Meeting-in-Progress Report from the HL7 Working Meeting, Orlando, USA
 
Dear HL7ers,
 
Please find below a brief work-in-progress report written halfway through the HL7 Working Meeting in Orlando, USA
 
Please feel free to contact me or any other other participant with questions, suggestions as we may still be able to address them while we are here.
 
Klaus
 
 
Overview:
A productive Working Meeting with ~500 participants from ~20 counties with 17 Affiliates formally represented.  A high-level delegation from the Uganda Ministry of Health in attendance, funded by the Rockefeller Foundation.
 
Pre-meetings started last Saturday and a post-meeting will run next Saturday; in recent years the HL7 Working Meeting has grown from 4.5 days to ~ 8 days
 
The meeting program lists 63 separate Work Groups, Committees, Boards and Councils; the educational track has 34 tutorials and education sessions.
 
As usual, some sessions start at 7am with other sessions running past 10pm.


HL7 International (Klaus Veil)
- May 10-15 2009 Working Meeting in Kyoto going ahead as planned, most committees expected to meet.
- 2010 May Working Meeting to be held in Brazil - details will be confirmed in the next couple of months.
- 2011 Working Meeting planned for Australia - probably in January; to be confirmed by the HL7.org Board.
- Report from HL7 Australia was given at the International Council Meeting on Sunday

HL7 Architecture "ArB"  (Grahame Grieve, Andy Bond)
The primary activity at this meeting has related to the rollout of the Service-Aware Enterprise Architecture Framework (SAEAF).  This is a set of basic principles that will guide the HL7 Working Groups (= committees) towards producing more coherent specifications more quickly.  Initiation and roll-out of SAEAF has commenced and the Working Groups are starting to understand and engage with the ideas in it although some (expected) consternation is occurring.  The ArB is spending most of this meeting managing this, spreading information, and explaining how things will and won't change. This work will produce outcomes in the medium term.

The second major piece of work relates to the behavioural framework, how to manage the question of who says what when. The final report will provide more information about this.

In addition, Richard Soley from OMG was present at this meeting. There was a flurry of action with regard to the relationship between OMG and HL7, and we can look forward to some significant announcements relating to joint activities, and a greatly improved relationship in the future.

HL7 Standards and Interoperability (Julia David, Klaus Veil)
The Working Meeting is very focussed on V3 and CDA - how wide the V3/CDA take up is and how will this impact Australia if we do not move forward with V3 and CDA is a point for discussion and speculation, particularly if Australia remains with V2.x (especially V2.3.1!).  HL7 V2.7 is under ballot and work on HL7 V2.8 has been approved by the CEO.  There is concern that there may be no further releases past V2.8 to force a move to V3.  The Australian position on this issue was put in our report on V2.x activity and roles.

There is increased use of OBX segments as "Z segments" in V2.x (eg. in prescription messages) where there are insufficient defined data items.  This may not promote interoperability as no-one else apart from specific vendors may define the data in the same way.

The is discussion regarding introducing null value flavours as defined for HL7 V3 into HL7 V2.7 or V2.8. This hasn't yet been agreed; one suggestion is that this could be achieved via escape sequences.  Some vendors supporting both V2.x and V3 want to be able to send the same null value in both the V2.x and V3 messages.  Open questions: Are all HL7 data types able to support escape sequences?  If implemented in HL7 V2.7 or V2.8 will vendors also use in earlier versions of HL7 2.x?


Clinical Document Architecture "CDA"  (Grahame Grieve, Vince McCauley)
Requirements continue to be gathered for CDA Release 3 and proposals can be made at www.HL7.org/memonly/cdasub.cfm.

CDA Release 3 ("CDA R3") will be developed in parallel with CCD Release 2 which will be based on CDA R3.  CDA R3 will incorporate the new datatypes and ITS (Grahame Grieve's work).

A whole session was spent discussing terminology - ostensibly in the context of a US Realm specific Public Health document but the debate became considerably wider.  For HL7 the debate was very contentious and chaired by the incoming HL7 Chair Bob Dolin.  The Regenstrief Institute (LOINC), IHTSDO (SNOMED) were represented at the meeting.  The outcomes were:
- use LOINC for Laboratory results (no-one and no country suggested otherwise - SNOMED in current form is not suitable for a broad lab terminology)
- for clinical: If concept only in one then use it.  If concept in clinical LOINC and SNOMED then publish and preferably incorporate both in data. 
Stan Huff (Intermountain Healthcare, Salt Lake City) suggested that the agreement with IHTSDO to harmonise LOINC and SNOMED may be signed in April 2009.  It will then take at least 2 years work to develop a workable map between both terminologies.


Service-Oriented Architecture "SOA"  (Vince McCauley, Andy Bond)
The Entity Identity Service ("EIS") work has been completed by OMG.  Documentation needs to be completed in the next 4 weeks for the final normative HL7 ballot before the HL7 WGM in May in Kyoto.  EIS incorporates person, provider and organisation identity.  EIS represents the first output of the Healthcare Services Specification Project ("HSSP") formed 2 years ago as a joint HL7/OMG process.

The Clinical Decision support Service specification is being worked on at OMG but will not be complete until July/August 2009.  The Record, Locate, Update Service (RLUS) is currently at the Finalisation Committee in OMG but will probably not go to normative ballot in HL7 until September 2009.  Considerable time is being consumed in discussing the HL7 wide SAEAF process to move the organisation to a service oriented approach.  The draft document presented at Vancouver has been released in its final form and its implications for the Working Groups structure and the standards development process are being considered and absorbed. Services for financial, terminology and other committees are under discussion

The opportunity of the SAEAF and future impact on the HL7 work program, the HL7 SOA framework and future service specifications and related Open Health tools (OHT) architecture implementation is being reviewed for Australia's national program.

V2.x & V3 Patient administration (Klaus Veil)
V2.7 Ballot resolution successful - ready to publish if other chapters are ready too
New V3 content for organisation registries, etc being added


V2.x & V3 Publishing (Klaus Veil)
V2.7 is ready for publication if all negative ballots are resolved at this meeting
I believe next V3 release will be 2010 Edition 

Certification / Compliance / IHE (Klaus Veil, Vince McCauley, Andy Bond)
Meetings were held with IHE Board members and good progress made to solve the remaining questions regarding IHE Australia.

We believe that the setting up of IHE Australia will allow us to have national certification approaches including coordinated international profiles of use without having to take up IHE profiles and approaches that are inappropriate for Australia


Security/Privacy/Access Control  (Julia Davis)
The security working group are currently only covering digital signing for CDA.  Need to establish if this is also going to cover HL7 V3 and whether the same standard can then be applied to V2.x but it appears that HL7 V2.x messages are not in scope for the security working group.
 

Patient Care & Patient Referral  (Max Walker, David Rowed)
- Presented HSSP Human Services Directory Project
- Conducted HL7 V2.7 3rd Ballot Reconciliation for Chapters 11 & 12 in Community Based Collaborative Care Working Group (CBCC)
- Participated in discussions in clarifying and defining Profiles for the HSSP Projects (and in particular PASS)
- Consent Directive Domain Analysis Model ("DAM") ballot is also being resolved in CBCC.
- Public Health & Emergency Response are doing a project on Vital Statistics (and, of course Vital Records) which has a thrust of getting the data from it's original owner, i.e. source it from the source. This is of particular interest in the context data collections.
- The Detailed Clinical Model (DCM) project has now been incorporated firmly within the Patient Care working group. There is a focus here on the usage and implementation of SNOMED-CT. It would therefore seem that NEHTA should be involved.


Implementation & Conformance Work Group
<meets later this week>

Electronic Health Record (EHR) & SDO Harmonisation (Renati Barel)
Child Health Functional Profile was approved by ANSI as a Standard

PHRS was approved by ANSI as a Draft Standard for Trial Use (DSTU)

EHR-S Functional Model: With ISO Central Secretariat for preparation for ballot.  Should go out for combined HL7/ISO DIS Ballot by March or April 09.

PHR: Two work items came from the ISO TC215 WG8 meeting in Istanbul (October 2008)
  o PHR, definition scope and context
  o Business requirements for e-health standards in developing countries

EHR Interoperability Group – Reference profile for CDA: 51 of the 56 EHR Requirements for interoperability were mapped.

Discussion on proposal for a new project at ISO: Business requirements for an e-Health enterprise architecture for the Global South (Proposed by Beatriz Leao, TC215 WG8 Vice Convenor) - Chris Bailey (WHO and Ed Hammond (HL7) are also interested in this work item

Clinical Interoperability Council (Vince McCauley)
The Council meets formally on Thursday (tomorrow).  However informal discussion suggest that the major issue will be what formalism should be adopted for representing clinical information in a format that can be imported to HL7 artefacts but readily accessible by clinicians.  Some initial work in this area has been going on in the Detailed Clinical Modelling group. There will also be discussion around work to expand the Clinical statement used as a common element in CDA and message models as to scope and utility.

Infrastructure & Messaging Work Group "INM" - Data Types (Grahame Grieve)
The formal responsibility for data types is moving from INM to MnM. This is the first of a series of committee adjustments prompted by the SAEAF organisation and architectural vision.  The datatypes are going out for one last ballot cycle, before the ISO datatypes are finalised.  The exact dates are not yet clear.

In addition, INM has just registered the mime types application/hl7-v2, application/hl7-v2+xml, application/hl7-v3+xml, and application/hl7-spl+xml with IANA.

The INM chapters of V2.7 have all passed ballot.
 
Data Type ballot reconciliation discussions were positive and most comments were resolved with the exception of some issues that relate to name/identification.

There is some proposals for very substantiative change in V2.8, particularly the introduction of V3 nullFlavors to V2.8 (see also above).  This would result in a series of sweeping changes to V2.x, which may stretch the definition of backwards compatible (quite a lot).  Opinions on the question of nullFlavors or substantial change to V2.8 are welcome (to grahame@kestral.com.au).
 
 
Vocabulary (Heather Grain)
The Core Principles Document is being refined to support facilitators and technical committees to consistently apply vocabulary to message and model specifications.  It was agreed that an additional piece of work is required to provide guidance and consistent approaches for implementers and affiliates to support implementation conformance.
 
Constraint Vocabulary: committee agrees that a mechanism to allow constraint of value sets and their bindings is required.

Compositional Grammar:  IHTSDO is consulting HL7 about the grammar of terminology messages and considerable effort has been put into this at this meeting.
 
Community-Based Collaborative Care (CBCC) are addressing vocabulary requirements of HL7 models for electronic privacy policies and consent directives (epolicy and econsent).  Vocabulary harmonisation proposals are being prepared and will need to be carefully reviewed to ensure that they reflect Australian requirements.
 
Code Conformance: rules have been established to support identification of maximum data sets and specification of minimum sets for a purpose that clarify whether a receiving system will accept, ignore or reject content.
 
SNOMED-CT/LOINC: when a new concept is identified in LOINC, IHTSDO will be informed and update SNOMED-CT to ensure that concepts (at least those developed in the future) will be able to pass through mapping without degradation and messaging processes can be consistent.  It is recognised that it will take some time to affect changes for existing concepts.
 
Code System vs Identifiers:  this discussion is still in progress but there are issues around the process of management for valuesets that can be both codesystems and identifiers.
 
 
HL7-ISO-CEN SDO Harmonisation (Renati Barel, Heather Grain, Klaus Veil)
The Joint Working Group on SDO Harmonisation met on Sunday 11 January 2009.
 
There were 60 attendees from Australia, Brazil, Canada, Finland, France, Germany, Greece, India, Japan, Korea, Sweden, Switzerland, The Netherlands, United Kingdom, United States, EU, CEN TC251, CDISC, HL7, ICH, IHTSDO and ISO TC 215
 
SKMT Standards Document Register and Glossary Final Development - Trial has started for the web based tool
 
13606 and HL7 V3 implementation guide project was approved by Joint Initiative Council and is awaiting funding or volunteer availability and confirmation of a lead

Data Types: There was discussion on the publication process and a possible move to publishing as HTML as this publication will need to be renewed every year.
 
ICSR: on schedule to be published
 
IDMP: Discussed whether this should be a Joint work item and agreed to continue the discussion on the formal approval of IDMP as a joint work item at a later date.
 
Glossary: Undertaken by Canada and Australia.  Approved work item.  Some limited funding has been provided by Canada to support the open web based tool development for the standard document registry and glossary
 
Clinical Data Modelling: Awaiting acceptance of the votes at the Edinburgh ISO/CEN meeting
 
New work item IHTSDO/ISO Medical device term coordination was proposed and will be taken forward to JIC
 
Ballot cycle coordination: A process to  harmonize the balloting cycles across the 5 Standards development organizations is required
 

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