HL7 DEV WG / IEEE 11073 WG Joint Working Group Meetings

May 6 - 10, 2013 @ Sheraton Atlanta, GA

Sunday   Note:  Official WG meetings do not begin until Monday Q2

Monday - Q1No WGM

Monday - Q2Welcome and Introductions:

John Rhoads - Philips Healthcare - john.rhoads@philips.com John Garguilo - NIST - john.garguilo@nist.gov Paul Schluter - GE Healthcare - paul.schluter@med.ge.com Masaki Hirai - Nihon Kohden - Masaki_Hirai@nifty.com

Jan Wittenber - Philips Healthcare - jan.wittenber@philips.com Allen Hobbs - Kaiser Permanente - allen.hobbs@kp.org Ken Fuchs - Mindray NA - ken.fuchs@ieee.org Trish Williams - HL7 Australia - trish.williams@ecu.edu.au Dmytro Rud - Roche Diagnostics (Switzerland) - dmytro.rud@roche.com

Reviewed and Accepted Agenda

Reviewed and Accepted Minutes of January Meeting

** Ken F. to collect action items which will be reviewed Tuesday

Review of Ventilator Nomenclature Issues

Paul S. demonstrated that there are many synonyms in current standard.  We need better guidelines and possibly consider deprecating some of these terms.

Monday - Q3

+Todd Cooper - Breakthrough Solutions / WestHealth - toddcooperafc@gmail.com +Tracy Rausch (on phone) - DocBox - tracy@docboxinc.com +John House (on phone) - KP (retired) -  - Trish Williams - Dmytro Rud

ICE Update:

Tracy Rausch & John House (On WebEx) Displayed MDC_UML_StdsFrmwk_jw3f.pdf (from wiki http://mdcx73-

working.wikispaces.com/MDCx73-Harmzn-MDSoS ... "Harmonization Framework (1)")  ICE group is focused on the "Ext. SCADA" (right side) rectangle, generating IDL for the

interfaces to the elements to the left Unfortunately lost WebEx connection; Jan W. continued discussion of the MDSoS slides set.

Monday - Q4

Ken F. collected action items from Phonix minutes.   The items were reviewed and status updated. See "Action Items Review - Atlanta - 2013-05"..." at

http://mdcx73-working.wikispaces.com/MDCx73_Meetings_May2013-Phoenix

Tuesday - Q1Welcome and Introductions:

John Rhoads - Philips Healthcare - john.rhoads@philips.com John Garguilo - NIST - john.garguilo@nist.gov Paul Schluter - GE Healthcare - paul.schluter@med.ge.com Jan Wittenber - Philips Healthcare - jan.wittenber@philips.com Allen Hobbs - Kaiser Permanente - allen.hobbs@kp.org Ken Fuchs - Mindray NA - ken.fuchs@ieee.org Jeff Rinda - Hospira - jeff.rinda@hospira.com Kathryn Bennett - IEEE - k.bennett@ieee,org Art Grieser - Prometheus Computing - a.griesser@prometheuscomputing.com Todd Cooper - Breakthrough Solutions / WestHealth - toddcooperafc@gmail.com

Co-Chair Update

Need to support SAIF DIscussion about disposition of negative comments Scolded for not getting minutes in on-time from Phoenix meeting Ioana S. needs to complete the Detailed Clinical Models (DCM) project work.  The Clinical

Information Modelling Initiative (CIMI) work may end up superceding the DCM work. More information @ http://informatics.mayo.edu/CIMI/index.php/Main_Page

Patient Care WG wants to support all other WGs in providing clinical input to them. They were advised that they should do some active outreach to the WGs and develop relationships with them

Martin H. proposes that HCD to take over Project.  WebEx arranged for Thursday. Reaffirmation of the HL7 part of the Annotated ECG is held up by FDA.  Paul S. to participate in

conf. call with other HL7 WGs and FDA to resolve.

IEEE Update

10101a Ballot Group formed and in balance Central Desktop will be demo'd at next Status Telecon (6/28).  May transition many of these

functions to Google Tools in the future WG stated their appreciation for the work that Kathryn has done on our behalf See file "11073 Update.pptx" at

http://mdcx73-working.wikispaces.com/MDCx73_Meetings_May2013-Phoenix See file "PAR-STD Report as-of-5-6-2013.xls" at

http://mdcx73-working.wikispaces.com/MDCx73_Meetings_May2013-Phoenix

ISO TC215 Update

Process of promoting IEEE 11073 Standards to ISO approval has been broken but is hopefully fixed.  Moved to a relatively automatic process.

Joe Llewelling should be kept in the loop regarding any ISO TC215 devices topics. Discussion concerning ISO requirement that delegates not pay for attendance at meetings.

** Todd to follow up (how to make these joint IEEE/HL7/ISO meetings)

IEEE 802 Coordination

Discussion of AAMI comment to FCC 5 GHz NPRM concerning additional spectrum allocation to ISM band.  Kathryn mentioned that there will be an 802.11 telecon on this topic and Ken could talk to the group or at least listen to the discussion.

Discussion of whether we should continue to pursue tutorial at 802.11 meeting.  Right now it seems the "wind is out of the sails".  While there is some possible work we could do in this regard, x73 does not really have the bandwidth at this time so it is difficult to justify additional work without strong demand from 802.15.4.

Tuesday - Q2

+ Kurella Murty - Roche - kurella.murty@ventana.roche.com

NIST Tooling Update

See posted presentation on MDCx73 wiki for Atlanta meeting "NIST_HL7_IEEE_Update_7_May_2013_Atlanta.pptx"

Question (from Monday for Art) --> what's the status of DIM UML --> generation of standard 10202?

Answer: Need to figure out how to Inject into Word Doc (Todd has example, which was emailed to NIST/Art/John G.)

**Outcome should be tied to IEEE new publications formats as identified (per Kathryn's update presentation)

10202 (electronic version of DIM): Equivalent XML (withdrawn)

**Possible New Par: UML + Companion Standards for syntactic representations (e.g., XML, JSON) + automated tooling(?)

Jan noted current “open window” w/in IEEE publication (e.g., repository IEEE is looking at to facilitate this kind of publication process…)

•Tiger Team **Art work w/ IEEE (Kathryn + Dom Messina(?)) ** Get Todd’s example (word doc infusion) - Completed

Tuesday - Q3

Test and Tooliing Discussion

Overview of NIST Tooling efforts.  See presentation " Cucumber and Gherkin

Tuesday - Q4

+ Barry Brown - Mortara - barrybrown@mortara.com

Gap Analysis Review

See Art Griesser's document provided prior to start of WG meetings (entitled: "DIM Gap Analysis v3.docx")

In general agreement by the WG of Art's findings (see recommendations for improvement table in document) - Much discussion around the

"Self Description" recommendation

Barry Brown - Mortara - presented "External File Reference Varialbles.docx"

 Mead Walker worked with Barry to look at aECG and decided no changes would need to be made in RMIM

Long Term aECG data records approach ** Documents to be updated

FDASIA Update (Todd Cooper)

FDA Safety & Innovation Act Working Group Charter:  Develop a report that contains a proposed strategy and recommendations on an

appropriate, risk-based regulatory framework pertaining to health information technology, including mobile medical applications, that promotes innovation, protects patient safety, and avoids regulatory duplication.

There are three working groups: Taxonomy of Clinical Systems - which clinical systems should fall under proposed

regulations?  In other words, establish the scope of technologies Risk Assessment & Innovation - identify the risk-based framework that will ensure

appropriate levels of safety while at the same time not overly impacting innovation Regulatory - Identifying "regulatory features" that may be used to effect the risk-based

framework for the identified clinical systems Initial drafting of recommendations due to the U.S. ONC Policy Committee by early August, with

a final draft by early September, 2013.

Mobile Health Update (Alan Hobbs)

Primarily keeping Application and exchange at high level so looking forward to meeting with mHealth group on Thursday

Device Security and Telemetrics Update (Alan Hobbs)

Looking at implants (slides presented "Design Challenges for Secure Implantable Medical Devices" - provided by Alan)

Security and Privacy in Implantable Medical Devices Security Goals for IMD Design Alan reference paper (to be provided in minutes) Telematics and Digital Health (Sensor/acuator control system in car w/ mobile capabilities)

Black box - autonomous Vehicles (e.g., Google Car in California)

Wednesday - Q1Welcome and Introductions:

John Rhoads - Philips Healthcare - john.rhoads@philips.com John Garguilo - NIST - john.garguilo@nist.gov Paul Schluter - GE Healthcare - paul.schluter@med.ge.com Jan Wittenber - Philips Healthcare - jan.wittenber@philips.com Allen Hobbs - Kaiser Permanente - allen.hobbs@kp.org Ken Fuchs - Mindray NA - ken.fuchs@ieee.org Jeff Rinda - Hospira - jeff.rinda@hospira.com Kathryn Bennett - IEEE - k.bennett@ieee,org Art Grieser - Prometheus Computing - a.griesser@prometheuscomputing.com Vivek Kamath (via WebEx) - WestHealth - vpkamath@westhealth.org Todd Cooper - Breakthrough Solutions / WestHealth - toddcooperafc@gmail.com Jim Beggs (via WebEx) - WestHealth - jpbeggs@westhealth.com

Common Networking Services - 20401

Discussion over whether QoS can be addressed in this project Review of Vivek's powerpoint presentation; posted to the MDCx73 Wiki as "IEEE 11073 20401

Atlanta Update r4". 

Wednesday - Q2

+Clem McDonald - NIH NLM - clemmcdonald@nlm.nih.gov

Simplified / Harmonized Association (POC)

Review of Jim Begg's presentation; posted to the MDCx73 Wiki as "improved_11073_assoc"

Nomenclature & Specializations - Ventilator

Ventilator "Mode" will not be addressed on this pass due to complexity and lack of harmonization. Should the newly defined CONC_GASDLV terms use the same codes as the previous

CONC_VENT terms? Default site, if not specified, will be Fresh Gas (measured at the common gas outlet)

Need to assess whether the default for CONC_GASDLV should be "Unknown" or "Fresh Gas" See updated document from Paul S. posted to MDCx73 Wiki - "GasREFIDs.3a.docx"

Wednesday - Q3

+Clem McDonald - NIH NLM - clemmcdonald@nlm.nih.gov +Masaki Hirai - Nihon Kohden - Masaki_Hirai@nifty.com +Muhammad Asim - Philips HC - muhammad.asim@philips.com

Nomenclature & Specializations - Infusor

Reviewed document on PCA terms Reviewed document on Pump Modes

Recommended to deprecate pca-and-continuous Recommended to replace -bolus with -clinician dose

Wednesday - Q4

FHIR Update:+Graeme Grieve - Joint w/FHIR+David Hay - HL7 NZ - david.hay@gmail.com+James Agnew - james.agnew@van.ca+ Eliot Muin - Interfaceware - eliot.muir@interfaceware.com+Rolin Cabrita - Interfaceware - rolim.cabrita@interfaceware

Reviewed Graeme's Resources developed for "device" Discuss published Joint Device Resources **Agreed to provide Graeme the UML model (developed by Art Griesser) which may shed light

on resouce relationships  **Timing: FHIR will be balloted in Sept 2013 - Agreed to continue work to have HCD joint

project included in that goal **HCD WG to provide a list of attributes of MDS, VMD, Channels and metrics **Suggested that Graeme provide a more detailed tutorial to HCD WG members

Wednesday - Q5

Wittenber, Garguilo, Griesser, Cooper, Schluter, Rhoads

Harmonization (3) - MDCx73 Wiki "MDSoS"

Jan W. provide an overview of MDCx73 Wiki and walked through and explained the various MD SoS documents

Thursday - Q1Welcome and Introductions:

John Garguilo - NIST - john.garguilo@nist.gov John Rhoads - Philips Healthcare - john.rhoads@philips.com Paul Schluter - GE Healthcare - paul.schluter@med.ge.com Jan Wittenber - Philips Healthcare - jan.wittenber@philips.com Allen Hobbs - Kaiser Permanente - allen.hobbs@kp.org Art Grieser - Prometheus Computing - a.griesser@prometheuscomputing.com Todd Cooper - Breakthrough Solutions / WestHealth - toddcooperafc@gmail.com

GAS (Anesthesia WG) Update (Martin Hurrel)

+Martin Hurrell (via WebEx) +John Walsh (via WebEx)  Discussion by Martin on HD taking the leadership role on project (over from Gas Group); Project

850 Other related groups - Co-Sponsors: Patient Care, Structured Docs, (mention of Emergency Care),

HD [now leader] Project 513: Gas, HD, Structured Docs (Gas participants: John Walsh, Martin, Terry Monk) Summary - Martin/GAS will look into how the device WG take over leadership - Anesthesia

(GAS) will update project scope statement and send to Melba where/how it goes from there; John

Walsh will send a CDA doc to show instances; GAS will provide as much information as they are able to provide.

ICE-PAC Update 

+Tracy Rausch, Doc Box, Inc. (via WebEx) Tracy showed diagram (EA) tied to the ICE side of Jan W's SoS diagram Need further elaboration on exactly what is the patient ID data ICE needs.... More discussion on this and related threads will continue on Monday afternoon ICE-PAC calls

Slide presentation on Patient ID/Association (John Rhoads)

See slide set from John (spilled over into Q2

Thursday - Q2Continued - Slide presentation on Patient ID/Association (John Rhoads)

See slide set from John (spilled over into Q2)

Update on CCHD and EHDI Implementation Guide - Harminonzation (4)  (Ken Pool) 

+Ken Pool. Ken will send to HD a detailed use-case (several?) which include a derivation to the Patient

association process from the child care viewpoint. Two re-ballots reconciled; will be posted to HL7 listserv for public comment Ken hopes to ask HD to carry these back across the hall to IHE as specific profiles...with a richer

message definition Ken noted Eric Hoss provided a lot of feedback to provisions allowing conformance...

 PHD Update (Jan W. via Daidi's slides set provided)

+Daidi, Michael Kirwan, and others on PHD TCon See slides Possiblility of joint meeting w/ PHD and PoC/PCD being explored (in Oct '13)

HD to provide an idea of folks who could attend to PHD (Michael Kirwan).

Harmonization (5) - PHD Status/Update (TCon)

 Nomenclature Paul noted probably don't need PHD in time for 10101a, but when done needs to be in

Rosetta (much is already captured in WAN section of Continua Guidelines) PHD should institute practice of capturing all co-constraints (to be added to RTMMS), i.e.,

not just partial terminology piece but everthing needed such as units (chemistry/physics), enums, body sites, etc.

 Association Jan W. had a list of canidates for agenda (given to PHD group, see bullets below)

Joining up in Geneva for a joint meeting (what procedurally would need to be done/ who's intrested)

x73-10101 Nomenclature and 10102 DIM revisions (balloting projected @ post-HIMSS (Feb '14)

x73 Association and -20401 (Common Networking Services) Harminzation (w/ Malcolme's help?)

Home<===>Hospital (H2H) application x73-HL7 FHIR device-related "resource" development

See Jan W's notes for summary of discussion around the above points Prospective ‘tiger team’ focal areas @ our discussion @ PHD tCon today

1.       X73-10101 Nomenclature and -10102 Domain Information Model (DIM) revision (balloting projected @ Fall’13 and Spring’14, respectively) 

2.       Command and Control harmonization 3.       X73 Association and -20401 (Common Networking Services) harmonization; 4.       “Home<== ==>Hospital (H2H) application;  5.       X73-HL7 FHIR Device-related “resource” development;  We had some in-depth discussion @ 1&2 on the tCon, both affirming relevance and

willingness to participate; and inter-Jan’13-May’13 F2Fs on 3&4, affirmed by Malcolm individually; 5 is a bit too recent for harmonization @ PHD/PoC WGs.

Additional notes from Jan Wittenber on these topics:“This page includes descriptions of inter-standard, or "Harmonization"-related models, generally dealing with systems of MDS-based systems (aka "MDSoS" @ "Model of Models (MoM) approach), to facilitate UML-based model and related tooling development, addressing main MDPnP Clinical Scenarios.

The first model set includes UML-based, detailed models of the Upper Layers (UL), particularly w.r.t. the "Medical Device Information Base (MDIB) as a basis for extended modeling of Event processing and namespace architecture in the [Mechanical] Ventilation* modality. See Harmonization Framework (1)...*See Vent DAM (Domain Analysis Model) and DCM modeling documents for additional UML definition; see related worksheets on mapping Gas-related variable nomenclature described in the Harmonization Framework document..

The second set develops a model of the PCA Infusion modality in particular, followed by description of a series of topological 'building blocks'; see Harmonization Framework (2).

The third set pertains to "Alert" harmonization between IEEE 11073 and IHE PCD; see Harmonization Framework (3) and related workbook (.xlsx; for snapshots of worksheets, see "x73_DIM", "AlertMapping"(and "Closeup"), :"x73nomenclature", and "harmonizedRosetta", the latter two being snapshots of nomenclature .csv downloads from the NIST RTMMS tool, the full downloads of which are in the corresponding worksheets.

The last set pertains to a work item coming out of the January, 2013 JWG F2F, involving harmonization with HL7 HCD JWGs with FHIR and Mobile Health (refer to "Home-to-Hospital Transfer (HHT)" for x73-related UML harmonization framework). Refer also to page MDCx73_Harmnzn for documents related to "Rapid Device Configuration" (RDC)", including UML and MDIB Emulation.”  

Thursday - Q3(Garguilo, Wittenber, Rhoads, Schluter, Hobbs)Action/planning (2) - "Tiger Teams"

Several planning roadmaps IHE-PCD cycle CP / TF updates ACSE/CNS West Health (resources tied to Pre-Connectathon + Connection + other endeavors) **Nomenclature ICE GAS (Anesthesia) Resources across all of the above + more (including standards work + ballot + scheduling) 

need to look at priorities or get more involved... FHIR **Containment Tree, Nomenclature + Co-constraints (with cardinality)

Cardinality (two-flavors: device or use-case(s))

Thursday - Q4(Garguilo, Hobbs, Wittenber, Schluter, Rhoads)

Joint w/Mobile Health (Gora Datta, Matthew Graham)www.hl7.org/Special/committees/mobile/index.cfm+ Gora Datta (Co-Chairs) CAL2CAL - gora@cal2cal.com+ Matthew Graham (Co-Chair) (Mayo) - graham.matthew@mayo.edu+ Dmytro Rud (Roche) - dymytro.rud@roche.com+ Allen Hobbs - allen.hobbs@kp.org+ Sasha Bojicre (?) (CHI) sbojicre@infoway.ca+ Laurie Williams - vlgwilliams@aol.com+ Daniel Henzi - daniel.henzi@standards.org.ca+ Lenel James (BCBSA) - lenel.james@bcbsa.com+ Ann Wrightson - ann.wrightson@wales.nhs.uk

Introductions See slide set provided (from Matthew Graham) Mobile Health is evolving both in U.S. and Internationally

Within HL7 international regions, two major themes - one is mobile health (Africa/Algeria)

Biggest problem is PHR<===> EHR, most apps are linked of health network... In past there was/is a massive gap of mobile health (being included in each individual work area). There are many factors that come into play in the mobile Poliferation of ideas / channels - telecommunication may be form factored to phone...

Gora cautioned going beyond the form factor - innovation which are taking place (e.g., breather tube which sends a signal when dose delivered

MH is expected that HD to perhaps outline the standards Thus, use cases should developed (by MH) - these are the use cases Curb-side medicine (docs are often not reimbursed) - but the reality is this should be paid

and be good Tele-health - CMS / VA - variety of experiments of playing with tele-health in which doc isn't

always tethered to physical location Alan suggested mapping standards  to laws/layers of standards which are adaptable to the

requirements of use cases (complications in which the usage will be enabled - HD would need to look at devices enabling all possibilities...

Use cases HD group is usually most concerned with are real-time/near real-time MD is also interested in HD knowledge of Regulations Actions

MH develop Use Cases Come together and look at a matrix of use cases mapped to standards Next WG meeting (Sept) have a joing presentation MH meets every Friday (11 am) Gora suggested a once-a-month meeting with HD Keep this as a joing WG meeting (Thursday, Q4)

The group determined that there was no need for general sessions in Friday Q1 and Q2, and that the time could be made available for small task group sessions.

General meeting adjourned.