
on Australian work to align better with international requirements.
It is recommended that Australia be further engaged in the
development of PGD body components.
NEHTA
Documents:
Patient Authored
Documents
IT-014
Action: NEHTA and Australia should participate and include
Australian patient generated documents body elements to this CDAIG on PGD IG. This will enable Australian implementers and
standards bodies to contribute and align with international
standards for patient generated documents.
Structured
Documents:
Questionnaire and
Questionnaire
Response CDA
Implementation
Guides
Structured
Documents:
Automation and open
source tooling for
clinical information
modelling
Structured
Documents:
Clinical Oncology
Treatment Plan and
Issue: Electronic interchange of meaningful question and response
documents between the practitioner and the patient.
NEHTA
Action: NEHTA and Australia should actively participate in the
standardisation of questionnaire and questionnaire response
documents. The Australian requirements for Consumer Entered
Health Assessment and Bluebook Questionnaire requirements
should be augmented to the universal realm. This is to align
Australian consumer/healthcare provider questionnaire documents
with the international questionnaire framework.
IT-014
Issue: There is a need for formal methodology or best practices for
developing CDA templates and implementation guides, and
appropriate tooling to support repeatable processes and deal with
the proliferation of templates.
NEHTA
Action: Investigate the use of Model Driven Health Tools (MDHT) as
a way of providing programmatic access to the information model
associated with templates, and supporting a scalable and repeatable
approach to the clinical information modelling. Consider positive
experience reported at this WG meeting regarding harmonisation
between C-CDA and IHE and as a way of dealing with the
proliferation of templates.
Issue: The current C-CDA Implementation Guide specification is a
good document from both the modelling and clinical perspective,
but is developed for the US Realm.
Action: Consider this document for relevant future developments
related to Australian e-health clinical oncology specifications.
IT-014-06-04
IT-014-06-06
IT-014-13
DoHA
Summary
HL7 Australia
Vocabulary:
Issue: HL7 Vocabulary Working Group requires a deep understanding
of the various technical vocabularies and project bases. At the
current meeting the Vocabulary tutorial was cancelled and therefore
mentored delegate was unable to fully engage in Vocabulary WG
development.
DoHA
IT-014
Action: Consider Australian vocabulary priorities and potential for
development and support of Australian subject matter experts in
future delegations.
18
Final Report HL7 Meeting—Atlanta, USA (May 2013)
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Vocabulary:
Issue: The use of HingX as a trial needs to be noted by Standards
Australia, for consideration of adoption of the tool as:
Future HL7
HingX
1.
2.
It may be useful to Standards Australia as a platform for
collaboration; and
The structure of resources needs to be well defined and input
to the structure required.
Delegation (to
review progress of
this project)
Action: This action is carried over from a recommendation made by
Heather Grain in the 2013 Phoenix Delegation Report. Please
monitored by future delegations for information to support
Standards Australia's review of tool and opportunities for use.
19
Final Report HL7 Meeting—Atlanta, USA (May 2013)
1.5
FUNDING SOURCES SUMMARY AND AUSTRALIAN ATTENDANCE
Twelve Australians attended as representatives for the duration of this HL7 meeting, six 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:
•
Daniel Henzi
•
Richard Dixon Hughes
•
Amy Mayer
•
Dr Zoran Milosevic
•
Dr Trish Williams
•
Nat Wong
The following delegates attended on behalf of NEHTA:
•
Dr Stephen Chu
Funding Source
Number
Change from
Previous
meeting
Full funding by employer: Private
0
0
Full funding by employer: States/Territories or National Initiatives (NEHTA)
1
-2
Funding assistance—DoHA through Standards Australia Funding Agreement
6
-3
Total:
7
-5
1.6
AUSTRALIAN LEADERSHIP POSITIONS
The table below lists leadership positions held by Australians at the HL7 meeting in May 2013.
Attendee
Position
Funding Source
Work Group or Committee
Dr Trish Williams
Co-Chair
Standards Australia
via the DoHA Funding
Agreement
Security
Dr Stephen Chu
Co-Chair
NEHTA
Patient Care
Nat Wong
Co-Chair
Standards Australia
via the DoHA Funding
Agreement
Electronic Services
Co-Chair
Standards Australia
via the DoHA Funding
Advisory Council to the Board of
HL7 International
Richard Dixon Hughes
20
Final Report HL7 Meeting—Atlanta, USA (May 2013)
Attendee
Position
Non-Voting
Member
Funding Source
Agreement
Chair—HL7
Australia
Work Group or Committee
HL7 International Board of
Directors
International Council Affiliate
Chairs Meeting
International Membership
Affiliation Taskforce (IMATF)
Dr Zoran Milosevic
Invited Member
Affiliate Due Diligence
Committee (of HL7 International
Board)
Appointed
Member
Affiliate Agreement Taskforce
(of the International Council)
Invited Member
Policy Committee (of HL7
International Board – invited by
HL7 Chair)
Appointed
Member
Intellectual Property Taskforce
(invited by HL7 Board)
Chair (2013/14)
Joint Initiative Council (JIC) for
Global SDO Health Informatics
Standardization
ArB Member
Standards Australia
via the DoHA Funding
Agreement
Architecture Review Board
21
Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.
2.1
2.1.1
WORKING GROUP REPORTS
ADVISORY COUNCIL
PROGRESS AT THIS MEETING
The Advisory Council performs most of its work through monthly teleconferences and a face-to-face
meeting at the annual Board retreat, but does not meet at WGMs. As the Chair of the Advisory Council,
Richard Dixon Hughes provides input on its behalf at the face-to-face Board meetings held at WGMs.
In the months leading up to this WGM the Council was consulted on several occasions, and provided
considerable further input on changes in HL7 membership benefits and fees following the strategic decision
to license HL7 standards and selected other HL7 Intellectual Property free of charge.
At this meeting Richard Dixon Hughes was asked to join a taskforce providing specialist advice to the HL7
Membership Committee on questions related to intellectual property and derivative works.
2.1.2
ACTIONS FOR AUSTRALIA
No actions required at present.
22
Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.2
2.2.1
AFFILIATE AGREEMENT TASKFORCE
PROGRESS AT THIS MEETING
The affiliate agreement, which provides a common framework for the contractual arrangements between
HL7 International and its affiliates around the world, comes up for renewal every two years. At the January
2013 meeting the International Council (Affiliate Chairs) re-established the Affiliate Agreement Taskforce
(AATF) with Philip Scott (UK) as Chair to identify and agree any further amendments to the standard affiliate
agreement for the next renewal cycle, commencing 1 January 2014. Richard Dixon Hughes was re-appointed
as a member of the re-established AATF.
Working by email and teleconference over the period between the January and May WGMs, the AATF
identified potential changes to the agreement. These were discussed in detail over several quarters at the
May 2013 meeting, with an updated draft being prepared. The changes included the following:
•
A proposal for agreements to run for one year rather than two years, so as to accommodate the
aspirations of some affiliates who feel that a two year period will inhibit adoption of other governance
changes proposed in last year’s International Membership and Affiliation Taskforce (IMATF) report. HL7
Australia prefers two year terms.
•
Accommodating the terms under which HL7 is now licensing its standards and other selected
intellectual property without charge, and related changes to membership models and fees.
•
Better integration with the HL7 International charter and by-laws as the source of member classes and
governance rights.
•
Anticipating an expansion of HL7 direct education and certification activities.
•
Many further refinements to improve the clarity and legal precision of a document that originally grew
from being more of a policy statement than a contractual agreement.
In total some 35 changes were agreed. A revised version 0.4 has been prepared and circulated for AATF
comment before being opened up for input from the International Council and feedback from HL7
Headquarters staff. Richard Dixon Hughes has suggested three further refinements to version 0.4, which
have been reviewed and recommended for acceptance by the AATF Chair.
The next steps will be to provide the draft to the full International Council and HL7 International HQ for
further review, comment and agreement in principle. Following a resolution of any further issues, it will
then be submitted to the HL7 Board for approval and distributed to affiliates for execution.
23
Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.2.2
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Affiliate Agreement
Issue: The AATF is producing the next version of the affiliate
agreement between HL7 International and its affiliates (including
HL7 Australia) to commence in January 2014. It is important that the
agreement continues to facilitate HL7 Australia's arrangements with
Standards Australia for the production and publication of Australian
HL7 implementation guides as Australian Standards and lowerconsensus publications.
HL7 Australia
Taskforce (AATF):
Renewal of affiliate
agreement 2014–2015
Richard Dixon
Hughes
Action: HL7 Australia to continue monitoring and negotiating the
affiliate agreement for 2014 with the aim of ensuring that it enables
the continued availability of HL7 materials in Australia under
reasonable commercial terms sufficient to allow the continued
publication of Australian HL7 Implementation Guides.
24
Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.3
2.3.1
AFFILIATE DUE DILIGENCE COMMITTEE
PROGRESS AT THIS MEETING
The Affiliate Due Diligence Committee (ADDC) assists HL7 International by reviewing applications to
establish an HL7 affiliate. This includes receiving and considering applications, conducting enquiries, and
making recommendations to the HL7 Executive Committee, who then forward their recommendation on to
the Board of Directors for final approval. The ADDC is also responsible for assisting HL7 International
maintain the affiliation criteria and associated processes, and providing information and guidance for
organisations considering becoming the HL7 affiliate in their country.
In addition to face-to-face meetings at WGMs, the ADDC has monthly conference calls and may meet more
frequently when required to progress particular matters. Richard Dixon Hughes is a member of the ADDC.
Beat Heggli (Chair of HL7 Switzerland) took over as Chair of the ADDC when Catherine Chronaki stepped
down shortly after her term on the Board of HL7 International expired at the end of December 2012. The
following were among the matters addressed when the ADDC met at this WGM:
•
An application has been lodged to form HL7 Malaysia. The report prepared by Richard Dixon Hughes
following his interview of Dr Khadzir (Head of the Health Informatics Centre and Deputy Director,
Planning and Development Division, Ministry of Health Malaysia) was discussed. It was noted that the
application from Malaysia was of generally good quality, the petitioners represented substantial and
balanced interests, and that misunderstandings over the government representation had been
addressed fully in the report. It was resolved to recommend progression of the HL7 Malaysia
application to the Executive Committee (EC). [EC agreement and subsequent steps were successfully
completed in time for a Board approval at its June meeting, with HL7 Malaysia then being invited to
complete the affiliate agreement and other formalities of becoming an affiliate.]
•
The status of the application from the Philippines was addressed. Concerns over the status and breadth
of representation of the various petitioners were discussed. It was noted that their affiliations could be
interpreted in different ways, and that when the principal function of each petitioner’s employer was
taken into account, a more than appropriate balance was evident. Diego Kaminker undertook to
complete the interview process, with support from Richard Dixon Hughes if required. The processing of
this application is taking too long to progress.
•
The status of other applications was discussed. Substantial progress has yet to be achieved on the
foreshadowed applications from Denmark, Poland and Slovenia. Follow-up actions were assigned to
European members of the ADDC. It was noted that free of charge licensing of intellectual property in
HL7 standards would increase the potential for official sanction of HL7 standards but may reduce the
short-term incentive to form affiliate organisations.
•
Time slots for regular conference calls in the European evening toward the end of the month were
discussed. These will be confirmed by a doodle poll.
•
A new ADDC member to replace Supten (whose term ended in December 2012) was discussed. Supten
did not wish to be reappointed due to having taken up a new leadership position in the national
eHealth program and retiring from being Chair of HL7 India. Several replacement candidates were
identified and will be sounded out.
2.3.2
ACTIONS FOR AUSTRALIA
No actions required at present.
25
Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.4
ARCHITECTURE REVIEW BOARD
2.4.1
PROGRESS AT THIS MEETING
Key topics addressed at this meeting were:
•
the completion of the SAIF CD and a presentation of Healthcare SOA Ontology (project in the SOA WG)
as a SAIF Implementation Guide for services;
•
Business Architecture Model (BAM) updates and communication to SD WG; and
•
administrative (i.e. the revision and revitalisation of the ARB membership) and planning issues.
In terms of planning it was agreed to assign specific future areas of interest (e.g. W3C semantic web and
FHIR) to specific members of ARB, who would report regularly on developments in these areas.
2.4.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project #365: Service Aware Interoperability Framework (SAIF); and
•
Project #915: Business Architecture Model (BAM).
2.4.2.1
PROJECT #365: SERVICE AWARE INTEROPERABILITY FRAMEWORK
PROJECT OBJECTIVE/TOPIC SUMMARY
SAIF provides HL7 with an Interoperability Framework (i.e. a set of constructs, best practices, processes,
etc.) that enable HL7 specifications to achieve cross-specification consistency and coherency irrespective of
the chosen interoperability paradigm (messages, documents or services).
SAIF consists of four core ‘frameworks’ including—
(1) information (including RIM, data types, vocabulary bindings, etc.);
(2) behaviour (subsuming the existing Dynamic Model);
(3) enterprise conformance and compliance (including HL7’s existing Implementation and
Conformance standards); and
(4) governance.
Originally titled SAEAF (Services Aware Enterprise Architecture Framework), the name caused confusion
with other enterprise architectures such as Zachman and Togaf. It was renamed in February 2010. SAIF
should be regarded as an adjunct to any EAF that focuses on Working Interoperability (WI). It is a framework
that brings from SOA practice two critical constructs which significantly enhance the path to WI, for
example—
•
the separation of concerns (static vs. behavioural semantics); and
•
the formal notion of contracts
SAIF is Interoperability-Paradigm-neutral (i.e. it is equally applicable to projects seeking to develop solutions
that use documents, messages and/or services).
26
Final Report HL7 Meeting—Atlanta, USA (May 2013)
PROJECT ACTIVITY/ISSUES AT THIS MEETING
At this meeting Zoran Milosevic introduced the ARB to a new project that can be regarded as a SAIF
Implementation Guide for eHealth services. This is the HL7 SOA Healthcare Ontology Services Release 1,
which was submitted as a ballot for comment in the January–May 2013 cycle. This project uses SAIF’s
behavioural and governance framework as a basis for a conceptual model for understanding, using,
constructing, composing, managing and evolving eHealth services. The ARB sees this work as a good starting
point for consistent description of behaviour related artefacts within HL7 and informing related BAM
aspects, and as a valuable link between different projects of the HL7 SOA WG. The relationship with the HL7
SOA WG also serves as an indirect link to the Object Management Group.
It was also noted there is an outstanding item where current SAIF CD document needs to be completed with
the Glossary attachment, and this is the work that has been finalised in September 2012 through joint work
of Cecil Lynch and Zoran Milosevic. A protégé based description of the Glossary was submitted to the ARB,
but due to an administrative oversight this has not been included in the SAIF CD draft and will be addressed
in the next cycle.
2.4.2.2
PROJECT #915: BUSINESS ARCHITECTURE MODEL
PROJECT OBJECTIVE/TOPIC SUMMARY
HL7 proposes to change their organisational structure, process and policies to become more product line
focused and customer focused. However HL7 currently does not have an updated, detailed, comprehensive
and consolidated description of its current organisational structures, roles, processes and policies other
than the Governance and Operations Manual (GOM). Further, HL7 does not have a detailed and
documented description of its ideal goal organisational structures, roles, processes and policies other than
the GOM. To address these issues HL7 intends to develop a business architecture model (BAM).
The purpose of this document is to define an architecture methodology including guidelines, meta-models
and work phases with inputs, steps and outputs for the development of the BAM.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
It was agreed that product family and product line definitions need to be further clarified, possibly defining
the attributes of each so as to support a downstream automated search. It was also agreed that the spread
sheet based approach to capture BAM processes, artefacts and roles is cumbersome to maintain so a more
formal and visually friendly approach should be adopted. The use of UML activity diagrams will be pursued
from now on and an initial version was worked on during the meeting. Note that the key distinction
between product lines and product families was communicated to the HL7 community via the May 2013
HL7 newsletter (published at http://www.hl7.org/documentcenter/public_temp_4F3763D7-1C23-BA170C1A04FF83EFF235/newsletters/HL7_NEWS_20130506.pdf).
Finally the ARB has presented the key elements of the new BAM methodology to the TSC as well as to the
SD WG, which is an early adopter of the BAM methodology. The SD WG will be applying the BAM
governance, management and methodology to each of the product family and product lines.
27
Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.4.3
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Architecture Review
Issue: Business Architecture Model (BAM) is optimising HL7
processes to meet Product Line and Product Family expectations.
NEHTA
Board (ARB):
Business Architecture
Action: Evaluate the BAM model to ensure use cases for HL7
products meet Australian expectations.
IT-014
Model (BAM)
28
Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.5
2.5.1
HL7 BOARD
PROGRESS AT THIS MEETING
The Board of HL7 International met for the first three quarters on Tuesday 7 May.
One of the major topics permeating discussions at all HL7 Board meetings continues to be the policy
implications and actions flowing from HL7 international standards and selected IP being licensed at no cost
from 1 April 2013. At this Board meeting gave particular attention to the—
•
progress of the recently formed Membership Committee, which replaced the former Membership
Taskforce (MTF) in recommending potential changes to HL7 International's membership model
including possible changes in membership levels, benefits and fees;
•
extent of the other intellectual property which would be freely available under licence; and
•
what level of restrictions might be appropriate to the creation, publication or distribution of ‘derivative
works’ and the re-publication or distribution of the standards in other forms.
Among the other significant matters considered by the HL7 Board at this meeting and reported later in this
section are the—
•
formation of HL7 Terminology Authority to enable HL7 International to moderate and register SNOMED
CT concepts under IHTSDO rules;
•
location and budgetary impact of May 2015 WGM, proposed to be held in France;
•
Treasurer’s report;
•
CEO’s report (including updates on other appointments to the senior executive team); and
•
introduction and presentation by the new member of the HL7 International staff—Ticia Gerber,
Director of Global Partnerships and Policy.
As the details of some matters are still under consideration by the HL7 Board, this report is primarily based
on information that is either publicly available, or has been presented or discussed in other open forums
(including material presented in the General Sessions at the WGM).
From an organisational (as distinct from a technical perspective) HL7 strategic activities are largely being
progressed within the following areas:
•
Membership – where much of the activity is focussed on the work of the Membership Committee,
whose recommendations provide the basis for Board consideration of changes to the membership
benefits and dues structures, including a range of new initiatives as outlined in section 2.5.2.1.
•
Education—Now headed by Sharon Chaplock, this division is looking at new approaches to deliver new
coursework and utilise new technology. The HL7 Education Portal will be available in June 2013.
•
Partnership and Policy—HL7 has just appointed Ticia Gerber to head this division. Currently the focus is
on global benefactors and funding opportunities, and the increasing role of HL7 policy issues on the
WGs and committees.
•
Marketing and Communications—Carol Carmick head this division and is investigating new global
marketing initiatives by gathering data and analysis on new branding and rebranding efforts.
•
Communications and Outreach—Andrea Ribbick has been active in media and PR. Andrea is responsible
for internal and external messaging, and has facilitated the new monthly news brief.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.5.2
CURRENT PROJECTS
2.5.2.1
PROJECT: UPDATE OF HL7 MEMBERSHIP STRUCTURE AND BENEFITS
PROJECT OBJECTIVE
This project relates to the activities of the Membership Committee (MC), which was established by the HL7
Board in light of the need for ongoing work following the implementation of its decision to licence HL7
standards and other selected IP at no cost. The mission of the Membership Committee is to advise the HL7
Board in the following three areas—
1.
new membership benefits to retain current and attract new members of HL7 International;
2.
models for expanding member categories, activities, meetings and conferences beyond the
technical processes of standards development; and
3.
a functional framework for the relationship of the affiliates to HL7 International.
The project includes recommending coordinated changes to HL7 International’s membership structure,
benefits packages, other services, by-laws, IP licences and support infrastructure to implement the
proposed changes in ways that increase member engagement and protect the viability of HL7.
In this regard the Membership Committee continues the work of the former Membership Taskforce of
which Richard Dixon Hughes was a member (his involvement is now reduced to participation in the IP
Licensing Taskforce due to the pressure of competing commitments).
The current members of the Membership Committee are Grant Wood (Chair—InterMountain Healthcare),
John Hatem (Oracle), Craig Gabron (BCBS of South Carolina), Ed Hammond (Duke University), Philip Scott
(HL7 UK), Diego Kaminker (HL7 Argentina), Russ Leftwich (CMIO, Tennesee Office of eHealth) and Dave
Shaver (Corepoint).
The work is supported by a senior strategic planning consultant, Virginia Riehl. It is understood that her
engagement in this activity has overtaken and continues to be resourced through an extension of Project
#766 HL7 Business Plan Contract, which was first registered in March 2011.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
A considerable proportion of the Board’s time at this meeting was spent receiving and reviewing
recommendations from the Membership Committee, with a focus on the proposed benefits structure and
its relationship to the various categories of membership.
The work of the committee has included the review of evaluation data collected from various sources,
including surveys and questionnaires to identify potential benefits of engagement with HL7, with a strategic
focus on—
•
repositioning HL7 as an organisation that both develops standards and supports implementations,
•
identifying and addressing potential areas of growth, and
•
sustaining and growing HL7 membership and revenue.
Assessment of potential benefits
Potential benefits were developed and assessed in terms of five key elements: description of benefit,
administrative overhead, market assessment, implementation requirements and a final recommendation.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
The committee has both a short term and a longer term agenda. The immediate priority is those
recommendations needed for HL7 to offer a revised membership package in October. Accordingly some
proposed benefits were recommended for progression, others are to be the subject of more detailed
research, and some have been set aside for possible further consideration down the track.
The HL7 Board agreed that the following initiatives should be progressed to be ready for roll-out in
September 2013—
•
current work on implementation tooling;
•
current machine-processable artefacts (subject to further TSC recommendations as to implementation
approach)—the identification of those artefacts to be freely available as part of the HL7 standards and
which will be restricted to a member benefit remains in contention;
•
small meetings with HL7 leaders and knowledge experts;
•
onsite instruction; and
•
members only webinars.
The following initiatives are to be progressed for roll-out by the end of September 2013, subject to
satisfactory further development and the gathering of supporting data—
•
HL7 Help Desk Service—subject to further market assessment to determine demand and better design
the service;
•
User Groups—subject to further research to understand demand and determine how the benefit
should be designed; and
•
an hour with an expert—known HL7 experts still to be surveyed in order to determine topics,
availabilities and fee structures.
The following initiatives continue to be progressed for potential roll-out at some future time, subject to
satisfactory further development and the gathering of supporting data:
•
The interoperability testing service will proceed by way of an RFI to assess the scope, options, costs,
revenue sharing and potential partnerships. It is proposed that this service will be restricted to CDA, V2
and V3 messages with those artefacts required for MU and attachments in the US being a possible
priority. Further research on vendor requirements is required to assess testing priorities.
•
Further research is needed to understand the demands, the priorities, and how to deliver benefits
through HL7 Connectathon.
•
Further market research is needed to determine what new implementation tooling to invest in. The
resources, costs and timeframe needed to develop required tools will also need to be determined.
•
Further market research is needed to determine what new machine-processable artefacts to invest in.
The resources, costs and timeframe needed to develop them will also need to be determined.
The following potential initiatives have been deferred for consideration at a later time and are not being
progressed further at present—
•
conducting a vendor showcase (potentially at WGMs);
•
certified HL7 educator;
•
trending information on who is using HL7; and
•
listserv to announce RFPs.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
Access to Work Group materials
With access to HL7 standards becoming freely available, full participation in the development of HL7
standards is increasingly being seen as a member benefit. This raises many policy issues for the Board of HL7
International, which is trying to balance ANSI requirements for access to and involvement in the standards
development process against the needs to have clearly defined member benefits and the quality of the
resulting products.
It had been recommended by the former Membership Taskforce that read only access to all HL7 WG
listservs, wikis, agendas and minutes be openly and freely available to both members and non-members,
but that the ability to write to HL7 listservs and wikis be restricted to members and to subscribers who pay
(say $200) for the privilege (on a per-WG, per annum basis). On further investigation it was found that
implementation of this recommendation would involve considerable re-engineering of HL7’s current listserv
and wiki support platforms at an indeterminate cost.
These matters were discussed at some length but not resolved entirely. The board agreed to move along the
following lines—
•
provide open access to WG minutes and agendas;
•
restrict access for material under development, such as pre-balloting artefacts, standards and IGs to
members—this is to reinforce the three months period for members-only access after standards and
IGs are balloted;
•
the ability to ask questions on the listserv will be limited to members in order to be consistent with the
help desk benefit;
•
have staff research and report options for implementing these approaches; and
•
survey work groups regarding the impact of maintaining two wikis so that restricted members-only
materials would be behind a firewall.
Impact on affiliates
The following recommendations of the Membership Committee relating to arrangements with affiliates
were apparently accepted by the HL7 Board but without any specific resolution—
•
affiliate voting rights and other benefits under the current affiliate agreement continue unchanged; and
•
development of new benefits by HL7 International should if possible take approaches that can be
leveraged by affiliates or that leverage the work of affiliates.
It is noted that achievement of these outcomes (particularly the second) requires good communication
between HL7 International and the affiliates, and ongoing active participation by the affiliates in the work of
the Membership Committee, in order to influence the development and specification of new benefits and
the classes of participation to which they apply.
Collaboration with ONC Help Desk
The ONC in the United States is developing a help desk to support the progressive roll-out of legislated MU
(Meaningful Use) capabilities. Given the cost of infrastructure required to run a help desk service,
consideration had been given to HL7 coming to an arrangement with ONC for accessing HL7 help desk
capability through the ONC help desk capabilities.
Although use of the ONC facility could potentially provide a contact point for initial triage, it is not a good
strategic fit with HL7’s requirements—particularly in respect of the loss of branding, reduced control over
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
triage, tracking and quality, losing the perception of a member benefit and associated credit, and reduced
potential for HL7 revenue generation. It was also noted that ONC would not necessarily have as broad a
focus as HL7. On the other hand there would be synergies for HL7 and ONC to work together.
The path to be followed is for HL7 International to develop a website presence under its own control and
branding, but to continue collaborating with ONC as a potential customer for help desk services. Other
government entities may have the same needs. HL7 could consider charging for these services.
IP Policy Issues
IP policy issues were presented and discussed at some length but without significant resolution. See
separate notes on the Intellectual Property Licensing Taskforce below for background and next steps.
Healthcare Provider membership
The HL7 rules currently require that a healthcare provider member be treating or seeing patients. The
particularly favourable rate offered to healthcare providers is intended to encourage them to participate in
HL7 activities—particularly requirements definition—but it has not been widely taken up. It was considered
that if more clinicians who are primarily engaged in senior health informatics roles within organisations
were to take up membership as a healthcare provider, it might encourage both their participation and
ultimately more organisational memberships.
The HL7 Board accepted the committee’s recommendation to extend the eligibility for ‘healthcare provider
membership’ to include anybody that ‘is currently seeing patients’ or ‘has 10 years of patient care
experience and is currently working for a healthcare organisation in an administrative role’.
Timelines
It was agreed that the Membership Committee would progress its work in accordance with the following
timelines—
•
ongoing refinement of benefit definitions and recommendations based on additional research data;
•
developing recommendations on benefits that require only focused review for the July Board meeting;
•
reviewing the communication aspects of the proposed benefits to ensure consistency for the July board
meeting;
•
conducting overall review and finalisation of recommended benefit packages and recommending a dues
structure for initial implementation for the July Board meeting (ensuring that there is sufficient
differentiation across membership levels); and
•
defining a strategy for growing membership for Board consideration at the September 2013 plenary
meeting.
2.5.2.2
INTELLECTUAL PROPERTY LICENSING TASKFORCE
The various HL7 International license agreements contain restrictions on the ability of recipients of HL7
documents to distribute them further, or to create and distribute ‘derivative works’ depending on whether
they are members, non-members or affiliate organisations. Under the current HL7 International IP policies
the following applies:
•
Organisational members of HL7 International and its affiliates are permitted to share excerpts of HL7 IP
with their customers, but individual members and non-members are not permitted to do this.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
Organisational members of HL7 International and its affiliates are permitted to develop ‘derivative
works’ (in particular implementation guides—IGs) but may only distribute them to their customers. In
reality this is difficult to enforce.
•
No one (whether they are an HL7 member or not) is permitted to republish original HL7 specifications
on public websites. Affiliates may distribute copies of HL7 specifications to members within their
territories, but always subject to the HL7 International IP policy.
•
No one is authorised to publish derivative works (including IGs) containing HL7 IP on a public website,
however a number of government agencies do this (some being members and some not) and it is
difficult to enforce—particularly against a non-member that did not download the original work.
•
There is reluctance on the part of governments to adopt HL7 standards, because their eHealth
authorities may be precluded from widely distributing implementation guides that they develop.
•
The HL7 vision ‘To create the best and most widely used standards in healthcare’ is difficult to achieve.
•
Individual organisations can obtain special permission for reasonable use of HL7 IP by getting approval
via the HL7 International Executive Committee, but this is not widely recognised or necessarily
acceptable to public authorities. HL7 Australia is one of the few organisations to get such an agreement
in respect of HL7 Implementation Guides as Australian Standards and lower consensus documents
prepared by Standards Australia and published through SAI Global.
The need for the HL7 Board to decide whether current policies and licensing terms should continue or be
revised was discussed, and it was agreed that further more detailed work is required to inform the activities
of the Membership Committee and any further decisions of the HL7 Board. Until a decision is taken the HL7
administration will continue to adhere to the long established policy of asking those who are publishing to
become members or cease their unauthorised use.
To inform further work of the Membership Committee and decisions of the HL7 Board, it was resolved that
and IP Licensing Taskforce would be established (which may include representatives who are not on the
Membership Committee) under the Membership Committee to review IP policies and provide
recommendations to the Board for discussion at the Board retreat.
It was noted that Richard Dixon Hughes, Keith Boone and Philip Scott would be among those willing to serve
on the taskforce, which would be convened by the Membership Committee.
2.5.3
CEO REPORT
Topics addressed during presentations and reports by the CEO (Chuck Jaffe) included:
MEMBERSHIP COMMITTEE
The Membership Committee is a board-appointed standing entity responsible for developing
recommendations about membership benefits and a new dues structure.
A large part of the various CEO reports during the WGM summarised key elements of the activities and
recommendations of the Membership Committee, including—
•
the composition and role of the Membership Committee and its evolution from the consultation and
other work carried out by the previous Membership Taskforce;
•
the substantial polling and market research that had been undertaken of both HL7 members and nonmembers since March 2013, including at HIMSS and by telephone and internet surveys;
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
the four enduring principles underpinning this work—consensus, collaboration, communication and
trust—underpinned with a need for good humour;
•
the identification of 14 areas of potential member benefit and the work being done to assign these to
different levels and categories of members and non-members, and the basis for a fair and equitable
dues structure;
•
the implementation impacts, including any further changes to IP policies and investments required to
deliver new benefits;
•
the areas for decision by the HL7 Board—who gets what and for how much, IP policies, investments in
new capability, and implementation timelines; and
•
a commitment to informative monthly updates on progress toward the introduction of new
membership benefits, organisation and directions coming into effect from October 2013 (and to be
presented at the September WGM and plenary).
A considerable portion of the face-to-face Board time at this WGM was devoted to discussing
recommendations of the Membership Committee [as reported above].
FREELY ACCESSIBLE STANDARDS
Individual HL7 standards became available for free download from 1 April 2013 from the HL7 website under
an updated license agreement.
The initial implementation required a questionnaire to be completed for each document downloaded and
this was of concern to those promoting the universal adoption and use of HL7 standards. This restrictive
approach had been accepted as a problem, and the site was being redesigned to enable multiple documents
to be downloaded based on a single response to the questionnaire and license terms.
Requests from the media continue to be received seeking information on HL7’s decision to make its
standards and other selected IP available free of charge.
The various license agreements contain restrictions on the ability of recipients of HL7 documents to
distribute them further, and to create and distribute ‘derivative works’ depending on whether they are
members, non-members or affiliate organisations. The need for a Board decision on whether current
policies and licensing terms should continue or be revised was highlighted and discussed [resulting in the
formation of an IP taskforce as reported elsewhere].
CHANGES IN HL7 EXECUTIVE SUPPORT PERSONNEL
The following recent additions to the HL7 International Resource Team were noted:
Dr Sharon Chaplock—Director of Education:
•
Since commencing in January, Sharon has been working on a significant expansion of HL7
International’s educational offerings and activities. This commenced with a popular new series of
webinars on topical issues, with new approaches, new coursework and new technology now being
planned.
•
The new education portal is due for initial release in June 2013 with a catalogue of offerings and
progressive enhancement over the coming year.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
Online testing for HL7 professional certification is expected to become available through the education
portal in Q3/2013, with plans for it to be available internationally through approved examination
centres.
•
Various professional and technical organisations are considering reuse of the HL7 eLearning program,
either as a stand-alone entity or through integration into more broadly based training programs.
•
HL7 Australia has noted that this expansion in HL7 International training and certification services may
impact on some services traditionally offered by affiliates and some third party HL7 training
organisations operating in their territories. Nevertheless, there are more potential synergies than
competitive disadvantages, even in countries (such as Australia) which do not have the natural barrier
of requiring training in a language other than English.
Ticia Gerber—Director of Global Partnerships and Policy:
•
Ticia commenced on 1 May after having held various policy and partnership development roles over
many years, including recent work with the WHO (eHealth strategy), the Rockefeller Foundation and
the eHealth Initiative. She will operate out of donated office space in Washington DC.
•
She was present at the WGM, and gave presentations to the Board and Affiliate Chairs introducing
herself, her role and aspirations (summarised below as a separate topic).
Carol Carmick—Director of Marketing:
•
Carol is due to join HL7 International in June and comes with an over 20 years in marketing of HIT
software, business solutions and professional societies (including some work for HIMSS).
•
Her responsibilities will include the development of marketing and communications campaigns, new
global marketing initiatives, data gathering and analysis, branding and re-branding activities, and
working with WGs and committees (particularly on the identification, packaging and marketing of
product families and product lines).
They join other longer-established members of the HL7 resource team in the areas of:
•
Operations—Chuck Jaffe (CEO), Mark McDougall (Executive Director) and Karen Van Hentenryck
(Associate Executive Director)
•
Strategic Planning—Virginia Riehl (contract consultant)
•
Membership Services—Diana Stephens
•
Communications—Andrea Ribick
HL7 BALLOTING OF IHE PROFILES
Implementation of the agreement between HL7 international and IHE international to ballot relevant IHE
profiles through HL7 is proceeding. Following the recent IHE technical meeting, significant challenges have
been recognised in relation to validating the process, defining objectives and selecting relevant profiles. To
resolve these issues there will be an IHE balloting pilot conducted by HL7 for which the initial profiles/IGs
have yet to be determined. Opportunities for the pilot to support ONC profiles for RFD (Retrieve Form for
Data Capture) and data segmentation for privacy are being considered.
The CEO has recommended that an HL7 taskforce be established to liaise with IHE counterparts in order to
develop process, select pilot artefacts and establish deliverables.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
OTHER COLLABORATION AND OUTREACH
A strong collaborative and outreach program continues to be pursued with the following being particularly
noted:
•
Current and/or planned HL7 Europe involvement in European Commission projects and activities.
•
Proposed activities of HL7 Asia, which is now operating with funding from respective ministries of
health in China, Japan, Korea, Taiwan, Hong Kong and Singapore.
•
Big data—interest in the potential applications of big data in health continues to explode, particularly
with the JAMIA special issue on big data, and the emergence of the Apixio platform and the Triad
DataSpace technology for secure storage and analysis of big data sets.
•
The CEO recommended that the TSC investigate the possibility of a work item proposal and leadership
of a project on potential HL7 engagement on big data.
•
IHIC 2013—support is encouraged for this event being hosted by HL7 Australia in Sydney on 28–
29 October 2013.
•
Paediatrics engagement—with support of the Vanderbilt Informatics group (Chris Lehmann) and the
American Academy of Pediatrics (AAP), the following are now progressing—
•
-
reactivation of the HL7 Child Health WG;
-
CDA pediatrics template development;
-
Electronics Pediatric Survey project; and
-
Portable Health Record, using the PHR-FM and modelled after an existing paper profile.
CEO news brief—the first issue was emailed to the membership in May. Critique and suggestions are
sought.
•
CIMI support—a financial proposal for HL7 support of CIMI development and meetings was delivered to
the CIMI International Executive Council. Response was awaited.
2.5.4
2.5.4.1
OTHER NON-PROJECT WORKING GROUP DISCUSSIONS AND
PRESENTATIONS
TREASURER’S REPORT
Calvin Beebe presented the Treasurer's report, which addressed both the final 2012 financial results and
audit report, and the preliminary indicators of performance for the 2013 year.
Key figures from these two sets of results are presented in the following consolidated table.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
2012 Actual
2013 YTD
2013 Y/E Budget
Revenue
$5.364M
(17.5% or $700K
favourable)
$1.868M
(slightly favourable)
$4.383M
Expenses
$4.564M
(6.3% or $305K
favourable)
$1.261M
(slightly favourable)
$5.042M
Surplus/(Deficit)
$800k
($1.1M favourable)
Slightly favourable to
budget
($659k) deficit
Reserves ($)
$5.377M
$4.803M
$4.762M
Reserves (months)
14.14 months
13.10 months
11.4 months
Most of the much better than expected financial performance in 2012 can be attributed to organisational
membership revenues coming in $618K (or 25%) over budget. A strong performance was also recorded for
distance learning, off-site workshops and certification testing—revenues from these sources were $150K
(or 50%) favourable to budget.
Delays in filling the Director of Education position due to unexpected illness of the candidate first selected
caused a shortfall in staff costs for 2012, however this saving came at the cost of significant delays in
progressing the education strategic plan and the benefits to flow from it.
Closely tracking any financial implications of the recent IP policy change is an important priority for the
Finance Committee, which monitors the net retention rates of organisational members each month.
Figures for the first four months are inconclusive but suggest the possibility of a slight down-trend in
numbers and revenue. If the Financial Committee determines that a significant adverse trend is occurring, it
will alert the HL7 Board.
2.5.4.2
HL7 TERMINOLOGY AUTHORITY
The Board approved a TSC recommendation to form the HL7 Terminology Authority (HTA) as a gatekeeper
to ensure that content from HL7 is submitted to IHTSDO in a controlled manner. It was noted that formation
of the Authority—
•
is required under the agreement between IHTSDO and HL7 International;
•
enables HL7 International to moderate and register SNOMED CT concepts under IHTSDO rules;
•
helps HL7 International to provide timely, high quality terminology products and services to meet its
business needs; and
•
provides a single point of communication with external terminology SDOs with which HL7 has formal
relationships.
The HTA operates as follows:
•
If terminology content already exists, then HTA would not take any action.
•
If new content is required for the universal realm, the request would come through the HTA.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
If new content is realm specific, the request for new content would go through the relevant IHTSDO
endorsed national release centre (NLM for the US and NEHTA for Australia).
The activities and operations of the HTA will be tightly coupled with the HL7 Vocabulary WG (of which
Heather Grain of Australia is a Co-Chair).
The NTA will have five members experienced in the maintenance of clinical terminology who will be
nominated by the CTO and appointed by resolution of the HL7 Board. At least two of the members will be
drawn from among the affiliates. A call for nominations will be issued.
2.5.4.3
MAY 2015 WGM IN EUROPE
Based on further investigation and reports of financial projections showing a considerable loss, the
Executive Committee had recommended against having the May 2015 working group meeting in Paris as
previously planned (their preference was Montreal). After some discussion and noting that several recent
meetings planned outside North America had been cancelled, the HL7 Board rejected the Executive
Committee’s recommendation and resolved to continue with plans to hold a European working group
meeting to be hosted in France.
The WGM is to be organised on behalf of HL7 Europe as a whole and not just HL7 France, although HL7
France (Interop Santé) would continue to have the lead role. Other European affiliates (notably the UK, the
Netherlands, Switzerland and Germany) pledged their support.
The HL7 Board’s approval is subject to a European organising committee being set up that presents the HL7
Board with a set of measurable and strategic objectives. Phillip Scott (UK) volunteered to work with Nicholas
Canu (France) to ensure that this occurred.
After some consideration of relevant European holidays and potential competing events, it was confirmed
that the meeting would continue to be planned for the proposed venue near Paris in the week of 10 May
2015.
2.5.4.4
DIRECTOR OF GLOBAL PARTNERSHIPS AND POLICY
The recently appointed Director of Global Partnerships and Policy—Ticia Gerber—was introduced by the
CEO. It was noted that her background included—
•
nearly two decades working with legislators, regulators, international agencies, donors and civil society
to achieve public policy change, and identify the funding and cooperation needed for better health;
•
being a key figure in securing bipartisan congressional support for eHealth legislation within the United
States while serving as Vice President of Public Policy at the eHealth Initiative;
•
leading a WHO project, facilitating the development of policy implementation knowledge and resources
for health information systems; and
•
advising the Rockefeller Foundation on eHealth and health system transformation issues, working to
draft and secure an international eHealth call to action, and compose the first comprehensive
publication on eHealth in the developing world.
She spoke to the key responsibilities of her role at HL7, which has two interrelated aspects—a global
partnerships perspective and a policy development perspective.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
The global partnerships aspect is involved with working with organisations to attract funding and
investment in and through HL7, in order to—
•
raise awareness of HL7, increasing its role and funding portfolio at both globally and at national level;
•
secure actionable, funded projects for HL7 through strategic outreach to potential donors and partners,
achieving funding of up to US$1 million in new partnership and policy initiatives within 12 to 18 months;
•
gather relevant market intelligence and engage with up to 100 potential donors and partners in the
fields of global health, international development, ICT and to government, academia and industry
within a few months; and
•
strengthen existing HL7 relationships with the US federal government and globally relevant
organisations with an eye towards increased grants and funding.
The policy development aspect is involved with—
•
increasing HL7’s policy capacity and member resources by building an active advocacy community
among HL7 members;
•
working to secure policy environments that enable the achievement of HL7’s vision, mission and
priorities, and engaging policy powerbrokers to boost HL7 policy presence and funding;
•
determining HL7’s unique policy contribution and member needs; and
•
developing strategies to leverage HL7 education and communication channels to inform members of
policy issues, and raise the eHealth policy profile of HL7 and its members.
Achievement of these outcomes will involve collaborating closely with the HL7 Resource, Communications,
Education and Marketing teams, as well as groups such as the Policy Advisory Committee.
When asked about what would differentiate her approaches at HL7 from those of her previous clients,
Ms Gerber indicated that she was particularly encouraged by the recent opportunities offered by HL7’s
recent decision to make its standards and other selected Intellectual property freely available.
Those who have had previous dealings with Ms Gerber were all enthusiastic about the potential
contribution that she could make to the HL7 community.
2.5.4.5
OTHER HL7 BOARD BUSINESS
CEO and CTO performance goals for 2013 as recommended by the CEO/CTO evaluation taskforce were
discussed and approved. Providing more measurable goals has been a key focus for the committee on this
occasion, responding to feedback from HL7 Board members.
The Chief Technical Officer (CTO)—John Quinn—also reported briefly, mainly covering matter addressed in
his other reports to the WGM. The following key points were noted.
•
SKMT (Standards Knowledge Management Tool)—use of this tool is being promoted within HL7 as a
means of harmonising HL7 terminology, and incorporating HL7 terms into the shared health informatics
glossary that is being maintained by ISO/TC 215 and supported by the Joint Initiative Council (JIC).
•
Because all HL7 terms are assigned to a single HL7 document within SKMT, all HL7 contributors have the
capacity to wreak havoc by making uncontrolled changes to terms and definitions entered by other HL7
contributors. HL7 contributors to SKMT were therefore asked to work with the Vocab WG, the CTO and
other contributors in adding or changing HL7 material within SKMT, and only change definitions for
which they had some clear level of responsibility within HL7.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
RIM in OWL—the HL7v3 RIM has been successfully generated in OWL and checked for validity. This
should allow it to be ported to other OWL environments and used by inference engines. The resulting
XML representation (approximately 300 pages in a single file) has been judged to be valid, although far
from elegant.
•
The second part of project will be finished in August. This should allow the RIM to be imported into off
the shelf tools.
•
There are plans to release the utilities to create the OWL XML file before the next meeting. In the
meantime the current XML file (one rev behind the current RIM) will be posted on the HL7 website for
download and experimentation. The CTO noted that it is quick and easy to download and install Protégé
from the internet and then import the XML file.
•
Those with an interest in tooling are encouraged to try to for themselves and investigate how this
resource can be used:
-
Tooling next steps—the Tooling WG and CTO will embark on a tooling tactical plan prioritised by
the decisions of the membership, policy committees and the Board as soon as those decisions
are made.
-
Involvement of HL7 in ISO/TC 215—John Quinn as CTO also participates in meetings of some
other SDOs representing HL7 International, asking questions and making suggestions on its
behalf. He noted that there were at least 16 other active HL7 members present at the
ISO/TC 215 meeting in Mexico City from 20 to 26 April 2012.
•
The CTO indicated that he would like to better coordinate the activities and improve the effectiveness
of HL7 at ISO and other meetings. He requested any others that take part in meetings of other SDOs to
make them known to him, so that he can work with them to achieve this goal.
In addition to the above matters, the following regular Board reports for information and possible action
were noted:
-
membership reports (including voting members, benefactors, 2013 statistics and detailed history
of affiliate membership information);
-
education WG reports on status of the Education Strategic Plan and statistics on Meaningful Use
(MU) webinars;
-
IHTSDO liaison officer’s report (Russell Hamm);
-
Regenstrief/LOINC liaison officer’s report (Ted Klein);
-
report of HL7 liaison to ISO/TC 215 on meeting in Mexico City (Ted Klein);
-
V3 Project Report—first trimester 2013 (Woody Beeler); and
-
various other reports from committee and WG liaisons for: Electronic Services WG, International
Mentoring Committee, Organisational Relations Committee, Process Improvement Committee,
Project Services WG Publishing WG, and Tooling WG.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.5.5
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
HL7 Board:
Issue: Changes to the HL7 membership model, membership benefits,
education and certification services, and IP licensing policies have
potential consequences for the HL7 affiliates, including HL7
Australia. Although generally positive for worldwide adoption and
acceptance of HL7 standards, these changes may impact the
perceived benefit of being an HL7 Australia member, and other HL7
Australia offerings and its contractual relationships.
HL7 Australia
Changes to HL7
International
membership model,
services and licensing
policies
Action: HL7 Australia will continue monitoring, analysing and
responding to the emerging changes in the HL7 International
membership model, services and IP licensing policies.
HL7 Board:
IP Licensing Taskforce
Issue: HL7 international has formed an IP Licensing Taskforce to
provide advice through the Membership Committee on IP licensing
issues arising from free licensing of HL7 standards. The IP Licensing
Taskforce will also provide advice on potential interactions with the
new membership model, including possible difficulties in relation to
the different treatments accorded to derivative works under various
contractual arrangements. Richard Dixon Hughes has been
appointed to the taskforce based on his legal qualifications, his
current role as Chairman of HL7 Australia, and his knowledge of
agreements between Standards Australia and HL7 Australia in
relation to the use of HL7 International IP in Australian Standards
and lower consensus publications.
Chair of HL7
Australia
Action: Richard Dixon Hughes is to participate actively as an
appointed member of the HL7 International IP Licensing Taskforce,
with a view to ensuring consistency between the various types of IP
licenses, the Affiliate agreement and other contractual
arrangements for use of HL7 International’s intellectual property.
HL7 Terminology
Authority (HTA)
Issue: The HL7 Board has accepted a recommendation to form an
HL7 Terminology Authority (HTA) under the agreement between
IHTSDO and HL7 International, which will act as a gatekeeper to
ensure that content from HL7 is submitted to IHTSDO in a controlled
manner. Of the five members of the Authority, two must come from
within the HL7 affiliates, be appropriately qualified and experienced,
and be prepared to participate regularly in required teleconference
calls. A call for nominations is to be issued. Appropriate Australian
candidates should be given the opportunity to nominate.
HL7 Australia
Standards Australia
Action: The HL7 call for nominations of suitably qualified persons to
serve on the HTA will be circulated to IT-014-02, IT-014-06 and
NEHTA (Terminology Services).
42
Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.6
CHILD HEALTH
2.6.1
PROGRESS AT THIS MEETING
The Child Health workgroup reconvened at the Atlanta meeting and confirmed three new Co-Chairs. Formal
voting for Co-Chairs will be conducted at the September meeting.
At the meeting this group identified a number of work items which would likely form its three year work
program—
•
reaffirming the EHR functional profile release 1 for child health, and following up with the development
of new functional requirements for inclusion in release 2;
•
neonatal functional profile (a continuation of the EHR functional profile activities);
•
portable health record;
•
EPSDT (early and periodic screening, diagnostic and treatment) milestone template;
•
paediatric nutrition and diet;
•
anthropometrics template; and
•
developmental surveys electronic question and response.
Portable health record—this is a record for parents to carry in case of an emergency. The content includes
problems, medications, allergies, healthcare provider details and special instructions on treatment or
procedures such as vascular access (which is important for children with chronic or potentially lifethreatening conditions). It uses CDA templates.
EPSDT milestone template—this is also a CDA template based project. It includes comprehensive physical
examination of the eye and vision, hearing, the teeth and mouth, the head and neck, the heart, and
milestones such as response to sound, rolling, behavioural observations, immunisation and a nutrition
section. Assessments are done at birth, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15
months, 18 months, and 18–21 years old. The content forms part of a child’s longitudinal record, and is
exchangeable with a personal health record (PHR) and EHR.
Anthropometrics template—this covers the height and length, weight, head circumference, and percentiles
based on growth charts.
Nutrition information—this includes diet and feeding history, food allergies, dental history, and
developmental or medical issues that impact on nutritional status.
2.6.2
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Child Health:
Issue: These potential projects are relevant to Australia’s PCEHR
Child eHealth Record.
IT-014-06-06
EPSDT Milestone and
Anthropometrics
Template
Action: The Australia e-Health community, specifically IT-014-06-06,
IT-014-13 and NEHTA, should observe these closely, and provide
input to the development of these templates.
IT-014-13
NEHTA
43
Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.7
2.7.1
CLINICAL DECISION SUPPORT
PROGRESS AT THIS MEETING
The WG is working hard to get back to ‘green’ and achieving a gold star to indicate a healthy working group.
Unpublished ballots include VMR CDS V2 IG R1 (DSTU ballot this cycle) and CDS Knowledge Artefacts
implementations R1 (needs DSTU pub request). A lot of time was dedicated in this WGM to reconciliation of
the Virtual Medical Record (VMR) ballot comments. This ballot was affirmative.
A new project for primary sponsorship by the CDS work group was presented—Expression Language
Functional Requirements. The scope statement is reported to be:
‘To develop a set of conceptual requirements based on existing HL7 work products for
expression languages used to complete results. It is not creating new functional
requirements for which we do not have existing examples of in existing expression
languages. Nor is it to determine what requirements must be met by an expression
language. Rather, it is a catalogue of requirements that have already been applied.’
There was a suggestion from the US VA that this work wouldn’t be particularly helpful or likely to be taken
up by Meaningful Use. A motion was passed to establish a new project with a scope joint among SD, CDS
and CQ to define the requirements for expressions based on extant HL7 expression languages and work for
the January 2014 ballot.
Outlook for new projects for this work group were also discussed as—
(1) CDS Guidance Service Implementation Guide—new PSS, DSTU (normative track with conformance
criteria);
(2) Decision Support Service revision with a new project scope statement submission and ballot new
release (go straight to normative if minor changes, go DSTU then normative);
(3) VMR Domain Analysis Model revision with a new PSS for new release;
(4) VMR XML Implementation Guide revision with a new project scope statement for the new release;
and
(5) CDS knowledge artefact implementation guide (go through DSTU again as a next release with a new
project scope statement).
A motion was passed to revise the four last project items.
The agenda for the Cambridge meeting was also set. The WG confirmed that they would keep the same
meeting days and set the provisional meeting dates of Wednesday, 25 September 2013 to Thursday,
26 September 2013. The planned agenda includes review work on Infobutton, VMR, CDS Knowledge Artifact
IG. A joint meeting is planned (hosted by Structured Documents) to discuss VMR/QDM harmonization and
the proposed new Expression Functional Model project.
2.7.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project #931: Implementation Guide: Clinical Decision Support Knowledge Artefact, Release 1
•
Project #875: Context-Aware Knowledge Retrieval, Knowledge Request, Release 2
•
Project #876: URL Based Implementations of the Context-Aware Information Retrieval (Infobutton)
Domain, Release 4
•
Project #184: Virtual Medical Record (vMR) for Clinical Decision Support
44
Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
Project #259: Order Set Publication Standard
•
Project #863: Cross Paradigm Interoperability Implementation Guide for Immunisations
•
Project #924: Healthcare Coordination Services
2.7.2.1
PROJECT #931: HL7 IMPLEMENTATION GUIDE: CLINICAL DECISION
SUPPORT KNOWLEDGE ARTEFACT IMPLEMENTATIONS, RELEASE 1
PROJECT OBJECTIVE
The project aims to provide guidance that facilitates the ability of content providers to create CDS artefacts
in a manner easily consumed by systems that provide CDS, and through CDS Knowledge Sharing support
widespread use of artefacts to improve care. There are a number of standards that currently exist to
address this need but to date there has been no coordinated effort to bring these standards together. The
project addresses the need to identify how to use each of these standards and a process for structuring the
implementation guidance of those artefact types that are currently not supported through existing
standards. This work effort will encompass the creation of a Domain Analysis Model (DAM) and associated
IGs for CDS Knowledge Sharing, which is informed in part by the requirements developed as part of the
Standards and Interoperability Framework's Health eDecisions initiative. To the extent possible, this project
will leverage and harmonise existing standards such as Arden Syntax, Order Sets, vMR and GELLO. The
project will include a gap analysis, recommended changes to existing standards, and recommendations for
pre-adoption of modifications and specifications that close the identified gaps. Additionally external (nonHL7) standards and specifications may inform the work to close those gaps.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Health eDecisions status update
Various pilots are currently in testing for use case one—authoring ordersets in CDS. So far the pilots look
successful. Use case two—CDS guidance service—is under ballot planning for September. Currently a
decision is needed between the use of DSS, SOAP, REST, Consolidated CDA or VMR. The goal is to ballot this
second use case in September.
2.7.2.2
PROJECT #875: CONTEXT-AWARE KNOWLEDGE RETRIEVAL, KNOWLEDGE
REQUEST, RELEASE 2
PROJECT OBJECTIVE
This project aims to revise the current standard, the supplement to the current standard and the IG. It will
be an enhancement of the earlier release of the normative standard Context-Aware Knowledge Retrieval—
Knowledge
Request.
Additional
information
can
be
located
at
the
HL7
website
(http://www.hl7.org/Special/committees/dss/projects.cfm?action=edit&ProjectNumber=875).
The Context-Aware Knowledge Retrieval (Infobutton)—Knowledge Request specification provides a
standardised knowledge request mechanism to act on knowledge resources such as Health Record systems,
so as to aid at the point of care by delivering both relevant clinical information and patient centred
education materials as relevant to the clinical context.
The Release 2 project addresses use cases requested by implementers. These include the ability to specify
additional patient clinical attributes and geographical locations of interest, the specification of a healthcare
45
Final Report HL7 Meeting—Atlanta, USA (May 2013)
payer as the performer or information recipient of an Infobutton request, and clarification of the
description of the modelling.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This DSTU was submitted for publishing following the January 2013 WGM. No further update was available
at this meeting.
2.7.2.3
PROJECT # 876: URL BASED IMPLEMENTATIONS OF THE CONTEXTAWARE INFORMATION RETRIEVAL (INFOBUTTON) DOMAIN, RELEASE 4
PROJECT OBJECTIVE
The aim of this project is to revise the current standard to develop an IG specifying URL based
implementations of the Context-Aware Knowledge Retrieval (Infobutton) Standard. It is intended as an HL7
Informative Document. It will support implementations that use URLs as communication protocols with the
ultimate goal of enabling a transition from URL based implementations to a services oriented approach.
Release 4 of this IG reflects changes made to its normative parent specification, Context-Aware Knowledge
Retrieval, Knowledge Request Standard. It also includes clarifications for the use of coded attributes and
provides a quick reference of code systems used in the IG.
Being URL based and employing HTTP, applications built around this implementation guide require less
understanding of HL7 V3 and could be simpler for vendors than the base Infobutton standards. Further
information can be located at the HL7 website
(http://www.hl7.org/Special/committees/dss/projects.cfm?action=edit&ProjectNumber=876).
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Infobutton project was discussed in a joint meeting with the SOA WG. IG Ballot Reconciliation was
completed. Guilherme Del Fiol provided an update regarding the various artefacts pertaining to the
Infobutton standard. This particular first normative ballot was approved (affirmative = 58, negative = 0,
abstention = 81). Ballot comments were reviewed and considered, dispositions were determined, and
reconciliation was completed.
2.7.2.4
PROJECT #184: VIRTUAL MEDICAL RECORD (VMR) FOR CLINICAL
DECISION SUPPORT
PROJECT OBJECTIVE
The objective of this project is to create HL7 VMR data models capable of supporting scalable, interoperable
CDS. The VMR uses only the CDS essential EHR abstractly specified data. It is thus independent of
implementation technologies including HL7 V2, V3 messaging and V3 CDA. It encourages CDS at the point of
care by reducing costs and response turnaround time. It eliminates the need for EHR vendors to maintain
proprietary CDS structures and messages. It is of great value to emerging clinically focussed applications
which address patient outcomes and community needs.
VMR is being further developed with more IGs and template specs for standard data models including CCD,
Care Plan of Patient Care and priority tasks of CDS (e.g. Drug to Drug interactions, vaccine advice, Family
History Risk Analysis and Genomics). Transformations are being developed between standard models which
are moving towards greater alignment with HL7 work.
46
Final Report HL7 Meeting—Atlanta, USA (May 2013)
The VMR has become a foundation source of modelling input for the ONC S&I Framework’s IG for
Knowledge Artefacts, which will be part of MU 3 (see project description above). Further information can be
located at the HL7 website
(http://www.hl7.org/Special/committees/dss/projects.cfm?action=edit&ProjectNumber=184).
PROJECT ACTIVITY/ISSUES AT THIS MEETING
VMR DAM Release 2 Ballot Reconciliation has been conducted. The ballot passed by the numbers (first
informative ballot) with 36 voting affirmative, 5 voting negative and 93 abstaining. Ballot comments were
reviewed and considered, dispositions determined, and reconciliation was completed. Main changes
included the removal of the SOAP specification, a revised and clarified RESTful and knowledge response
specification, a redesigned ATOM category specification, and an added JSON knowledge response. Next
steps will likely include the synchronisation and consolidation of the two implementation guides into one
specification. A number of diet related comments were reconciled as provided by the International Dietetics
group. These primarily related to naming changes to ensure consistent terms with the Diet Order DAM.
These included enteral feeding, feeding volume and caloric density.
Lantana raised the issue that a VMR problem may include items that would not be in a patient’s problem
list, such as an encounter diagnosis from a past encounter or an inactive problem. There appeared to be
some confusion about definition of a problem list, and whether this would include inactive problems and
diagnoses (not just current problems). Discussion was dedicated to whether a template would need to be
included, and the clinical quality and harmonisation of what could be done in this space. The note was also
made that the model lacks classes for communications. This will be evaluated by Health eDecisions pilot
activities and incorporate a refined model as appropriate following review in an HL7 work group call.
Andrew McIntyre (Australia) presented the VMR V2 Implementation Guide. Ballot comments were
reconciled and the ballot was passed.
The target for this project is that HL7 publishes HL7 vMR DAM Release 2 as an Informative Specification with
the target date being the September 2013 WGM. There was some general discussion about how FHIR may
make vMR redundant. The suggestion was made that if this was the case within the community then it may
be appropriate to consider.
VMR V2 Implementation Guide
Andrew McIntyre presented the topic of this project. VMR V2 is a batch of messages. The agenda was to
discuss and resolve ballot comments submitted by OO members who unfortunately were not present at the
meeting. However the members in attendance were able to continue the resolution process.
It is expected that this project will be the basis for an Australian implementation guide. Problematically,
there is a desire to use more than 10% of the HL7 International content in the Standards Australia
Implementation Guide. This would be a breach of the terms of the Standards Australia agreement with HL7
Australia and HL7 International.
Daniel Henzi (SA) raised the matter with Richard Dixon Hughes (HL7 Australia Chair) and Nat Wong (HL7
Australia Secretary). Richard and Nat noted that while an exception might be possible, neither felt that HL7
International would see a reasonable case for such an exception. Nat noted that it would be much simpler if
the Australian IG for this project followed the same rules as other Australian IGs and referenced the HL7
International Standards work appropriately, while also acknowledging that this would mean that the
Australian IG could not be read without heavy reliance on the HL7 International VMR project.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.7.2.5
PROJECT #259: ORDER SET PUBLICATION STANDARD
PROJECT OBJECTIVE
This project has developed a special instance of a structured document standard and associated IGs for the
publishing and sharing of interoperable order sets for clinical system vendors to deploy for CDS at point of
care. It is really a knowledge document, not an instantiated order set. Further information can be located at
the HL7 website
(http://www.hl7.org/Special/committees/dss/projects.cfm?action=edit&ProjectNumber=259).
Order Sets are one of the three knowledge artefact groupings in the ONC S&I Framework’s IG for Knowledge
Artefacts that will be part of MU 3 (see project description above). The HL7 Order Set Standard is closely
aligned with that part of the ONC S&I IG.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
No update was available at this meeting.
2.7.2.6
PROJECT #863: CROSS PARADIGM INTEROPERABILITY
IMPLEMENTATION GUIDE FOR IMMUNISATIONS
PROJECT OBJECTIVES
The CDS WG and the PHER WG are co-sponsors with SOA of this SAIF framework project. This was worked
on in common with the CDC immunisation evaluation and forecasting logic specification project, and
immunisation use cases have been incorporated. Semantics of Business Vocabulary and Business Rules
(SBVR) is used and RuleSpeak is under consideration.
The project is factoring out common material from a large and perhaps challenging number of multiple
platforms and models to develop a common information and common behavioural model. Arden Syntax and
VMR have previously been recommended by CDS for consideration in this work but currently not adopted.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
No update was available at this meeting.
2.7.2.7
PROJECT #924: HEALTHCARE COORDINATION SERVICES
PROJECT OBJECTIVE
This is a SOA project with Patient Care (PC) and CDA WGs as co-sponsors. It aims to create a standard and
other specifications for an HL7 SOA Care Coordination Service to support collaboration amongst a
multidisciplinary care team, consisting of members from either the same or different organizations (e.g.
primary care clinic, home care, allied health professionals, hospital or skilled nursing facility). It is intended
for real time deployment, meaning that changes made by one participant are propagated to all. All
stakeholders and collaborators in a patient’s care can make updates to the care plan, update health
concerns and add supporting detail relevant to the care record. The Care Coordination Service (CCS)
interface will expose a consolidated view to all participants. It is a healthcare socio-technical standard for
enabling live collaboration among care team participants.
48
Final Report HL7 Meeting—Atlanta, USA (May 2013)
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This is a SOA project with Patient Care (PC) and CDA WGs as co-sponsors. No input from the CDS WG was
given at this meeting.
2.7.3
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Clinical Decision
Support:
Issue: Infobutton standards address relatively simple interactions with
EHR based applications, and address both patient and provider
knowledge needs. US implementation is required for Meaningful
Use 2. These needs are universal, and the standards offer benefits to
Australian healthcare providers, consumers and vendors.
IT-014-13
Infobutton
Action: Ongoing development of Infobutton standards in the
Australian context to be informed by international developments.
Clinical Decision
Support:
Virtual Medical Record
(vMR) for Clinical
Decision Support
Clinical Decision
Support:
Virtual Medical Record
(vMR) for Clinical
Decision Support
Clinical Decision
Support:
VMR v2
Implementation Guide
Issue: Standards Australia’s CDS project HL7 V2 Virtual Medical Record
Profile is feeding into HL7 International’s CDS and V2 work and vice
versa.
IT-014-13
Action: International development in the vMR work and IGs to
continue to inform HL7 V2 Virtual Medical Record Profile project in
Australia.
Issue: Incorporation of nutrition and diet specifications is included in
the vMR from the Diet Order DAM. Such requirements are important
for decision support and patient safety for dieticians, speech
pathologists, physicians, nurses and their patients in Australia.
Action: It will be important for take up in the Australian context that
these specifications for decision support are included and modelled
on international Diet Order specifications. Other allied health
requirements should also be explored for decision support.
Issue: A relaxation of the amount of content of HL7 International
Intellectual Property included in Standards Australia Implementation
Guides may be required for this project, or in the absence of such a
relaxation a review of the manner in which this Australian
Implementation Guide will be structured.
IT-014-13
Allied Health
Professions Australia
(AHPA)
Standards Australia
HL7 Australia
Action: Review proportion of original HL7 content in CDS
implementation guides.
49
Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.8
CLINICAL STATEMENT
2.8.1
2.8.1.1
PROGRESS AT THIS MEETING
CLINICAL STATEMENT (CS) MODEL
The CS model completed a normative ballot in May 2013. There were about four negative ballot comments
to be resolved. One of the negative comments required a couple of structural codes to be added to the
mood code of the Supply Act class. The group voted to accept the ballot comments and recommended the
addition of the structural codes as required. This was considered to be a significant change and vocabulary
harmonisation. Resubmission of the CS ballot after vocabulary harmonization for re-ballot in September is
required. A motion was passed to accept the reconciliation recommendations, withdraw the CS model from
normative publication and prepare for the September 2013 ballot.
2.8.1.2
TOOLING LIAISON UPDATE
The CS workgroup is regularly required to perform model harmonisation between the CS model and models
produced by other domains or workgroups that impact on the structure and semantics of the CS model. This
is currently a manual process, which is not only extremely labour intensive but also error prone. There is a
requirement for an automated model-to-model transform checker or validator. More generalised use cases
will also benefit from the use of such automated model validation:
To check that a particular RMIM is a proper constraint of its parent DMIM, including conformance to
classes, attributes, relationships, datatypes, cardinalities, conformance and vocabulary/terminology.
However such a tool is very difficult to produce. The most feasible solution appears to be using an OWL
based tool to output an OWL based representation of two different HL7 v3 models, and perform a
comparison of the two OWL outputs to determine differences between the two models. It appears that an
OWL tool has been developed by one of the developers that have a built-in tool to perform the OWL
representation comparison. This is a work-in-progress tooling project.
2.8.2
CURRENT PROJECTS
Currently there is no active Clinical Statement Project.
2.8.3
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Clinical Statement:
Issue: This tool may be very useful for validating the conformance of
patterns of detailed clinical models to CDA, as well as Pharmacy and
Patient Care RMIMs.
IT-014-06 and its
OWL-based HL7 v3
model-model
validator
Action: It will be useful for IT14-06 subcommittees, NEHTA and
PCEHR groups to keep a close watch on the development and
maturation of this OWL based tool, and to evaluate its
appropriateness and adequacy for adoption.
subcommittees
NEHTA
Australia eHealth
communities
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.9
COMMUNITY BASED COLLABORATIVE CARE
2.9.1
PROGRESS AT THIS MEETING
As detailed below, the progress focussed on the collaborative work with the Security WG on the Data
Segmentation for Privacy (DS4P) and associated projects. It is important that these work items are soundly
and correctly integrated with respect to the current trials that are informing the projects. Details of these
are given below and in the Security WG section.
2.9.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project #798—Refactor HL7 Confidentiality Concept Domain, code system value sets. HL7 Healthcare
Privacy and Security Classification System, Release 1;
•
Project: Data Segmentation for Privacy (DS4P); and
•
Project #800 Behavior Health Domain Analysis Model, Messages and CDA Profiles (aka Behavioral
Health Continuity of Care Document—BH CCD).
2.9.2.1
PROJECT #798: REFACTOR HL7 CONFIDENTIALITY CONCEPT DOMAIN,
CODE SYSTEM VALUE SETS—HL7 HEALTHCARE PRIVACY AND SECURITY
CLASSIFICATION SYSTEM, RELEASE 1
PROJECT OBJECTIVE
The current HL7 Confidentiality concept domain, code system and value sets are overloading the coded
attributes of confidentiality. As a result implementers are able to change the meaning of these attributes via
the vocabulary bindings. The project provides a thorough analysis of the current confidentiality concept
domains, coding system and value sets. As part of the analysis the CBCC WG intends to make clear a
distinction in the confidentiality concept domain, coding system and value sets about how this vocabulary is
to be used with patient-centric information.
The project identifies the changes to be proposed that may include revised, deprecated and additional
vocabulary to support and expand the current confidentiality codes. Further evaluation may also introduce
additional concept domains, coding systems and value sets. The project also identifies the impacts of
proposed changes on current implementations, communicates proposed changes to the community, and
discusses and documents feedback. Based on the feedback this project may produce a Vocabulary
Harmonisation Proposal.
There are several projects under the parent project, as detailed below.
Health Classification Scheme (HCS)
This is new in healthcare, as no other standards currently exist for this and the project will produce a useful
healthcare vocabulary for data tagging. It is developing a new scheme in healthcare originating from work in
the US, based on the Data Segmentation for Privacy (DS4P) project that is an offshoot from the PCAST
Congress of Health Information Technology report 2010. It was identified that gaps could be filled with a
classification scheme, as the current coding is clinically based and does not include any social privacy or a
security classification of this information. The Health Classification Scheme (HCS) looks at the perceived
harm that could occur from the disclosure of this information beyond where it is used. It is policy based and
builds on clinical objects in EHR but includes perceived risk of exposure. Therefore someone accessing the
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
object (classification is a colouring on the clinical facts) needs to have appropriate access based on a
security engine. The HL7 Security WG is working with the EHR WG in the area of data integrity to define the
contextual differences in the meaning of integrity (e.g. security integrity means to protect against
unauthorised modification, and for clinicians integrity relates to provenance, trustworthiness and history of
the data).
Personal Health Information Exchange—Privacy Information Content
Substance Abuse and Mental Health SA (SAMHSA) may embark in a standardisation of vocabulary in regard
to substance abuse data. This will include safety items, such as restricted access due to personal or
community risk (e.g. violent behaviour) for certain policy reasons. It has been suggested that a step in the
direction of detailed code subsets need to be put together (value sets), which can become a standard in HL7
and a vetted, open value set. If HL7 engages in this type of vetting on sensitive information it will become an
open information resource. The project may be started in the SHARPS (Strategic Healthcare IT Advanced
Research Projects on Security) program by Carl Gunther, which investigates how you take the indicators
such as clinical semantic labelling and group in such a way to encapsulate (e.g. ‘this is the category’ for HIV),
then apply access control system to these labels.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Health Classification Scheme (HCS)
In the recent ballot 2% passed, 51 affirmed 11 over 15 negatives, and there were 57 abstentions and 27 no
votes.
There were a lot of abstentions, and it was thought that this was because it may not have been on the radar
for vote as it was informative and not normative or voters were not aware of the work. Some of this may
also have been due to the new HL7 rules where if a negative is recorded then a comment was required. Also
this may have been driven by the new rule where getting involved in the derivate work is forced. If you are
ever interested you MUST submit a vote (sign up and abstain). Alternatively it is possible that having that
many abstentions means that people are interested, rather than just non-voting. These are issues that are a
concern for any ballot.
The result is that whilst the HCS was created because of the identified gap. This is part of the DS4P project,
and as such with the HCS and HCS IG we will have two normative items and two informative in the package:
HCS has two informative documents, which are—
•
one is explaining in the normative; and
•
the other is elaborating by example using the HL7 vocabulary.
The DS4P items would be considered normative.
The discussion of the format for the ballot was extensive, so as to assess the complications that would arise
if the HCS and DS4P IG were balloted together. The concern was that the HCS would complicate the
adoption of the DS4P internationally, as the HCS does not need to be adopted as is for the DS4P IG to
function. The outcome was that the SEC/CBCC joint group would work on a new project proposal for the
DS4P IG separately (this work is listed under the SEC WG as the sponsor of this work item).
2.9.2.2
PROJECT: DATA SEGMENTATION FOR PRIVACY (DS4P)
Also see the new project under SEC WG.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
PROJECT OBJECTIVE
The term ‘data segmentation’ refers to the process of sequestering from capture, access or views certain
data elements that are perceived by a legal entity, institution, organisation or individual as being
undesirable to share. This basic definition does not however account for the multiple permutations of
segmentation in the healthcare context (e.g. granularity) nor does it adequately capture the varied
considerations required for development of segmentation policy.
A US national project called ‘The Data Segmentation for Privacy Initiative (DS4P)’ is based on the Data
Segmentation for Electronic Health Information Exchange Whitepaper from ONC, produced to support the
S&I Framework. Additional information can be located at the S&I Framework wiki
(http://wiki.siframework.org).
The S&I Framework is to enable the implementation and management of disclosure policies that originate
from the patient, the law or an organisation in an interoperable manner within an electronic health
information exchange environment, so that individually identifiable health information may be
appropriately shared for:—
•
patient treatment and care coordination;
•
third party payment;
•
analysis and reporting for operations, utilisation, access quality and outcomes;
•
public health reporting; and
•
population health, technology assessment and research.
The purpose of this initiative is to enable the implementation and management of varying disclosure
policies for an electronic health information exchange environment in an interoperable manner, with the
goal of producing a pilot project allowing providers to share portions of an electronic medical record while
not sharing others, such as information related to substance abuse treatment (which is given heightened
protection under the law).
Data segmentation—also referred to as data tagging, data labelling and metadata tagging—is important to
security as it relates to privacy metadata and the issue of interpretation of the confidentiality code between
organisations. The initiative is to address issues of determination of which part of the health record should
be protected by jurisdictional or organisational policy or by regulation (e.g. substance abuse info and vet
affairs providers for three specific conditions). For example if you have a document that has protected
information and non-required protection, how does a system identify and manage this? Also, what occurs
when this information is passed on to another organisation? How do you define this for the receiving
organisation (i.e. using the metadata used in the transportation of information)? On a national basis the
progress to date has been to identify use cases, and now scoping requirements are being undertaken.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Update on progress of S&I Framework progress in relation to DS4P is that upon a recommendation to the
US HITSC Privacy and Security Work group in March, the Data Segmentation for Privacy (DS4P) Initiative has
transitioned from a fully facilitated initiative to a community led initiative. This is significant in its aim to
integrate into the wider healthcare environment and for full adoption. Deliverables from the Initiative
include the DS4P Use Case, three implementation guides, test procedures, and evaluations and completed
requirements traceability matrices from the completed pilots. Future work in the initiative will focus on
implementation and testing, and transition of the DS4P implementation guides to standards development
organisations including HL7 for refinement and maintenance. Five pilots are underway for the initiative,
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
including VA/SAMHSA, the Software and Technology Vendors Association (SATVA), NETSMART, Jericho
Systems/UT-Austin, and Greater New Orleans Health Information Exchange (GNOHIE) pilots. Pilot activities
are based on the Reference Implementation Guide, describing the use of standards for applying privacy
metadata to enable the sequestering of certain data which requires enhanced protection under the law,
while allowing other data to flow more freely.
The S&I Framework Working Group have initiated an implementation guide (IG) for the DS4P work. They
have requested to transfer the IG publication to the standards organization to align and maintain them in an
appropriate way. IHE, OASIS, HL7 are delighted to get response from all the SDOs but appreciate that HL7
Security and HL7 CBCC are working collectively to work on the DS4P for direct and exchange project. S&I will
continue to support the effort.
S&I report that it is it has been concluded that the national initiative need the 'go with the national
initiative’ to be vetted through the SDO process. Although there is considerable participation, S&I still want
to be involved in the SDO process. It is proposed that the involvement of the community in the IG and its
use in the DS4P will be an exemplar that needs input from the SDO community.
Currently there is a web service example—an SMTP based IG and another Restful or FHIR example in trial—
and these are the intended three modes of transport that S&I are looking to implement. The SEC and CBCC
WGs will need to devise the ballot process. The RESTful implementation will need collaboration with IHE.
There are five pilots up and running and two more under development. The US Veteran Affairs project is
moving into systems implementation and is no longer a pilot.
CBCC member Iona S in conjunction with SAMHSA have worked on the test procedures for the
implementation and successfully completed the testing that needs to be done. The testing scripts are based
on the user stories and they have been tested against the pilot. This pilot is aimed at a high level so that all
the use cases can be captured. This will add to the completeness of the IG and add to the conformance
measures.
The issues discussed were about the development of this work as an international standard, and not just for
the US realm. It was decided that we need to produce the US guide first. After this we will produce the EU
profile, as this includes the classification types we can move to a wider application. Also careful
consideration needs to be made of the differing legal aspects. It was agreed that the work should aim to be
international, particularly as we refer to some of the ISO specifications (e.g. 26 000) and using labelling as an
approach seems the most effective for the future.
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
CBCC/Security:
Issue: Increased involvement of Australia in input/feedback on HCS as
a foundation for information sensitivity labelling and secure handling.
SA
Healthcare
Classification Scheme
(HCS)
Action: Notification by SA to IT-014-04 balloting of HCS, and IT-01404 to review and comment on this to provide feedback to HL7
Australia on next ballot.
IT-014-04
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.9.2.3
PROJECT # 800 BEHAVIOR HEALTH DOMAIN ANALYSIS MODEL,
MESSAGES, AND CDA PROFILES (AKA BEHAVIORAL HEALTH CONTINUITY
OF CARE DOCUMENT (BH CCD)
PROJECT OBJECTIVE
HL7 has several standards that support the interoperability requirements of the behavioural health
community, including the HL7 EHR Behavioral Health Functional Profile, Release 1, the HL7 Social Service
Invoice
Common
Message
Element
Model
(CMET),
A_BillableSocialService
universal
(COCT_RM610000UV06),the Semantic Health Information Performance and Privacy Standard Domain
Analysis Model (SHIPPS) and the Consent Directive Clinical Document Architecture (CD) Implementation
Guide Draft Standard for Trial Use (DSTU).
These standards were developed over several years with input from a wide range of behavioural health
experts from the US and abroad. Some stakeholders have more encompassing requirements than this
current set of standards supports.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The project was a 2013 May Ballot Cycle Info: DSTU Ballot as HL7 Implementation Guide for CDA® Release 2:
Behavioral Health Assessment, Release 1—US Realm NIB, and an Informative Ballot for HL7 Version 3
Domain Analysis Model: Behavioral Health Assessment, Release 1—US Realm NIB.
Behavioural health DAM is specific to behavioural health. It was used as a basis for analysis for CDA2 and
creating the privacy consent directive CDSA IG went for normative ballot. When there is resolution of the
two organisational negatives the ballot will pass. The aim (in terms of process) is to create a DAM from a
CDA document. To date this has been using the open health tools and created java libraries for the privacy
consent directs.
ACTIONS FOR AUSTRALIA
No actions required at present.
2.9.3
2.9.3.1
OTHER NON-PROJECT WORKING GROUP DISCUSSIONS AND
PRESENTATIONS
PRIVACY CONSENT (CONSENT TO SHARE)
An example of a common sense privacy consent/policy choice model is given below:
A Common Sense Privacy Consent/Policy Choice Algorithm
Purpose: To describe an intuitive process to segment and protect privacy sensitive, clinical
information, so that patients can knowingly choose more or less protection
(1) Stigmatised/sensitive Conditions?
a. No; then no restrictions; STOP
b. Yes; then proceed
(2) Sensitive condition/problem ontology, initial use cases
a. Substance abuse, by substance type ontology
b. Mental health problems by problem ontology
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
c.
Sexually transmitted diseases (STDs), by type
d. HIV/AIDS
(3) Threats/risks/costs due to unauthorized disclosure of clinical information
a. Legal (e.g. loss of parental rights, criminal justice)
b. Financial (e.g. employment opportunities, life insurance)
c.
Social status, position in communities and family
(4) Levels of trust, as defined by giving access to sensitive information
a. ‘Care Team’ or ‘Core Care Team’
i. If no concerns, then no restrictions; STOP
b. If some concerns, then some restrictions; then proceed to V
i. If grave concerns, then global restriction: then proceed to VI
c.
Extended Care Team (see i, ii, iii above)
d. Other Third Parties (see i, ii, iii above)
(5) Record segmentation gradients/staging process
a. Only hint at issues, do not disclose detailed problems (e.g. indicate addiction
symptoms without disclosing specific substances abused)
b. Only disclose less sensitive problems (e.g. show alcohol but hide heroin use)
c.
Underplay problem severity/number of symptoms (e.g. show past use, but not
current)
d. Global restrictions
(6) Reconsider privacy policy restrictions (Step V) if/when
a. Restrictions create personal safety risks
b. Payers can sidestep privacy restrictions and share data with third parties
c.
Jurisdictions require reporting public safety risks.
Healthcare organisations that deal primarily with sensitive information such as SAMHSA have a complex mix
of requirements that people will have to know in order specific privacy consent. It is designed to provide a
personal user-interface which gives people a series of choices as to who their information is sent to, to the
main point at some point (previous controversial) detailed. In a primary care record some of the information
is interspersed within the record. Essentially this consideration is trying to be forward looking and giving
accountability to the organization and giving some additional privacy protection and specifying more or less
privacy. The requirements include the following:
•
An ability to filter the information.
•
Sanitise the information, so that the risk of being stigmatised is minimised.
•
Subsequent healthcare providers may want to ask some questions and this may then expose the
information that was intended to keep private. This is also in relation to information being sent to
central repositories, such as defined by the US PCAST, and similarly the Australian PCEHR.
•
This will rely on the clinical rules engine and policy rules engine allowing, at various levels of granularity,
to segment and send information in a restrictive manner.
Using standard terminology this is attempting to define the rules in terms of levels of trust and risk, and
segmenting the record accordingly. This avoids the ‘all or nothing’ approach. This approach is trying to
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
simplify the healthcare providers managing the consent and information sharing, and providing a more
granular consent, so that people do not have to make the choices—often incorrectly. In the US this also
related to the financial status of the patient or payer.
What is important is to weigh the interest of the patient clinically and health wise against ‘need to know’
consent (e.g. a dermatologist requesting mental health information). In Australia, when information for
instance on patient referral is provided to specialist, how much of the history that is not relevant is
provided? This may not be related to hiding information but protecting the patient’s feelings about the
information.
In the US this also relates to the ‘payer’, however all countries need to consider the national policy
coverage, local coverage determination which indicates the information needed to justify a condition.
ACTIONS FOR AUSTRALIA
No actions required at present.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.10
2.10.1
EDUCATION WORKING GROUP AND MARKETING COMMITTEE
PROGRESS AT THIS MEETING
The strong focus on education in HL7 was again evident this WGM. There were a number of important areas
considered including the educational requirements for FHIR and the progression of the e-learning agenda.
The impact of the changes to IP availability were again raised in the context of education being one of the
key member value propositions for HL7, as well as leveraging new developments such as FHIR. Potential
resurrection of the certification project was suggested in several discussion forums and it was suggested
that HL7 Australia could lead this project. The role of HL7 International paid positions at headquarters was
discussed, as input and support from such positions will likely become increasingly important as education is
featured more prominently in business and membership models. Potential education platforms were
outlined as: e-learning, webinars, face to face workshops, hands on at connectathons, ambassador
presentations and affiliate programs.
In addition to these topics there was a presentation from the International Mentoring Committee that is
continuing to target Africa and low and middle income countries (LMIC) for the development of standards
and education to develop local standards experts. Two delegates from Kenya were in attendance at the
WGM. The eLearning program will be open to LMIC with the objective that academics from such countries
may take up these educational opportunities to foster local development and understanding. The
International Mentoring Committee proposed the possible topic for the September plenary meeting as ‘low
and middle income countries access and usability’.
Planning for the Boston WGM included leaving the meeting schedule unchanged with joint meetings with
marketing and international mentoring, again held in the Monday lunchtime session and the quarter one
and two meeting spaces for project work and planning.
2.10.1.1
MARKETING AND EDUCATION REQUIREMENTS FOR FHIR
A strong methodological and dynamic approach was discussed as necessary in relation to FHIR. Education is
needed around developer conformance to achieve a high degree of consistency. The education strategy
needs to be targeted at both entry level and more proficient users (base level and more advanced).
Emphasis was given to the fact that FHIR is new and changing and the strategy needs to reflect this.
Education also needs to be evolving and able to match updates from the development team. The
importance of feeding in updates and change needs directly and timely to the education WG was
highlighted. The suggestion was made that rather than having to be so responsive a large part of the focus
and strategy could be to develop the knowledge base around where to find content and read changes. The
requirements for practical and sample implementation was also discussed e.g. how to start communicating
in FHIR, how the governance works, how the management group works, where to find attributes. This could
all be conveyed via a light weight webinar or pre-recorded meeting. Potential audiences include
implementers, decision makers/governments, standards organisation/people, technology and application
architects (vendors). Marketing to these groups needs to include consideration to the key questions: what is
FHIR about and why should I care? What is it about what HL7 is doing that makes me want to pursue it? The
suggestion of the need for a market analysis was made. The strong point that FHIR is not like other aspects
of HL7 was made and that there is an inherent risk that that the people who will use it won't be drawn
effectively into the HL7 membership community. Being effective in the use of FHIR was suggested as a
necessary benefit of membership. The critical question therefore becomes how does HL7 International
convey and communicate this effectively?
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
Other key strategic issues and questions include:
•
Leveraging projects that are using FHIR
•
Positioning of FHIR and how it reinforces the HL7 brand (e.g. mobile health)
Potential limitations were recorded as:
•
Community that will get the most use out of it are likely to never be represented in the HL7. Also the
potential implication that healthcare IT is simple and easy may be conveyed.
•
Education needs to be linked strongly to marketing and from these discussions, it can be concluded that
education needs to be linked to membership as well.
2.10.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project #865: HL7 Certification Program Enhancement
•
Project #548: Strengthening HL7 Education (Education Strategic Plan)
•
Project #877: Develop HL7 Ballot Site Education Tutorial
2.10.2.1
PROJECT #865: HL7 CERTIFICATION PROGRAM ENHANCEMENT
PROJECT OBJECTIVE
This project will enhance the HL7 certification program by taking into account the process used for
certification as well as the actual certification testing. Enhancements include:
•
other HL7 International Educational opportunities e.g. e-Learning, HL7 International Summits or WGM
tutorials;
•
educational events organised by HL7 Affiliates or other organisations e.g. workshops, conferences, elearning, etc.;
•
the certification candidates work experience with HL7 products; and
•
the certification candidate involvement in HL7 International or Affiliate WGs e.g. Co-Chair, member, etc.
The certification program will also take into account the roles and skill levels needed to work with HL7
standards in healthcare-related organisations at different areas of responsibility. The project will:
•
establish a table of competencies categories, subcategories and skills, related to HL7 standards or
products;
•
establish areas of responsibility/job roles related (using, developing, making decisions) to HL7
standards/products;
•
establish a framework, mapping the roles to the competencies;
•
define the name of the levels of certification;
•
define and/or investigate existing skill metrics (i.e. how to acquire credits for certification) and create
the policies;
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
evaluate the current HL7 and HL7 Affiliate offerings in terms of specific skills acquisition and create the
corresponding Quality Assurance mechanisms;
•
define the process for the certification program management e.g. HL7 staff chores, HL7 Affiliate chores
(options include certifying people and/or a course) and define the process for post-certification
continuing education (CE); and
•
launch the new certification program.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Some discussion was dedicated to this project at the current WGM. Issues discussed included electronic
certification and home proctoring regulations. Concerns have been expressed by some affiliates about the
use of “home proctoring” where certification candidates sit exams on their home computer with a web cam
for monitoring and the computer locked down to prohibit access to exam content. Some further thought
and planning will be undertaken in this area.
Discussion amongst the Australian delegation was positive in developing some extended credentialing for
practitioner certification and this will be picked up locally via the HL7 Australia Board and Education Council.
HL7 International Director of Education, Sharon Chaplock, also expressed that the electronic bank of exam
questions will help to guide and inform a blueprint of competencies for certification levels.
2.10.2.2
PROJECT #548: STRENGTHENING HL7 EDUCATION (EDUCATION
STRATEGIC PLAN)
PROJECT OBJECTIVE
This project aims to develop a policy by which affiliates are encouraged to advertise HL7-wide educational
offerings such as e-learning, as well as notifying HL7 HQ of their own educational initiatives so that they can
be added to the HL7-wide calendar of educational offerings. It will define 'associates' and determine
appropriate means and policies for interacting with associates. Distinct policies might be crafted for
different classes of associates.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Heather Grain is currently developing a webinar on how to develop a HL7 tutorial following her review of all
of the HL7 tutorial content and framework. A matrix has been developed that outlines important
information about each HL7 tutorial including: audience, product family, tutors, objectives, level (e.g.,
beginner, intermediate, advanced etc). The vision for this is to roll out for each work group starting with one
trial WG (e.g. this is underway with Tooling and was suggested for use with FHIR). This will be reviewed by
David Hay (NZ) for FHIR requirements. Heather Grain will also be involved in the development of a UML
tutorial specification. This will possibly be available at the January 2014 WGM (at the earliest). SAIF tutorial
has been dropped from the tutorials list due to low registrations. Requirements have been added by the TSC
for tutorials and there will be a webinar in response to this.
2.10.2.3
PROJECT #877: DEVELOP HL7 BALLOT SITE EDUCATION TUTORIAL
PROJECT OBJECTIVE
The intent of this project is to develop a tutorial on how to use the HL7 Ballot site. This tutorial will be
developed in English.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
PROJECT ACTIVITY/ISSUES AT THIS MEETING
No update available from this WGM.
2.10.3
OTHER NON-PROJECT WORKGROUP DISCUSSIONS AND
PRESENTATIONS
HL7 FUNDAMENTALS (PREVIOUSLY THE E-LEARNING PROGRAM)
2.10.3.1
As Heather Grain previously reported in the January 2013 Phoenix WGM report, “The e-learning project has
more than 600 students who have registered. Materials have recently been updated and the examination
components are now automatically marked. A site has been established where tutors can suggest changes.
The course is now called HL7 Fundamentals, rather than the e-learning course.
Within the current WGM access to the e-learning materials has been achieved and electronic copies of
materials will be forwarded to HL7 Australia’s Education Council. A FHIR component will be added and this
has been developed in conjunction with David Hay (NZ). The suggestion was made that XML and UML are
mandatory pre-requisite knowledge for entry to the course.
HL7 Brazil presented a summary of their e-learning course. The course is 15 weeks with XML and XML
mandatory (these can be completed in one additional week each). The course is priced at $25,000 USD and
has a 75% average course requirement to receive certification and fulfil the requirements for successful
completion. The course has around an 8.8 hours per week work requirement however there were
indications that this may be higher overall at around 10 to 20 hours. A total of 92% of enrolments had no
experience in HL7. The course leverages online forums for tutors, online chat space for student to student
and student to tutor (which is reportedly well used by students) and also uses social media groups.
New Zealand has run the e-learning course once with less than favourable results. This evaluation was
consistent in Canada and this was primarily due to material concerns as some were seen to be
inappropriate. US feedback was that student frustration and annoyance increased from Version 2 to Version
3 and so too did the time requirement for the course during this learning component.
2.10.4
ACTIONS FOR AUSTRALIA
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Education:
Issue: There is agreed and inherent value in building varying levels of
certification for an advanced practitioner level as distinct from base
level certification. Previously a certification project was active with the
Education Work Group however the project leader was no longer
available and the project is no longer active.
HL7 Australia
Action: HL7 Australia to consider taking up leadership of this project
to reinstate as an active project.
WGMs
Issue: An e-learning course for Australia could be established. The
course can be set up for the HL7 Australia Board to review. (This issue
was reported by Heather Grain at the Phoenix 2013 WGM and
continues to be relevant.)
HL7 Australia
Certification Project
Education:
e-learning Plan
Future Education
representative
delegations to
Education Council
Action: HL7 Australia Education Council to review e-learning course
materials.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
2.11
ELECTRONIC HEALTH RECORDS
2.11.1
PROGRESS AT THIS MEETING
Most of the EHR WG activity at this meeting involved:
•
Reconciliation of ballot comments received on the flagship standard, EHR System Functional Model
Release 2 (EHR-S FM R2) that is also being progressed in parallel as an update of ISO/HL7 10781 and as
a JIC-endorsed project.
•
Reconciliation of ballot comments on the work item to elevate Personal Health Record System
Functional Model from DSTU to a normative ANSI/HL7 standard, being balloted in parallel in ISO/TC 215
as ISO/HL7 16527 as a JIC-endorsed project.
The EHR WG also confirmed that the following two projects are currently active and resourced (both are
discussed in more detail below):
•
Project #688: EHR System Function and Information Model (EHR-S FIM).
•
Project #831: EHR-S FM Profiling tool
It was noted that the following projects have been moved to inactive status because of completion, being
rolled into other projects, or no longer being resourced.
•
Project #843: CDA Transform to Blue Button:
The project is finished and published. “Blue button”
functionality enables information to be extracted from clinical information systems in a portable format
meeting US-Government requirements.
•
Project #819: EHR-S Profile for Health Information Exchange Metadata - this project went to commentonly ballot for May 2012 with outcomes taken into account for EHR-S FM R2.
•
Project #739: HL7 EHR FM Records Management and Evidentiary Support Functional Profile
Implementation Guidance - Phase 1 - Environmental Scan and Analysis - this project went to commentonly ballot in 2011 with outcomes taken into account for EHR-S FM R2 and pending update of RMES.
These three projects were particularly oriented towards the needs of the US-realm.
Other points of note included the following:
•
Project #1008: Meaningful Use EHR System Functional Profile (of EHR System Functional Model
Release 2). [See further report below].
•
Preliminary discussion of the form that the future Release 3 of the EHR System Functional Model might
take. How to move forward?
Steve Hufnagel spoke to a 16 page outline and call for volunteers to work on a fundamental reengineering of the next generation of the EHR-S FM from a normative framework populated with
some 320 functions and 2300+ conformance criteria to a reference architecture: “EHR-S Functionand-Information Reference Architecture Release 3.0 (EHR-S FIM RA-3.0)” in which the specific verbs
and criteria would be in profiles and not the architecture itself and the architecture would identify
functions in terms of the information objects they process.
A parallel vision suggested by Helen Stevens is of a library of functions, assembled and constrained by
various functional profiles as required.
More work is required on refining and agreeing the concepts. The topic is to be progressed on
fortnightly teleconferences (of the EHR Interoperability Sub-Group) with a view to creating a two62
Final Report HL7 Meeting—Atlanta, USA (May 2013)
year Plan of Actions and Milestones (POA&M) and Project Scope Statement (PSS) for approval at the
next HL7 WGM in September 2013.
[Also see comments under Project #688: EHR-S FIM, concerning this project’s influence on
development of R3 of the jointly balloted and accepted EHR-S FM. This influence needs to be
monitored and, if possible, guided to ensure that the outcomes do not prejudice the ability to
continue future versions of ISO/HL7 10781 as an international EHR-S FM standard].
•
Project #995: Usability Guidelines for EHR Systems.
The title for this project in the current project list (below) has been updated and a project progress
report provided.
•
Project #984: Reaffirmation of HL7 EHR Behavioral Health Profile, Release 1, and
•
Project #985¨ Reaffirmation of normative standard for HL7 EHR Child Health Functional Profile,
Release 1
The functional profiles addressed by these two projects are ANSI/HL7 normative specifications which
will hit the 5 year mark for systematic review at the end of 2013. These will be included in the
September 2013 ballot for reaffirmation.
Given changes in the EHR-S FM since the documents were first published and parallel work in on R2
profiles for the Behavioral Health (BH) and Child Health (CH) domains, explanatory material will be
included outlining the status and differences in content of R1, R1.1 and R2 of the EHR-S FM (i.e.) and
pointing to continuing work on providing profiles against R2 to address current needs of the BH and
CH domains.
•
Proposed reinstatement of: Project #610:
HL7 White Paper: 'Balancing the Integrity and Value of
Personal Health Records with...' (Aka “The PHR White Paper”).
The full title of this document, originally produced in 2009, is: "Balancing the Integrity and Value of
Personal Health Records with Consumer Adoption, Current Health Information Technology Standards,
and Privacy Rights – A Discussion of the Alteration of Professionally-Sourced Data". This 35-page
document was prepared to provide background and research needed to complete the PHR-S FM and
it was used to inform its content.
It was noted that the PHR domain has changed since 2009 and the White Paper should to be updated
to take into account Mobile Health, Bring-Your-Own-Device, Blue Button, and legal/governance,
other work that has occurred in the industry and changes in the stakeholder population.
A new set of volunteers who could help update the white paper are to be invited, including:
Professional associations representing risk managers, fraud prevention, and lawyers, and the BYOD
technology advocates.
•
Project #982: EHR-S Public Health Functional Profile Release 2 - Reconciliation of information only
ballot.
•
Joint meeting with Mobile Health hosted by EHR WG.
Elysa Jones of OASIS gave a brief presentation seeking the level of EHR WG interest collaboration on
PHER WG projects:
-
Project #971: Implementation Guide for transforming messages between OASIS Tracking of
Emergency Patients (TEP) and HL7 V3
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
-
Project #970: Implementation Guide for transforming messages between OASIS Tracking of
Emergency Patients (TEP) and HL7 V2.7.1
The main focus of the session was a presentation by Tim McKay of the mHealth WG on how mobile
devices are getting more and more important in healthcare organisations and applications but HL7
standards are slow to recognise this. Key points arising were:
-
The basic framework of PHR-S FM doesn’t have to be changed for mobile devices but some
functionality needs to be tailored for the new capabilities offered by mobile devices (such as
geo-location, app-controlled cameras, environmental and motion sensors, and SMS messaging).
-
mHealth WG suggest that some profiles be created for the PHR-S FM that account for use of
mobile devices and that the information obtained also be used to inform other HL7 work groups
of where they might be affected by mobile device usage.
-
Mobile health applications have the potential to cut across many of the Meaningful Use (MU)
criteria in the US and the standards that support them, specifically in the areas of: messaging,
document architecture, functional models and services. This needs to be considered in relation
to the S&I framework, to optimise mHealth support for MU.
•
Joint meeting with Security and CBCC WGs hosted by EHR WG.
Discussion in this session focused on issues arising from work on R2 of the RMES functional profile
including the implications of the many new requirements for EHR systems to hold metadata on
record entries in EHRS FM R2 (and they are extensive).
Security WG has a strong interest in having requirements for Privacy and Security metadata that
support its Healthcare Classification System (HCS)
The RMES Sub-group and Security WG also see work on EHR-S FM R2 as a continuing opportunity to
further establish commonality in key terms and concepts that will serve other Work Groups. [NB.
These changes will probably result in further Glossary changes needing to be tracked and
harmonised].
•
Joint meeting with PC, PHER and Pharmacy WGs and Clinical Interoperability Council (CIC) hosted by
EHR WG. This was basically an update session in which presentations were given on the following
topics:
-
Public Health Functional Profile team’s experiences updating EHR-S FM R1 Functional Profiles to
the new EHR-S FM Release 2 format (John Ritter).
-
Work on Project #1004: V3 Allergy and Intolerance Clinical Models being led by the Patient Care
WG on (Elaine Ayres)
-
Patient Care WG work on developing standards for Care Plan (Stephen Chu)
-
Work by the CIC to support the (US-realm) S&I Framework Structured Data Capture initiative,
which uses the "Retrieve Form for Data Capture" (RFD) for public health data.
•
Joint meeting with FHIR, SOA, Pharmacy, Security hosted by EHR WG (Thursday Q2).
The session commenced with two presentations were given by John MoehrkeI in the nature of a
“Free Security Tutorial”. They are available from the HL7.org web site at:
-
May 2013 Security Education: Audit Logging and Reporting
-
May 2013 Security Education: Sec, mHealth and FHIR
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
Subsequent discussion centred on the need for some EHR-S FM conformance criteria (specifically, the
Record Lifecycle event metadata in R2) to be accommodated within the FHIR framework, noting that
this harmonization effort needs to occur by July 2013. FHIR tags need to begin envisioning the
workflow and processes related to information exchange, in particular: Access Control and Audit
Event Reporting.
Australia had difficulty maintaining a presence in the EHR WG activities during the week as the WG runs
solidly throughout the week and there were many schedule conflicts.
Meaningful engagement in ballot reconciliation was also difficult because much of this is extremely detailed
and is done in small break-out teams and Australian delegates, when available, could only contribute from
their knowledge to a single stream at a time.
Australian contributions are always welcomed by the EHR WG and we have a long history of making modest
but worthwhile contributions to these standards, which are primarily still used in the United States,
although there has also been some significant use in several other countries.
2.11.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project #551: EHR System Functional Model (EHR-S FM) Release 2
•
Project #660: PHR System Functional Model (PHR-S FM)
•
Project #688: EHR System Function and Information Model (EHR-S FIM)
•
Project #831: EHR-S FM Profiling tool
•
Project: EHR FM R2 Glossary Update. Completed; remove from list for September 2013 report
•
Project #995: Usability Guidelines for EHR Systems – project information updated
•
Project #1008: Meaningful Use EHR System Functional Profile (of EHR System Functional Model
Release 2)
2.11.2.1
PROJECT #551: EHR SYSTEM FUNCTIONAL MODEL R2
PROJECT OBJECTIVE
The EHR System Functional Model (EHR-S FM) provides a consistent framework of functional capabilities
against which the functionality of an EHR system may be evaluated. It is a comprehensive list designed to
be used with functional profiles, each of which identifies which of the many capabilities are required in a
particular setting (e.g. primary care, aged care or acute care emergency department). Release 1.1 was
published as a full ANSI normative standard and also as the international standard, ISO/HL7 10781:2009
Health Informatics, Electronic Health Record System Functional Model Release 1.1.
Key objectives of the current EHR-S FM R2 project are to:
•
enhance the current joint ISO/HL7 EHR-S FM Release 1.1 into Release 2.0 incorporating input from
functional profiles, CCHIT certification criteria, EHR Interoperability Model DSTU and EHR Life Cycle
Model DSTU, plus additional content recommended and developed as a result of the R1.1 joint ISO/HL7
ballot comments; and
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
To support EHR-S FM R2's users' needs to quickly produce Functional Profiles that are conformant to
base EHR-S FM Conformance Clause, tooling may be developed that includes an XML version of the
EHR-S FM R2.
Redevelopment of existing profiles (subsets) derived from the EHR-S FM in various care settings e.g., long
term care, child health, emergency services is not included in this project but are the subject of separate
consideration. Developers of existing profiles will be encouraged to update the profile based on the new R2
development and many already have a strong need to update to R2 but cannot do so with certainty until the
updated standard is available.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This project is being progressed as a JIC Joint Initiative with parallel balloting in ISO/TC 215, CEN/TC 251,
GS1 and in HL7 International. Previous reports had noted that:
•
The first HL7 normative ballot of the R2 text closed on 7 May 2012 with 866 comments to be addressed.
•
The parallel ISO/TC 215 DIS ballot did not close until 26 September 2012 but passed with 100% of the
vote and around 40 comments needing to be reconciled (some containing sub-comments).
The following points were noted from discussion at this WGM:
•
Following the previous WGM, a further updated draft had been prepared as planned with the second
normative (HL7/N2) ballot opening on 25 March and closing on 29 April 2013.
•
395 comments were received in the latest HL7/N2 ballot, including some negative majors. Taking into
account the earlier ISO/DIS and other SDO ballots, there will have been over 630 changes since the
original ISO/DIS draft was issued.
•
Reconciliation of the HL7/N2 ballot comments had commenced via teleconferences and individual
offline reviews and continued through breakout groups at this WGM. Significant progress in ballot
reconciliation was achieved; however, there were around 100 items remaining at the end of the WGM
to be resolved over the coming weeks. Completion was expected by mid-June.
•
All ballots had passed, but because of the number of substantive changes, a further ISO/DIS2 and
HL7/normative ballot will be required.
•
It is the view of the Co-Chairs that the reconciliation has not resulted in any “substantial” changes from
HL7’s point of view and that the next HL7 ballot would be a final confirmatory ballot limited to those
who had voted in the previous N2 ballot.
•
Some requested changes that might have been seen as substantial were considered an extension of the
R2 scope and were deferred for consideration in the next release (possibly a release 2.1)
•
Harmonisation of these ballots is posing a challenge because of the different timescales and rules for
voting and commenting on second round ballots in ISO, CEN and HL7 International. As JIC Chair,
Richard Dixon Hughes has been asked to assist in resolving these issues in collaboration with the
EHR WG Co-Chairs, Naomi Ryan (ISO/TC 215/WG 1 secretariat) and Lisa Spellman (ISO/TC 215
secretariat).
•
Significant applications of the EHR-S FM have been reported in: Ireland, Brazil, Mexico (2010), USA
(extensively through CCHIT), The Netherlands (for Behavioural Health), Japan, Italy and Canada.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
Thanks to the efforts of Lisa Spellman (ISO/TC 215 and JIC secretariats) and Dr Mary Lou Pélaprat
(ISO/CS), previous issues surrounding the ISO publication formats for the EHR-S FM appear to have
been resolved.
2.11.2.2
PROJECT #660: PHR SYSTEM FUNCTIONAL MODEL (PHR-S FM)
PROJECT OBJECTIVE
The full title of this project is, ‘HL7 Personal Health Record System Functional Model - Promote from DSTU
to Normative and Promote to ISO TC215 under ISO/HL7 Pilot Agreement’. The background to this project is
as follows:
•
The HL7 PHR-S FM specification was published by HL7 as a draft standard for trial use (DSTU) in 2008.
•
A profile was also developed to specify the functions of a shared PHR system that includes many
functions similar to those that might be considered relevant in the context of the Australian PCEHR
project.
•
Following expiry of the trial use period, the document is being updated and balloted as a full ANSI/HL7
normative standard. The most recent release is a major update.
•
It is also being jointly balloted as a full international standard, ISO/HL7 16527 as a JIC Joint Initiative.
This standard addresses the functional needs of Personal Health Record (PHR) system developers and users.
PHR information is expected to be sent, received, or exchanged from multiple systems, including: EHR
systems; insurer systems; payer systems; health information exchanges; public health systems; Internetbased health education sites; clinical trials systems; and/or collaborative care systems.
Work is being harmonised as much as possible with work on R2 of the EHR-S FM.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The following points were noted from discussion at this WGM:
•
Within HL7, the first normative (HL7/N1) ballot closed on 24 September 2012 and reconciliation within
HL7 has been underway from that time onward. In total, there are some 318 comments to be
reconciled from the HL7 ballot.
•
The ISO/TC 215 DIS ballot closed on 5 February 2013 and was approved with 17 in favour, one negative
(UK) and 13 abstentions – there were 36 comments from ISO/TC 215 respondents.
•
The attendees at the April TC 215 meeting in Mexico City resolved to allow PHR-S FM to a second round
ISO/DIS2 ballot once ballot reconciliation had been completed within HL7.
•
The UK voted negative on the PHR-S FM ballot based on the immaturity of the PHR system market in
the UK and suggested that the document be offered as an ISO technical report, instead. Norway had
suggested that it would have preferred that it be a technical specification.
•
Applications of the PHR-S FM have been noted in: UK (Telehealth), Wales (Welsh Care Record Service)
and USA (county PHR systems). Given the reports of use in the UK, it is interesting that the UK
responded negatively on the grounds that the market for was not sufficiently mature. The comments in
the ballot did not appear to reflect the UK usage.
A small team met throughout the week to work to reconcile the PHR-S FM ballot comments, while a larger
group focussed on the EHR-S FM. The PHR group will continue its efforts by teleconference with expected
completion by mid-June.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
The next step will be the joint HL7/N2 and ISI/DIS2 re-ballot, which should be ready to open soon.
[Australian interests needs to be ready to review and respond to this invitation, noting that it is an N2/DIS2
ballot and that responsibility for this work within IT-014 is moving from the former IT-014-09 to IT-014-13.]
HL7 will re-cast the document into the same format as EHR-S FM R2 prior to submission for HL7/N2 and
ISO/DIS2 ballot. This should avoid excessive delay in getting the ballot documents issued by ISO/CS.
2.11.2.3
PROJECT #688: EHR SYSTEM FUNCTION AND INFORMATION MODEL
(EHR-S FIM)
PROJECT OBJECTIVE
This project is described as producing a set of Conceptual Information Models called EHR-S ‘data profiles’.
Each EHR-S data profile corresponds directly with an EHR-S function profile. Pairs of EHR-S function profiles
and data profiles can be used to define business objects that can be composed into software components,
capabilities, applications, systems and their information exchanges e.g. messages, documents and/or
services. The superset of EHR-S data profiles is called the EHR-S Information-Model.
The objective of this project is articulated by its originators, Steve Hufnagel and Nancy Orvis, as:
“The EHR-S FIM vision is that analysts, engineers or testers can efficiently compose and
refine the architecture and workflow agnostic EHR-S FIM into interoperability
specifications, which meet their System Acquisition, Implementation or Test needs.”
PROJECT ACTIVITY/ISSUES AT THIS MEETING
As previously noted, even though this project has been underway for some time, a lot of the proposed
detail of the FIM (Function and Information Model) has yet to emerge, despite some specific areas having
been developed in detail to illustrate the concepts.
There was no explicit discussion at this meeting focussed on progressing the FIM as a separate project. It
appears that the energies of the FIM team (including their fortnightly teleconference calls) are now fully
deployed in developing proposals to generalise and re-shape the next major release (Release 3) of the EHR-S
FM to effectively be the FIM.
The FIM work is strongly based on the interests of some in the US Military and with all the use cases and
comparisons focussed on the need of national programs in the US realm. There has also been some
presumption as to adoption of the HL7 v3 RIM as the underlying reference model for the information
aspects, although this may have been moderated.
Australian needs to continue monitoring this
development and, if possible, contributing constructive input to ensure that any evolution of EHR-S FM is
appropriate to it’s continuing to be a jointly developed and maintained international standard.
2.11.2.4
PROJECT #831: EHR-S FM PROFILING TOOL
PROJECT OBJECTIVE
This project will produce a (web-based and/or desktop) tool to create EHR-S FM profiles (starting with the
EHR-S FM R2), with enforced profiling rules, and exports as documents, support for an XML interchange
format for reuse across profile tool instances or for use in other tools. Additionally, the tool aims to support
multiple platforms, Windows, Linux, and MacOS and to be available via OHT. There is a defined XML
exchange format that is used by at least one other tool (e.g. Import the FM in Enterprise Architect). This tool
will become a tool in the HL7 suite of tools.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Michael Van der Zel (The Netherlands) presented an overview of the "EHR Profile Designer Tool”, which is
based on the Enterprise Architect product, developed by Sparx Systems in Australia. He recommends using
the latest version (version 10) of Enterprise Architecture.
The tool is loaded with the content of the EHR-S FM input to the model as XML which was produced from
the PHR-S FM spreadsheet developed by Corey Spears and which provides the tool’s instantiation of the
EHR-S FM conformance validation rules, formatting rules, and other rules.
Once the EHR-S FM is loaded, the tool can be used to generate profiles.
He reported that the installation process is simple but care is required as previous installations can be easily
deleted during the installation process.
During discussion the following issues were raised:
•
Recording and tracking of changes over time. Helen Stevens explained how spreadsheets could be used
to record changes to be fed into the tool when using subsequent versions of the model and/or profiles
•
Work is expected to result in a June release in according to the current timetable
•
During phase 2 of the work, consideration should be given to tracking changes in the rules database and
profiles.
•
Whether the PHR-S FM should become just another set of profiles for the EHR-S FM? It was agreed that
this is not currently planned but could be considered down the track. In the meantime the two models
would be loaded into the tool separately
2.11.2.5
PROJECT: EHR FM R2 GLOSSARY UPDATE
PROJECT OBJECTIVE
The HL7 Electronic Health Record System Functional Model (EHR-S FM) Glossary is an HL7 reference
document that provides a set of definitions and guidelines in order to ensure clarity and consistency in the
terms used throughout the functional model. The Glossary includes the definition of important terms used
in the expression of EHR systems’ functionalities, and comprises a consensus-based list of Action-Verbs and
specific guidelines for constructing conformance criteria (CC).
HL7’s EHR WG intends to continually unify the glossaries that support both the EHR and Personal Health
Records (PHR) System Functional Models and align them with terms used in other HL7 domains and
specialist areas. The need for this has been highlighted by inconsistencies and ambiguities in the EHR-S FM
work, mismatches identified by the FIM project between terms used in the functional model and related
concepts/terms in the information modelling and enterprise contexts, and some profiling activities. It is
expected that Functional Profiles (FP) created within the context of the EHR-S FM will align with and respect
this Glossary noting that some context-specific differences may still be required and these will be
documented in complementary glossaries.
Continuity with previous EHR-S FM versions is provided by including glossary terms that have been
deprecated, accompanied by suggestions for preferred replacement terms. Vigorous efforts were made to
reduce the ambiguities inherent in the use of human language, to respect the fundamental meaning of
words and to avoid domain specific usage of terms.
Where definitions of terms are taken from recognized sources, specific references are being included.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
PROJECT ACTIVITY/ISSUES AT THIS MEETING
At the previous HL7 WGM in January, this work was being progressed by a small glossary working party led
by John Ritter (US), Mark Brueckl (US) and Mark Janczewski (US). It was understood that the target for
completion was some 6 weeks from the end of the WGM (i.e. in late February) and that the resulting
harmonised glossary would be included in the next EHR-S FM R2 ballot, which closed on 29 April 2013.
This activity was not specifically discussed further at this WGM and appears to have been completed;
however, harmonisation with Security WG and RMES may result in some more glossary updates needing to
be more broadly harmonised as part of routine harmonisation.
It is recommended that this topic be deleted from the list of current projects to be reported at the
September 2013 HL7 WGM and Plenary.
2.11.2.6
PROJECT #995: USABILITY GUIDELINES FOR EHR SYSTEMS
PROJECT OBJECTIVE
This project was originally focussed on providing guidance/criteria on the usability of systems used at the
point of care. The motivation for the project was inspired by the guidelines on aircraft cockpit design
presented to senior members of HL7 at a recent AMIA conference. The AMIA presentation apparently
stressed the importance of human factors and reasonably consistent presentation in minimising the time to
respond to crisis situations and avoiding costly errors.
Discussion of this topic at the January 2013 WGM had identified that this was potentially a complex area in
which a lot of work had already been done and in which there are strong proprietary interests. It was
therefore recognised that any work by HL7 in this area needed to be informed, collaborative and build on
both previous and concurrent activities, some of which were identified at that WGM.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Based on the feedback from the January 2013 WGM, a draft Project Scope Statement (PSS) had been
prepared and was supported by the Steering Division on 22 April. It was subsequently forwarded to the
TSC, which suggested a number of changes to the originally proposed approach.
At this WGM, there was considerable discussion within EHR WG of how this item would be progressed, with
the following points being noted:
•
In their consideration of the proposed project, the first issue raised by the TSC was the extent to which
HL7 is limited in its activities to interoperability standards and guidelines.
It was noted that the EHR-S FM and PHR-S FM are precedents for standards that go beyond this
narrow interpretation. They provide frameworks for assessing systems functionality but they do not
breach the long-standing principle that HL7 should avoid attempting to standardise the features of
EHR systems. The proposed work on usability should also respect this principle.
•
The TSC also requested that the background review of existing literature and work (originally put
forward as a second step) should be done as a clearly defined first step – and before moving to
recruiting a broad range of experts from across many intersecting fields to undertake the subsequent
work.
•
The goal of this project is now focussed on translating existing, well-established usability guidelines and
health information management principles into functional criteria within the EHR System Functional
Model (EHR-S FM), rather than developing a separate “EHR Usability” specification.
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
•
Within EHR WG there is quite a lot of support for integration of this activity with the work on Clinical
Quality Information (CQI) by the CIC, which is, in turn, related to US-realm needs for quality measures in
MU Phase 3. TSC has indicated concerns about basing a Universal Realm (UV) specification too reliant
on US-realm requirements but there is still a strong push to progress the CQI relationship in some way,
possibly through parallel development of related functional profiles that would test out the UV-realm
extensions to the EHR-S FM.
•
The next steps identified in the PSS are the development of a usability framework against which the
EHR-S FM can be assessed and, finally, the incorporation of relevant functions and criteria into the
EHR-S FM, relevant functional profiles and, possibly, the identification of other types of guidelines or
specifications to support usability. There was a lot of speculation on how this might be approached,
which will become clearer as the project progresses.
The EHR WG is setting up a Usability Sub-Group to hold regular conference calls to progress work on this
project (in the form it is finally approved by TSC). Participation by Australians with interest and existing
expertise in the area would be welcome.
2.11.2.7
PROJECT: #1008: MEANINGFUL USE EHR SYSTEM FUNCTIONAL PROFILE
(OF EHR SYSTEM FUNCTIONAL MODEL RELEASE 2)
PROJECT OBJECTIVE
This project aims to develop a “Meaningful Use” EHR System Functional Profile (FP) by identifying
functions/criteria from the EHR-S FM Release 2, pertinent to US Meaningful Use (MU) Stages 1, 2 (and 3, as
it develops) and aligning these with the associated ONC 2014 Certification Criteria. The project is being led
by Gora Datta and will use the Enterprise Architect (EA) based EHR Tooling to develop the functional profile.
Availability of the MU functional profile will provide the potential for EHR Systems to be simultaneously
certified against MU1, MU2 and MU3 criteria and related EHR-S FM criteria.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This project is just commencing. The proposed project scope statement (PSS) was reviewed and supported
by the Structure and Semantic Design Steering Division at this WGM and at the time of writing had been
submitted to the TSC for approval.
The project responds to the US-ONC suggesting that it might be good to use certification against ISO/HL7
10781 (the EHR-S FM) as a means of providing an added value to US stakeholders, whereby, if vendors'
systems achieved certification in the US, those advances might be leveraged in non-US realms.
The two project leads, Julie Richards and Gora Datta, invited participation in the project; the team utilizes
the EHR Interoperability WG conference call coordinates every 2nd and 4th Tuesday at 1:00 PM US Eastern
Time.
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2.11.3
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
EHR WG
Issue: There is a mismatch between the HL7 and ISO re-ballot
requirements in relation to the next round of normative balloting to
finalise the ISO/HL7 10781 EHR-S FM R2 standard. The leaders of
EHR WG have sought advice and assistance on managing the
potential issues through the JIC Chair (Richard Dixon Hughes), the
ISO/TC 215 Secretariat (Lisa Spellman), and the ISO/TC 215/W G1
Secretariat (Naomi Ryan).
ISO/TC 215 WG 1
Secretariat
(Naomi Ryan)
Re-ballot of R2 EHR-S
FM
Richard
Dixon Hughes
Action: Naomi Ryan (WG1) and Richard Dixon Hughes to consider
issues relating to harmonisation of DIS2 ballot of ISO/HL7 10781
with HL7 N3 and assist HL7 EHR WG Co-Chairs and ISO/TC215
secretariat in finalising a joint publication in the most effective
manner.
EHR WG
HL7/N2 and ISO/DIS2
ballot of PHR-S FM
Issue: An Australian review and response to these two ballots of the
ISO/HL7 PHR-S FM will be required in coming months. This was
previously covered by IT-014-09 but now falls under IT-014-13 with
its broader responsibility of “Clinical workflow and care systems”.
The HL7/N2 ballot through HL7 Australia is likely to close much
earlier than the ISO/DIS2 ballot. A consistent approach is desirable.
IT-014 Secretariat
HL7 Australia
Action: IT-014-13 and former members of IT-014-09 to be invited to
prepare ballot responses to HL7/N2 and ISO/DIS2 ballots in
collaboration with HL7 Australia.
EHR WG
Proposals for R3 of
EHR-S FM
Issue: While preparation of Release 3 of the EHR-S FM is still some
time away, the preparation of the PSS for this work is already being
progressed by Functional Information Model (FIM) Sub-Group, who
are recommending a fundamental re-engineering based on
incorporation of their current approaches. While this may or may
not have merit, the preliminary work on the FIM is strongly U.S.based and there is a risk that the International applicability of the
EHR-S FM as an international standard will be prejudiced or lost in
this process. It is desirable that this move be closely monitored and,
if necessary, addressed at an early stage to ensure that any
outcomes are internationally applicable.
IT-014
HL7 Australia
Australian
delegations to HL7
WGMs
Action: Future delegations, IT-014 and HL7 Australia monitor the
proposals and scope statement for R3 of the EHR-S FM to ensure
that future revisions are likely to remain relevant as an international
standard. As the HL7 process for approval of Project Scope
Statements is an internal function of the TSC without external input,
raising early harmonisation of this work through JIC should be
considered.
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Topic
Issue/Action/Recommendations for Australia
EHR WG
Issue: Participation in the work of the new Usability Sub-Group of
the EHR WG by Australians with interest and expertise in usability of
systems would be welcome. The project is commencing with a
literature review and white paper, with a view to identifying
relevant usability criteria and incorporating them into the EHR-S FM.
Australian and related ISO/TC 215 guideline documents on user
interfaces and the application of clinical decision support are among
the key references identified to date.
Usability Sub-Group
Recommended for
Action by
IT-014
HL7 Australia
Action: IT-014 and HL7 Australia to circulate information on the HL7
EHR Usability Project among relevant experts with an invitation for
them to participate in the activities of the Usability Sub-Group of the
EHR WG.
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2.12
ELECTRONIC SERVICES
2.12.1
PROGRESS AT THIS MEETING
Progress at the Atlanta WGM for this WG was substantively impacted by the absence of three of the four
Co-Chairs who had been managing a number of the key projects of the WG.
The WG had planned to support the virtual attendance of Ken McCaslin (an ES Co-Chair) using a Google
Hangout. This required the supply and setup of equipment with video and microphone that was projected
using the Audio Visual equipment in the meeting room. While the equipment functioned correctly and 3
WG members were able to be linked into the virtual meeting that was projected on the meeting room
screen, Ken was not able to join the session because of restrictions in his corporate firewall.
The ES WG has been trialling technologies such as Google Hangout to support virtual attendance at HL7
meetings that provide a more integrated approach to participation than one of more of teleconference and
WebEX connections. HL7 International policy is to disallow virtual attendance, though it is not uncommon
for Co-Chairs who are not able to attend a WGM to “dial in” over a phone connection. At this WGM, the
level of sophistication of such attendance ranged from a mobile phone passed around the room, to the ES
WGs attempt to have shared video, desktop and remote presentation capability.
Given the current common but somewhat illicit participation of HL7 Co-Chairs, the need for Co-Chair
participation by all Work Groups, and for HL7 staff members in Technical and Support Services Work
Groups, allowing and more so supporting virtual attendance for Co-Chairs and HL7 Staff at a WGM ought to
be facilitated. Nat Wong led this dialogue and has been tasked with liaising with HL7 International to table
the request.
At the request of Nat Wong, Dave Hamill presented an update on the provision of a HL7 Help Desk. At the
Phoenix WGM, this Help Desk had been provisionally focused on the supporting HL7 Tools. The scope in
Atlanta for this help desk appears to suggest a much broader role including the participation of onsite HL7
support. Dave indicate that HL7 International had begun exploring different Help Desk systems, however as
the HL7 Board had yet to confirm any particular Help Desk function, Help Desk software review and
selection remained at a preliminary investigative stage.
Dave Hamill was also able to provide an update on changes to the HL7 Membership software system. Dave
indicated that Mike Kingery (Director of Technical Services) and Diana Stephens (Director of Membership
Services) have been working on changes to the GoMembers membership software used by HL7
International. While the HL7 Board was yet to confirm the exact nature of the new membership tiers, it was
expected that the software changes that had been implemented would cover the scope of membership tiers
that had been tabled. These changes are expected to take effect somewhere between July and September,
however it is unlikely that these changes would impact on the day to day use of the HL7 website.
During the T3SD Steering Division meeting, in response to a discussion with John Ritter and Diego Kaminker
in their roles on the International Mentoring Committee, Nat Wong mentioned the work that the HL7
Australia ES committee had been discussing on the concept of an “Affiliate in a Box”. While this project was
still in its formative stage and focused strictly on the provision of a reusable Infrastructure platform, interest
was expressed in keeping up to date with this work by the other Steering Division participants.
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2.12.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project #880: HL7 Website Enhancements
•
Project #877: Develop HL7 Ballot Site Education Tutorial
2.12.2.1
PROJECT #880: HL7 WEBSITE ENHANCEMENTS
PROJECT OBJECTIVE
The goal of this project is to enhance the existing HL7 website with new and extended functionality. The
Project is preceded by Projects #786, #785 and #674 that also dealt with enhancements to the website.
Each of these projects embodies incremental extensions both to the internal intranet resources used by HL7
HQ and the external/public Internet.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
No progress was made on this project at this WGM.
2.12.2.2
PROJECT #877: DEVELOP HL7 BALLOT SITE EDUCATION TUTORIAL
PROJECT OBJECTIVE
The intent of this project is to develop a tutorial on how to use the HL7 Ballot site. This tutorial will be
developed in English.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Don Lloyd presented a brief progress update on the progression of the Ballot site tutorial material,
indicating that the tutorial content had been developed, but had yet to be recorded. In the absence of the
majority of the key players in this project, further discussion of this project was deferred to a later meeting.
2.12.3
ACTIONS FOR AUSTRALIA
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Electronic Services/
T3SD
Issue: Work in Australia on update of its electronic services may be
complementary to other HL7 work.
HL7 Australia
Action: Keep the Technical and Support Services Steering Division
updated with the progression of the “Affiliate in a Box” concept
being developed by HL7 Australia.
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2.13
2.13.1
HEALTH CARE DEVICES
PROGRESS AT THIS MEETING
The meeting in Atlanta was a joint meeting of IEEE EMBS 11073 and HL7 Health Care Devices (DEV) WG.
2.13.1.1
REVIEW OF VENTILATOR NOMENCLATURE ISSUES
11073 Nomenclature to be revised as current standard for measurements is 10 years old for ventilator or
anaesthesia machine. The changes remove the need to pre-coordinate the different measurements into the
terminology as units of measures.
Need to assign identifiers that include default point of measurement, inspiration and expiration, i.e. link to
breathing cycle. Discussion on acronyms and their reflection of what is being measured – and what it is
measuring semantic refinements needed after point of flow, concentration, gas and phase (Inspir, Exspir) =
phase of ventilator, patient or circuit.
Suggestion for category for airway measure consolidated
(MDC_CONC_AWAY, MDC_VENT_AWAY).
Whilst clear on diagram as you add more concepts it becomes less clear in practice what is being measured
at what point. It was demonstrated that there are many synonyms in current standard. The work needs to
devise improved guidelines and possibly consider deprecating some of these terms.
2.13.2
ACTIONS FOR AUSTRLIA
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Health Care Devices:
Ventilator
Nomenclature
Issue: Standardisation of measurement points and variables.
Standards Australia
(HE-003)
Action: Advise Standards Australia Health Care Devices mirror group
HE-003 of revisions and canvas for potential members or
manufacturers to engage in this work.
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2.14
HL7 ACTIVITIES WITH OTHER SDOS
2.14.1
PROGRESS AT THIS MEETING
The agenda for the Sunday Q4 session of this group identified some 30 potential liaison reports that could
be covered. Of these, reporting was largely by exception and by those present and included the following:
•
DICOM (Harry Solomon).
Development of web‐based access mechanisms is continuing, including working with FHIR. DICOM
WG‐27 was holding a joint meeting with the web services group at this WGM. They are also having
vocabulary cleanup in the dental realm.
•
IHTSDO (Russ Hamm)
IHTSDO Workbench. The Vocabulary and Tooling WGs are continuing with activities to trial and
integrate the IHTSDO Workbench into HL7 Vocabulary harmonisation and, ultimately, management
of al content. He anticipated that this would need to be a funded project effort.
U.S. SNOMED CT® Content Request System (USCRS). The IHTSDO has begun to use the USCRS that
was produced by the US-NLM. The USCRS provides users with the ability to request basic changes to
SNOMED CT via a web interface and allows for those requests to be analysed and triaged by the
vocabulary maintenance team.
A proposed Vocab WG project for HL7 to trial USCRS has the
potential to streamline HL7 vocabulary harmonization and would serve to align HL7 vocabulary
tooling with that of the IHTSDO and the NLM.
John Quinn (CTO) noted that a core of some 20 HL7 vocabulary/terminology experts also regularly
attend IHTSDO.
Some including Kaiser Permanente also participates in CIMI, supporting
communication between these groups and efforts to build UML micro‐models.
Jim Case supplemented these reports. He noted that all SNOMED CT editing has now moved from
CAP to be done in-house at IHTSDO; the web-based USCRS is now used as the request submission
system. Known as “SIRS”, the IHTSDO version of USCRS will only accept requests from authorised
release centres, which will shortly include the HL7 Terminology Authority (HTA) [see notes on HTA in
the Board report].
IHTSDO is hiring three editors and is also introducing a one-year apprenticeship-style program to
train consultant terminologists able to action large and small ‐ terminology changes and
model/design national terminology releases. There is also the SNOMED implementation advisors
group, another channel for communication with IHTSDO. There will be an implementation showcase
at the IHTSDO conference at Washington DC in October.
Ann Wrightson advised of the UK Terminology Centres implementation forum and their published
webinars that are publicly available.
•
ISO/TC 215 (John Quinn).
HL7 would like to achieve greater coordination among the 20 or so HL7 experts that attend
ISO/TC 215 meetings and, also, have HL7 officially receive communications for all ISO/TC 215 WGs.
He also mentioned HL7 commitment to SKMT and the issues associated with managing HL7 updates
[see CTO report under HL7 Board for more information].
Richard Dixon Hughes also reported on ISO/TC 215 noting that changes to WG structure are complete
and the new business plan has been approved in principle. A proposed re-statement of TC 215 scope
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has raised some issues with IEC/TC 62 (Medical Devices) and ISO/TC 121 and is being worked through
with assistance from Todd Cooper and Sherman Eagles and others well known in HL7. The next
ISO/TC 215 meeting will be in Sydney on 21-25 October and will be followed by IHIC 2013 early the
following week. All HL7-ers are welcome.
Ted Klein and Woody Beeler highlighted a project that they are leading in ISO/TC 215 for using core
principles for binding of terminology with ISO 21090 data types. It promotes using HL7 normative
mechanisms for terminology binding to data types.
•
JIC (Richard Dixon Hughes)
An update was provided on the April JIC meetings, held in conjunction with the ISO/TC 215 meeting
in Mexico City. In addition to thanking John Quinn for HL7’s contribution to JIC, Richard spoke to a
brief presentation, available at:
http://gforge.hl7.org/gf/download/docmanfileversion/7324/10423/JICISO-TC215Atlanta.pptx
(accessed 16 June 2013).
Points highlighted in speaking to the presentation included:
-
progress on the strategy for engagement with LMIC, building on the recommendations of the
ISO/TC 215 Public Health Taskforce and opportunities to progress collaboration through
professional societies (notably IMIA), global agencies such as WHO and ITU and funder/donors.
-
IHE’s recently joining of JIC and the benefits in terms of strengthening the focus on
implementation for JIC joint projects.
-
The importance of other SDOs, including HL7, becoming involved in balloting of cornerstone
standards on the JIC list of joint projects. ISO 13940 System of concepts for continuity of care
(ContSys) has recently been out for DIS ballot and provides a framework of concepts, terms and
definitions that should be underpinning the vocabulary used across the JIC members and also
the terms and definitions preferred in SKMT. It is vital that HL7 is involved in the development of
these artefacts and uses them as shared foundations.
-
Formatting problems have been overcome and EHR‐S FM, PHR-S FM are being balloted
simultaneously in HL7 and ISO/TC 215/WG1.
•
OASIS (Elysa Jones)
It was reported that OASIS had developed an MOU with HL7 for Tracking of Emergency Patients (TEP)
standards, initially addressing TEP transform to HL7 V2 or V3 messages to be balloted in the next
cycle. OASIS will also be bringing in Hospital Availability or HAD into HL7 as a project.
•
Regenstrief/LOINC (Ted Klein)
Ted mentioned his involvement in the February LOINC clinical conference and proposed updates in
LOINC licensing arrangements. He provided a brief presentation, available at:
http://gforge.hl7.org/gf/download/docmanfileversion/7310/10400/LOINCliaisonreportMay2013.pptx
(accessed 16 June 2013).
Jim Case reported that final the signed version for LOINC/IHTSDO Collaborative agreement on use of
LOINC with SNOMED was imminent. From a practical viewpoint, vital sign ontology and document
ontology are primary areas of initial focus for alignment.
Planning session (Q3 Monday). After a brief discussion (which was attended by Richard Dixon Hughes en
route to another session), the group dispersed with a resolution to set up a conference call in several weeks
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to review future plans for TSC's Activities with other SDOs communication. There is some concern within
HL7/TSC that the traditional role of the Sunday session is an additional overhead for TSC and attendance is
down as it is competing with more and more other activities (such as free FHIR tutorials). It was indicated
that the Australian delegation would prefer that this Sunday session be retained as it one of the few
opportunities for TSC to support HL7’s commitment to joint activity.
2.14.2
ACTIONS FOR AUSTRLIA
There are no actions for Australia specifically arising from this activity, although some of the matters
reported here are the subject of actions raised elsewhere.
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2.15
HL7 ARCHITECTURE PROGRAM AND SAIF
2.15.1
PROGRESS AT THIS MEETING
Each project from the SAIF architecture program provided a brief overview of their status. Some projects
have reported no or insignificant progress due to lack of resources, e.g. SAIF Implementation Guide, SAIF
Artifact Definition (led by MnM) and Composite Order, so most of the meeting was focused on describing
progress from two projects, namely:
•
Project # 587 - Lab Order Template (OO) and
•
Project # 863 - Cross-Paradigm Interoperability Implementation Guide for Immunizations project (“X
Paradigm”) (SOA)
Note that Project # 863 - Cross-Paradigm Interoperability Implementation Guide for Immunizations project
(“X Paradigm”) (SOA) is discussed in the SOA WG description section of this report.
Note also that the items recommended for Actions for Australia identified at the Phoenix WG meeting are
still open and carried into this report. They were not addressed due to the insignificant progress in the
related projects since the Phoenix WG meeting.
2.15.2
CURRENT PROJECTS
The following project is discussed in this section:
•
Project: SAIF Artifact Definition
•
Project: Project # 587 - Lab Order Template (OO)
2.15.2.1
PROJECT: SAIF ARTIFACT DEFINITION
PROJECT OBJECTIVE
The goal of the project is to identify and define the artefacts to be created and used as part of HL7
standards development work. The wiki page provides a means for formally defining all of the artefact types
that will be developed, maintained and published by HL7 WGs under the SAIF methodology. This content
will form a significant portion of HL7's SAIF IG.
The artefact definitions attempt to identify the purpose for a given artefact, the reasons for its existence as
well as the various constraints on when and how it is used and the content it may contain.
Further information can be found at:
http://wiki.hl7.org/index.php?title=Category:SAIF_Artifact_Definition [Accessed 23 January, 2013]
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This and the following project were discussed at length and are summarised below. Of interest for SAIF
Architecture program is that the X-paradigm and Lab Order template projects took different modelling
approaches, in that the X-paradigm is looking breadth wise, rather than diving down the specification stack.
These two groups met to discuss early in the effort, and decided that it was worthwhile for each to take
separate paths, and then come together to discuss lessons learned nearer the end, so we could compare
and contrast artefacts for specific uses.
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2.15.2.2
PROJECT: PROJECT #587: LAB ORDER TEMPLATE
PROJECT OBJECTIVE
To develop specifications and models for communicating orders for laboratory (specimen-based) testing
using the new, alpha, just developed, Service Aware Architecture Framework (SAIF). SAIF specification is at
the conceptual or canonical description level; currently there is no v3 SAIF Implementation Guide for HL7.
Therefore, the work in this laboratory conceptual specification is best-guess and alpha-level thinking. The
project team believe the current artefacts thoroughly describe the interoperability space for laboratory
order; however, those exact artefacts are not necessarily the artefacts that will eventually be contained and
defined by the SAIF IG and are presented as draft and present for your consideration.
Further information can be found at:
http://wiki.hl7.org/index.php?title=Lab_Order_Template [Accessed 19 May, 2013]
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Lorraine Constable, Modelling, SOA Facilitator reported some progress in the last quarter. The majority of
progress relates to the expression of requirements using the Sparx EA tool and specification of the
Conceptual Roles and Conceptual Information Model. There was also initial work on requirements
traceability. The next steps are to work on the logical specification, taking into account the Lab Order
RMIMs, and to further focus on traceability through the SAIF matrix.
2.15.3
ACTIONS FOR AUSTRALIA
As per previous meeting recommendations
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
HL7 Architecture
Program and SAIF:
Issue: It is not clear at present how Product Line/Product Family
concepts from the ARB BAM project are related to the SAIF
Architecture Program.
HL7 Australia
SAIF Artifact Definition
Action: Contribute to and influence product Line/Product Family
developments while linking it with the experience and deliverables
from the SAIF Artifact Definition project.
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2.16
INTERNATIONAL COUNCIL—GENERAL SESSION
The following 14 affiliates were represented at the general session by their Chair or another nominee from
their affiliate: HL7 Argentina, HL7 Australia, HL7 Brazil, HL7 Canada, HL7 France, HL7 Germany, HL7 India,
HL7 Italy, HL7 Japan, HL7 The Netherlands, HL7 Norway, HL7 Puerto Rico, HL7 Switzerland, and HL7 UK. A
representative of the USA membership also attended.
The following 5 affiliates were represented by a proxy from another affiliate: HL7 Colombia, HL7 Czech
Republic, HL7 Korea, HL7 New Zealand, and HL7 Russia.
2.16.1
PROGRESS AT THIS MEETING
Matters addressed in general session included:
•
$3,500 USD had been approved for HL7 UK to support a meeting of European affiliate Chairs in Ireland
in eHealth week, May 2013.
•
HL7 Education WG Report. The following were particularly noted:
-
Increased activity and focus since the appointment of Dr Susan Chaplock as Director of
Education.
-
Continued delivery of HL7 e-learning courses (HL7 Fundamentals)
-
Development of Portuguese- and Japanese-language editions of the e-Learning program
-
Development of additional e-Learning material on FHIR, authored by David Hay (NZ)
-
New hands-on workshops at the educational summits
-
Electronic outreach - new MU webinar series; new skill building for certification webinars; new
education portal (due June 2013)
•
Preparing for electronic certification testing in July 2013
Membership Committee. This committee was formed by the HL7 Board. Its role, membership and
activities are reported in more detail in the section of this report on the HL7 Board.
Philip Scott and Diego Kaminker were confirmed as International Council representatives on the
Membership Committee.
There was some discussion regarding the progress and scope of this committee and the Council’s
desire to provide additional support to Philip and Diego and representation from the international
community. It was agreed that Diego and Philip would discuss with Grant Wood (Chair of the
Membership Committee) the addition of Bernd Blobel and Melva Peters to the Membership
Committee.
ELECTIONS
Helen Stevens was elected as International Council’s to the HL7 Nominations Committees.
Confirm International Council representatives on Membership Committee – Philip Scott, Diego Kaminker,
and Melva Peters and Bernd Blobel newly elected
AIR MILES COLLECTION PROPOSAL
This initiative is to provide expertise to new affiliates at a lower cost. It has been suggested that air miles
that are about to expire may be donated to HL7 for members to be able to subsidize travel to access
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expertise. This would include international Council members from less well-off affiliates and LMICs to
WGMs. This would need robust governance rules about the program. Investigation is underway on a
program for this.
FHIR UPDATE
A brief introduction to FHIR from an international perspective was given by Lloyd Mckenzie, covering key
features and references to further information for follow-up via the following channels:
•
Read the specifications and other commentary at: hl7.org/fhir
•
Follow #FHIR on Twitter
•
Shape the specification by making comments online (using the wiki linked to hl7.org/fhir)
•
Attend FHIR sessions at WGMs
•
Try implementing it and/or come to a FHIR Connectathon
•
Email contact: lloyd@lmckenzie.com
The focus for FHIR continues to be on implement-ability and international specifications (AU, Canada and
Netherlands). The management group emphasised that FHIR is licensed under a different agreement to
other HL7 products and that no share back requirement for developers using FHIR is currently in place.
FHIR was discussed as another key aspect for membership going forward and an opportunity for strategic
marketing by HL7.
EDUCATION UPDATE
Education was emphasised as one of the strongest earners for HL7. In context of the Chair report education
was also referred to as an important aspect for membership value. The importance of member access to
development of HL7 knowledge through training, certification and access to materials was highlighted.
Some significant deliverables include:
(1) Education portal to be available in approximately June this year via the website. This will have links to
registration and program information to improve access to curricular.
(2) Development of E learning for FHIR has progressed to the point that it is about to be launched. This
has been developed with David Hay (NZ).
(3) Electronic outreach will be ongoing in the form of power points available as webinars on the website.
(4) Preparation for electronic certification is continuing.
HL7 INTERNATIONAL BOARD
There was an intense discussion over the composition of HL7 International Board. Many affiliates are
concerned over the distinction between the 7 “Directors at Large” elected/appointed from the HL7
International direct membership, who are predominantly from the US, and the 2 “Affiliate Directors”
elected from the Affiliate membership. Under the constitution these numbers can be up to 8 and 4
respectively. It was proposed that it is preferred to have a better geopolitical balance of these directors. A
potential motion was put forward:
“Motion to express the will of the Council that a phased proposal be developed to
remove the distinction between directors at large and affiliate directors and to have
equitable voting rights for HL7 International and affiliate members as well as a balanced
geographical representation structure at the HL7 Board.”
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Australia’s position is that this is insufficiently discussed and formulated at the present time. This will be
further discussed at the meeting later in the week.
AFFILIATE VALUE PROPOSITION TASKFORCE
There has not been any progress since the last meeting, however an overview of how this has been
approached in the UK of the possibilities by Philip Scott.
The UK analysed the spread sheet of HL7 benefits, identified what offered to UK community members, and
the themes broadly were education, implementation support, marketing and strategic guidance. This
includes localisations, help desk, user groups, vendor showcase, products and service directories,
educational discounts, and access to UK profiling and tooling.
What was identified was to be of value would be:
•
Support HL7 implementations
•
Provide marketing opportunities for vendors
•
Provide education support for next generation implementers
•
Validate products and people
•
Access to UK products and profiles.
A draft business plan has been done for each of these areas to see how this would work. The discussion and
progression of this is on-going.
CONFERENCES
Richard Dixon Hughes gave an update on IHIC 2013 in Sydney on 28 and 29 October 2013. In addition there
will be a parallel FHIR Connectathon.
The EFMI STC (special topics conference) on Data and Knowledge for Medical Decision Support had taken
place in Prague on 17-19 April (brief report given by Bernd Blobel).
2.16.2
2.16.2.1
CHIEF TECHNOLOGY OFFICER (CTO) REPORT
SKMT
Four years ago Heather Grain approached HL7 (Ed Hammond, John Quinn and others) for HL7 support and
contribution to an ISO TC 215 Health informatics "Glossary project" called SKMT (Standards Knowledge
Management Tool). HL7 International contributed a number of glossaries and acronym lists that HL7 and its
members had created over the life of HL7 to this project.
It was requested that members of HL7 start using SKMT and provide feedback on its use. The SKMT website
can be found at www.skmtglossary.org. Registration is required but has no cost. All registered users
currently have edit rights that are constrained only by the membership organization defined during user
registration.
There are otherwise no bounds on edits, so John cautioned people that rollback/undo
functionality is not yet well defined.
It was requested that anyone making changes should contact the Project committee, and to otherwise
refrain from making changes, or if making changes, to only change definitions for which they have some
level of responsibility within HL7. Currently HL7 entries of terms belong to a single 'document' (or node).
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RIM IN OWL
2.16.2.2
At the Phoenix WGM HL7 kicked off a tooling project based on the idea from Lloyd McKenzie that the RIM
could be expressed in OWL. This approach proposed the creation of an XML expression of the RIM that
could be imported into an off the shelf OWL tool. In March HL7 International received a 300-page XML
representation of the RIM from Lloyd. Using Protégé (an open source ontology editor and knowledge base
framework), this was able to be loaded as an XML file. The utilities used to create the XML file will be made
available before the next meeting. In the interim, the current RIM XML file would be made available on the
HL7 web page. This XML file is one revision behind the current version.
The utilities used to convert the MIF need to be made more robust. The project was presented this project
to CIMI, however the response was less warm. Berndt Blobel indicated that the relationship with CIMI was
complicated.
2.16.2.3
MORE TOOLING
The Tooling Strategic plan was unanimously approved by the HL7 Board in a Teleconference after the
Phoenix WGM. The Tooling WG will embark on a Tooling Tactical plan prioritised by the decisions of the
membership and policy committees and the HL7 Board as soon as those decisions are made. The Tooling
Tactical plan needs to be aligned with the new membership structure and is likely to preoccupy discussion
on Tuesday. The Tactical plan cannot be progressed until the membership structure has been worked out,
as the two are tightly coupled.
2.16.3
TECHNICAL STEERING COMMITTEE (TSC) REPORT
The TSC report was presented by Austin Kreisler.
The WG Health measures/metrics are being extended to the mid-tier governance groups including FHIR.
This includes the TSC and Steering Divisions. The International Council has been asked if they would also
like to be measured. The metrics are still being determined, but a draft copy of the expected metrics is
available on the TSC website. Melva Peters (HL7 Canada) has taken on the tasks to clean up the metrics for
the Steering Divisions.
TSC elections are occurring this summer. TSC is forming a nomination committee.
The TSC has a number of strategic projects in progress. These include the following:
•
HL7 Business Architecture Modeling (BAM) project: The intent of this project is to develop a business
architecture that incorporates Product lines and Families. This project is already underway. The first
pilot is FHIR and is an 'experiment' using the SAIF governance model. The second pilot is a CDA IG
family. This is taking an existing standard as a product family. This is considered a test. The HL7
Product line Architecture program is tasked with doing the work of standing up the projects in relation
to the model.
•
SAIF Project: The task of rolling out SAIF across HL7 International is currently stalled.
A permanent committee has been established to do risk assessment and define governance points for the
TSC. The committee is analysing source documents such as the GOM, trying to surface the risks for which
the mitigations were originally designed. This is a somewhat interesting way to recover those risks in the
absence of any other organisational knowledge.
ANSI’s audit of HL7 international balloting practices has resulted in a change that will impact Work Groups.
There is now a 1 year deadline to complete reconciliation and publish. If further time is required then TSC
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
approval must be sought, as the TSC needs to notify ANSI about the extension. There will be some leniency
in the publication dates as there are some clear cases in which exceptions will be required.
The ANSI audit also suggested that HL7 International’s Governance and Operations be separated from the
ANSI compliance process. Otherwise, all HL7 internal processes are evaluated. This will effectively mean
the creation of two Operations manuals, so ANSI will stop grading HL7 on how it deals with its own internal
processes.
2.16.4
REGIONAL REPORTS
HL7 EUROPE
2.16.4.1
Currently Europe HL7 has 19 Affiliates. Current and/or planned HL7 Europe involvement in the following
European projects and activities were noted:
•
epSOS: Second phase approved and funding provided. Increasing reliance on CDA provides
opportunities for greater SDO collaboration.
•
Semantic HealthNet: (HL7 project lead: Charlie McCay). Annual review in February commended HL7
work. A further update was expected in April.
•
eHealth Governance Initiative: eID workshop February 10-11 in Brussels, focused on the specific
authentication and identification requirements of eHealth.
•
ANTILOPE project: (HL7 project lead: Catherine Chronaki) Initiated in February. Focus will be testing; its
first meeting including SDO members will be in Dublin on May 16.
•
HL7 workshop at WoHIT on May 13 prior to Ministers meeting as part of the eHealth Europe week in
Dublin.
•
The next HL7 Europe newsletter is planned for production in time for the eHealth Europe week in
Dublin.
2.16.4.2
HL7 ASIA
Following the formation of HL7 Asia with funding from respective ministries of health in China, Japan, Korea,
Taiwan, Hong Kong and Singapore and the election of Ken Toyoda (Japan) as its first Chair, HL7 is planning
engagement through:
•
HL7 Asia Meeting. This will be the inaugural meeting of HL7 Asia and is expected to attract some 200
delegates. It is planned to take place in Tokyo on 18-19 July 2013.
•
HL7 Asia is also collaborating with the organisers of the following upcoming events, with a view to
participation and promotion of HL7 Asia:
-
HIMSS APAC Greater China eHealth Forum being held in Hong Kong from 31 July to 2 August
2013.
-
HIMSS APAC Digital Healthcare Week (Asian Ministry Conference). Singapore, 21-24 October
2013.
2.16.5
HL7 AROUND THE WORLD
A synopsis of developments from reports of international affiliates around the world is provided in Section 4
below.
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2.17
INTERNATIONAL COUNCIL—AFFILIATE CHAIRS SESSION
2.17.1
PROGRESS AT THIS MEETING
The affiliate chairs session at working group meetings is the forum in which the International Council (IC)
makes most of its major decisions.
The following 14 affiliates were represented at the general session by their Chair or another nominee from
their affiliate: HL7 Argentina, HL7 Australia, HL7 Brazil, HL7 Canada, HL7 France, HL7 Germany, HL7 India,
HL7 Italy, HL7 Japan, HL7 The Netherlands, HL7 New Zealand, HL7 Puerto Rico, HL7 Switzerland, and HL7 UK.
A voting representative of the US membership also attended.
The following 9 affiliates were represented by a proxy from another affiliate: HL7 Austria, HL7 Colombia,
HL7 Czech Republic, HL7 Luxembourg, HL7 Korea, HL7 Norway, HL7 Russia, HL7 Spain and HL7 Uruguay.
With 23 out of 35 affiliates represented, a quorum of the International Council was present.
Matters addressed by the affiliate Chairs included:
•
HQ Liaison and Financial Report (Philip Scott).
-
The IC budget allocation for 2013 is now fully committed and includes $5,000 already approved
for HL7 Australia toward the cost of running IHIC 2013 in Sydney in October.
-
Requests for the 2014 budget should be submitted at least 35 days in advance of the September
HL7 WGM so that they can be distributed and voted upon at the September meeting.
-
The budgeted allocation of $3,500 to HL7 Taiwan was approved to support funding speakers
from Asia (Japan, Korea, and China) for the Asia-Pacific HL7 Conference in October 2013.
•
Policy Advisory Committee (PAC) membership. Hans Buitendijk (Chair of the PAC) presented an
overview of PAC activities and plans.
The following points were particularly noted during his
presentation and subsequent discussion.
The PAC is a Committee appointed by the HL7 International Board and will now be working closely
with Ticia Gerber as the newly appointed Director of Global Partnerships and Policy in identifying
opportunities for HL7 policy input to government and industry bodies around the world and the
exploitation of opportunities for HL7 to partner in projects of global significance.
The current members of the PAC are: Keith Boone, Bill Braithwaite, Hans Buitendijk (Chair), Kathleen
Connor, Bob Dolin (Executive Committee liaison), Richard Dixon Hughes, Jamie Ferguson, Dennis
Giokas, Stan Huff and Ticia Gerber (staff).
One of the key PAC roles is collating, drafting and editing white papers, drawing on the expertise of
the wider HL7 community. For example, in the US realm, it prepared a response to the recent
ONC/CMS regulatory RFI on Interoperability; it is working with CQI WG on a response to the US
NPRM on the Inpatient Prospective Payment System (IPPS) in relation to quality measures; and work
is also taking place in relation to the roll out of Blue Button.
In Canada, US and EU developments in the area of privacy and security of health information are
being tracked with further inputs expected to be required.
[Bernd Blobel noted an upcoming
European by invitation only meeting on next steps in privacy].
Globally, the PAC is tracking activities of WHO and ITU in the promulgation and standardization of
eHealth.
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There is work currently underway on developing better relationships with eHealth initiatives in Latin
America and a high-level executive meeting with the Pan American Health Organization (PAHO) is
being planned for June to explore roles that HL7 International might play.
The PAC has concluded greater regional representation among its members could assist it in
identifying other similar opportunities and it is exploring the potential for representatives from South
America, Europe and Asia to join the PAC.
A question was raised on how this might relate to the European and Asia offices and their roles. The
IC considered that it would be ideal if regional representatives are engaged in the HL7 regional
groups, where they exist. Contacts for further discussion include Catherine Chronaki, SecretaryGeneral of the HL7 Foundation (HL7 Europe), and the Chair of HL7 Asia (currently Michio Kimura).
The IC resolved to request the appointment of regional representatives to the Policy Advisory
Committee - initially for South America, Europe and Asia.
Hans Buitendijk will take this up with the HL7 administration and HL7 Board and report back to the IC
at the HL7 WGM in September.
[Note: there is also a brief report on PAC activities at this WGM in section 2.25 of this report].
•
International Working Group Meetings
Earlier in the meeting, the HL7 Board had resolved that the May 2015 WGM would be an
“international” meeting to be staged by the European affiliates in Paris (at the location originally
proposed by HL7 France.)
There was a lot of discussion within IC about the structure and organisation of the Paris meeting,
including the possibility of having a European “plenary” on the Monday morning and “policy tracks”.
There was also discussion about the more general problems of getting suitable venues, prices and
engagement for HL7 WGMs held outside North America. There were two main outcomes:
-
The IC resolved to establish a steering group for the May 2015 Paris WGM comprising: Philip
Scott (Chair), Helen Stevens (HL7 Board representative), Nicolas Canu (HL7 France), Lillian
Bigham, Mark McDougall and Ticia Gerber (HL7 HQ), Beat Heggli (HL7 Switzerland), Kai Heitmann
(HL7 Germany), Tom de Jong (HL7 The Netherland), and Carlos Gallego Perez (HL7 Spain).
The Steering Group’s responsibility is to focus on a plenary program, Tuesday policy track,
securing European participation, securing additional sponsorship, additional educational
opportunities and social events.
It was confirmed that that there will be sub-committees/groups brought in to do a lot of the
organizing, there is no expectation of financial commitment from European affiliates other
than HL7 France, HL7 HQ would develop a meeting schedule, HL7 France will establish a local
team of volunteers to manage their end of the event.
-
Given the difficulty of securing appropriate venues and the desirability of holding regular
international meetings, the IC resolved to reactivate the existing “International WGM
Assessment Team” – Kai Heitmann, Lillian Bigham and Melva Peters and request that they report
back to the IC at the HL7 WGM in September on suggested locations and dates for international
WGMs beyond 2015.
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•
Special Interest Topic – Political realities in New Zealand by David Hay, Chair of HL7 New Zealand.
David’s’ presentation covered the following points:
-
The funding model involves a mix of public and private service provision, universal health
insurance and accident compensation commission funding.
-
Overall health IT policy is managed by the “IT Health Board” a subcommittee of the National
Health Board which, in turn, advises the Government on the planning and funding of the New
Zealand public health services.
-
The IT Health Board provides leadership in the implementation and use of information systems
across the health and disability sector and is charged with ensuring that health sector policy is
supported by appropriate health information and IT solutions. It has membership representative
of a broad range of interests and its remit includes funding of Health IT. HL7 NZ has a seat on
the peak IT Health Board.
-
Health information standards fall under the Health Information Standards Office (HISO).
-
New Zealand has a health IT strategy that is focusing on computerisation of primary health and
community care and the secondary/Tertiary acute care sectors in the initial stages, specifically in
relation to referral, discharge summary (both supporting the continuity of care), electronic
prescribing, medications reconciliation, GP to GP communication and national specialty systems.
-
The creation of shared clinical data repositories deriving information from these primary sources
will ultimately support shared care, tracking patient visits, e-events, care plans and clinical
decision support.
-
The achievement of this vision is supported by a health interoperability architecture (2011)
comprising building blocks (regional and national repositories linked via IHE/XDS), clinical
content models (local CCR/archetypes) and document exchange formats (HL7 CDA).
-
At present, there is national infrastructure for identification, some national, regional and private
repositories and widespread use of HL7 V2 messaging, with some CDA documents.
Terminological resources in use include Read codes, ICD, LOINC, and SNOMED.
-
There is a considerable gap to be bridged when the future vision is stacked up against the
current state of shared regional/national services, standards, primary and community care
systems and hospital systems, most of which are dominated by legacy products and approaches.
-
David Hay perceives a strong role for FHIR in helping to integrate these disparate resources and
HL7 NZ is strongly encouraging the potential of this technology.
In concluding, he summarized the particular opportunities and challenges facing HL7 NZ:
-
The size and location of New Zealand creates challenges in participating in HL7 activities
internationally.
-
We have our own internal challenges – political, funding, human resource - that are doubtless
shared by many others.
-
Excellent relationship with HL7 Australia.
-
IP Changes had greater impact than expected – though not insurmountable. Support the
concept.
-
Current HL7 emphasis on on-line training/certification is very important to NZ.
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•
International Council Evaluation Metrics. The TSC had invited the international Council to consider
developing performance metrics to measure its effectiveness, in line with other governance
committees within HL7.
This was debated at some length within IC with some affiliates (including Australia) being in favour
and others being opposed to a variety of reasons. At the conclusion of the discussion of the motion
“that International Council agrees in principle that there should be performance metrics for the
Council, the details of which need to be agreed to by the Council” was defeated – with 9 in favour, 12
against and 2 abstaining.
•
HL7 Board Report. Some relatively minor issues concerning the Membership Committee and the
financial outcome for 2013 which was somewhat better than expected were the main points noted.
•
Proposals to “Internationalize” the HL7 Board.
This discussion continued the points which had been raised by Kai Heitmann at the general sessions
and commenced with a more detailed presentation of the following concepts:
-
Removing or reducing the distinction between “directors at large” (some of which are elected
and some directly appointed) and the “affiliate directors”;
-
A proposal for “balanced” geographical representation on the HL7 Board. To be achieved by
appointing the Chairs of HL7 Europe and HL7 Asia to the Board (to increase the number of
affiliate address directors to the fore currently allowed in the GOM); and
-
Giving members of affiliates and members of HL7 International equal rights to vote for the Board
of HL7 International (the long-standing one member one vote issue).
The European affiliates are reported by some of their advocates to be strongly behind these
proposals because they continually face push back from the European establishment on the grounds
that that HL7 International is a US-dominated organisation.
The International Membership and Affiliate Taskforce (IMATF) final report also proposed that some
of these changes be considered but that report is not being actively considered at present because of
the pressures brought about by the decision to license HL7 standards and other selected IP free of
charge. Consideration of this report is understood to be on the longer-term agenda of the
Membership Committee.
HL7 Australia is in a minority. It understands the issue and concerns but does not see how the
proposals are equitable to those who pay considerably more to belong to HL7 International; nor or
are they favourable to all affiliates or consistent in stripping away special identification of “affiliate”
directors but then replacing them with directors from identified regions.
The final resolutions represent the minimum common ground, namely:
-
Request to the board to change HL7 website and other communications so that all affiliate
directors and directors at large are listed as “Directors”.
It was understood that this would not require any changes to the voting process or the
Governance and Operations Manual (GOM).
-
Request that the Board activate the additional 2 Affiliate Directors for the 2013 election cycle.
(Australia, UK and US abstained).
-
Further discussion regarding the Internationalization of the HL7 Board would be tabled until the
September WGM.
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•
Affiliate Nominations Strategy
Helen Stevens reviewed the positions on the HL7 Board, TSC and Steering Divisions up for renewal
this year. Members of the council were encouraged to identify suitable candidates from their
affiliates for these positions and submit nominations. Questions may be sent to Helen Stevens (as
the Council’s representative on the Nominations Committee).
•
HL7 Global Partnerships and Policy Discussion (Ticia Gerber)
Ticia Gerber, HL7 Director of Global Partnerships and Policy gave a presentation on her role and
activities, similar to that presented to the HL7 Board (see under the heading “DIRECTOR OF GLOBAL
PARTNERSHIPS AND POLICY” in the report on HL7 Board activities above).
•
IHIC 2013 Update. Richard Dixon Hughes gave presentations on progress toward organisation of IHIC
2013 in Sydney on October 29-30.
2.17.2
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
International Council:
Issue: HL7 Australia is organising the International HL7
Interoperability Conference (IHIC 2013) in Sydney in a time slot
adjacent to the ISO/TC215 meeting being planned for October 2013
and has received $US5,000 support toward this end from the HL7
International Council. There is a lot of organisation still to be
completed.
HL7 Australia
Staging of IHIC 2013 in
Sydney
Action: HL7 Australia to progress the organisation of IHIC 2013 in
Australia in October 2013 and get calls for papers and publicity in
progress by end-June 2013.
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2.18
JOINT INITIATIVE COUNCIL LIAISON
2.18.1
PROGRESS AT THIS MEETING
As Chair of the joint initiative Council for global health Informatics standardisation (JIC), Richard Dixon
Hughes was involved in a range of JIC liaison activities, principally
•
Representing and presenting on progress of the JIC at the “HL7 and other SDOs” session conducted by
the TSC.
•
Informal discussions on behalf of the JIC with the CEO, CTO and members of the Board of HL7
International.
Some HL7 WGMs represent an opportunity for Richard Dixon Hughes to meet face-to-face with the Lisa
Spellman, head of the JIC Secretariat.
This HL7 WGM followed the TC215 meeting in Mexico at which there had been a face-to-face meeting of the
JIC executive, which had also been attended by HL7 representatives and the JIC Secretariat.
The week after this WGM, further meetings relating to JIC activities were planned at the European eHealth
week in Dublin, which was also attended by the JIC Secretariat.
Under these circumstances the requirement for JIC liaison this WGM was somewhat reduced.
2.18.2
ACTIONS FOR AUSTRALIA
No actions required at present.
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2.19
MEMBERSHIP TASKFORCE
PROGRESS AT THIS MEETING
The former Membership Taskforce has now been replaced by a Membership Committee, which is an
enduring committee of the HL7 Board.
Information about the activities of the Membership Committee are reported under the heading
“MEMBERSHIP COMMITTEE” in the section of this report dealing with the HL7 Board.
2.19.1
ACTIONS FOR AUSTRALIA
No actions required at present.
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2.20
MOBILE HEALTH
2.20.1
PROGRESS AT THIS MEETING
This group is established to work with health care devices, EHR, Pharmacy, PHER, and Security groups to
create and promote a framework and standards for mobile health.
It has developed a set of scenarios that depict how mobile health can contribute to improved patient care
and health outcomes:
•
An EHR system services (including devices and applications) that follow providers around in hospital.
•
Assisted independent living (of frail, elderly, those with mental difficulties) using a range of mobile
devices.
•
Patient empowerment and support for long term condition management across a range of lifestyles.
•
Behavioural health support anytime, anywhere.
•
Providing trusted health information on child health to hard-to-reach families.
It has also developed a mobile health requirements matrix for a range of health care settings to which the
above scenarios can be mapped.
Security of mobile health application design, implementation, testing, compliance verification and
evaluation is considered increasingly important for developers and users. The group also plans to develop
an FAQ wiki page to provide information on security issues relevant to mobile health applications. A project
scope statement has been developed and is currently in approval phase. Target publication and annual
revision dates are set to the end of each calendar year.
It appears that a parallel group called Open Mobile Health (http://openmhealth.org/) has been established
after 2010 to develop open standards/infrastructure to grow data standards and software to support
implementation of mobile health technologies. It uses a use-case driven approach to drive the development
of open standards in architecture, data and applications. It has published example polymorphic data
models, schema and is building a catalogue of schema IDs, APIs and application modules to support the
exchange of health data between mobile applications/devices.
2.20.2
CURRENT PROJECTS
There are currently seven projects that are awaiting approval.
•
Project #956: Education and Communications
•
Project #955: Standards or Guidelines for using mobile devices in LMIC to reduce childhood mortality
•
Project #954: Mobile Specific Profile for PHR-S
•
Project #953 Conformance Spec for mobile device interface to EHR/PHR
•
Project #942 Medical device information guidelines
•
Project #941 Security Guidelines for Mobile Health Informatics Products
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2.20.2.1
PROJECT #956 EDUCATION AND COMMUNICATIONS
PROJECT OBJECTIVE
Educate the industry on mHealth topic; Communicate news and updates on mHealth; Advocate on issues
related to mHealth; Collaborate with mHealth groups/orgs and invite experts and leaders to share
information.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
First MH Newsletter and MH Articles were released. The need for HIT Standards in this area was noted.
2.20.2.2
PROJECT #955: STANDARDS OR GUIDELINES FOR USING MOBILE DEVICES
IN LMIC TO REDUCE CHILDHOOD MORTALITY
PROJECT OBJECTIVE
To produce standards or guidelines for using mobile devices in LMIC to reduce childhood mortality. No
further details are yet available.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This project being run by the MHWG LMIC sub-group is being led by John Ritter, Gora Datta and Nadine
Manjaro but has get to progress significantly. Mention was made of activities related to e-Health and LMIC,
notably the “Save a Million Lives” project.
2.20.2.3
PROJECT #954 MOBILE SPECIFIC PROFILE FOR PHR-S
PROJECT OBJECTIVE
Review the PHR-S functional model to determine how the introduction of mobile devices as actors within
the model may result in changes to the model.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The ability of mobile health to capture environmental metrics and alerts was discussed, as was smart
phones as application for improved workflow management.
2.20.2.4
PROJECT #953 CONFORMANCE SPEC FOR MOBILE DEVICE INTERFACE TO
EHR/PHR
PROJECT OBJECTIVE
To standardize implementation guides to facilitate mobile health application development. Phase 1:
Develop Conformance Specifications for Mobile Interoperability Phase 2: Develop an Implementation Guide
in collaboration with the FHIR Workgroup Phase 3: Education and Industry Adoption.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Due to unavailability of delegates, detailed reporting was unable to be provided on this project.
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2.20.2.5
PROJECT #942 MEDICAL DEVICE INFORMATION GUIDELINES
PROJECT OBJECTIVE
To publish Medical Device Information Guidelines for mobile devices – no further detail is available yet.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Continued work with Health Care Devices (HCD) and broad scope of Mobile Health.
2.20.2.6
PROJECT #941 SECURITY GUIDELINES FOR MOBILE HEALTH
INFORMATICS PRODUCTS
PROJECT OBJECTIVE
To publish Security Guidelines for Mobile Health Informatics Products – no further detail is available yet.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Due to unavailability of delegates, detailed reporting was unable to be provided on this project.
2.20.3
2.20.3.1
OTHER NON-PROJECT WORKING GROUP DISCUSSIONS AND
PRESENTATIONS
EDUCATIONAL SESSION
A mobile health free tutorial was attended in the context of this working group meeting. The Education
working group discussed feedback amongst participants at this tutorial about the benefit of adding more
technical information. Never the less this tutorial was an interesting introduction to the HL7 mobile health
working group agenda.
Some drivers for mobile health development were explained as including:
•
Correlation of mobile health with personal and electronic health records
•
The need to define and define the use and storing of mobile health data in the privacy, regulatory and
quality domains as well as medico-legal areas
•
Improved patient and clinical safety
•
The integration with telehealth and other mobile solutions
•
The ever expanding focus on interoperability e.g. "smart homes"
The scope and purpose of the mobile health work group does not so much seek to offer new technology but
integrates work from existing HL7 areas.
Examples were given to include: an EHR following patients and providers around settings, providing mobile
PHR interfaces and to support ordering.
Use cases for mobile health include: ward rounds, administering mediations, monitoring and recording,
phlebotomy, clinical handover.
Normally tied to closed networks which is an issue - open standards and open networks to get devices to all
link up are needed e.g. doesn't matter where you fall or where you need the reminder - Problem : standards
working in the semantic domains for interoperability - family law and divorce : both parents can log into a
website to see information about a child - cross over between other sectors e.g. community services, law 96
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health care advice outreach for basic services - continuity of services displaced people, seasonal contract
workers - Significant difference between a mobile app that only gives information to one that gives you
instructions to do something.
2.20.4
ACTIONS FOR AUSTRALIA
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Mobile Health
Issue: Benefits and opportunities for mobile health include: extending
provider mobility especially for community clinics, rural and remote
and more mobile workforces e.g. district nurses, improving safety
through identification standards, record keeping, identification of
devices for supply chain management.
IT-014
Standards Australia
Future delegations
Action: integration of mobile health within Australian context and
work programs.
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2.21
MODELLING AND METHODOLOGY
2.21.1
PROGRESS AT THIS MEETING
The progress reporting is limited due to limitations of the delegation to cover this workgroup. The progress
is reported under the project below.
2.21.2
CURRENT PROJECTS
The following project is discussed in this section:
•
Project #891: FHIR Resource DSTU Ballot
2.21.2.1
PROJECT #891: FHIR RESOURCE DSTU BALLOT
PROJECT OBJECTIVE
This project will document the core elements of the FHIR specification, including aspects of the
methodology resulting from the FHIR methodology project and combine this content with resources defined
by various HL7 committee resources. This combination of materials will then be balloted as a DSTU
specification. The project will also manage coordination of resolution of ballot issues amongst the disparate
submitters. The project will also coordinate the collection and publication (for review) of a set of key
extensions for data elements not handled directly by resources that are expected to be needed by initial
implementers.
Note that FHIR combines both granular and aggregated clinical concepts along with an XML-focussed,
RESTful and/or SOA exchange format. The WG is considering approving FHIR as a standard for rapid
adoption of RIM and CDA R3 standards.
FHIR defines a set of ‘Resources’ that represent granular clinical concepts. The resources can be managed in
isolation, or aggregated into complex documents. This flexibility offers coherent solutions for a range of
interoperability problems.
The simple direct definitions of the resources are based on thorough requirements gathering, formal
analysis and extensive cross-mapping to other relevant standards.
Technically, FHIR is designed for the web and the resources are based on simple XML, with an http-based
RESTful protocol where each resource has predictable URL. Where possible, ensure open Internet standards
are used for data representation.
This project is targeted at green-field sites and offers an alternative approach to CDA as it simplifies the data
into more manageable XML structures.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
A substantiative part of the MNM FHIR sessions were related to the resolution of ballot comments
submitted in the January FHIR Ballot for Comments.
As has been the case at previous WGMs, FHIR continues to rapidly evolve. Notably, as knowledge and
understanding of FHIR methodology has become more widespread, the nature of the discussions have
become more informed and focused. The instigation of a Quality Assurance program across FHIR promises
improved consistency across this evolving standard.
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FHIR does however remain a challenge for WGs who have been involved from an early stage in the
development of FHIR resources, in respect that the methodology, rules of thumb and implicit best practice
approaches that currently change from WGM to WGM require a review of already completed resources, and
imply an element of rework.
2.21.3
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Modelling and
Methodology &
Patient
Administration:
Issue: FHIR Resource development requires ongoing Australian input
to influence the inclusion of data elements that would be considered
core for Australia.
NEHTA
FHIR Resources
Action: Continue to support and engage Australian Subject matter
experts in the development of domain specific resources including
Encounter resource for community contexts.
Standards Australia
Future HL7
delegations
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2.22
PATIENT ADMINISTRATION
2.22.1
PROGRESS AT THIS MEETING
The Patient Administration agenda for this WGM was focused almost exclusively on FHIR resources, and
resolution of FHIR Ballot comments relating to the core resources for which the PA WG is responsible.
Perhaps as an indicator of the widening focus on FHIR, the WG was attended by a significantly larger
contingent of vendor representatives. This included a tripling of the number of participants from EPIC, and
the participation of at least one Cerner representative in every PA FHIR session.
With the participation of Industry behemoths such as Cerner and EPIC, and the extensive use of at least
Cerner’s software through Public Hospitals in Australian states, it is imperative that Australian requirements
are tabled and argued in this forum.
Attendance at this WG was limited due to the logistical shortage of attendees. Australia (via Amy Mayer)
has however agreed to assist with the development of the Encounter resource for community contexts. This
will be progressed in the coming weeks and months out of session and during conference calls. This is in line
with the recommendation made by the delegation to the Phoenix working group meeting in January this
year that FHIR Resource development needs Australian input to influence the inclusion of data elements
that would be considered core for Australia.
2.22.2
CURRENT PROJECTS
The following project is reported on in this section:
•
Project #925: Development of FHIR Resources
2.22.2.1
PROJECT #925 DEVELOPMENT OF FHIR RESOURCES
PROJECT OBJECTIVE
This goal of this project is to identify and define an initial set of foundation FHIR resources within the
Patient Administration Domain.
PROJECT ACTIVITY
In addition to FHIR Ballot reconciliation, significant progress was made in the discussion and evolution of the
Visit/Encounter resource, and the separation of the concepts of a planned attendance (i.e. an Appointment)
and the actualisation of an attendance (i.e. an Encounter).
The Encounter resource is designed to accommodate multiple domains including InPatient admissions,
Outpatient and Community visits, so its scope is significant.
An extensive debate was had amongst the EPIC, Cerner and Australian representatives on the granularity of
the Encounter resource elements. There was considerable push from the US multinationals for preserving
existing HL7 v2 concepts and workflows, while the Australian representative argued for structures that
better supported Australian federal and state based reporting requirements.
This remains a difficult
argument for Australia, as from a FHIR development perspective EPIC and Cerner represent a sizeable
portion of the worldwide installed base of Hospital Information Systems, and on the FHIR 80/20 rule this
implies a degree of influence on outcomes that is not necessarily in Australia’s long term interests.
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2.22.3
ACTIONS FOR AUSTRLIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Patient Administration:
Issue: FHIR Resource development needs Australian input to influence
the inclusion of data elements that would be considered core for
Australia (as noted previously in Phoenix 2013 Meeting report).
NEHTA
FHIR Resources
Action: Engage Australian Subject matter experts in the
development of domain specific resources.
Standards Australia
Future HL7
delegations
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2.23
PATIENT CARE
2.23.1
PROGRESS AT THIS MEETING
There were a number of important Patient Care Workgroup Activities during the Atlanta meeting. These
activities can be broadly divided into two categories: Patient Care projects and FHIR resource development.
2.23.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project #675: Allergies and Adverse Reactions
•
Project #932: Care Plan Initiative
•
Project #924: Care Coordination Services Functional Model
2.23.2.1
PROJECT #675: ALLERGIES AND ADVERSE REACTIONS
PROJECT OBJECTIVE
This project is about harmonising a number of different models that are in use, or are being considered in
various parts of the world, and to improve on the existing DSTU artefacts previously produced by the
Patient Care (PC) WG. The project team conducted detailed comparative analysis of care plan models
submitted from around the world including the US, Canada, Sweden and Australia (NEHTA). This ongoing
work aims at developing a DAM to ensure that all requirements are met in the redevelopment of the
existing DSTU package content that included the allergy/intolerance model.
The current Allergy/Intolerance topic DSTU expired in June 2012. A request had been made and approved to
extend the current DSTU for another 2 years. The project team co-led by Stephen Chu of Australia and
Elaine Ayres of the US National Institute of Health, and supported by a number of contributors, including a
US-based allergist, has been developing a DAM to define and model the requirements thoroughly, assess
the adequacy and currency of the current DSTU, and the extent of work required to be done on the DSTU.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The DAM package was revised in accordance with the ballot disposition decisions arising from the
reconciliation process after the first informative ballot in January 2013. It has undergone a second
informative ballot in May 2013. A much smaller number of Ballot comments were received, which were
addressed during reconciliation discussions at the WGM.
A new project is in the process of being established to develop a logical model and full HL7 v3 artefacts to
support documentation and exchange of allergy/intolerance lists and adverse reaction information and
reporting. A new project scope statement (PSS) has been development that was endorsed by Patient Care,
Orders and Observations (OO) and the Clinical Decision Support WG joint meeting. The Pharmacy WG is also
a co-sponsor of this project. The group is currently reviewing the PSS and conduct an e-voting process to
formalise the endorsement of this project. The pharmacy WG is in principle supportive of this project but
has requested clarification of the boundary and scope of a couple of proposed artefacts.
This project has attracted attention and interest from the US Office of National Coordination of IT (ONC),
which has engaged a consultant from Accenture to work on this topic.
More details of this project are available on the Patient Care wiki:
http://wiki.hl7.org/index.php?title=Allergy_%26_Intolerance [accessed: 16 May 2013]
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2.23.2.2
PROJECT #932: CARE PLAN
PROJECT OBJECTIVE
The Care Plan Topic is one of the rollouts of the 2007 version of the Care Provision Domain Message
Information Model (D-MIM). The Care Plan is a specification of the Care Statement (now replaced with
Clinical Statement) with a focus on defined Acts in a guideline and their transformation towards an
individualized plan of care in which the selected Acts are added.
Generally a care plan greatly aids the team (responsible parties) in understanding and coordinating the
actions that need to be performed for the person.
The objective of this project is to develop a domain analysis model (DAM) to support the definition of:
The care plan structure covering key components such as health concern, risks, goals, intervention, outcome
reviews, etc., to support effective management action plans of various conditions identified for the target of
care. It is the structure in which the care planning for all individual professions or for groups of professionals
can be organized, planned, communicated, implemented and checked for completion against
predetermined goals and planned actions. Care plans also permit the monitoring and flagging of
unperformed/overdue activities and unmet goals for later follow up.
The behavioural requirements to support effective implementation of the care plan and the care
coordination required.
The Care Plan project was established in 2011 with Stephen Chu (Australia) and Laura Heermann Langford
(Intermountain Medical Centre, USA) as co-leads. The goal is to complete a DAM to describe the context of
the act of care planning and artefacts created during the process.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The project plan of submitting the Care Plan DAM package for first informative ballot in May 2013 did not
eventuate due to the complexity of use cases/storyboards and the higher than expected number of
comments from various interested parties, in particularly the care plan structure model. A decision was
made to defer the first informative ballot to September 2013.
The Care Plan Project continues to receive a significant amount of engagement from the ONC S&I
framework Longitudinal Care Coordination (LCC) workgroup. The ONC LCC group has established a tiger
team to work closely with the care plan project and care coordination functional model teams. A number of
intensive email changes and conference calls were initiated between the LCC group/tiger team and the Care
Plan project team to harmonize business/clinical terminology and care plan structure requirements.
More information about the ONC initiative on care plan is available on the LCC website:
http://wiki.siframework.org/Longitudinal+Coordination+of+Care+%28LCC%29 [accessed on 16 May 2013]
Further harmonization conference calls between the LCC tiger team and the care plan project team have
been planned for Wednesdays at 5:00pm US Eastern to accommodate Australian (Stephen Chu) time
constraints. The first call is scheduled for Wednesday 15 May.
The care plan project team members (e.g. Laura Heermann and Susan Campbell) are also working closely
with IHE Patient Care Coordination (PCC) on its technical profile for care plan. The objective is to ensure
harmonization of the structural and behavioural models produced by the two groups.
More information on the care plan project is available on the Care Plan wiki:
http://wiki.hl7.org/index.php?title=Care_Plan_Project_2012 [accessed: 18 May 2013]
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2.23.2.3
PROJECT #924: CARE COORDINATION SERVICES FUNCTION MODEL
PROJECT OBJECTIVE
The Care coordination Services (CCS) Functional Model (FM) project is a Patient Care project with Service
Oriented Architecture (SOA) and Clinical Decision Support workgroups as co-sponsors.
Its objective is to provide a platform independent model of capabilities to support care coordination and
collaboration among a multi-disciplinary care team consisting of members from either the same or different
organizations (e.g. primary care clinic, home care, allied health professionals, hospital, skilled nursing
facility, etc.)
The service specification will support real time conversation between participants based on a shared
coordinating care plan. All authorised stake holders and collaborators in a patient’s care can participate in
planning, initiation, updating the care plan contents including health concerns, health risks, care barriers,
and perform reviews (goals, plan effectiveness, outcomes) where appropriate/required. The CCS interface
will expose a consolidated view to all participants and maintain a shared context.
The CCS FM builds on the business/clinical requirements and the behavioural requirements defined in the
care plan DAM project.
The ultimate object of the CCS FM is to support the design and development of a set of CCS technical
specification to support care services coordination. The technical specification will be developed by the
Object Management Group (OMG) in collaboration with HL7 SOA and Patient Care WG.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The CCS FM project team consists of modelling leads from the SOA workgroup, the co-leads from the care
plan project and a number of active Patient Care members. The development process of the CCS FM
continued to provide very useful feedback that resulted in refinements of the Care Plan structural model
design.
Acknowledging the importance and significant interest in the care plan and its related project, the ONC LCC
tiger team met almost weekly leading up to the closure of the CCS FM ballot to review the ballot contents
and provide feedback/comments to both the care plan and CCS project teams.
The CCS FM has gone through an informative ballot in the May 2013 ballot cycle. It attracted approximately
80 ballot comments, majority of which were from the ONC LCC tiger team. Ballot reconciliation was initiated
in the Atlanta meeting and will continue via post Atlanta meeting conference calls.
The plan is to fully address the ballot comments and to move onto DSTU ballot in September 2013.
More details of this project are available at this wiki page:
http://wiki.hl7.org/index.php?title=Care_Coordination_Capabilities; and
http://hssp-carecoordination.wikispaces.com/home [both accessed: 20 May 2013]
2.23.2.4
PATIENT CARE FHIR RESOURCES
The FHIR modelling team developed a number of Patient Care WG related FHIR resource models:
•
Allergy/intolerance
•
Adverse reaction
•
Care plan
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•
Family history
•
Observation
•
Problem
•
Procedure
While they are very useful resources, with the exception of a couple, they are essentially too simplistic.
Members from Patient Care and other groups such as clinical genomics criticised some of the FHIR
resources as “disconnected from clinical reality”. The Patient Care WG had a joint meeting with FHIR
modelling team in Atlanta to review and improve some of the models. Engagement via email will continue
leading up to the first ballot of these FHIR resources in September.
Details on Patient Care FHIR resources are available at the FHIR wiki:
http://hl7.org/implement/standards/fhir/index.htm [accessed: 20 May 2013]
2.23.3
ACTIONS FOR AUSTRALIA
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Patient Care:
Issue: Ongoing work on allergy/intolerance and adverse reaction in
Care Plan DAMs needs to be noted by relevant IT-014 groups and
considered for incorporation into relevant Australian activities.
IT-014-06-04
Allergy/Intolerance
and Adverse Reaction,
Care Plan DAMs; CCS
FM; and FHIR
resources models
IT-014-06-05
Action: Allergy/Intolerance, Adverse Reaction, and FHIR resource
Models are of interest to and should be monitored by IT-014-06-04,
IT-014-06-05, IT-014-06-06 and IT-014-13.
IT-014-13
Care Plan and CCS are of interest to IT-014-06-06, IT-014-09 and
IT-014-13.
Australian eHealth
All these projects are of interest to NEHTA and PCEHR projects.
IT-014-06-06
Communities
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2.24
PHARMACY
2.24.1
PROGRESS AT THIS MEETING
There was no ballot submission or new project for the Pharmacy workgroup at the Atlanta meeting. For this
meeting, the discussions focused on a number of topics:
The modelling of access in the [medication administration] Device model, Medication profile, FHIR
resources for pharmacy, and ISO WG6 Updates.
2.24.1.1
ACCESS IN DEVICE MODEL
There is a requirement to indicate that a medication is administered through an access port (e.g. an
intravascular catheter such as a subclavian line) connected to an IV infusion pump. The intravascular
catheter is a multi-port access device where each port is designated by a Port ID.
Currently there is some issue/confusion in the pharmacy DMIM (domain messaging information model) in
how the Device Entity and Access is modelled.
It was agreed that the relevant DMIM and other appropriate RMIM (refined messaging information model)
would be updated as part of the DMIM/RMIM synchronisation activities.
2.24.1.2
MEDICATION PROFILE
There were extensive debates on what actually constituted a medication profile.
An extensive literature search by a number of active members of the Pharmacy WG members (including
Stephen Chu and Julie James) could not identify any known definition of medication profile. The group
agreed that it would be difficult to clearly identify what constituted medication profile in the absence of any
clear definition.
Discussions shifted to identifying what would the business/clinical process be and what useful building
blocks would be.
The group also looked at an example of “medication profile” from the Saskatchewan province of Canada
and concluded that it was more likely to be a medication list.
Based on the discussions at the Baltimore meeting, the group agreed that if a set of existing queries
previously defined by the group were to be used to retrieve medication data:
•
Medication order query
•
Medication dispense/supply query
•
Medication statement query
The queries would return one or more medication lists and not necessarily a ‘medication profile’. The group
agreed that this was a good starting point.
It was suggested that all possible query parameters should be identified to allow implementers to define
different combinations of required queries. The result of the queries would bring back the building block
information required for the medication list or profile to be constructed.
It was also agreed that the resulting information constructed from the query results should be extended to
something that could be used in C-CDA.
The next step is to build the storyboard narrative to reflect the types of query required.
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The plan is to prepare the content for September 2013.
2.24.1.3
FHIR PHARMACY RESOURCES
Five pharmacy FHIR resources have been developed:
•
Medication
•
Medication prescription
•
Medication dispense
•
Medication administration
•
Medication statement
These resources were modelled by one of the Pharmacy Co-Chairs who are also a member of the FHIR team.
Nevertheless, a number of issues were identified and discussed/debated. For example:
•
Medication resource needs to be added to medication dispense.
•
Medication administration requires inclusion of person (e.g. patient, relative, and carer) who administer
the drug.
•
Decide whether dose titration and “rescue agent” in chemotherapy prescribing and administration are
in scope for FHIR (decision: probably out of scope).
•
Decide whether device and medication should be separate resources.
In the UK, a medication is defined as a substance that has a pharmacological effect on a person. Substances
like artificial teardrops that only have a physiological effect cannot be classified as a medication. This
regulatory constraint causes a problem in recording administration of such an agent. There was a strong
argument to use “device” as a generic concept covering both pharmacological and physiological agents. This
approach is likely to cause confusion in other realms where device is taken to mean infusion pump,
monitors, etc. There was no conclusion and discussion is likely to continue.
More information about pharmacy FHIR resources can be located on the FHIR resources wiki:
http://hl7.org/implement/standards/fhir/ [assessed: 20 May 2012]
2.24.1.4
ISO WG6 UPDATES
ISO Workgroup 6 is working on a number of specifications and new work item proposals:
Dose Syntax: This is a business requirement document on dose syntax and not a technical specification on
how dose syntax should be structured to support complex prescribing. There appeared to be little progress
on this work item since the last meeting. It was mentioned that the requirements were leaning towards the
NCPDP (the US National Council for Prescription Program). Members expressed concern in the change in
direction. Confirmation would be required.
Drug Dictionary: This work item is based on drug dictionary work done in Singapore. It appeared that this
item was still in a brainstorming mode. The project goal is to establish a comprehensive list of requirements
for drug dictionary. A new work item proposal is expected to be published in June 2013.
Prescription Standard: This specification is based on previous work done by the Netherlands. Members at
the HL7 meeting expressed significant concern with this project as prescription practices are heavily
regulated by legislation from different realms/jurisdictions. A specification based on Dutch experiences
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would be unlikely to have international applicability and would potentially be in conflict with existing
international standards. It is expected that a draft specification will be available for comment in June.
Dispense Record: This is also based on work from the Netherlands. The focus of this work item is likely to be
on functional requirements and not on content or technical specification. The proposal is also expected to
be available for comment in June 2013.
Administration Record: This will be another new work item proposal. Information is scarce on this work
item. HL7 Pharmacy is waiting for more information from WG6.
Compound Medicine: This is intended to cover magisterial/extemporaneous (off-label) preparations. Again
the scope of this proposal/project is unclear at this point in time.
Electronic Patient/Consumer Drug Information: This new proposal/project aims to replace the current
paper version of consumer drug information by an electronic publication. HL7 Pharmacy members
questioned the viability of such a project as many international realm’s/jurisdiction’s legislation require
such materials to be provided as hard copy. It appears that ISO is working with European legislators to
overcome this issue.
It appears that WG6 is establishing a very large number of work items without much consultation with other
international standards bodies. While many of the items listed are still in a “brain-storming” stage, they
triggered serious concerns and questions on the utility of such projects and the resources available to
complete these projects. HL7 Pharmacy, IHE Pharmacy and ISO WG6 will meet in an out-of-cycle pharmacy
meeting in Europe in June. These projects will be discussed further at this meeting.
2.24.2
ACTIONS FOR AUSTRALIA
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Pharmacy:
Issue: The medication profile work is of high importance to Australia.
IT-014-06-04; IT-014-06-06 and IT-014-13, NEHTA and PCEHR projects
in particular should monitor and provide relevant input to this activity.
IT-014-06-04
HL7/IHE Medication
Profile
ISO/TC 215 WG6
projects
Action: The ISO WG6 activities remain a concern to other
international groups. There needs to be a closer link between the
Australian delegate to ISO WG6 and IT14-x groups to ensure visibility
of the ISO projects.
IT-014-06-06
IT-014-13
Australian eHealth
communities
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2.25
POLICY ADVISORY COMMITTEE
2.25.1
PROGRESS AT THIS MEETING
Richard Dixon Hughes attended a face-to-face meeting of the board-appointed Policy Advisory Committee
(PAC). Matters addressed included:
•
Follow-up on recent HL7 responses to US government agencies in respect of proposed regulation.
•
A meeting with Ticia Gerber concerning her role and functions and her plans to leverage and
complement the skills and capabilities of the PAC.
More information on Ticia Gerber and her role is reported under the heading “DIRECTOR OF GLOBAL
PARTNERSHIPS AND POLICY” in the section of this report on the HL7 Board activities.
•
The potential to expand the PAC to include more non-US representatives and to prepare materials
relevant to policy in other realms (particularly Latin America) was discussed. This potential will be
explored further with the International Council, noting that the PAC is a board-appointed committee.
It was noted that the CQI committee will be considering whether it wishes to lead the drafting of a response
to the US-CMS Notice for Proposed Rule Making (NPRM) on US Hospital Inpatient Prospective Payment
System for Acute Care Hospitals (IPPS) which needs to be submitted by 25 June.
The work of the PAC will continue by the normal regular monthly teleconferences.
More information on the PAC and its activities may be found in the report of the meeting between the PAC
Chair and the International Council in section 2.17.1.
2.25.2
ACTIONS FOR AUSTRALIA
No actions required at present.
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2.26
SECURITY
2.26.1
PROGRESS AT THIS MEETING
The majority of the security sectors were dealing with ballot reconciliation and new project development.
2.26.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project #646: Security and Privacy Ontology
•
Project #823: Fast Health Interoperability Resource (FHIR)
•
Project: # 529 Composite Security and Privacy Domain Analysis Model (DAM)
•
Project #1006: HL7 Data Segmentation for Privacy (DS4P) Implementation Guide
•
Project #914: HL7 Security Service Oriented Architecture Domain Analysis Model (SSOA DAM).
2.26.2.1
PROJECT #646: SECURITY AND PRIVACY ONTOLOGY
PROJECT OBJECTIVE
This project will develop a domain ontology encompassing the healthcare IT security and privacy domains
providing a single, formal vocabulary embodying the concepts in each domain as well as concepts shared
between the two. The concepts identified and defined in this ontology will be primarily drawn from those
concepts contained in the Security and Composite Privacy DAMs. The concepts in this ontology will be
extended in order to bridge to standard ontologies in associated domains such as enterprise architecture,
clinical care and biomedicine. This project will support modelling and analysis of the unified Security
(privacy DAM), and identify areas where reference value sets are needed. Existing terminologies, where
applicable, will be utilised and/or extended. Where appropriate terminologies are not available, they will be
developed to meet the needs of the models. Concepts covered by security and privacy domains that are
relevant to this ontology include (but are not restricted to) security and privacy policies, consent directives,
and access control.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The ballot resulted in an achieved quorum 75% approval 51 to 17. Several comments are to be applied at
reconciliation. The majority of the meeting time was used to reconcile and resolve the ballot comments.
2.26.2.2
PROJECT #823: FAST HEALTH INTEROPERABILITY RESOURCE (FHIR)
PROJECT OBJECTIVE
FHIR combines both granular and aggregated clinical concepts along with an XML-focussed, RESTful and/or
SOA exchange format. The WG is considering approving FHIR as a standard for rapid adoption of RIM and
CDA R3 standards.
FHIR defines a set of ‘Resources’ that represent granular clinical concepts. The resources can be managed in
isolation, or aggregated into complex documents. This flexibility offers coherent solutions for a range of
interoperability problems.
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The simple direct definitions of the resources are based on thorough requirements gathering, formal
analysis and extensive cross-mapping to other relevant standards. A workflow management layer provides
support for designing, procuring and integrating solutions.
Technically, FHIR is designed for the web and the resources are based on simple XML, with an http-based
RESTful protocol where each resource has predictable URL. Where possible, ensure open Internet standards
are used for data representation.
This project is targeted at Green field sites and offers an alternative approach to CDA as it simplifies the
data into more manageable XML structures.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
One of the issues raised was the attributes associated with FHIR. There is discussion on the attributes
location in a general resource. There is concern regarding the clinical attributes and how these are dealt
with in the general FHIR and security and privacy are treated in the same way. In FHIR’s purposeful light
weight design, items that are part of the resource (like attributes) are not part of the resource but
extensions. John Moehrke, on behalf of the Security WG has been involved.
There are issues in relation to how FHIR models the security, privacy and provenance that are integral to the
work occurring in CBCC and SEC projects. Further information can be found on this discussion in the CBCC
minutes from the 2013 Atlanta Working Group Meeting.
2.26.2.3
PROJECT: # 529 COMPOSITE SECURITY AND PRIVACY DOMAIN ANALYSIS
MODEL (DAM)
PROJECT OBJECTIVE
This project is intended to create and ballot a single HL7 DAM integrating both security access control and
privacy information models.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Composite security and privacy DAM/Information: It was discussed that there is a need to review and apply
changes and it is related to several items. The work may need to re ballot and enumerate the changes. The
aim will be to engage the HL7 community in reviewing this as a new artefact, although being cognizant of
the issues this may raise. The changes may include adding the Healthcare Classification Scheme labelling
and elaborating on the contextual operations.
This will require amendments to the scope statement and will include the harmonization of the DAM and
ontology as the DAM is the basis of all the projects. The work needs to more closely adapt to the DAM, and
because conceptually the DAM leads to the ontology. There is also a possible review of the DAM required in
light of the other projects currently underway, with a possible re-ballot in September 2013. Whilst the DAM
is a static picture currently and provides the classes, but the attributes have not yet been added. Whilst the
baseline classes will not change, we also need to see how the run time version will look when labels are
integrated into the whole picture.
It is also important to qualify the connections between the attributes and classes as the problem is the
people who use the dam are not necessarily the people who are sitting at this table; they are using this as
an IG. They do not take the management approach and it becomes 'when talking implementation, it doesn’t
match the model that you need. The forthcoming changes are a refinement and the implementer needs
more detail. Bernd Blobel will provide details of who is using the DAM in the EU and possible use cases. In
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the original scope statement it was proposed that the DAM would be used by SDOs as well, as a
representation of particular requirements, based on PMAC. The potential issue is that if the DAM is highly
defined for HL7, then it cannot be used for other SDOs. We have several DAMs that are highly specialized
that are not associated with a domain and this is problem for the standards community in cross-use of
standards. It was proposed that the group also look at the mandatory NIST security and privacy goals,
aligned with the dam and where the security is aligned with privacy (controls). NIST Standards link:
http://wiki.hl7.org/index.php?title=HL7_Security_Document_Library
2.26.2.4
PROJECT: #1006: HL7 DATA SEGMENTATION FOR PRIVACY (DS4P)
IMPLEMENTATION GUIDE
PROJECT OBJECTIVE
This project is intended to create and ballot a single HL7 DAM integrating both security access control and
privacy information models.
The Office of the National Coordinator DS4P Implementation Guide (IG) will provide the core input into the
HL7 DS4P IG project. The project scope is the publication of a U.S. realm DS4P DSTU specification as an
exemplar for an IG that could be used by other realms. This will entail:
Developing:
•
A US profile of the DS4P transport for email/XDM, SOAP/XDR and CDA content.
•
Conformance statements and constraint mechanisms required for publication are included in the HL7
DS4P IG.
Ensuring that:
•
The IG identifies the normative standards that it constrains, and a description of how the IG is
compliant with its base normative standards.
•
The US realm constrained IG is clearly derived from the current or updated ONC DS4P IG and IG
derivatives per exchange architecture.
•
The IG includes adequate implementation guidance to developers.
•
All IG non-HL7 standards (including vocabulary) are identified and any gaps addressed, e.g., as future
harmonization proposals or as requests to appropriate SDOs.
Alignment with:
•
Other HL7 Security, CBCC, Structured Documents, and SOA Work Group standards is specified as
appropriate, e.g., relationship to the:
•
Security Work Group HL7 Security and Privacy DAM and Healthcare Privacy and Security Classification
System.
•
CBCC Work Group Privacy Consent Directive and CDA R2 Implementation Guide DSTU/Normative.
•
Structured Document Work Group CDA, CCDA, and where appropriate to CDA R3 as an emerging
standard.
•
SOA Work Group PASS artefacts.
•
Applicable IHE standards in addition to the base XD* metadata and exchange protocols, such as ATNA
and XUA.
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•
Applicable ONC Standards and Interoperability standards, such as Direct exchange protocol.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Following the work that has been undertaken in piloting the DS4P project by the US Department of Veterans
Affairs (VA), the Substance Abuse and Mental Health Administration (SAMHSA), and Jericho Systems, this
new project was developed at this working group meeting.
The need for the project is that some health data requires special handling according to law, organizational
policies, or patient preferences. For appropriate sharing of health information to occur, a patient must trust
that a provider organization will properly handle their health data, and disclosing organizations must have
confidence that recipients will follow privacy protections according to any special handling instructions. In
order to facilitate this secure and trusted exchange, data needs to be segmented and assigned specific
privacy controls.
Data segmentation is “the process of sequestering from capture, access, or view certain data elements that
are perceived by a legal entity ac, institution, organization or individual as being undesirable to share,”
(Melissa Goldstein and Alison Rein, make reference).See Coleman, Johnathan. "Segmenting Data Privacy:
Cross-industry Initiative Aims to Piece Out Privacy Within the Health Record." Journal of AHIMA 84, no.2
(February 2013): 34-38.
The proposal is for the Implementation Guide to be put up for a normative ballot in January 2014. The
project includes collaboration with IHE, ONC - Standards and Interoperability Framework (S&I) artefact, and
OASIS - XACML / SAML artefacts. Also, the project will leverage the ONC DS4P IG, but will incorporate HL7
IG required information.
Although this project is initially for the US Realm, a global version will be developed in tandem to minimise
the effort required to extend this to other realms in the shortest possible timeframe, as and when it is
required more globally. Australia is currently not in a position to implement DS4P and Japan indicated that
it would want to create its own framework. If Japan were to adopt a DS4P approach, it would not work on a
profile of the DS4P because core parts of it would be replaced with Japan's workflows and Japanese clinical
document standards.
Data Segmentation is: Process of isolating from capture, access or view certain data elements that are
perceived by a legal entity and institution. The discussion is about whether or not the detailed clinical
models should have specific tags i.e. security labels bind clinical metadata to patient consent. These are
implemented dynamically when the information is exchanged. E.g. the synergy is layered between the
system functions. The premise is to keep the clinical and security models separate. Data modelling needs
contribution because adding security and privacy to the metadata is how would changes in security and
privacy metadata be handled? E.g. a sensitive condition is no longer considered sensitive, a privacy policy is
pre-empted, or a privacy consent directive is revoked or expires?
Provenance of the data is separately maintained (some standards W3C are coming up in relation to
provenance). Health Care Security Labels (HL7 Healthcare Classification Systems) derived from NIST FIPS
PUB 188 Security Labels which states how security labels should be defined and used. Integrity is different
from provenance – integrity is a quality of the information, provenance is history and ownership – attribute
of the data - similarity groups together because the integrity is linked to the attestation of the document.
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ACTIONS FOR AUSTRALIA
Topic
Issue / Action / Recommendations for Australia
Recommended for
Action by
Security:
Issue: The development of the Security implementation guides needs
wider than US input.
HL7 Australia
HL7 DS4P IG
2.26.2.5
Action: It is important that Australia contribute to the development
of this project to ensure its companion work is suitable for Australia
in the future.
IT-014-04
PROJECT: # 914 HL7 SECURITY SERVICE ORIENTED ARCHITECTURE
DOMAIN ANALYSIS MODEL (SSOA DAM)
PROJECT OBJECTIVE
The goal of the HL7 Security SOA Architecture project is to develop a SAIF compliant Domain Analysis Model
for a security service oriented architecture, which will be the conceptual information and behavioural
foundation for past and future HL7 Security and Privacy Services artefacts. The input for the SSOA DAM: HL7 Composite Security and Privacy Domain Analysis Model R1 DSTU - HL7 RBAC Catalogue - HL7 Consent
Directive CDA Implementation Guide DSTU - HL7 Security and Privacy Ontology - HL7 Security and Privacy
related vocabularies - HL7 v2 Confidentiality Codes and v3 Harmonization - HL7 Healthcare Security and
Privacy Classification System - V3_PASS_AUDITSERV_R1_D1_2010SEP.pdf - PASS Alpha - Access Control
Conceptual Model Release 1.0 - Post-Ballot Reconciliation.pdf - PASS Alpha - Access Control - Domain
Analysis Model - Draft 0.1.doc - PASS Alpha - Access Control - Functional Model - Draft 0.1.doc - Data
Segmentation for Privacy Implementation Guide - Query Health Envelope - VA Security Service Logical
Model support for Data Segmentation and Health Care Security and Privacy Classification System - VA VAPii
Reference Model - FHIMS - OASIS XSPA - WS* - OAuth 2.0
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This project has been deferred. The next milestone is now 2016 Jan WGM, and Project End Date 2018 Sept
WGM. This is because there are no resources currently to undertake the project.
2.26.3
2.26.3.1
OTHER NON-PROJECT WORKING GROUP DISCUSSIONS AND
PRESENTATIONS
EDUCATION
The free education session that was run for was well attended with 17 people attending the session. There
were presentations on consent directives for CDA, HIMSS DS4P pilot and video, FHIR Security and audit
logging to support security surveillance.
2.26.3.2
REALM REPORTS AND PRESENTATIONS
ISO
A full report on the ISO WG4 Security meeting was presented by Lori Forquet. The slides are available from
the ISO website.
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JAPAN
Japanese Association of Health Care Information Systems (JAHIS) industry has 357 companies (90% of all
Japanese companies). One business section is to develop standards:
•
Data exchange protocols (HL7)
•
Technical reports
•
Security standards
•
Patient safety
In 2010 a new IT strategy was launched. JAHIS is part of the committee that is implementing this strategy.
Aim to bring ‘my hospital everywhere’. Japanese PHR system is dependent on the patient. The patient
entrusts the clinical information bank with his/her information. The patient will allow the access to a
specific service provider, e.g. hospital, fitness club. JAHIS is HL7 Japanese Realm, and has published many
profiles using HL7 v2.5.
There is one Japanese certificate authority for health professionals. At the moment a list of all healthcare
service providers so the patient can tick which ones will have access (permission table). An in-depth
discussion regarding digital signatures and partial signatures was undertaken. Every provider has a
government issued JPKI from Japanese national Certificate Authority. Patients use at 3rd party PKI. Patient
can choose the permission table in the PHR to allow a service provider to access the patient's PHR.
Transport is a web service.
Currently there are detached (file CDA and a separate signature file), enveloped (signature is within the CDA
file) and enveloping (CDA and signature part in one file) signatures. IHE use cases are the way that detached
signature is good enough. Japan uses the permission table in the PHR. In the future, that the permission
tables would be managed centrally so that any organization meeting the clearance would have access to the
patient's PHR rather than having the patient directly involved in authorizing each service provider.
Japan uses all three types of digital signature.
HL7 Japan has developed a CDA for prescriptions rather than phone/fax. Japan requires prescriptions in a
document form. Use has Patients prefer paper prescriptions.
SAUDI ARABIA (LORI FOUQUET)
Saudi Arabia will use a national PKI, which is encouraged, but not mandated. It is not specific to healthcare.
Providers and organizations will be issued PKI, but no plans for provisioning patients at this time. The
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Saudis are developing a provider registry and establishing professional roles. GE Healthcare has the project
management contract for the analytics and specification development
Most of the information is highly qualified. The focus is on health information exchange, the level of
information is primarily investigating what will go into policy. The policies have not yet been approved. They
are looking at an IHE federation and it will likely be centralized, but if a hospital system is purchased, with
local repository options, it will not be precluded. Approximately 60% of healthcare is administered publicly,
20% through national guard/government base and another 20% in the private sector. Primary care is only
dealing with initial situations, anything more than that goes to hospital (specialist).
The delivery system is unique. It is very green field, not HIPAA, there is no privacy legislation but the system
is using this exercise whether they should instantiate or keep in their very policy. Saudi Arabia has identified
information that is sensitive mental health, substance abuse and HIV. Even though a person can opt in or
out, the HIE is an opt-out, so all information goes in, but patient can opt out, but will not hold ability to
break glass. The healthcare providers feel very strongly on being able to treat the patient. Opt out is not
total out because a clinical override also applies. There is a disclosure in education to patients, they have
not had define a policy on where and not to disclose things, but they will mark HIE as part of the exchange.
They have put into effect a solution to the patient identity problem as everyone has a unique ID. The person
receives no healthcare until you have a national healthcare ID. At birth a newborn gets an id. There are not
a lot of legacy systems to worry about backwards compatibility as there are for other countries worldwide.
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2.27
SERVICES ORIENTATED ARCHITECTURE
2.27.1
PROGRESS AT THIS MEETING
Progress at this meeting is detailed through the current working group projects that are summarised below.
Note that two projects were submitted for ballot comment in this cycle, namely Healthcare SOA Service
Ontology and Patient Care Co-ordination Service (CCS) Project. Both of these projects were successfully
balloted. In addition, three new projects within the SOA WG were proposed, namely Unified
Communication Service, Pub/Sub Service and Ordering Service. Note that the action items were slightly
updated from the previous WG meeting to reflect progress since that meeting.
2.27.2
CURRENT PROJECTS
The following projects are discussed in this section:
•
Project #863: Cross- Paradigm Interoperability Implementation Guide for Immunization.
•
Project #628: Healthcare SOA Service Ontology.
•
Project (NEW): ORDERING SERVICES INTERFACE SPECIFICATION PROJECT.
2.27.2.1
PROJECT #863: CROSS- PARADIGM INTEROPERABILITY
IMPLEMENTATION GUIDE FOR IMMUNIZATION
PROJECT OBJECTIVE
This is a new joint project with the SOA and ArB WGs and is co-sponsored by the CDS and PHER WGs.
This IG will explore the SAIF methodology to show how various HL7, IHE and OMG immunisation-related
artefacts can be deployed to satisfy immunisation interoperability use cases. Additionally, it will provide
feedback to the MnM SAIF Implementation Guide project regarding artefacts and governance necessary to
develop this project’s deliverables. It will build upon existing artefacts rather than create anything new.
Previous work includes:
•
The Practical Guide to SOA in Healthcare Part II: the Immunization Case Study;
•
The Immunization DAM;
•
v2 immunization messages;
•
v3 POIZ messages;
•
v3 Care Record document;
•
v3 Care Record message;
•
vMR; IXS (Service Functional Model and Technical Specification);
•
RLUS;
•
DSS;
•
hData;
•
Arden Syntax;
•
GELLO;
•
IHE profiles including PIX, PDQ, and Immunisation Content; and
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•
The IHE SOA White Paper.
The scope of the immunisation use case will be limited to use cases specifically related to interoperability,
primarily patient identification, immunisation data exchange and decision support (recommendations,
adverse reactions, contraindications). Additional information can be located at:
http://hssp.wikispaces.com/Cross+Paradigm+Interoperability+Implementation+Guide+for+Immunization
[Accessed 20, January 2013].
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The focus of the project at this meeting was in demonstrating how the OMG Model-Driven Message
Interoperability (MDMI) specification can be used to support automated mapping between different
information models, e.g. between V2 and CDA artefacts, or between FHIR and C-CDA. MDMI is a generic
mapping approach and the tooling was developed as part of the Model Driven Health Tools (MDHT) project.
Although this specific X-paradigm project is scoped by the immunisation use case context, it can be used to
support mapping between any two messaging payload types. For example, as discovered in the joint
SOA/PHER (Public Health and Emergency Response) meeting, an interesting application could be mapping
between OASIS Common Alerting Protocol (CAP) used for different types of alerts for emergency
management, and HL7 V2 messages of relevance for PHER.
The X-paradigm project uses the SAIF matrix to highlight different concerns for the mappings being
developed. The SAIF matrix includes both the MDMI components such as Clinical Referent Index (which is a
clinical refinement of the MDMI referent index used to support any type of message mapping), and the HL7
information models such as C-CDA models, V2 models, FHIR models etc. The immunisation DAMs are
positioned in the conceptual perspective.
It was recognised that this project provides significant value to HL7 and the project was encouraged to
continue on its path in line with the Project Scope Statement (PSS) direction. In case of possible extensions,
the project would need to advise the TSC or issue another PSS with a new scope.
2.27.2.2
PROJECT #628: HEALTHCARE SOA SERVICE ONTOLOGY
PROJECT OBJECTIVE
This project aims to develop a ‘Health Interoperability Service Ontology’ encompassing the description and
classification of healthcare-oriented SOA services into a single, formal vocabulary. The concepts identified in
this ontology will be derived from several sources including, but not limited to, the SAIF, the SOA WG
Roadmap, and service capabilities identified in the HL7 EHR Functional Model. The concepts in this ontology
will be extended to bridge standard ontologies in associated domains such as enterprise architecture,
clinical care, and biomedicine.
The project will:
•
Identify where reference value sets are needed;
•
Collect and/or develop use cases to define the objectives of the Healthcare SOA Terminology work;
•
Assess existing SOA ontologies for applicability to meet the needs of the healthcare domain, and
recommend the best-fit for HL7; and
•
Enhance/extend, or create a taxonomy for healthcare SOA services in the event that an existing bodyof-work is incomplete or insufficient.
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Existing terminologies, where applicable, will be utilised and/or extended.
Where appropriate
terminologies are not available, they will be developed to meet the needs of the use cases identified.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Significant progress has been made in this project since last WG meeting and as a result the project lead,
Zoran Milosevic, has led the team towards ballot comment submission. The ballot reconciliation process
was performed at this meeting. Several minor comments were accepted and the only major comment
suggesting the development of a formal ontology to support reasoning and inferencing will require further
clarification in the document, with the emphasis of this being a subject of a future release. It was also
agreed to continue testing the service concepts in specific projects. There is currently interest from Canada
Infoway to apply the concepts in the context of a new version of the Infoway Blueprint in terms of its
business and systems architecture. It is anticipated that Infoway and Deontik experts will be leading this
effort with the aim of reporting progress at the September 2013 meeting.
2.27.2.3
PROJECT (NEW): ORDERING SERVICES INTERFACE SPECIFICATION
PROJECT
PROJECT OBJECTIVE
The VA has sponsored a project to develop a set of ordering service interfaces to support:
•
Delivery of alerts, recommendations and other notifications using email, SMS, VOIP and other
communication channels
•
Tracking targets (e.g. relevant clinicians) to deliver the notification/alert messages
•
Standard ways to initiate ordering of pharmacy, lab, radiology, consult and nutritional services
•
Applications and service-to-service interactions, e.g. by CD
•
Subscription to clinical events of interest and receiving notice when new data is available
The proposed Ordering Service is intended to complement existing SOA services and the SAIF Behavioural
Framework (BF) for HL7. Pre-existing conceptual work in topics such as Composite Orders, Laboratory
Orders, Nutrition, Medication, and FHIR Order and Prescription resources will be leveraged extensively to
help document the necessary definitions, descriptions, graphics, and artefacts that are relevant. The Service
Interface Specification will provide functional, semantic, and conformance profiles.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The primary sponsor of project is Orders and Observations (OO) and co-sponsored by Clinical Decision
Support and SOA groups. It is targeting January 2014 for an initial informative ballot and DSTU ballot in May
2014.
A project scope statement was presented at the joint OO-Patient Care-Clinical Decision Support WG
meeting and approved at the joint meeting.
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2.27.3
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
SOA:
Issue: The OMG MDMI standard can support many types of
information mappings but is not sufficient to support general
behavioural mapping.
IT-014-09
Cross Platform
Interoperability
Implementation Guide
for Immunisation
SOA:
SOA Service Ontology
Action: Continue analysis of alternative approaches to support
behavioural mapping, including the use of an MDMI standard and
other MDHT components as well as new SOA Ontology concepts.
Issue: The ontology paper included on the SOA ontology wiki page:
http://hsspinfrastructure.wikispaces.com/HSSP+SOA+Service+Ontology provides
the basis for the development of a rich set of discoverable and
interactive e-Health services. When balloted it needs to be explained,
discussed, socialised and commented upon by a wide audience within
the health standards and software community.
SOA Ontology WG
HL7 Australia
IT-014-09
NEHTA
Action: Develop and present a brief paper for Standards Australia,
outlining the approach and consider the application of SOA ontology
for Australian e-Health, e.g. National Health Services Directory, the
ELS and PCEHR. Note that the SOA Ontology is directly related to the
e-Health Interoperability Framework, developed within IT-014-09,
and thus this group is a natural home to progress this work.
Action: Communicate SOA Ontology work to other relevant
organisations and encourage the use of the ontology in SOA oriented
solutions.
SOA:
Patient Care Services
Co-ordination Project
SOA/Patient Care:
Ordering Services
Interface Specification
Issue: This seems to be a well-defined project and the only issue
would be feasibility of executing it in sync with other projects of the
SOA or other WGs.
Action: Investigate how the PCC service can be expressed using the
concepts proposed by the SOA Ontology project.
The SOA/Patient Care ordering services interface specification
project is relevant and of interest across the IT-014 and the wider
eHealth standards community.
Action: SOA/PC work on ordering services interface specifications to
be reviewed by IT-014-06-04, IT-014-06-05 and IT-014-13 as basis for
wider discussion and need for complementary Australian activity.
IT-014-09
Future delegates to
SOA Ontology WG
IT-014-06-04
IT-014-06-05
IT-014-13
Australian eHealth
communities
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2.28
STRUCTURED DOCUMENTS
2.28.1
PROGRESS AT THIS MEETING
Progress at this meeting is described in the context of the specific projects included in subsequent sections.
A number of topics are at the level of the overall SD WG, including joint activities with other WGs, and these
topics are described in this section.
The meeting began with the committee providing an update of the SD WG 3 Year Plan. The intended topics
for next 3 years are:
•
FHIR document resource monitoring.
•
C- CDA maintenance and update.
•
Quality (HQMF, QDM, QRDA and Handoff).
•
Patent Generated Documents.
•
Disease Specific.
•
HAI and Public Health Report.
•
CDA product Families – reflecting Product Family/Lines approach being developed by ARB.
•
International Version of C-CDA/IHE.
•
Template Repository.
•
Pilot of the IHE balloting process.
•
Implement recommendation of CDA publishing sub group.
There was a joint session with the ARB where the ARB Co-Chair gave a presentation about product families
and product lines which highlighted the need to establish separate governance, management and
methodology groups (as defined in the HL7 SAIF) for the SD WG. Note that a governance group is already in
place for FHIR project. The classification of CDA R2, CD R3 and C-CDA products into CDA Product
Families/Product Lines is increasingly being socialising within the SD and this WG is an early adopter of the
new product development approach being developed by ARB.
There was a discussion between SD and Clinical Decision Support (CDS) about the need to consolidate
various expression languages developed by different projects from these two WGs. For example, a concern
was raised that different expression languages for expressing quality measures in HQMF and Health
eDecisions (http://wiki.siframework.org/Health+eDecisions+Homepage) will present problems when linking
systems that implement these specifications, e.g. if CDS systems need to intervene in cases where there are
quality issues. The problem of non-alignment of these languages comes from the fact that they were
developed by different groups, each with its own modelling approach: HQMF followed HL7's modelling
structures to develop a representational model, which was then transformed into a XML representation
through the HL7 predefined, automated process. The existing Health eDecisions work went straight to an
XML representation which eliminated much of the implementation complexity implied by the HL7
automated process. That said, it was observed that there are the similarities between the two models that
would help expose the commonality and it was agreed at the meeting that a consolidation across these
languages is required. A proposed way forward is to define requirements for a common set of functionality
for the languages and possibly use the SAIF framework to structure these requirements. It was noted that it
would be helpful for meaningful use stage 3 if we use the same syntax for both HQMF and Gello.
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At the last WG meeting, a new ‘C-CDA Taskforce’ project was created to recommend to SDWG a process for
managing and responding to implementer questions on C-CDA – as well as tooling to support it. The HL7
Wiki link for the C-CDA taskforce:
http://wiki.hl7.org/index.php?title=Consolidated_CDA_Task_Force [Assessed 04, February 2013].
However, the project has not made it out of committee at this point due to the lack of a project facilitator
role, and without a project facilitator, the project can’t move forward. At this point, the HL7 Board has
deferred the question of moving forward with funding a Help desk (which is essentially what this project is
about). The problem is that this project requires a major investment in time, and it is not possible to
resource this on a volunteer basis. It remains to be seen when this project will be established.
There was a joint session with Patient Care at which a new Project Scope Statement (PSS) was discussed for
updates of C-CDA to better support care plans. Existing Consolidated CDA (C-CDA) needs to be enhanced by
adding templates to represent priority data elements. Modified or new section level and document level
templates are also needed for transitions of care and care plans, areas essential to patient care and the
meaningful use of EHRs. Many organisations expressed interest in contributing to this project including:
•
ONC S&I Longitudinal Coordination of Care (LCC) WG;
•
Improving Massachusetts Post-Acute Care Transfers (IMPACT) Project;
•
New York eHealth Collaborative (NYeC);
•
Continuum of Care Improvement Through Information New York (CCITI); and
•
Center for Disease Control.
The PSS was approved at this meeting and it was intended that the first specification is submitted for ballot
in September 2013.
In a joint session with FHIR, the FHIR document resource was presented and discussed. It was emphasised
that FHIR focuses on what 80% of systems need (not 80% of use cases) and this also applies to the
document resource. It is noted that FHIR will be submitted for DSTU ballot in September 2013 cycle, which
is impressive considering that this new initiative started roughly a year ago. The ballot would coincide with
CDA R3 which took substantially longer to reach this stage. It is also to be noted that FHIR will have all
resources necessary to do C-CDA structures but will not be able to support extensions. It was also reported
that Grahame Grieve is working on transformation of C-CDA to FHIR.
Finally, a number of projects raised concerns about extending the C-CDA US realm focus into a more
universal realm and this was recognised an important issue that needs to be addressed. Some C-CDA IG
projects are already addressing this, including Patient Generated Documents, Forms and Questionnaire
Response Documents and Care Plan C-CDA extensions and updates.
2.28.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project # 477: CDA Release 3.
•
Project # 900: Patient generated documents.
•
Project #853: IHE Health Story Consolidation, DSTU Release 1.1.
•
Project # 977: Questionnaire And Questionnaire Response Documents.
•
Project # 921: Clinical Oncology Data Standards.
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2.28.2.1
PROJECT #477: CDA RELEASE 3
PROJECT OBJECTIVE
The CDA R3 project is primarily involved in delivery of an updated release of the CDA standard: Clinical
Document Architecture, Release 3 (CDA R3), including updated technical artefacts for the CDA RMIM,
Hierarchical Description, and XML Schemas. Based on committee action it has been determined that CDA R3
will incorporate an updated Clinical Statement Model, utilize HL7 V3 data types, and R2 will be updated to
be consistent with V3 Vocabulary model.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The CDA R3 meeting was primarily focused on addressing several remaining reconciliation issues and
discussing preparation for editing and issuing a ballot in the September cycle. One issue discussed was how
to handle weak semantics associated with the responsibleParty concept. The committee decided to
deprecate the old pattern usage and align with the related modelling pattern used within Patient
Administration.
2.28.2.2
PROJECT # 900: PATIENT GENERATED DOCUMENTS
PROJECT OBJECTIVE
In the ‘era of patient empowerment’, a specification for patient-generated clinical documents is seen to be
required. Medical practices are looking for ways to allow patients to electronically complete certain tasks
online such as filling out registration forms, health history forms, consenting to certain practice policies, and
other types of clinical documents yet to be defined. As electronic document interchange increases, there is
a growing need to communicate documents created by patients including those needed by providers and/or
those document types defined by patients. Often, this is done through a secure web interface controlled by
the patient such as a patient portal or a PHR. As more and more practices incorporate EMR technology into
their practice workflow, they want to be able to import patient provided structured information into their
EMR’s. This is being driven by the need to meet MU 2 requirements for patient engagement as well as other
needs to reduce manual processes managing patient-provided data. The HL7 CDA Consolidation Documents
types only address provider-initiated documents and do not incorporate guidance for patient-generated
documents. It is necessary to create a new IG describing how to incorporate patient-generated input. In
many cases, existing templates within the current Consolidation Template Library can be re-used with
minimal modification.
Additional information can be located at:
http://wiki.hl7.org/index.php?title=Patient_Generated_Document_Informative_Document
[Accessed 04, February 2013].
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The header part of the Patient Generated Documents IG was balloted at the previous WGM (Phoenix). This
included header elements for US and universal realms. The purpose of this IG is to develop a standard way
to evolve the health information ecosystem to capture records and make interoperable, patient generated
information within the current framework of structured documents. The goal is to enable patients to
participate and collaborate electronically with care team members. Ballot reconciliation is currently
IN_PROGRESS: All 95 comments have been reconciled (April 19th) and the WG is now republishing with
changes. The US realm PGD header will now be a further constraint on the C-CDA R2 header. The new IG will
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cite only further constraints on the C-CDA R2 header for the US realm. Further, the new IG will define a full
set of constraints for the Universal realm, which will be generalizations of constraints in the US realm.
The WG is planning to test use of the Trifolia tool to produce the IG for publication and will need help from
the HL7 publication team and Trifolia Support in the publication process. They also stated a need to
understand the process of the inclusion of the Patient Generated Document (PGD) header in the next
version of C-CDA. Further, they need to encourage all other patient generated CDA documents to use the
PGD header. Finally, they identified a need for the MU Phase 3 Patient Generated Health Data (PGHD)
requirements to include the use of the HL7 PGD header.
It is also to be noted that Australian requirements were adopted in this version for the header and that the
project will be seeking input from the international organisations for future developments, such as the
document body specification.
2.28.2.3
PROJECT #977: QUESTIONNAIRE AND QUESTIONNAIRE RESPONSE
DOCUMENTS
PROJECT OBJECTIVE
This project will define a specification for the structured representation of a Form Definition and
Questionnaire Response documents focusing initially on the requirements presented by the Continua Health
Alliance Questionnaire Use Case. The specification will leverage HL7 CDA base standard and derived
implementation guides.
In the context of remotely monitoring patients, there is a need to facilitate the exchange of questionnaires
between practitioners and patients. Electronic interchange of patients’ vital signs to the monitoring service
or medical practitioner is but the first step in enabling effective dialogue and health practice. Of equal
importance is the electronic interchange of meaningful questions and answers between the practitioner and
the patient. The Continua Health Alliance is recognizing this need and has identified the following main
areas for the meaningful exchange of the questions and answers:
•
Structured Form Definition Document representation.
•
Structured Questionnaire Response Document representation.
The approach is to represent the Questionnaires and Responses in a structured document by reusing and/or
enhancing existing CDA templates where possible while creating new CDA templates where necessary.
The HL7 wiki for this project is available at:
http://wiki.hl7.org/index.php?title=Form_Definition_and_Questionnaire_Response_Documents
[Accessed 16, May 2013].
PROJECT ACTIVITY/ISSUES AT THIS MEETING
At this meeting a number of reconciliation issues were addressed. The majority were minor issues, mostly to
do with the cardinality of modelling elements. One major issue (and also negative vote by Keith Boone, GE)
was that CDA was developed with the purpose of specifying clinical documents rather than the definition of
document forms. Thus the CDA R2 is not the right vehicle to DEFINE forms. This is definitely an issue that
needs to be addressed in CDA R3 but in the meantime it was agreed to address the problem by providing an
extension in CDA R2 by including status code ‘New’ (suggested by Austin Kreisler and accepted by Keith
Boone and the committee). This is a workaround and might not be entirely correct, but is probably the best
that can be achieved in CDA R2.
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2.28.2.4
PROJECT: HL7 IMPLEMENTATION GUIDE FOR CDA® RELEASE 2: IHE
HEALTH STORY CONSOLIDATION, DSTU RELEASE 1.1
PROJECT OBJECTIVE
The Consolidated Templated implementation guide contains a library of CDA templates, incorporating and
harmonizing previous efforts from Health Level Seven (HL7), Integrating the Healthcare Enterprise (IHE), and
Health Information Technology Standards Panel (HITSP). It represents harmonization of the HL7 Health
Story guides, HITSP C32, related components of IHE Patient Care Coordination (IHE PCC), and Continuity of
Care (CCD), and it includes all required CDA templates in Final Rules for Stage 1 Meaningful Use and 45 CFR
Part 170 – Health Information Technology: Initial Set of Standards, Implementation Specifications, and
Certification Criteria for Electronic Health Record Technology; Final Rule. It is commonly referred to as
"Consolidated CDA" abbreviated C-CDA or CCDA.
Further details can be found at:
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=258 [Accessed 16, May 2013]
PROJECT ACTIVITY/ISSUES AT THIS MEETING
At this meeting Keith Boone from GE raised three challenges that IHE has in harmonization with C-CDA.
First, there is a problem with the existing template approach; in particular that template changes bubble up
due to existing template methodology. The solution to this problem is to adopt template versioning in
templates. This topic was to be further discussed at the Template WG. An interesting summary from the WG
is provided in Keith Boone’s blog:
http://motorcycleguy.blogspot.com.au/2013/05/versioning-templates-in-definitions-and.html [Accessed 18,
May 2013].
The second problem is that C-CDA is US Realm but the IHE audience is International, which has particular
implications for vocabulary. The WG solved this by identifying 97 concept domains that are used in their
current template, i.e. replacing value set binding with concept domains.
The third problem is scalability as a result of some 500 templates in the consolidated work. The WG solved
this through automation using Model Driven Health Tools (MDHT), identifying a CCDA concept binding for
problems. In his blog, Keith Boone, provides some insights and highlights the value of using MDHT tools:
http://motorcycleguy.blogspot.com.au/2013/04/mdht-enables-ihe-pcc-and-hl7-ccda.html
[Accessed 18, May 2013].
2.28.2.5
PROJECT #921: CLINICAL ONCOLOGY DATA STANDARDS
PROJECT OBJECTIVE
This project will promote interoperability and information exchange among cancer care providers and
patients. At this stage, focus is on immediate steps which will enrich the transfer of primary electronic
information among providers and between providers and patients. It is an incremental step in establishing a
rapid learning system and ultimately will benefit the research and reporting activities which, in turn,
support the delivery of care. The Project will augment access to and reuse of this mission-critical
information through development and promotion of a series of data specifications built on CDA templates.
The initial work will develop templates required for exchange of the ASCO Treatment Plan and Summary
and the disease-specific Breast Cancer Adjuvant Treatment Plan and Summary. These may be balloted
together or incrementally. Later work will include developing templates which include the complete
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oncologic treatment history for a patient diagnosed with cancer. This may include diagnostic workup
including laboratory, pathology, radiology, and molecular information; surgical treatment information;
radiation treatment information; and chemotherapy/hormonal/immunotherapy treatments. In order to
limit the initial scope, we will focus on the one disease scenario represented in the ASCO Breast Adjuvant
Treatment Plan and Summary. This is moderately advanced stage breast cancer, i.e. breast cancer treated
surgically with curative intent followed by adjuvant therapy (chemotherapy and/or radiation and/or
hormones). This particular subgroup of cancer patients represents an ideal use case as most of the
diagnostic and treatment approaches used in cancer are represented here.
Further details can be found at:
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=258 [Accessed 17, May 2013].
PROJECT ACTIVITY/ISSUES AT THIS MEETING
At this meeting ballot reconciliation was performed for the HL7 implementation Guide for CDA, Release2,
Clinical Oncology Treatment Plan and Summary. This was considered a very good specification. Many of the
minor ballot issues were addressed but a number of interesting issues are highlighted in the following text.
There was a question about whether the LOINC code used should be specific (e.g. breast cancer) or more
general (e.g. to catch broader cancer treatment plans). It was agreed that the current work by LOINC on
document ontologies may provide a degree of freedom so there would be no need to note on the template
ID that this is a specific breast cancer treatment, i.e. it can be a cancer treatment summary, and then rely on
the external ontology to identify the specific document types and the related treatments.
There was also an interesting observation by an oncology specialist which is of relevance for future
modelling of cancer observations: In future, treatment may be based on genomics information because it is
becoming increasingly evident that some cancer types (e.g. rare types of breast cancer) have the same type
of mutation as other cancer types (e.g. ovarian cancer). It would be worthwhile to consider this likely
development in current and future document design activities.
2.28.2.6
CONSOLIDATED CDA DSTU 2013 UPDATE (TO INCLUDE TEMPLATES
SUPPORTING EXCHANGE OF CARE PLAN DOCUMENTS)
This is an ONC funded project to update the current C-CDA DSTU to include a number of artefacts to
support:
•
The incorporation of new data elements identified by ONC S&I LCC community providers for exchanging
consultation notes, referral and transfer summary.
•
A care plan document using existing CDA templates and new templates identified by ONC S&I LCC
community providers.
•
The linkage of consultation notes, referral and transfer summary to care plan documents where
necessary and appropriate.
•
Alignment of the C-CDA care plan document with the Care Plan model currently being developed by the
Patient Care project team.
A project scope statement for this project was presented to the Patient Care and the Child Health work
groups. Both groups voted to support this project and to become project co-sponsors.
The plan is to have the relevant content ready for DSTU ballot in September 2013 and approval for
publication in December 2013.
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The project timeline is very ambitious and is driven by the US Meaningful Use Stage 3 requirements. The
three groups (ONC S&I LCC, Patient Care and Structured Documents) agreed to work closely together via
weekly conference calls.
2.28.3
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Structured
Documents:
Issue: CDA R3 will be submitted for ballot in September 2013.
NEHTA
Action: Monitor new CDA R3 developments and understand industry
acceptance and impact on Australian specifications that are based
on R2. NEHTA and IT-014 committees to monitor the progress on this
item.
IT-014
CDA R3
HL7 Australia
Also monitor interplay of R3 with FHIR specification that will be
published in the same balloting period.
Structured
Documents:
Patient Authored
Documents
Issue: The Patient Generated Document (PGD) IG is intended to
provide implementation guidance on the CDA header and body
elements for documents authored by patients or representatives of
patients. The PGD header now includes international inputs based
on Australian work to align better with international requirements.
It is recommended that Australia be further engaged in the
development of PGD body components.
NEHTA
IT-014
Action: NEHTA and Australia should participate and include
Australian patient generated documents body elements to this CDAIG on PGD IG. This will enable Australian implementers and
standards bodies to contribute and align with international
standards for patient generated documents.
Structured
Documents:
Issue: Electronic interchange of meaningful question and response
documents between the practitioner and the patient.
Questionnaire and
Questionnaire
Response CDA
Implementation
Guides
Action: NEHTA and Australia should actively participate in the
standardisation of Questionnaire and Questionnaire response
documents. The Australian requirements for Consumer Entered
Health Assessment and Bluebook Questionnaire requirements
should be augmented to the universal realm. This is to align
Australian consumer/healthcare provider questionnaire documents
with the international questionnaire framework.
Structured
Documents:
Issue: There is a need for formal methodology or best practices for
developing CDA templates and implementation guides and
appropriate tooling to support repeatable processes and deal with the
proliferation of templates.
Automation and open
source tooling for
clinical information
modelling
NEHTA
IT-014
NEHTA
Action: Investigate the use of Model Driven Health Tools (MDHT) as
a way of providing programmatic access to the information model
associated with templates and supporting a scalable and repeatable
approach to the clinical information modelling. Consider positive
experience reported at this WG meeting regarding harmonization
between C-CDA and IHE and as a way of dealing with the
proliferation of templates.
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Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Structured
Documents:
Issue: The current C-CDA Implementation Guide specification is a good
document from both the modelling and clinical perspective but is
developed for the US Realm.
IT-014-06-04
Clinical Oncology
Treatment Plan and
Summary
Action: Consider this document for relevant future developments
related to Australian e-health clinical oncology specifications.
IT-014-06-06
IT-014-13
DoHA
HL7 Australia
Structured
Documents:
This project is relevant and of significant interest to IT-014-06-06, IT014-13 and many Australian jurisdiction initiating care plan projects.
Australian eHealth
communities
Consolidated CDA
update including Care
Plan document
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2.29
TEMPLATES
2.29.1
PROGRESS AT THIS MEETING
There were some 14 delegates in attendance for the Templates WG session on the Friday morning including
Richard Dixon Hughes and Zoran Milosevic from Australia.
Topics discussed encompassed the following:
•
Formal representative to/from other WGs.
Lisa Nelson is the (informal) representative for Templates WG in Structured Documents WG (SDWG);
and the (formal) representative for SDWG in Templates WG and will ensure coordination between
the two groups. At Lisa’s request, Mark Shafarman will help her do this.
•
Andy Stechisin remains the Tooling WG representative to Templates WG.
•
Project: HingX (Health Ingenuity Exchange) – Review use as a templates repository [see report under
current projects below].
•
Project #885: HL7 Templates ITS Pilot. Andy Stechisin reported [see current projects below].
•
Templates DSTU R2 - including versioning, governance and Templates ITS. The next revision of the
HL7v3 Templates specification was the main topic of discussion and drove the session into extra time
[see report under current projects below].
Kia Heitmann gave an update on the ART-DECOR toolset, noting that:
•
It is being used on more than 12 projects in the EU.
•
The template editor is a draft version.
•
It manages versions and template relationships.
•
It has a repository of building blocks and references other projects: C-CDA, epSOS and IHE.
•
Further development is based on a Schematron Engine and includes support for open and closed
templates, use cases and repositories.
•
In terms of follow-up actions, Kai Heitmann agreed to circulate an update on DECOR including
information about the demonstration of an EKG report template, data on the “building block repository”
of all CDA specifications and plans for a live demonstration.
2.29.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project: HingX (Health Ingenuity Exchange) – Review of use as a templates repository, related to
Project #904: HL7/OHT Health Ingenuity Exchange Alpha Program Participation.
•
Project #885: HL7 Templates ITS Pilot.
•
Project: Templates DSTU R2 - including versioning, governance and Templates ITS, from archived
project #272 Updated Template Interchange Format DSTU.
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2.29.2.1
PROJECT: HINGX (HEALTH INGENUITY EXCHANGE) – REVIEW USE AS A
TEMPLATES REPOSITORY
PROJECT OBJECTIVE/ TOPIC SUMMARY
HingX is a registry and repository for health related ICT resources. It was initially sponsored by the
Rockefeller Foundation to enable an enterprise architecture approach to e-health for low resource countries
they are also sponsoring. HL7 is committed to HingX as early adopter. Software versions are planned for
release every one to two months.
The HingX registry functionality has been tested against Templates Registry Business Process requirements.
Also tested is the registration of artefacts produced by a number of HL7 WGs including Tooling, Publishing,
SOA, and Templates. Metadata about these resources are stored in the registry and used to index and
search for the resources.
HingX has also defined a number of user types (e.g. individuals and groups such as project, team,
organization, community) and user roles (to designate the set of actions that a user can perform regarding
the resources related to a specific user group).
It is possible that HingX can be a registry and repository for HL7 artefacts, which provides the following
features:
•
A global resource registry with relationships between resources;
•
A reference repository; and
•
Access to other repositories.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
There was limited discussion of HingX. Lisa Nelson (Cox Systems) reported that she is collecting information
on all the extensions that have been created for CDA R2 including the numerous CCDA extensions. She is
planning to review that collection for Templates registry metadata requirements and will share with Kai
Heitmann and other interested parties and this will be posted on a wiki page linked to linked to the
Structured Documents WG wiki.
If time permits, and if the data and metadata analysis supports it, this could then be used to look at how
HingX might be used to manage this type of information.
[Subsequent to this discussion] Jane Curry volunteered to lead work with Kai Heitmann and Lisa Nelson on
analyzing how HingX might be used as a potential templates registry.
Again, if time permits, Templates WG as a group will also investigate using the now-published HingX API to
test HingX as a possibility for a Templates Registry. This would include lessons learned from the several
international groups now working with Templates (including CCDA, MDHT, Lantana, DECOR, NHS, NEHTA
and Infoway), and be integrated with the findings of the Templates Registry Business Process Analysis
document.
2.29.2.2
PROJECT #885: HL7 TEMPLATES ITS PILOT
PROJECT OBJECTIVE/ TOPIC SUMMARY
The focus of this project is to create an ITS that supports an interchange format in a canonical form for HL7
CDA templates. This project is a tightly focused sub-project of the templates interchange project (Project
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#272 in Project Insight) to move work forward in a specific area. The lessons learned from this project will
feed back into the wider project.
The requirements analysis for this project includes detailed review of requirements arising from MDHT
(Model Driven Health Tools), Lantana Consulting Group’s Trifolia Workbench, DÉCOR, and Templates
Registry Business Process Requirements.
The Template ITS specifies templates using the German DECOR (data elements, codes, OIDs and Rules)
approach to create HL7 CDA templates. It can be used to transform Trifolia CDA template data into a DECOR
template (a 2-step conversion). Continuous gap analysis is being conducted on the transform and DECOR
output layouts. It was previously reported (January 2013) on the basis of conversions done in late 2012 that
DECOR appears to have been able to meet the requirements identified.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The project is continuing to progress, albeit slowly due to volunteer bandwidth issues.
Andy Stechisin expects to have completed the conversion of the Lantana Trifolia templates to Templates ITS
format (i.e. ART- DECOR XML) by the end of May.
Keith Boone has contacts within MDHT and is starting to work with their templates; he will collaborate with
Kai Heitmann on this and will contact MDHT representatives and request their participation in the
Templates ITS project.
The time is approaching to contact NHS (UK), NEHTA (Australia) and Infoway (Canada) to explore their
potential participation in the Templates ITS project.
2.29.2.3
PROJECT: TEMPLATES DSTU R2 - INCLUDING VERSIONING, GOVERNANCE
AND TEMPLATES ITS (FROM PROJECT #262)
PROJECT OBJECTIVE/ TOPIC SUMMARY
The “Templates DSTU”, HL7 Version 3 Standard: Specification and Use of Reuseable Information Constraint
Templates, Release 1, was published in 2006 and expired under ANSI rules on 7 February 2010 DSTU.
Despite now being expired, it is still the basis of templates that constrain v3 messages and, more
significantly, CDA documents.
Project #272: Updated Template Interchange Format DSTU was approved by TSC in August 2011. The aim
of the project was to revise and republish the Templates DSTU to reflect the lessons learned from current
approaches to defining and implementing templates, noting that:
•
There is an opportunity to align approaches and identify information needed to be able to
communicate templates from one application to another.
•
At a minimum, the DSTU needs to provide guidance to designing, implementing and validating
templates and the specification of a workable template interchange format.
•
While the primary focus was to be V3, application to V2 messaging was to be considered.
•
The work also aims to develop SAIF viewpoints at the three levels of: Business process level ((including
public and private governance requirements and relationships among governance organizations; design
level (addressing identification and versioning), and implementation (via repositories and ITS instances).
•
Template versioning, relationships and governance have been core issues needing to be resolved.
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A high level of consensus around these issues was considered a pre-requisite for a successful outcome from
Project #262; however, the project became more complex with the advent of consolidated CDA, the
proliferation of new families of profiles and templates (e.g. though IHE and national programs) and the
creation of different tools to facilitate the application of these approaches.
Particular stakeholders and interests include: The German dEcor project (Kai Heitmann), IHE profiles for CDA
templates (Keith Boone), the Lantana Consulting Group’s Trifolia repository and templated C-CDA, the
Templates ITS project and other stakeholders with interests in template exchange and repositories,
including MDHT, US-DVA, and possibly UK-NHS and NEHTA.
Failure to progress to development of a draft DSTU for ballot within the ANSI time limits meant that TSC was
required to withdraw Project #262 entirely from the HL7/ANSI notified work program in December 2012 and
since then the project has officially been archived.
The work currently underway is therefore officially “preliminary” work to secure agreement on key issues –
the approach to governance, design and characterisation of families of templates (i.e. issues of
identification, versioning, publishing, and deprecation/retirement). When the project is ready to progress,
it appears that a new PSS will be needed before the revised DSTU can be balloted.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Issues surrounding template versioning and relationships have been the subject of weekly Templates WG
teleconferences from October 2012 to May 2013 (and are summarised in the report of the Australian
delegation to the January 2013 WGM meeting in Phoenix).
In terms of actually producing the draft Templates DSTU R2, the WG noted that the content needs to be
separated into levels according to SAIF:
•
Governance level - the basic metadata that defines a family of templates (i.e. all the versions with a
given template id) based on template registry requirements.
•
Design level – the information and computational processes for managing template version and
publication status encompassing the needs of developers, registries and implementers.
•
Implementation level – the information and structures needed by implementers to know which version
of a template should be used to create or validate a given instance, and if there are any particular
requirements for later re-use of the data.
All three levels must be consistent and applicable across any mix of closed/private and open/public
contexts.
The ways in which DECOR and IHE in particular use OIDs and other Template-IDs, versions and status
metadata and creation/population dates of instances and, also, issues of backwards compatibility for
existing templates and data were discussed at some length (with some reference to Trifolia and other
contexts). The approaches used in each context are significantly different but it seemed that the various
groups are prepared to work in a timely fashion toward an agreed common interchange format.
More work is needed on use cases for versioning requirements at both the design and implementation
levels, and their interactions. The Templates WG agreed that they needed to collect more use cases from
the major implementers of templates identified above.
There seemed to be general agreement that the draft templates DSTU R2 would encompass the following
content:
•
Glossary.
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•
The governance, design and implementation levels discussed above, including updated requirements
for managing template versioning, relationships and instances.
•
Exchange formats and templates – the Templates ITS.
•
Conformance guidance (requiring liaison with the CGIT WG).
•
Contributions to harmonisation with IHE.
Notwithstanding Project #262 having been withdrawn from the HL7/ANSI work program in December last
year, Templates WG was still planning to have the project reinstated with a completed draft of the
Templates DSTU R2 specification out to “for comment” ballot in the September 2013 ballot cycle. If this
deadline is achieved, templates WG was hoping to get to hold the final DST R2 ballast for January 2014.
These timelines seem highly ambitious. It is unclear how much of the final text is yet available and the
project needs to be reactivated before it can be balloted.
2.29.3
ACTIONS FOR AUSTRALIA
There are no further actions for Australia as a result of progress at this WGM; however, those actions put
forward at the last WGM in January 2013 relating to monitoring of developments remain current
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2.30
VOCABULARY
2.30.1
PROGRESS AT THIS MEETING
The Vocabulary Working Group very much missed the expertise and guidance of Australian subject matter
expert and Vocabulary Co-Chair Heather Grain at this working group meeting. Heather however was able to
attend many of the meetings via teleconference from Australia. At this current working group meeting the
three year plan for the group was updated with some projects moved to this area (project #499 Review ISO
Principles and Guidelines of Terminology Maintenance and project #308 the Vocabulary conceptual model).
General discussion amongst the work group included discussion of how the WG can be less reactive and
increasingly approach work priorities in a less ad hoc fashion.
From the Phoenix working group meeting the issue and recommendation of the use of HingX as a trial
needing to be noted by Standards Australia, for consideration of adoption of the tool as:
•
It may be useful to Standards Australia as a platform for collaboration; and
•
The structure of resources needs to be well defined and input to the structure required.
There was an action listed that further information would be provided at next HL7 meeting to support
Standards Australia's review of tool and opportunities for use. This was not able to be followed up in the
context of this meeting and will be added to the recommendations list to be followed up within IT-014 and
the Vocabulary Work Group.
2.30.2
CURRENT PROJECTS
The following projects are reported on in this section:
•
Project #948: Facilitator Training.
•
Project #947: Vocabulary Maintenance in the IHTSDO Workbench.
•
Project #945: Evaluate NLM vocabulary submission tool for HL7 use.
•
Project #324: Common Terminology Services Release 2 (CTS 2) – Normative (ballot next cycle).
•
Project #946: CTS2 incorporation of Shared Value Sets.
•
Project #874: V2 code table versioning and alignment to V3 vocabulary model.
•
Project #839: TermInfo – Implementation Guide for using terminologies in HL7 artefacts Release 2.
•
Project #806: Development of policies and procedures of an HL7 terminology authority.
2.30.2.1
PROJECT #948: FACILITATOR TRAINING
PROJECT OBJECTIVE
This project will create a series of webinars/podcasts and other forms of media to provide training to HL7
modelling, publishing and vocabulary facilitators. These will be offered as stand-alone tutorials that can be
given on demand and on a scheduled basis to support new and existing HL7 Facilitators in understanding
their role and how to perform related tasks.
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PROJECT ACTIVITY/ISSUES AT THIS MEETING
Heather Grain presented a very comprehensive framework she has developed for Vocabulary facilitator
training. This was presented to the working group meeting by Heather via teleconference. The progress for
this will be to forward the completed framework and content to the Education Working Group for adoption.
2.30.2.2
PROJECT #947: VOCABULARY MAINTENANCE IN THE IHTSDO
WORKBENCH
PROJECT OBJECTIVE
The scope of this project is to be able to represent the HL7 vocabularies, code systems, and value sets
(content) in the IHTSDO Workbench to a degree that permits the IHTSDO Workbench to be used to perform
vocabulary maintenance activities on that content. It will use the native vocabulary maintenance
capabilities in the Workbench and identify what changes would be necessary to the Workbench to permit it
to be used as HL7’s content development environment. A phased approach is recommended where Phase 1
builds upon the mapping previously completed between the Model Interchange Format (MIF) and the
IHTSDO object model to complete a proof of concept based on Harmonization use cases. Phase 2 would only
be required after successful completion of Phase 1. The estimate of effort required for Phase 2 could then
be based on the required customizations identified in Phase 1. Phase 2 would require the ability to load
(import) all the HL7 content from the MIF into a running instance of the IHTSDO Workbench as well as
export content from the IHTSDO Workbench to a valid MIF representation. The import and export should be
based on the current version of MIF 2.2.0. The phased approach is recommended to purposely separate the
evaluation of functionality from larger development efforts. Thereby providing a means by which HL7 can
complete the evaluation without committing to a larger development effort.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This project was reviewed and an action to look at establishing the next milestone date.
2.30.2.3
PROJECT #945: EVALUATE NLM VOCABULARY SUBMISSION TOOL FOR
HL7 USE
PROJECT OBJECTIVE
The project will document the feasibility of implementing the NLM Request Submission System (USCRS) for
use in Vocabulary submissions to the HL7 Harmonization process. It will define the functional requirements
that the system must support as well as requirements to support the system from the perspective of both
the technical components in the HL7 tooling environment and the process implications for harmonization
and vocabulary maintenance processes.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This project is close to commencement and a Wiki page has been created under the Vocabulary Working
Group on the HL7.org site.
2.30.2.4
PROJECT 324 COMMON TERMINOLOGY SERVICES RELEASE 2
PROJECT OBJECTIVE
CTS2 is a model and specification for discovering, accessing, distributing and updated terminological
resources on the internet. This community is a collection of individuals and organizations interested in
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
developing, using, and consuming CTS2 resources. Structured terminologies provide a foundation for
information interoperability by improving the effectiveness of information exchange. They provide a means
for organizing information and serve to define the semantics of information using consistent and
computable mechanisms. Terminologies are constructed to meet scope specific domain requirements. The
domain specific nature of structured vocabularies often leads to variation in design patterns across the
available terminology space. The ability to provide consistent representation and access to a broad set of
terminologies enables multiple disparate terminology sources to be available to a community, and helps to
ensure consistency across the domain space of that community. Service interfaces to structured
terminologies should be flexible enough to accurately represent a wide variety of vocabularies and other
lexically-based resources. The PIM specified in this document for CTS2 is intended to mediate among
disparate terminology sources by providing a standard service information and computational model. The
Information Model specifies the structural definition, attributes and associations of Resources common to
structured terminologies such as Code Systems, Binding Domains and Value Sets. The Computational Model
specifies the service descriptions and interfaces needed to access and maintain structured terminologies.
Further information can be located at:
http://informatics.mayo.edu/cts2/index.php/Main_Page [Accessed 11/02/13]
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This is project was reportedly moving at a good pace with a recent normative ballot successful. The plan is
that this project will be a normative standard with reconciled comments completed at the working group
meeting.
2.30.2.5
PROJECT #946 CTS2 INCORPORATION OF SHARED VALUE SETS
PROJECT OBJECTIVE
The objective is to align data elements and align signature components. This work will also provide
guidance and input on ‘impedance mismatches’. A demonstration of the Mayo Clinic value set service was
provided.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
An update for this project was presented and a website reference provided for value sets in the US realm
https://vsac.nlm.nih.gov/ [Accessed 11/05/13].
2.30.2.6
PROJECT #874: V2 CODE TABLE VERSIONING AND ALIGNMENT TO V3
VOCABULARY
PROJECT OBJECTIVE
The scope of this project is to review all code tables that have ever existed in the published HL7 V2.x
standard and identify the type of V3 terminology model component (concept domain, value set, or code
system) that is associated with each code table. If the V3 terminology model component is a value set or a
code system, an Object Identifier (OID) will be assigned to them. Existing identifiers in V3 terminology
model will be considered to leverage for re-use where possible. As a result of identifying the code tables,
this will clearly outline which code tables are the code systems to constrain for value set implementation
and identify the migration path to V3 terminology model. A constrain mechanism will be provided in a
separate initiative. The analysis and action plan of the gap between V2 code tables and V3 terminology is
out of scope of this project. Names for the new concept domains will be developed. A process for ongoing
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maintenance of V2.x (V2.9 and beyond) code tables and OID associated with each code table (as
appropriate) will be established. End deliverable: All the code tables in chapter 2c will be augmented with
the V3 model component determined by the project. Metadata for all the code tables will be augmented.
An error list will be identified and given to the applicable WG to resolve. Appendix A will be regenerated
from chapter 2c.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
This project is now co-sponsored by the Vocabulary Work Group with primary sponsorship from the
Conformance and Guidance for Implementation/Testing Work Group.
2.30.2.7
PROJECT #839: TERMINFO – IMPLEMENTATION GUIDE FOR USING
TERMINOLOGIES IN HL7 ARTEFACTS RELEASE 2
PROJECT OBJECTIVE
This project is to develop the policies and procedures for the establishment and ongoing operation of an
HL7 Terminology Authority to administer terminology content in SNOMED CT.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
Two TermInfo working sessions were conducted this WGM. Balloting as a normative standard is planned
however it was acknowledged that a critical mass of interest was needed for this. The working group
proposed to address issues of overlap between the terminology and information models. A lengthy
discussion was held regarding issues of expression of negation in terminology and how this would be
approached in CDA and Version 3. It was noted that there is no negation indicator in FHIR. A paper was
proposed as useful for project direction. Also links with Modelling and Methodology were suggested. A
template for use cases will be developed to support consistent information for different technology
families. Moving forward with the negation issue the following was proposed by the working group:
1.
Creation of a template using a fill in the blanks sentence approach for expressing requirements in
concepts e.g., in family hx, allergies.
2.
Make a start with the nine use cases in CDA.
Possible development of a white paper with a succinct set of guidance to define when guidance will work
for specific terminology families, when it is uncertain and when it will not work. Overall there was a
requirement for deep understanding of terminological principles to actively participate in this project
discussion.
2.30.2.8
PROJECT #806: DEVELOPMENT OF POLICIES AND PROCEDURES OF AN
HL7 TERMINOLOGY AUTHORITY
PROJECT OBJECTIVE
This project is to develop the policies and procedures for the establishment and ongoing operation of an
HL7 Terminology Authority to administer terminology content in SNOMED CT and define the responsibilities
and relationships of HL7 to SNOMED CT and its use.
The purpose of this group is to:
•
Manage the integration of SNOMED CT content into HL7 value sets, although other code systems will be
under its purview.
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•
Develop and manage a process and structure to triage and route terminology requests to IHTSDO or
other external terminology organisations.
•
Define the processes to submit terminology to an external terminology body, and to define the scope of
process within HL7.
The need for this work was driven by the requirement to form a single point of contact with HL7 for IHTSDO
content management.
PROJECT ACTIVITY/ISSUES AT THIS MEETING
The end date for this project was listed as the current working group meeting however no update or
working session was presented in the context of this meeting.
2.30.3
ACTIONS FOR AUSTRALIA
Topic
Issue/Action/Recommendations for Australia
Recommended for
Action by
Vocabulary:
Issue: HL7 Vocabulary Working Group requires a deep understanding
of the various technical vocabularies and project bases. At the
current meeting the Vocabulary tutorial was cancelled and therefore
mentored delegate was unable to fully engage in Vocabulary WG
development.
DoHA
IT-014
Action: Consider Australian vocabulary priorities and potential for
development and support of Australian subject matter experts in
future delegations.
Vocabulary:
HingX
Issue: The use of HingX as a trial needs to be noted by Standards
Australia, for consideration of adoption of the tool as:
Future HL7
3.
review progress of
4.
It may be useful to Standards Australia as a platform for
collaboration; and
The structure of resources needs to be well defined and input to
the structure required.
Delegation (to
this project)
Action: This action is carried over from a recommendation made by
Heather Grain in the 2013 Phoenix Delegation Report. Please
monitored by future delegations for information to support
Standards Australia's review of tool and opportunities for use.
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3.
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
ADL
Archetype Definition Language
AG
Advisory Group
AHIEC
The Australian Health Informatics Education Council
AHIMA
American Health Information Management Association
AHMAC
Australian Health Ministers’ Advisory Council
AHML
Australian Healthcare Messaging Laboratory
AIHW
Australian Institute of Health and Welfare
AIIA
Australian Information Industry Association
AMIA
American Informatics Association
AMT
Australian Medicines Terminology
ANSI
American National Standards Institute
ANZCTR
Australia New Zealand Clinical Trials Registry
API
Application Programming Interface
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
ATNA
Audit Trail and Node Authentication (IHE Standard)
AU
Australia abbreviation in the Int'l comment form
AWI
Approved Work Item
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Final Report HL7 Meeting—Atlanta, USA (May 2013)
Abbreviation
Meaning
BAM
Business Architecture Model (HL7 ARB Project)
BAU
Business As Usual
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
BYOD
Bring Your Own Device
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]
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 and Prevention (within US/DHHS)
CDISC
Clinical Data Standards Interchange Consortium
CDS
Clinical Decision Support [HL7 Workgroup]
CDV
Committee Draft for Vote
CEN
European Committee for Standardization (Comité Européen de Normalisation)
CENELEC
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
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Abbreviation
Meaning
CMS
Centres for Medicare and Medicaid Services (within US/DHHS)
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]
CPOE
Computerized Physician Order Entry or Computerized Provider Order Entry (In US)
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
Committee on Developing Country Matters [ISO]
DHHS
Department of Health and Human Services (US Government Agency)
DICOM
Digital Imaging and Communications in Medicine
DIISR
Department of Innovation, Industry, Science and Research
DIS
Draft International Standard (fourth stage in developing an ISO or IEC standard—the
main opportunity for public input)
DMP
Dossier Médical Partagé (Shared Medical Record) (France)
DoHA
(Australian Government) Department of Health and Ageing
DS4P
Data Segmentation for Privacy
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]
DVA
(Australian Government) Department of Veterans Affairs
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Abbreviation
Meaning
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
EMR
Electronic Medical Record or Electronic Medical Record System
EN
European Standard (Européen Norm)
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 http://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
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Abbreviation
Meaning
GSRN
Global Service Relation Number
GS1
An international SDO – primarily in the supply-chain domain
GVP
Good Pharmacovigilance Practices
HCD
Health Care Devices Committee
HDF
HL7 Development Framework
HeD
Health E-Decisions (project or group within ONC for decision support in MU3)
HI
Health Identifiers
HIE
Health Information Exchange
HIMSS
Healthcare Information and Management Systems Society
HingX
Health Ingenuity Exchange (HL7 International and OHT)
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]
HTA
HL7 Terminology Authority
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
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Abbreviation
Meaning
ICNP
International Classification for Nursing Practice
ICPC2+
International Classification of Primary Care 2
ICSR
Individual Case Safety Report [related to Medicines/Devices]
ICT
Information and Communications Technology
IDMP
Identification of Medicinal Products
IEC
International Electrotechnical Commission (an international SDO)
IEEE
Institute of Electrical and Electronic Engineers (US) (also an SDO)
IG
Implementation Guide
IHE
Integrating the Healthcare Enterprise
IHI
Individual Healthcare Identifier
IHPA
Independent Hospital Pricing Authority (Australian)
IHTSDO
International Health Terminology Standards Development Organisation
IMATF
International Membership and Affiliation Taskforce
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 Taskforce
ITU-T
International Telecommunications Union—Standards Division
IXS
Identity Cross Reference Service [OMG/HL7 HSSP]
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, GS1 and IHE)
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Abbreviation
Meaning
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 [Regenstrief Institute]
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
MDHT
Model-Driven Health Tools
MDMI
Model Driven Message Interoperability
MIC
Medium Income Country
MIF
Model Interchange Format
MLM
Medical Logic Module
MM
Maturity Model
MnM
Modelling and Methodology [HL7 Workgroup]
MOU
Memorandum of Understanding
MSIA
Medical Software Industry Association
MT
Maintenance committee (IEC)
MU2/MU3
Meaningful Use Stage 2 and Stage 3 (US Initiative)
NASH
National Authentication Service for Health
NATA
National Association of Testing Authorities
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Abbreviation
Meaning
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
NHPA
National Health Performance Authority (Australian)
NHS
(UK) National Health Service
NIH
(US) National Institutes of Health
NIST
National Institute of Standards and Technology (USA)
NLM
National Library of Medicine (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
NPRM
Notice of Proposed Rule Making (a step in the regulatory process in the US)
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
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Abbreviation
Meaning
Department of Health and Human Services)
OSI
Open Systems Interconnection
OTF
Organisation Taskforce [ISO TC 215]
OWL
Web Ontology Language
PA
Patient Administration [HL7 Workgroup]
PACS
Picture Archive and Communication System
PAS
Patient Administration System
PASS
Privacy Access and Security Service
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
PGD
Patient Generated Document [HL7]
PHDSC
Public Health Data Standards Consortium
PHER
Public Health and Emergency Response [HL7 Workgroup]
PHR
Personal Health Record
PHTF
Public Health Taskforce
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
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Abbreviation
Meaning
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]
QDM
Quality Data Model of the US National Quality Forum
RACGP
Royal Australian College of General Practice
RCPA
Royal College of Pathologists Australia
RCRIM
Regulated Clinical Research Information Management [HL7 Workgroup]
RDF
Resource Description Framework (W3C)
REST
Representational State Transfer
RFI
Request for Information (a step in the regulatory process in the US)
RFID
Radio Frequency Identification
RFP
Request For Proposal(s)
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)
RMES
Records Management—Evidentiary Support (HL7)
RMIM
Refined Message Information Model
RM-ODP
Reference Model of Open Distributed Processing
RO
Responsible Officer
SA
Standards Australia
SAIF
Services Aware Interoperability Framework
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Abbreviation
Meaning
SAMHSA
Substance Abuse and Mental Health Administration
SC
Subcommittee
SD
Structured Documents [HL7 Workgroup]
SDO
Standards Development Organisation
SHARPS
Strategic Healthcare IT Advanced Research Projects on Security
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 Expert
SMTP
Simple Mail Transfer Protocol
SNOMED CT
Systematised Nomenclature of Medicine—Clinical Terms
SOA
Service Oriented Architecture
SOAP
Simple Object Access Protocol
SSD
Single Sign On
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
Taskforce
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)
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Abbreviation
Meaning
TS
Technical Specification (a normative standards publication having a lower level of
consensus than a full international standard)
TSC
HL7 Technical Steering Committee
UAT
User Acceptance Testing
UCUM
Unified Code for Units of Measure [Regenstrief Institute]
UHI
Unique Healthcare Identifier
UML
Unified Modelling Language
UN
United Nations
VA
Department of Veterans Affairs (US)
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 [UN Agency]
WI
Work Item
WTO
World Trade Organisation
XDS
(IHE’s) cross enterprise Data Sharing protocol
XML
Extensible Markup Language
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4.
4.1
REPORTS FROM HL7 AFFILIATES AROUND THE WORLD
HL7 ARGENTINA
Website: http://www.hl7.org.ar.
HL7 Argentina has pursued active engagement with health sector institutions, involvement in industry
events and the continuing provision of educational services, including the following:
•
March 2013 – two-day HL7 Argentina Conference on at the University of Lujan in Buenos Aires focussing on v2 and CDA experiences
•
19 April 2013 - full day workshop on standards for exchange of clinical information co-hosted with the
nuclear medicine Association (FUESMEN)
•
25-26 April 2013 - presentation to 4th International Conference on Hospital Management
•
July 2013 - participating in the "Expo Hospital" event in Santiago – Chile involving over 180 firms
•
August - HL7 Argentina paper being presented at MEDINFO 2013 in Copenhagen(August)
•
16-20 September 2013 – jointly organising the 4th Argentinean Health Informatics Congress (CAIS 2013)
“Connecting Healthcare Actors", with a full day of HL7 tutorials/workshop and coverage of V2-CDA-FHIR,
QRDA (Quality Reporting Document Architecture), CDA around the world, and Introduction to IHE
•
25-27 September – HL7 participation is planned in the main healthcare provider and services event in
Argentina (www.expomedical.com.ar) including an information desk and HL7 workshop.
•
Health informatics conference to be held at Hospital Italiano de Buenos Aires - Planned presentation of
pre-certification courses. certification testing, implementation experiences and presentations by invited
international HL7 experts.
•
Joint activity with Universidad del Centro de la Provincia de Buenos Aires (UCPBA) – including delivery
of 2-day course (Intro/ V2.x/CDA R2, 3 hours theory / 6 hours lab) with 50 undergraduate students
taking optional 'Medical Informatics' stream and conduct of workshops under proposed MOU.
Collaboration with the Health Ministry on interoperability projects has continued, including implementing a
web service with XML and HL7 v2.5; and on the NOMIVAC (immunization); REDOS (blood bank); and
REMEDIAR (medication) projects.
As the creator of the HL7 Foundations e-learning course (ELC), HL7 Argentina continues to be strongly
involved in both the development and delivery of the course, with the following highlights being noted:
•
Delivery and scalability of the course has been improved, with the current international edition in
English having more than 300 students from 22 countries (including Australia) supported by 14 tutors
from 9 countries. The current international edition in Spanish has over 50 students from 8 countries
•
Collaborative e-learning courses are being run with HL7 affiliates in Austria (finishes May 2013),
Pakistan (started March) and Romania (started April); scholarships have been provided to students
from Puerto Rico; and Australia is continuing its evaluation of HL7 e-learning materials
•
The first Portuguese edition of the ELC has been produced as a collaboration with HL7 Brazil
•
A FHIR unit is being developed for the course (with input from David Hay in New Zealand)
The 2013 membership of HL7 Brazil remains stable at 24 and finances are also sound.
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4.2
HL7 AUSTRALIA
Membership is stable and there were several successful educational events held in 2012.
The International HL7 Interoperability Conference (IHIC) is planned for October 2013 in Sydney, Australia.
Affiliate input into this event is requested.
4.3
HL7 AUSTRIA
No report was given at this WGM.
4.4
HL7 BRAZIL
Website: http://www.hl7.org.br/
HL7 Brazil has been very active and works in close collaboration with other South American HL7 affiliates in HL7 Argentina, HL7 Uruguay, HL7 Colombia, HL7 Mexico, HL7 Venezuela and HL7 Chile,
Translation of the HL7 e-learning course (ELC) into Portuguese is being carried out in conjunction with HL7
Argentina and Instituo Edumed and is largely complete. The first ELC in Portuguese is expected be run
online from Sao Paulo commencing in August and will assist in spreading interest in HL7 and
implementation skills among Portuguese-speaking countries including Portugal, Angola, Mozambique,
Macau and Timor Leste amongst others.
In 2012 HL7 Brazil also entered into a joint venture with the Brazilian health Informatics Association to share
administrative facilities and to conduct joint educational activities. 3 courses have were conducted in the
first semester - HL7v2, HL7v3 and Software Certification. More on the HL7 Brazil’s educational offerings is
available on the HL7 Brazil education website: www.hl7.virtual.org.br.
HL7 Brazil participates in the National Healthcare Standards Committee. By Ministerial Mandate 2073
executed in August 2011, the Brazilian government nominated the following standards for use in the
national eHealth program:
•
HL7 for interoperability among systems for communicating laboratory orders and results
•
HL7 CDA as the architecture for clinical documents
Other international standards and specifications approved that the same time included:
•
LOINC for codification of laboratory tests,
•
SNOMED CT for clinical terminology an
•
DICOM for image communication
•
openEHR reference model for defining EHR content
•
IHE PIXv3/PDQv3 profiles for access/update to the national unique identifiers database (currently with
220 Million people registered), supported by a PKI-based capabilities in a clinical ID card.
The next national eHealth strategic planning cycle ran from August 2012 to May 2013 with a final strategic
planning document being released on 30 April. The recommended strategies include:
•
Adoption of IHE profiles for IT infrastructure and PCC (Patient Care Coordination)
•
Hospital summary discharge and primary care continuity of care record to be the first CDA documents
to be shared.
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HL7 Brazil publishes an HL7 newsletter, runs a local OID registry and has 5 working groups in the areas of:
Nursing Informatics, Certification and Standards, Education, Telehealth and Healthcare Standards. Key
partnerships include relationships with:
•
The Federal Medical Council (CFM), including a formal agreement establishing a joint program for
certification of Electronic Health Record Systems.
•
Datasus - Department of Health Informatics and Information - Ministry of Health
•
ANS - National Agency for Supplementary Health
•
ABNT - ISO TC215 Mirror Committee, IMIA and the regional IMIA-LAC organisation
Notable work on implementing HL7 in Brazil includes:
•
The national health identifiers register
•
Provision of an integrated pathology laboratory network in São Paulo City to serve a population of 20
million people. The network is based on 4 private and 2 public laboratories and uses CDA R2 for results,
“green” CDA for orders and LOINC for lab test identification (the solution is deployed in 2 laboratories
and is planned to be fully operational by year end).
•
laboratory integration for Belo Horizonte (in Minas Gerais State) - under development using CDA R2 for
orders and results)
The EHR system certification program being conducted jointly with the CFM is a major activity aimed at
improving the quality of EHR systems, increasing information security, paperless record-keeping and helping
physicians to select EHR systems for use in their practices.
Establishment of the program included
identifying requirements for EHR-S: security, structure, content and functionality and the means of testing
and auditing these in real EHR-systems based on assessment involving suitably qualified technical opinion.
Currently: 12 EHR systems have been certified; another 40 are being assessed; a new 2013 version of the
best practice manual has been produced, international; and interest in the program has been expressed
through ISO/TC 215 and requests for partnership with other health workers’ councils. More than 200
professionals have been trained and new auditors are being accredited. The next steps will be programs on
the handling of Digital Medical ID and system/process maturity levels.
HL7 Brazil has 20 members – 10 organisational members (all major corporations,, universities or health
services) and 10 individual members (physicians consultants and IT professionals).
HL7 Brazil looks forward to the possibility of hosting an HL7 working group meeting in 2016, or in 2017 after
the Olympics in Rio de Janeiro.
4.5
HL7 BOSNIA AND HERZEGOVINA
No report was given at this WGM.
4.6
HL7 CANADA
The Canada Health Infoway Standards Collaborative (SC) is the singular standards organization that
functions as HL7 Canada, IHE Canada, and the Canadian national member body for ISO/TC215 and IHTSDO
A multi-tiered SC membership model was introduced May 2012 which has been very successful. As at the
end of March 2013, there were 122 corporate members, 90 individual members and 15 student members
subscribing as "premium members" (all are members of HL7 Canada). Overall, since the new model was
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introduced, there has been an 87% increase in membership, with numbers since the start of 2013 being
stable.
Some features of current and proposed HL7 activities in Canada include:
•
Tooling for HL7v3 implementers being available from Canada Health Infoway and being widely used by
EMR vendors and others
•
Numerous CDA implementations underway within the provincial jurisdictions and a Pan-Canadian CDA
Project is creating a standard CDA header and publishing a CDA Implementation Guide
•
Maintenance releases of Pan-Canadian standards planned for 2013 to address needs in the Public
Health, Shared Health Records, Claims, Medication Management, Laboratory, Client Registry, Provider
Registry, Location Registry, Record Access, Terminology and Infrastructure domains. These will support
continued HL7v3 implementations underway across these domains, including:
-
Provider Registry – operating in multiple jurisdictions and supporting some 10K messages per
month
-
Laboratory services and patient care (e.g., allergy)
-
Medication management, which is being implemented in multiple jurisdictions for exchange of
HL7v3 messages for pharmacy dispense; integration with clinical Electronic Medical Record
(EMR) systems for exchange of electronic prescriptions is underway. There are already more
than 1 million HL7v3 messages per month being processed to support medication management.
The SC also runs a range of training courses and activities including : Orientation to HL7 v3 (46 recent
participants), Foundations of HL7 v3 for Technical Professionals (11), Orientation to CDA (68), Introduction
to HL7 v2.x (7), Introduction to HL7 v3 (11), customised HL7v3 workshop (14 and Introduction to CD (8
participants). 12 candidates successfully completed HL7 Certification
4.7
HL7 CHINA
No report was given at this WGM.
4.8
HL7 COLOMBIA
No report was given at this WGM.
4.9
HL7 CROATIA
No report was given at this WGM.
4.10
HL7 CZECH REPUBLIC
No report was given at this WGM.
4.11
HL7 FRANCE
HL7 France is part of the "Interop Sante" collaborative which is also home for IHE France. The main French
interest in HL7 relates to the use of CDA in the two major national programs:
•
DP (Dossier Pharmaceutique or medication record) uses CDA for the electronic transfer of prescription
and dispense record documents. The DP program is relatively successful with information on some
26.18 million persons being held at the end of April 2013. 22,220 or 97.6% of pharmacies are
participating.
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•
The DMP (Dossier Medical Partagé or shared medical record) is being taken up at a much slower rate.
At the end of April there were some 329,000 DMP records nation-wide, with some 60,000 in the Picardy
region, which has the highest per capita uptake.
HL7 France will be hosting the May 2015 WGM in the vicinity of Paris on behalf of the European affiliates
(subject to final arrangements for organisation being resolved).
4.12
HL7 GERMANY
There is continued collaboration with other German-speaking countries in the region focussed on:
•
Understanding, responding to and managing risks arising from the changes in HL7 International HL7 IP
policy and its impact on affiliates in the region.
•
A shared HL7 journal published jointly in German by the HL7 affiliates in Germany, Switzerland, Austria
and Luxembourg.
•
Expanding use of ART-DECOR tooling for managing the production and maintenance of templates, value
sets and other HL7 modeling artefacts, particularly for Germany and Austria but extending to some
other European countries including The Netherlands and Norway (with more to come). This product set
is being developed as the core of a tooling strategy to support regional implementations.
•
The eHealth Interoperability Forum which was run collaboratively with IHE Germany in 2012 will be run
again as an HL7+IHE Annual Plenary Meeting in October 2013 in Göttingen with the aim of expanding
collaboration nationally and internationally [unfortunately this clashes with ISO/TC 215 in Sydney]. This
is an incremental step in the direction of a potential standards collaborative.
•
Enhancing and updating the content of the Wiki on national and international standards and their use.
This is to support marketing and dissemination of information is on HL7 standards and their use.
With contributions from across the continent, HL7 Germany has led production of the third edition of the
HL7 Europe Newsletter. This is available online at: http://www.hl7.eu/download/feun-03-2013-web.pdf. It
is also available as marketing collateral for European HL7 affiliates with printed copies being distribution at
the eHealth week in Dublin (in May) and planned for Medinfo in August in Copenhagen.
Domestically, recent highlights have included:
•
Expanding collaboration with IHE Germany and other parties, like gematik (infrastructure).
•
A growing role for HL7 Germany supporting the development of national e-health infrastructure;
several more implementation guides have been produced to support: - Discharge Letter (Release 2),
Infectious Disease Reporting and Cancer Registry Reporting.
•
HL7 Germany providing comments to the German Government on a strategic study by the Health
Ministry on Interoperability of health information.
•
Participation in a large health IT vendor exhibition - conhIT in April in Berlin.
•
An upcoming retreat planned for the HL7 Germany Board of Directors to discuss strategic initiatives,
particularly any new initiatives in response to the free licensing of HL7 standards.
•
Making contributions at HL7 International on behalf of the German membership and feedback on the
activities of HL7 task forces and key Working Groups (CGIT, Security, Templates).
Despite the feared fall out from free licensing of HL7 standards, membership has been stable, still slightly
increasing, with considerable focus on HL7 Germany being more widely relevant to local and regional needs.
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4.13
HL7 INDIA
The international Council welcomed Dr Lavanian Dorairaj MBBS, MD as the recently elected Chair of HL7
India and noted the contribution of his predecessor Prof Supten. Dr Dorairaj summarised activities in the
previous year, the current year of the steps being taken to provide value for members. Membership growth
has been relatively slow and currently stands at 11 organisations and 26 individuals. Nevertheless interest
in eLearning courses (ELC) has been strong with two coursed having been run in the last year. Of 286
candidates undertaking the course 198 passed.
There has been increasing positive interaction with the Ministry of Health and Family Welfare of the
Government of India (MH&FW-GOI) and the Centre for Health Informatics (CHI) as the coordinating centre
for e-Health activities in India.
The annual General Body Meeting (GBM) took place in April 2013 and with a refreshment of the Board was
an opportunity to discuss consider past performance under way forward, particularly with respect to the
changes brought about by the ability to download HL7 International standards free of charge.
New
directions being pursued include:- reaching out proactively to industry, universities and hospitals, moving to
hire a marketing agency/person, updating the HL7 India web presence and membership tracking.
A stronger value proposition is required to attract and hold members, with the following initiatives being
under consideration:
•
Setting up a service to test and certify e-health applications (something like CCHIT in the US), and
publicising the results of positive certification
•
Supporting HL7 implementation by providing strategic advice and support and (still under consideration)
“easy connect widgets”
•
Providing member rebates for training and HL7 activities
•
Working with government to recognize HL7 as the standard for healthcare Interoperability, and working
closely with IHE India, formed in April with HL7 India being a member.
APAMI 2014 is being held in New Delhi, India and will provide potential opportunities for wider
engagement.
4.14
HL7 ITALY
Web Site: http://www.hl7italia.it/. Chair: Stefano Lotti, CTO : Giorgio Cangioli.
HL7 Italy is carefully monitoring its membership renewals in light of the recent change to license HL7
International standards and other selected intellectual property (IP) free of charge. Although membership
subscriptions have yet to close, it appears that with 38 organisational members (compared with 43 in 2012)
and 13 individuals having renewed, a small reduction in membership is possible but it is unclear whether
any drop-off is due to the change in IP policy or to the current economic crisis. The reduction appears to be
mainly in small enterprise; almost all of the leading Italian Health IT companies have remained as members
of HL7 Italy for 2013.
A key initiative involving HL7 Italy is the proposed creation of an EHR System Functional Model for Italian
Regions addressing the new legal framework for EHR in Italy and supporting uniform core features in EHRs
for use across the Italian regions. An initial conference was held on 28 January in Bologna hosted by EmiliaRomagna Regional Administration attracting more than 75 attendees with very positive feedback. The
conference discussed issues and challenges of a cohesive Italian EHR development and increased
understanding of the relevance of tool, such as the HL7 EHR-S FM to homogenize and govern the
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development of interoperable EHR systems. Speakers came from several regional administrations, interregional consortiums and from research institutions.
As a follow up, HL7 Italy and CISIS (IT interregional PA consortium), have established a working group on
Italian EHR functional model (FSE-FM) with membership from 11 Regional Administrations/Agencies, CNRICAR (National Council of Research), CISIS, and HL7 Italy. Work started in February, with initial drafts of
scenario documents being released by regions in subsequent meetings.
The first HL7 Italy eLearning: course (ELC) was successfully completed (thanks to Fernando Campos and
Diego Kaminker of HL7 Argentina). The next course will be scheduled for September 2013.
On 23 February HL7 Italy held a kick-off meeting in Rome to start a project to produce a SOA HSSP IG (no
further detail was provided).
HL7 Italy was also supporting the “Summit on Evolving an Open e-Health Platform. Bringing Down Business,
Policy, Information, and Technology Barriers”, which was held in Berlin on 17 June. The summit sought to
combine selected presentations and case studies with community dialogue to chart a course for e-Health
that is practical and implementable. Case studies were presented from Victoria Health (Australia), the Mayo
Clinic (US), the National Health Service (UK), Phast (France) and others and addressed topics ranging from
information representation to architectural “services” to business policies.
4.15
HL7 JAPAN
Ken Toyoda, Director & Secretary General, HL7 Japan, presented the report from HL7 Japan.
HL7 Japan has a strong membership base which, as at the end of 2012, included 343 industry members that
are also members of JAHIS (Japan Association for Health Information Systems), 24 other industry members,
8 user organisations (hospitals/clinics) and 98 individual members, giving a grand total of 473.
HL7 Japan’s plans for 2013 include:
•
Developing a “Discharge Summary Standard” based on Consolidated CDA templates
•
Delivering a full version of the e-Learning course in Japanese - with a pilot session having been
successful
•
Producing a Japanese "Guide to HL7" based on translation of material on HL7 messaging
•
Establishing an HL7 conformance test capability following successful completion of trial testing
•
Continued support of HL7 Asia, particularly through organisation of the first HL7 Asia symposium to be
held in Tokyo in July and also production of the HL7 Asia News etc.
4.16
HL7 KOREA
No report was given at this WGM.
4.17
HL7 LUXEMBOURG
No report was given at this WGM.
4.18
HL7 NEW ZEALAND
A presentation from HL7 New Zealand was not given in the general session but it was the turn of Dr David
Hay, Chair of HL7 New Zealand, to give a fuller presentation to the affiliate chairs meeting in the “political
realities” segment. As reported in the section of this report on the International Council (Affiliate Chairs)
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meeting, he outlined the current organisation of e-health activity in New Zealand, current national
strategies and the role played by the various government bodies, HL7 New Zealand and other groups.
4.19
HL7 NETHERLANDS
Roel Barelds, TSC Co-Chair and HL7 Netherlands board member presented the HL7 Netherlands (HL7 NL)
report as proxy for the Chair, Robert Stegwee. Website: www.hl7.nl
HL7 NL only has organizational members.
The total membership of 215 is split evenly between
vendors/consultancy firms (108) and healthcare/institutional members (107).
These members are
represented by 556 individual persons registered with HL7 NL. Membership is currently stable.
HL7 NL is restructuring the organisation of its technical activities from working groups to project teams to
increase active member participation and achieve more focus within individual projects.
The
business/revenue and membership models are also under review. The potential consequences of the
change in HL7 International's IP policy continue to be monitored.
From the strategic perspective, HL7 NL entered into a formal agreement with IHE-NL on January 1, 2013
with the aims of:
•
Delivering combined HL7 implementation guides and IHE profiles: “packaging”
•
Setting joint priorities and conducting joint public relations, marketing and training
•
Speaking with a single voice on all national standards policy levels
HL7 NL will also be part of a wider collaboration amongst all the major Dutch health Informatics standards
development and implementation organisations under a charter executed on 27 May by HL7 NL, IHE-NL,
Nictiz, NEN and the Dutch IHTSDO National Release Centre (NRC). The objectives of this collaboration are to
improve nationwide coordination of health informatics standards activities; an end to scattered initiatives;
and the conduct of joint projects. More information is available in the third HL7 Europe newsletter
available from: www.HL7.eu.
Recent and planned HL7 NL activities include:
•
Publication of an updated HL7 NL v2.4 implementation guide (in December 2012)
•
Definition of a single universal generic document for nationwide transfer of clinical documents to
support continuity of care - supported by a Dutch CDA Implementation Guide based on CCD/CCR
•
FHIR presentations and publications (by Ewout Kramer)
•
Completion of 30 DCM models - an area of on-going work
•
A very successful series of training programs (led by Rene Spronk) - with classes on HL7, IHE and DICOM
•
The HL7 Jubilee Conference in December 2012 celebrating 20 years of HL7 Netherlands, the first HL7
affiliate
•
Joint Health Architecture Conference with IHE, Nictiz and NAF on June 21, 2013, and
•
MIC 2013 - the Annual Medical Informatics Conference, planned for November 2013.
4.20
HL7 NORWAY
Line Andreassen Saele presented a report from HL7 Norway. As one of the most recent affiliates to be
established, the principal activity is running HL7 information days in Norwegian. One information day had
been conducted in 2013, with others planned for different locations around the country in June and after
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the summer break. Some training has been delivered in recent years with the assistance of experts from
other Northern European affiliates. Training on IHE is planned for June and on FHIR in September.
4.21
HL7 PUERTO RICO
The report from HL7 Puerto Rico (HL7 PR) was given by Julio Cajigas, Chairman HL7 PR.
As one of the most recently established affiliates, HL7 PR has been most active and is operating on a firm
professional basis, achieving recognition as a partner in the development and realisation of the national
e-health strategy.
HL7 PR has 5 office-bearers - Chairman, Secretary, Treasurer, Membership Coordinator and Workgroup
Coordinator.
The membership structure has 6 categories of member loosely mirroring relevant HL7
International membership categories. The categories and associated annual fees are: – individual member
$525, organisation $910, supporter $1,400, medical group $805, student $50 and health professional $100.
The fee-scale for the main categories is 70% of the corresponding base level fee for the corresponding HL7
International membership categories. No indication was given of member numbers.
HL7 PR activities are operating to an aggressive timeline at a time of reform in the use of electronic
information in the Puerto Rico health system. Milestones along this pathway have included:
•
Participation in the 2012 and January 2013 WGMs
•
Hosting a two-day Caribbean HL7 Conference in February, 2013 - keynote speakers included Ed
Hammond (Secretary and Chair Emeritus of HL7 international), Philip Scott (HL7 UK and Co-chair HL7
International Council) and Diego Kaminker (HL7 Argentina and HL7 Board Member).
•
Conducting online education through participation of Puerto Rican students in the HL7 e-learning
course (ELC) – including negotiating scholarships to increase participation
•
Planning to hold an HL7 Educational Summit in Puerto Rico in August 2013.
HL7 PR has also been collaborating with the Government (Health Department and economic development),
the clinical professions, health care facilities, industry/trade associations and others as a participant in the
I4HIE ("Initiative for Health Information Exchange"), which is developing and implementing a federated
collection of interconnected health information exchanges (HIEs) that will evolve into a nation-wide health
information network. Early experiences with the electronic transfer of prescriptions demonstrated the
importance of building solutions to rigorous national e-health standards.
The initial (Phase 0) pilot of I4HIE is operating in the West of the country supporting a population of some
580,000 people and 7 hospitals. It is being extended incrementally, and will shortly include another 90,000
people and another hospital. In the pilot stage, HL7 CDA is being used for a CCD Discharge Summary.
Ultimately The Puerto Rico health information exchange envisages a federation of local HIE engines, each
supporting a hospital regional health information organisation supporting exchange of CDA-based clinical
documents between hospitals, patients, physicians, consultants, pharmacies, insurers, public health
agencies and HIE engines in other regions, as well as the exchange of message-based laboratory
communications.
HL7 has a series of meetings to conclude legal formalities and secure its participation in upcoming stages of
the I4HIE program and its involvement has support from the Health Department and PRTEC (PR TechnoEconomic Corridor).
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Puerto Rico is engaged in a health reform program being led by Dr Jorge Sánchez. Future directions include
development and collection of locally agreed metrics for meaningful use and further expansion if the I4HIE
program.
A key national objective is to be a Caribbean leader in eHealth interconnectivity to support two-way trade in
health services with facilities in the US and across the Caribbean.
HL7 Puerto Rico offers itself as a manageable case study for implementation of HL7 in support of
widespread health information exchange and a potential host for an upcoming HL7WGM
4.22
HL7 PAKISTAN
No report was given at this WGM.
4.23
HL7 SINGAPORE
No report was given at this WGM.
4.24
HL7 SPAIN
No report was given at this WGM.
4.25
HL7 SWITZERLAND
The HL7 Switzerland (HL7 CH)report was presented by,Beat Heggli, Chair HL7 CH, who noted that there had
been no changes in membership since last meeting, notwithstanding the changes in HL7 International's IP
policy allowing its standards to be licensed free-of-charge.
Following recent HL7 CH elections, there have been some changes on the Board with Marco Demarmels
being the Chair-elect.
HL7 CH is developing a CDA Implementation Guide for reporting laboratory-results to public health
authorities as a joint venture with IHE-CH. This is proceeding in stages. The first stage addresses notifiable
results reporting and is nearly finished for approval by government.
The second stage will produce a CDA implementation guide and Schematron rules for laboratory results
used in organ transplantation. For use in Switzerland, it is also likely these documents will need to be
translated into French and Italian, which may be of interest to some other affiliates.
4.26
HL7 TAIWAN
No report was given at this WGM.
4.27
HL7 UK
Dr Philip Scott, Chair HL7 UK presented the HL7 UK report. Website: www.hl7.org.uk
Total membership remains unchanged at 162 members although there has been a shift from organisational
membership to personal membership. “Free IP” has not yet had any discernible impact on membership, but
general awareness is still low and many uncertainties remain.
Recent and planned HL7 UK activities include:
•
A FHIR meeting led by Ewout Kramer
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•
CDA Forum webinars run by DHID/HSCIC
[Note: the Department of Health Information Directorate (DHID) has been disbanded and some of its
functions have been taken over by the Health and Social Care Information Centre (HSCIC)].
•
Planning underway for the June AGM and associated technical committee meeting
•
Training courses on HL7v2 and UK Interoperability Toolkit (ITK)
•
Academic outreach: 2-day Summer School in July
•
Increasing collaboration with IHE-UK, the BSI IST/35 Health informatics committee, BCS Health SIG.
New types of activities and approaches have been emerging from the UK government in recent times. The
previous “Information Sharing Challenge Fund” (ISCF) activity run by the former DHID was noted. This
attracted 95 applications seeking £5.6m for local NHS interoperability projects to be completed by Q1 2013.
43 projects involving 40 companies, most of whom were unfamiliar with the ITK, were awarded funding of
£2.17m. 23 projects were fully delivered, 12 were partly delivered and 8 did not deliver.
ISCF has demonstrated the feasibility of rapid CDA solution development/deployment by vendors new to
the market, given tight NHS specification and implementation support. A further round of competition has
now been announced, with an additional round if KPIs are achieved.
The latest NHS re-structuring still settling down. The commissioning power now rests with “NHS England”
and the residual CFH roles of DHID have now been taken over by the HSCIC. Its website is at:
www.hscic.gov.uk/systems.
The UK Government is making a major investment in EHR based research collaborations with four regional
consortia being funded (university/NHS/industry). They need to interoperate but academic projects often
use theoretical or home-made rather than real-world standards. There is a substantial opportunity to
embed re-usable standards and engage a new stakeholder group. HL7 being a truly open standard is a
critical success factor in realising this opportunity.
The HL7 UK Management Board is developing new value streams with emphasis on implementation
support. There are opportunities for HL7 UK to leverage and facilitate interchange of technology and
approaches used in ISCF work but only if concern over HL7 International’s IP licensing policy in relation to
derivative works can be resolved satisfactorily. These opportunities are being held back because UK
Government is increasingly looking to support "open" standards and stated limitations on creation and
distribution of derivative works in the HL7 International licence for its “free IP” do not look like an ‘Open
Standard’ to HL7 UK or NHS England - hence the need for further discussion of these issues, which is now
taking place.
Other planned engagement and activities included participation in EU eHealth Week in Dublin, May 2013
(hosting the fully-booked free HL7 session on Monday afternoon) and hosting a meeting of European
affiliates on Tuesday morning.
4.28
HL7 US
The report of the US representative to the international Council was presented by the Chair of HL7
International, Dr Don Mon, as a proxy for Dr Ed Hammond, who could not be present at the General
Session. As all US activity takes place within HL7 international, rather than through a separate affiliate, Dr
Mon's presentation focused on how HL7 International activities in the US realm support US national
initiatives.
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HL7 responded to the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare
and Medicaid Services (CMS) Request for Information (RFI) on Advancing Interoperability and Health
Information Exchange (Interoperability RFI), identifying the needs for:
•
a data sharing culture and infrastructure.
•
use of the HL7 Health Quality Measure Format (HQMF) standard format for documenting the content
and structure of quality measures
•
Adoption of Healthcare, Community Services and Provider Directory standards
•
Vocabularies, and coordination of -Blue Button with C-CDA,
The CMS Continuity Assessment Record and Evaluation (CARE) project is using CDA specifications for
exchanging standardized patient assessment data, HQMF and QRDA
The Centers for Disease Control & Prevention (CDC)/National Center for Health Statistics Public Health
Reporting Initiative (PHRI) are engaging with HL7 on the development of the EHR-S FM Public Health
Functional Profile.
Within the ONC S&I (Standards and Infrastructure) Framework there are ten active areas in which HL7
volunteers are engaged, for example:
•
Health eDecision: HL7 CQI (vMR/QDM harmonization)
•
Electronic submission of medical documentation (esMD): structured data, records management &
evidentiary support
•
Transitions of Care, Longitudinal Coordination of Care: HQMF, QRDA
HL7 is a participant in the Structured Data Capture initiative, which has scope:
“To define the necessary requirements (including metadata) that will drive the
identification and harmonization of standards to facilitate the collection of
supplemental EHR-derived data.”
This involves the development and validation of a standards-based data architecture so that a structured set
of data can be accessed from EHRs and be stored for merger with comparable data for other relevant
purposes to include: electronic Case Report Form (clinical research, including Patient Centered Outcomes
Research Initiative), Incident Report (patient safety leveraging AHRQ common formats), Surveillance Case
Report Form (public health reporting of infectious diseases). It will result in four standards
•
A standard for the Common Data Elements that will be used to fill the specified forms or templates
•
A standard for the structure or design of the form or template (container)
•
A standard for how EHRs interact with the form or template
•
A standard to enable these forms or templates to auto-populate with data extracted from the existing
EHR.
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