September+19+2012+Agenda+and+Meeting+Minutes

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 * Date: September 19, 2012**
 * Name:** Public Health Reporting Initiative Web Conference

Live Meeting: []
 * Location:** Conference Call: 1-866-842-6975; passcode: 218840#

**Agenda/Objectives:**

 * **Topic** ||= **Time Allotted** ||
 * Welcome / Agenda Overview - Lindsay Brown ||= 4:00 - 4:05 ||
 * HL7 Thoughts ||= 4:05 - 4:15 ||
 * Consensus Review ||= 4:15 - 4:30 ||
 * Data Harmonization Update - Nikolay Lipskiy ||= 4:30 - 4:35 ||
 * Stage 3 Sprint Update - Seth Foldy ||= 4:35 - 4:40 ||
 * Federal Health Information Model Presentation - Galen Mulrooney ||= 4:40 - 5:00 ||
 * Adjourn ||= 5:00 ||

**Meeting Minutes**

 * __HL7 Working Group Meeting __**
 * Thoughts and impressions from members who attended
 * Lise Stevens: Participated in the Patient Safety and a joint meeting with Public Health Emergency Response. People showed great interest in what we’re doing, our final deliverable, and how it can be applied or referenced compared to other activities organizations may have in place today.
 * John Ritter: EHR system functional model (including the public health reporting) is up for ballot. PHR system function model (including public health facing sides and functions) is also up for ballot and closes on Monday. The Mobile Health Workgroup within the HL7 workgroup is new. It is envisioning how public health is related to EHRs, public health surveillance, statistics, and social networking.
 * PHER: Had two ballots out for comments –EDHI and CCHD—will be re-balloting for next cycle. See documents and please ballot.
 * __Consensus Update & Review __**
 * Consensus Statement: The general consensus of the Public Health Reporting Initiative is that the Use Case and Functional Requirements documents are complete and correct in their representation of a provider-initiated report from an EHR system to a public health agency system (within the constraints of the scope of the Initiative).
 * Votes Received:
 * 8 were ‘yes’
 * 2 were ‘no’ with comments
 * Votes received from the following organizations:
 * FDA
 * PHDSC
 * Oregon Health Authority
 * FHA
 * Registry Widgets
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">iConnect Consulting
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">CDC – NCHS (x2), NIOSH, OSELS
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Process comment: Difficult to vote ‘yes’ and still include comments with the way voting was set up. Some felt they needed to vote “no” in order to make a minor comment.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">If you have any final comments, contact Lindsay Brown < <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 13.3333px;">lrbrown@cdc.gov <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">> by Friday, September 21, to share your comments if not discussed today.

<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">NCHS
 * __<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Consensus Review __**
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Comment || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Resolution || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Acceptance ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Suggest providing some clarification in the introduction paragraph to the user stories to indicate that these stories represent current process and proposed future flows. Readers may misinterpret the stories as representing current processes. This distinction is noted in Appendix A in the user story names. For example, in the Chronic Disease #1, it indicates 'future flow for NCHS'. || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Add to introductory section in both documents the following statement "Some of the user stories submitted for this initiative represent current workflow and information flows, but others represent a proposed future state." || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">9/12/12 - Yes ||

<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">iConnect
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Comment || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Resolution || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Acceptance ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Use Case document: page 6/32 - 3.0 -last sentence in first paragraph: delete 'to create' after 'pharmacy, etc.)': (e.g demographic, clinical, laboratory, pharmacy, etc) .. and send a report... || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Sentence would read: “In the context of this UC, the reporting process is facilitated by the healthcare provider’s EHR and assumes that the EHR system contains or is used to create all relevant information (e.g., demographic, clinical, laboratory, pharmacy, etc.) to send a report to a public health agency.” || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">9/19/12 - Yes ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">page 18/32 - 11.1.4 - 3rd sentence: add 'is' in front of 'determined': When an adverse event occurs and .. determined ... || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Sentence would read: “When an adverse event occurs and is determined to meet appropriate reporting criteria …” || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">9/19/12 - Yes ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">page 20/32 - bottom of page delete lone table header page || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Insert page break. || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">9/19/12 - Yes ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">23/32 - 12.0 first paragraph, last sentence: add 'and/' in front of 'or': ...requirements and may vary from condition-to-condition .. or jurisdiction-to-jurisdiction. || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Sentence would read: “The public health reporting criteria are based on specific jurisdictional or public health agency requirements and may vary from condition-to-condition and/or jurisdiction-to-jurisdiction. || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">9/19/12 - Yes ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Functional Requirements document: page 22/26 – last sentence before 6.0 remove second period at the end || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Remove. || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">9/19/12 - Yes ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">page 24/26 - table first row (reporting criteria) column description - 4th row: add 't' to 'definitions': definitions and add space after the comma || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Update formatting. || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">9/19/12 - Yes ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">It is my assumption, that the data elements document referenced in the Functional Requirements document will be voted on separately. Otherwise, I cannot approve the Functional Requirements document until that task has been completed. || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Add footnote to document that read “data elements not yet finalized or consensus approved”/ Note: footnote will be removed once data elements are consensus approved. || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">9/19/12 - Yes ||
 * vote successfully changed to a 'yes'

<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">NIOSH <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">NIOSH votes ‘no’ in acknowledgment of the absence of public health reporting of injuries and related acute health conditions from the Use Case. Public health reporting of injuries encompasses unintentional and intentional trauma, acute poisonings, and “medical misadventures” i.e., injuries arising from medical procedures. These outcomes may be either occupational or non-occupational in nature. While injury stakeholders (including occupational health) did not submit user stories describing the reporting of injuries for the PHRI process, public health reporting of injuries is within the scope of the Initiative. Generally, the Use Case document should note this limitation and suggest that future use case development by non-represented domains is appropriate. To communicate to the public health community that this initiative aims to represent the full range of public health reporting, injury should be mentioned specifically as a missing domain.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Comment || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Resolution || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Acceptance ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Use Case: To page 5, following the sentence beginning with “Future Use Cases that could be developed include..”, add: “As additional public health stakeholders become engaged in Standards and Interoperability Framework activities, use cases for domains not represented in this effort (e.g., injury) should be developed and incorporated into future public health reporting documents.” || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Will add || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Consensus - 9/19/12 ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Use Case: To page 15, under “11.1 User Story”, after the sentence beginning with “These user stories have been generalized..”, add: “PHRI acknowledges that not all domains were represented in this recent process, and that future efforts are needed to ensure that public health reporting standards also reflect the requirements of significant missing domains (e.g., injury). || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Possible resolution: The first sentence “The User Stories below are meant to be representative across the selected domains,” can be removed. || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Consensus 9/19/12 ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Functional Requirements: On page 3, strike the word “representative” from the sentence beginning “The PHRI use case was derived using a representative sample..” In that sentence, the meaning of the word “representative” is unclear and may suggest a process of selection among candidate domains or scenarios. As an alternative, the sentence could be re-written : “The PHRI use case was derived from current public health reporting scenarios submitted by participating public health domains.” || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Will update the functional requirements document to address the inclusion of additional domains in future stages (e.g., injury) || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Consensus 9/19/12 ||
 * Note that NIOSH will inform PHRI if the vote has successfully been changed to a 'yes' on Friday, Sept 21, 2012.


 * __<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Data Harmonization Update __**
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Data Harmonization: Finalizing remaining data elements and identifying ‘parking lot’ items this week. In 2 – 3 weeks, we should have a first logical information model based on FHIM.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Will investigate the inclusion of ‘medical devices’ as a common core data element category
 * **<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">In Progress ** || **<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Complete ** ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Health Problems || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Patient Contact Information ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Exposure || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Prayer Information ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Risk Factor || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Provider Information ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Injury || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Procedure ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Report MetaData || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Social History ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Patient Information || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Family History ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Encounter/Patient Visit || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Order/Diagnostic Test ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Facility Result || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Allergy/Adverse Event ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Specimen || <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Vital Sign Indicator ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Employment Information ||  ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Immunization ||  ||
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Medication ||  ||

<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Presenter: Galen Mulrooney <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">The Federal Health Information Model (FHIM) is an effort to create a logical information model, complete with terminology bindings, for use by Federal Health Architecture (FHA) partner agencies in their respective Enterprise Architecture programs. The FHIM models provide a common set of standards-aligned semantics which can be used in conjunction with Model-to-Model transformations to generate implementable artifacts. The Public Health Reporting Initiative is leveraging the FHIM both to define those data elements that are needed for public health reporting (especially those which are common across different reporting domains) and to accelerate implementations by providing usable software components to developers. For more information on the FHIM, and to view the FHIM itself, please see: www.fhims.org <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">FHIM fact sheet available on the wiki: <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 13.3333px;">
 * __<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Stage 3 Sprint Update __**
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Sprint Team: Reviewing draft implementation guidance for the first sections of the CDA and 2.5.1 draft documents
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Sprint team is going from the text implementation specification to clinical document architecture side of work.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Questions currently being discussed include:
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">To what extent will the new document reflect data elements that are not part of the harmonized common core?
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">What is the scope of the document? Exactly how many and which existing implementation guides and content profiles might be reflected?
 * __<span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Federal Health Information Model Presentation __**
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">FHIM is a collaborative effort of 23 different agencies.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">It is a federally sponsored effort, but it’s not limited to the confines of the government and aligns with standards allowing easy collaboration outside of the government.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Aligns closely with standards i.e., HL7, NCPDP, x12, NIEM and others.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">When FHIM first discovered the S&I Framework, FHIM was interested to see if PHRI workgroups wanted to leverage FHIM’s existing model.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">The data model general description
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Uses HL7 color schemes and design patterns to represent the elements in the UML model.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Uses object oriented programing model.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">FHIM can generate boilerplate code from the data model.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">FHIM model & PHRI data elements
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">FHIM would like to bind the vocabulary in coded values to PHIN VADS.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">Notation “code” means a plugin is written that has terminology tab. When clicked, it displays a box containing matching elements/vocabulary
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">FHIM data elements are mapped to the PHRI data elements. The PHRI common core data elements are notated with “cc.” The visibility could be set to only view the common core data elements, which can then be used to create various documentations.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">FHIM is a logical information model, and it is not meant to be implemented directly. The model is a depiction of the real-world because FHIM realizes different standards are not compatible.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">FHIM learned that different standards can be treated as platform in model driven approach. FHIM can generate a final artifact (like standard HL7 model) from the FHIM model using a transformation process.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">FHIM model is published on the web at <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 13.3333px;">[|www.fhims.org] <span style="font-family: 'Arial','sans-serif'; font-size: 13.3333px;">.

Presentation


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