Tuesday, January 22, 2019

The January HL7 Working Group Meeting

HL7 Working Group meetings are a phenomenal way of keeping up with what HL7 is doing. The biggest challenge I have is that I cannot be everywhere at once.  January is also the HL7 Payer Summit, and so there is a lot of activity going on.

The working group meeting starts on Saturday with two activities: The FHIR Connectathon, and the International Council meetings.  I didn't go to either this year, but heard we had about 240 people at the 20th FHIR Connectathon.  I expect to be at the next Connectathon.  For a variety of reasons, a lot of payers were in attendance at the FHIR Connectathon trying out some of the new Da Vinci profiles (e.g., CRD).

While I had some minor challenges with my flight out on Sunday (for some reason my expense application notified me of flight cancellation, but United completely failed to let me know until I arrived at the airport), I did arrive just in time for the working group meeting "proper", the Monday to Thursday (and sometimes Friday) meetings that make up the bulk of HL7 activities.

Structured Documents reviews their plan for the week first thing Monday morning, and I make mine.  I still consider SDWG to be my "home committee", but my interests are too divergent to spend time with any single group.  My plan for the week was to spend some time with SDWG, CQI and CDS, Patient Care in a large joint meeting with CQI and CDS and others, Attachments (another "old home"), and FHIR-I (joint with SDWG). Structured Documents is one of the work groups piloting the use of Confluence to capture the WGM activities.  You can see the output from SD here, including the results of the Wednesday morning, and Wednesday afternoon sessions that I also attended. 


The Monday joint meeting with Patient Care discussed a new Provenance project, which several workgroups have interest in.  PC was going to sign on as a "Interested Party", a commitment with no actual governance associated with it, and there was some ongoing discussion during the week between the Security Workgroup, the Community Based Care and Privacy workgroup (formerly Community Based Collaborative Care, renamed to effect what has been the reality for this workgroup over the last half-decade) about who might become primary sponsor.  I had suggested the EHR workgroup (not even in the room at the time, but the one workgroup who had published functional requirements on Provenance, but they later declined).  It eventually wound up I think, with Patient Care as a sponsor (a role that does provide project governance).


I got to spend some time with attachments at their joint meeting in the Payer Summit and hear from Steve Posnack and folks from the CARIN Alliance, and where I popped in for a a few other meetings to hear what is going on.  Attachments is very closely following the Da Vinci project, so it is a good place if you aren't a member of the Da Vinci project to learn about what is going on there.  There are a number of payers and clearing houses working on Coverage Requirements Discovery, a topic I have some interest in.  It's basically a "pre-prior-auth" sort of specification, that basically allows a provider to ask a payer what data requirements a payer has to cover care for a given condition (including the need for a prior-auth, since there are no "standards" for what does require one).  FHIR has got payers excited, and for good reasons.  It's allowing them to modernize a HealthIT infrastructure that's long been in need of rejuvenation.

Da Vinci

Da Vinci has several projects going on.  I'm not specifically a member of the Da Vinci project (it too requires a membership fee, and I've got a limited budget).  Even so, many of the Da Vinci specifications are being balloted in HL7 projects, and you can follow them through their sponsoring workgroups, including:

The eHDX project was discussed somewhat in the Patient Care joint meeting.

SD to be Cleaning up the Template Publication Format

Wednesday morning I found myself in a discussion of a topic that I complained about on Twitter and FB a year ago, the use of PDF (or other document formats for multi-ream documents (if printed).  SD won't do that any more after projects in flight are finished (you can't retroactively make a project do more work than they've committed to, HL7 would never get anything done, they learned that from V3).  I nudged that one along after Bret complained ("can you perhaps state that as a motion"), which I quickly seconded.  We spent a lot of time working out the exact wording of the motions, and the follow-on details, but just about everyone was on board with this. 

Technically, this is not as huge a challenge as it once was.  Later in the week Structured Documents assimilated the Templates workgroup, and the FHIR StructureDefinition and ImplementationGuide resources can handle most of the heavy lifting publication needs that the former V3 Templates specification was supposed to help with.  Between the publication of CDA R2 as a StructureDefinition, and the aforementioned resources, CDA templates can be published using FHIR IG tooling with perhaps some modest changes being needed.  I'm still using Trifolia as my de-facto reference for C-CDA templates until HL7 fixes this problem.

HSP Marketplace

No plan stays the same once the battle is engaged, and I found myself in other places, most notably a quarter with the SOA workgroup "battling" out my feedback on the Health Services Platform Marketplace negative.  As battles go, this one was mild, since the workgroup took most of my feedback into account.  The biggest discussion was around Chapter 4, the API, in which my major comment was simply put: "Use API documentation tools to document the API", and "describe your concepts better", again, they agreed in general, and we spent most of our time arguing the specifics.  The HSP Markeplace is shaping up, but I think it still has a long way to go.

V2 to FHIR

I also spent time with Orders and Observations (a.k.a, O&O, or simply OO), on the V2 to FHIR specification.  I spent the last half hour of one meeting unsuccessfully trying to find out what was going there and failed due to agenda overload, but DID get a good overview Wednesday afternoon.  This one has meat on its bones, and offers incredible value as Healthcare organizations figure out the many and various ways to get data into FHIR format.  I also spent Thursday morning 7-8am with several supporters of this project to talk about the tooling needed for this specification.    We agreed in principle to use the FHIR ConceptMap or StructureMap to capture the results of this effort, so that the end result will be computable. I am clearly going to be spending more time with this group, as this is directly related to my current work.

What I Missed

I had plans to spend time with both the Clinical Decision Support and the Clinical Quality Information workgroups this time around and failed because a 30 minute diversion (SOA) turned into the entire quarter, and OO's V2 FHIR project was more immediately compelling.  The case for cloning is never stronger than attending an HL7 Working group meeting.  I also missed out on some discussions in Public Health (formerly Public Health and Emergency Response, but the latter simply folds into the former), and Infrastructure and Messaging (InM) [which simply had nothing on their agenda to which I needed to pay immediate attention].  I'm certain I'll have to spend time with these groups at future meetings.



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