CET+-+Ballot+Reconciliation

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1.0 Overview
The Standards Development Organization (SDO) ballot process is critical in gathering the support and feedback of the healthcare community to develop and publish a healthcare standard. Thus far, two S&I Framework Initiatives have elected to produce standards through Health Level Seven (HL7) due to its' role as an international SDO that has created the most widely adopted health IT standards. While S&I Framework Initiatives are not restricted to producing HL7 balloted standards, Initiatives have elected to do so in support of interoperability and knowledge that HL7 leverages its diverse membership in the ballot process to create, refine, and publish widely adopted healthcare standards.

2.0 Ballot Process
The ballot process involves participation from the healthcare community (represented as blue in figure below) as well as formal Standards Development Organizations (SDO), such as HL7. As a group of healthcare community stakeholders, the S&I Framework (green in Figure) participants work to resolve comments in order to resubmit to achieve publication as a balloted standard. The ballot process contains the following steps:



The [|HL7 Ballot Process]
1. **Registration**: Participants who wish to participate in the Ballot process may do so as an HL7 member or register for a particular Ballot as a non-member participant, which requires a nominal fee. Registration should be completed 7 days prior to the Ballot close and provides members access to HL7 Workgroups and Ballot documents. For full instructions on the HL7 Ballot registration process, please follow the link above.

2. **Ballot Download**: Upon registering for a specific Ballot Pool through the HL7 Ballot Desktop, participants are able to download the Ballot materials in the form of a .zip file. The file may contain several items:
 * Balloted document
 * Comment spreadsheet, as well as
 * Supplemental material

3. **Balloted Document Review**: Participants have at least one month from the time Ballot documents are posted to the HL7 Ballot Desktop until Ballot reconciliation activities begin to review the document. When reviewing, participants should follow the guidelines:

4. **Submit comments into the comment spreadsheet provided**.
 * Categorize comment as Affirmative or Negative. Negative comments must contain a description and reason. Also, provide an actionable proposed resolution.
 * Specify the severity of the issue as either Major or Minor.

5. **Provide Vote**: Upon reviewing the Implementation Guide, each organization represented may cast one final vote as negative or positive and submit the comment spreadsheet to HL7. Votes will be aggregated and compared against the required amount of votes for publication. If the votes do not meet the necessary threshold, then the ballot enters reconciliation.

6. **Ballot Reconciliation**: Please refer to Section 1.2.1 for additional details and figures.

7. **Ballot Resubmission**: After all comments have been resolved, the Balloted document is resubmitted for either publication or re-Ballot.

2.1 S&I Framework Ballot Reconciliation Process
Ballot reconciliation is the formal process for addressing the comments submitted by the HL7 participants and involves both HL7 (light blue in the figure below) as well as the S&I Framework (red). The S&I Framework serves as a channel to leverage additional healthcare experts for feedback on how to disposition comments. Refer to the figure below for the Ballot reconciliation process:



1. **Consolidate Comments**: Once the Ballot is closed, all the submitted comment spreadsheets are consolidated into an Amalgamated Ballot Spreadsheet by HL7. This document is the primary tool used through the reconciliation process and captures all dispositions and feedback.

> Further, a commonality analysis is conducted by the Workgroup conducting reconciliation to assess the number of duplicates or similar comments submitted. Due to the variety of organizations and submissions received, it is common to have redundancies; similar comments can be resolved with the same disposition. Additionally, if a comment is unclear or incomplete, the workgroup can request the submitter to attend a reconciliation meeting. If they do not respond with additional guidance, their comment will be withdrawn.
 * 2. *Review and Categorize Comments:** HL7 and S&I Framework leads will be responsible for reviewing and categorizing each comment by:
 * Type (negative vs. affirmative)
 * Severity (major vs. minor)
 * Complexity
 * Content vs. Publication. (Publication comments pertain to the organization and format of how a document entry is represented rather than the content itself)

3. **Disposition Comments**: Controversial comments or comments that require discussion are addressed during Initiative Workgroup meetings. Less complex comments may be resolved offline upon consensus by Workgroup participants on resolution. Comments that request that the submitter be present are also addressed by S&I Framework Initiatives. Comments that contain dispositions in the S&I Framework are passed to the HL7 Structured Documents Workgroup (SDWG) for an official block vote. Block voting addresses multiple votes at once to facilitate an efficient reconciliation process. Participants are able to further discuss specific comments in a particular block before a formal vote.


 * 4. Prepare Ballot Submission:** When preparing for ballot submission, Workgroup Leads are encouraged to contact submitters who initially cast negative votes to ask for their withdrawal if their comments have been resolved. Afterwards, the Ballot and the updated Amalgamated Comment Spreadsheet are submitted by the workgroup and a decision to publish or re-Ballot is made by HL7. If the document is re-Balloted, the Ballot documents are made publicly available and posted for at least one month on both the HL7 and S&I Framework websites and the ballot process restarts.

3.0 Reference Resources

 * **ID** || **Template Name** || **Link** || **Description** ||
 * **1** || Amalgamated Ballot Spreadsheet || [|Sample Amalgamated Ballot Spreadsheet.xls] || This is a sample Amalgamated Ballot Spreadsheet used in ballot reconciliation. ||
 * **2** || HL7 Website || [] || Landing page of the HL7 Website. ||
 * **3** || S&I Wiki Website || http://wiki.siframework.org/ || Landing page of the S&I Framework Website. ||
 * **4** || Webinar Link || [] || Refer to the following Webinar link for guidance on how to register and participate in the HL7 Ballot process. ||

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