Implementation Conformance Working Group

Implementation Conformance Working Group Meeting – January 2011

Implementation Conformance Working Group Orlando, FL, USA – May 16-20, 2011

1. Monday – Q1

Implementation Conformance Meeting Minutes Date: May 16, 2011 Location: Magnolia Time: 9:15 – 10:30am

Facilitator Frank Oemig Note taker(s) Wendy Huang

Attendee Name Email Affiliation

Rob Snelick [email protected] NIST

Frank Oemig [email protected] HL7 Germany

Wendy Huang [email protected] Canada Health Infoway

Quorum Requirements Met: (yes/No)

Yes. Quorum achieved as defined in the Work Group Decision Making Practices – 3 members plus co- chair

1.1. Agenda Topics for Quarter

# Key Description Presenter Action Needed Time 1 Call to Order 9:15 2 Approve agenda Frank 3 Approve minutes from Sydney Frank 4 Follow-up action items Frank 5 SWOT analysis Frank 7 Review projects Frank 9 Adjournment 10:30

1.2. Minutes/Conclusions Reached

1.2.1. Approve Agenda The agenda for the WGM was reviewed. The following amendments were proposed:  Swap Wednesday Q2 to Monday Q4  Switch tooling preparation discussion for Monday Q1  Added tentative discussion with ArB on ECCF for Wednesday Q2  Switched 3 year roadmap to Wednesday Q1

072506ee3accd0d3d3d1b8374d69940c.doc Page 1 of 19 Implementation Conformance Working Group Meeting – January 2011

The agenda was accepted as amended. Motion to approve: Rob/Wendy (32-0-0)

1.2.2. Approve Minutes The minutes were accepted as posted. Motion to approve: Wendy/Rob (23-0-0)

1.2.3. Follow-up action items Nothing to report.

1.2.4. SWOT analysis This was determined to be reviewed only on an annual basis.

1.2.5. Review Mission and Charter No further discussion on the mission and charter. It will was subsequentlybe sent forto approval at Foundation & Technology Steering Division meeting for approval on the same night, and it was approved unanimously.tonight.

1.2.6. Review Projects Between now and September 2011, review the documents on the wiki: http://wiki.hl7.org/index.php? title=Implementation_and_Conformance#Documents to determine if they need to be active, updated, or archived. Project scope statements will be created for those artifacts that need to be updated or documented on the Project Insight tool.

1.2.7. New Projects Rene proposed that I/C create a project to provide implementation guidance for V2/V3 transitioning/integration. Noting that some systems at the HIE level communicate with V3 (the V3 cloud) but at the HIS level communicate with legacy V2 systems. So the problem is that how do we transition V2 data to the V3 world. Can I/C provide guidance in this area? I/C should review existing work (e.g., Robert WardWorden, NwHIN, etc.). Issues to consider are that the V2 to V32 transition might not be rich enough. So what should be done? Can a V2 conformance profile be created to help (should profiles be created for datatypes?)? The scope would be to write a white paper.

1.3. Meeting Outcomes

Actions  Review existing projects on the document  Communicate with Rene on the V2/V3 transition/integration project that IC can be the co- sponsor of and contribute to this project, but cannot be act as the primary sponsor. Next Meeting / Preliminary Agenda Items Review v2.8 Chapter 2B with proposals (602 605 606 612 613 614) included

 Review Chapter 2B Edits  Discuss specific proposals/changes o Changes to overview section o Change chapter title to Conformance (remove Using Message Profiles) o Table Definition o Changes to Usage section o New Documentation section

o New Assessment of Conformance Construct section

o Introduce outstanding issues list

1.4. Supporting Documents WGM Agenda IC DMP SWOT Analysis Roadmap

2. Monday – Q2

Implementation Conformance Meeting Minutes Date: May 16, 2011 Location: Magnolia Time: 11:00am – 12:30pm

Facilitator Rob Snelick Note taker(s) Frank Oemig

Rob Snelick r Rob [email protected] NIST

# Key Description Presenter Action Needed Time 1 Call to Order 11:10 2 V2.8 Proposals Rob 3 Adjournment 12:40 072506ee3accd0d3d3d1b8374d69940c.doc Page 3 of 19 Implementation Conformance Working Group Meeting – January 2011

2.2.1. v2.8 Proposals  #602: Table Library: Initial draft created in chapter 2B. Text needs to be reviewed and completed. Action: need to solve how table library will reference tables (value sets). This should be resolved via the proposed project with vocabulary. Also, the format of how to represent the tables needs to be decided on; HITSP C80 is one possibility. needs review  #605: Rob applied some changes to the wording,; draft text is in version 2.8, needs review.  #613: Text needs to be added to chapter; schema needs to be updated  #614: submitted and approved; amendment to constrain repetitions based on repetition number and/or typeCode. The draft text needs to be added to chapter 2B. This needs to be added.  The definition of “message profile” requires an update, as the current definition is more likely to be an implementation guide.  Clarification of implementation guides and message profiles: MSH-21 should refer to a message profile, not a conformance statement. It should be a link to an OID which can be used for validation. The current message profile definition (with an ID) can refer to a set of dynamic definitions (with IDs) and static definitions (with IDs). So, whatere does MSH-21 refer to? The MWB currently support a single static definitions. Therefore, what is stated a “message Profile” in the standard is in principle an implementation guide. A message is a single interaction. A transaction is a complete set of interactions. In return, a use case provides a set of transactions. It was suggested that we look at the ECCF definitions and incorporate then in chapter 2B. A message profile is more accurately associated with an interaction. The updated text will reflect this. Do we always need to specify a message profile in MSH-21? Or should it be possible to introduce parts of it as well? It could be possible to refer to segment definitions or datatype definitions as well. The table separation is then only part of it. A message profile should be limited to one static definition. To further go on, it could be split into different parts which can be identified as “components” separately. These components can stand by themselves. So, all profiles listed in MSH-21 all together specify the details of the individual message. Motion: Adjust proposal #602 to also reflect different components (like segments and datatypes) being part of a single message profile so maintenance gets easier (Frank/Wendy): 2-0-0  #690: replaces #612 (Conformity Assessment) The update on Chapter 2B includes this proposal. Rob has sent it to the list the week before the meeting. The section has been added to chapter 2B. This proposal also goes inline with deleting the option to ignore a required element. The best solution for a harmonisation of sender and receiver profiles is a component orientation as described in the previous topic. In addition the harmonized profile reflects the common elements. From a tester’s perspective, documented exceptions are out of scope for testing. Therefore, everything must be implemented correctly given the profile is complete. Action item is to write guidance describing how to harmonize message profiles.  conformance verbs: it should be somewhere in v2; This needs to be discussed with I&M.  evaluation of constrainable profiles: tabled for future discussion.

Actions 072506ee3accd0d3d3d1b8374d69940c.doc Page 4 of 19 Implementation Conformance Working Group Meeting – January 2011

 Write a proposal harmonising related/similar profiles (Rob)  conformance verbs: bring it to InM (Rob, Frank)  review chapter 2B text  Complete table library text; associate with joint vocabulary project Next Meeting / Preliminary Agenda Items  Pick discussion on how to evaluate/implement constrainable profiles

2.4. Supporting Documents V2.8 Proposals

3. Monday – Q3

Implementation Conformance Meeting Minutes Date: May 16, 2011 Hosting: Structured Documents Time: 1:45 to 3:00 pm Location: Magnolia

Facilitator Frank Oemig Note taker(s) Rob Snelick

Keith Boone [email protected] GE Healthcare

Michael Martin [email protected] ALVD

Doug Pratt [email protected] Siemens

Larry Reis [email protected]

Nelson Hsing [email protected] VHA

Sean Muir [email protected] VA

Delane Heldt [email protected] AMA

Jennifer Trajkuski [email protected] AMA

Elane Ayres [email protected] NIH

Margaret Ditloff [email protected] CBORD

Adri Burggraaff [email protected] HL7-NL

David Parker [email protected] Evolvent

Kent Stevenson [email protected] Evolvent

Steve Fine [email protected] Cerner

Liora Alschuler Lantana

Fred Behlen [email protected] ACR

Kai Heitmann [email protected] HL7-DE

Thom Kuhn [email protected] ACR

Brett Marqward [email protected] Lantana

Calvin Beebe [email protected] Mayo Clinic

Yes. Quorum achieved as defined in the Work Group Decision Making Practices – 2 members plus co- chair.

# Key Description Presenter Action Needed Time 1 Call to Order 13:45 2 Consolidation IG 3 Vocabulary Binding Syntax 4 Ballot Reconciliation 5 Adjournment 15:00

3.2.1. Consolidation IG: Look & Feel

Look and feel for CDA consolidation implementation guide; a presentation was made that described the IG and the conformance statements:  Guide based for model driven tools

 The guide is created out of MDHT or the templates database using structured information.  Produces English (text) document from tool

 The different conformance statements are generated from the database. The discussion is about whether textual context information can be added.  Need to discuss conformance/how is conformance represente

 Each template can have a number of conformance statements

o Statement

o Database number (reference) in database

 Furthermore, the group feels that conformance statements require a syntax definition in form of a grammar as well.  ITS wants feedback on the structure/look and feel of the conformance representation

 K. Boone asked the question if there should be a “global” statement stating whether or not to declare the IG as open/closed instead of repeating that it is declaring it for each template

 Members wanted more detail associated with each conformance statement; discussion focused on publishing different versions depending on the reader. The implementer may want more information some may not. HMDT can be configured to do this.

 The conformance statements are generated automatically; not the entire IG. Dita can be used to do that as well.

 Should create a superset document and then render the subpart as needed

 It was expressed a need for examples; this is extremely important for implementers

Conformance Statements  Discussion focused on writing an English narrative and along with the canonical representation

 Some of the same principles are the same as in the binding syntax project

The guide is created out of MDHT or the templates database using structured information. The different conformance statements are generated from the database. The discussion is about whether textual context information can be added. Furthermore, the group feels that conformance statements require a syntax definition in form of a grammar as well.

3.2.2. Vocabulary Binding Syntax Frank Ppresented the result of the binding syntax project and proposed the same principles in the binding syntax.. Structured Documents feels that the text is too long and should be represented in a more pragmatic/shorter way because most of the implementers would not like to read it. Proposal is SD to come up with a terse form being mappable back and forth.

 Project almost complete

 Informative (not normative)

 Action items is to try to make this more terse (shorter)

 ITS to look at doing the modifications and following up with Frank

3.2.3. Ballot Reconciliation Not applicable.

Actions  SD to provide a shorter representation for the binding syntax Next Meeting / Preliminary Agenda Items  Joint meeting again at September 2011 WGM to continue the work.

3.4. Supporting Documents -

4. Monday – Q4

Implementation Conformance Meeting Minutes Date May 16, 2011, 2011 Hosting: ITS, Tooling Time: 3:30 pm – 5:00 pm Location: Magnolia

Andy Stechisin [email protected] GPi

Dale Nelson [email protected] Squaretrends

Paul Knapp [email protected] CSI

Vassil Peytchev [email protected] Epic

Tod Ryal [email protected] Cerner

# Key Description Presenter Action Needed Time 1 Call to Order 15:40 2 ITS – Encoding 3 MWB 16:55 5 Adjournment 17:00

4.2.1. ITS - Encoding Discussing different examples:

@TEST@ | @TEST@ | ^ ^ || || ab&cd a^b

A direct string replacement is not correct. Some kind of escaping according to the encoding rules must be applied.

ITS said it will provide general guidance on how to encode. Not saying how but state best practice and worst practice. Vendor need to check what is put into a message. A simple test should be conducted to determine if this is implemented correctly. Add test like “Mi||er” note the double pipe. This can be added in the notes field for example to see if vendors are doing the encoding correctly.

4.2.2. Messaging Work Bench (MWB) The source code should be out on some public gForge server. Most probably the ownership rests with the VA. The question is whether VA wants to release the IP. The other question is the technology, because the MWB is written in Delphi.

According to the funding perspective, even if there is money, Tooling will invest it in OHT with the static model designer.

Actions  IC to create a project scope statement on how to handle proper encoding (and testing) => IC to create a PSS  Rob to determine available of MWB source (for public domain) Next Meeting / Preliminary Agenda Items  meet again -> IC will host

4.4. Supporting Documents -

5. Monday – Q5

At the Foundations & Technology Steering Division meeting, the IC work group mission & charter was approved. As a result, the work group will now be known as Conformance & Guidance for Implementation and Testing (CGIT).

Subsequent actions will be taken to reflect the name on the work group page, wiki, listserv, and other areas within HL7 documents/artifactsartefacts.

6. Tuesday – Q1

Implementation Conformance Meeting Minutes Date: May 17, 2011 Location: Room Magnolia Time: 9 am – 10:30 am

Facilitator Frank Note taker(s) Wendy Huang

HL7 Canada/Canada Health Wendy Huang [email protected] Infoway

Adri Burggraaff [email protected] HL7 Netherlands

# Key Description Presenter Action Needed Time 1 Call to Order 9:00 2 Draft review of V2.u conformance section Rob Snelick 3 Adjournment 10:30

6.2. Draft review of V2.8 conformance section Please see the updated v2.8 conformance section. The discussion of defining interaction and transaction raised related to a message profile. SAIF behavioural framework defines interaction and transaction. This should be leveraged to indicate interaction and transaction in V2.x standards.

It has raised that V2 vocabulary has business requirements to better represent terminology being used. Currently, the code tables do not serve the value set management and exchange needs. The methodology used v3 with value set definition and value set expansion seems be suitable for the value set format. This will also bring the v2 vocabulary structure closer to V3. However the issue arise with code system versioning where currently there is only one OID v2.x table. There are different scenarios of adding codes which causes invoke using a new code system (e.g. v2.4 to v2.5) or simply invoke a new version of a code system. How to distinguish “married” and “male” is difficult when the entire set of v2 code tables is considered as one code system.

Actions  Add the vocabulary discussion to the Thursday Q1 joint with vocab. Next Meeting / Preliminary Agenda Items  Review next steps

6.4. Supporting Documents V2.8 conformance chapters.

7. Tuesday – Q2

Implementation Conformance Meeting Minutes Date: May 17, 2011 Location: Room 274 Time: 11 am – 12:30 pm

Adri Burggraaff

Tony Julian Mayo Clinic

# Key Description Presenter Action Needed Time 1 Call to Order 11:10 2 ECCF Discussion with ArB 072506ee3accd0d3d3d1b8374d69940c.doc Page 11 of 19 Implementation Conformance Working Group Meeting – January 2011

3 Adjournment 12:30

7.2. Minutes/Conclusions Reached An Eexplanation of the current situation was presented to to Tonyi. He agrees that the current Enterprise Conformance and Compliance Framework ( ECCF) document is not sufficient. Also, the tabular expression should not introduce an orthogonal structure. Most of the (interoperability) problems come from missing documentation and wrong expectations.

We need to fix the terms within the ECCF.

Tonyi will discuss with ArB and come back well before September meeting for next steps.

Actions  Toni will discuss with ArB and come back well before September meeting. Next Meeting / Preliminary Agenda Items  Booked a follow up session with Tony at the September 2011 WGM.

7.4. Supporting Documents ECCF

8. Tuesday – Q3

Implementation Conformance Meeting Minutes Date: May 17, 2011 Location: room 174 Time: 1:45 - 3 pm

Larry Reis [email protected]

Dave Shaver CorePoint Health

Sandy Stuart [email protected] Kaiser Pemanente

Tony Julian [email protected] Mayo Clinic

# Key Description Presenter Action Needed Time 1 Call to Order 14:00 2 New v2.8 Proposals Rob 3 Adjournment 15:00

8.2. Minutes/Conclusions Reached See also the minutes taken by InM.

8.2.1. v2.8 proposals IC wants to introduce the new content for v2.8 to InM.

Usage Codes: We want to clarify the concepts. The main change is the separation into the sending and receiving perspective and the delineation . It should also express into implementation and operational requirements, i.e. whether someone has to implement something or not. For the receiver, the operational requirements prior to this version stated “process or ignore required elements”. We removed the “or ignore” part. Removing this raises some resistance, but we understand why this happens. Currently, there is no management of the “ignore” rationale, i.e. everyone can do what he likes and there is no means to test something. The group agrees with this change.

To further clarify the usage codes a new section call conformity assessment has been added. This section provides a set of truth table to assess the usage codes given data and the results of the conditional predicates. The other new construct is the conformity assessment of how to test usage codes with respect to the expected results.

Introduction of the Documentation Hierarchy concepts: The group agrees with this approach. However, the problem comes from the vendors who do not want to document their interfaces. There could be two levels introduced between level 4 and 5: a) whether the profile is officially published and b) it has an OID assigned to it.

Proposal #608 introduces to have the standard be a profile as well;, as such it should be documented with usage and cardinality. InM will check that.

Actions  InM to start scheduling teleconference calls June 6, June 20 to prepare for V2.8 ballot. Next Meeting / Preliminary Agenda Items  To be determined on the teleconference calls.

8.4. Supporting Documents

9. Wednesday – Q1

Implementation Conformance Meeting Minutes Date: May 18, 2011 Location: Room 5.06 Time:

Rob Snelick r Rob. [email protected] NIST

Wendy Huang

# Key Description Presenter Action Needed Time 1 Call to Order 9:05 2 Planning for Sept 2011 WGM Frank 9:05 3 Review 3 year roadmap Frank 10:00 4 Adjournment 10:35

9.2.1. Planning for Sept 2011 WGM see Wiki page: http://wiki.hl7.org/index.php?title=ICTC_Sept_2011_WGM_Agenda

9.2.2. Review 3 year roadmap see wiki page: http://wiki.hl7.org/index.php?title=ICTC_Strategic_Plan removed (archived) closed projects introduction of year 2013 updates with new steps

Actions  find a time slot with SD and Tooling/ITS/Rimbaa on Wed q3 or Thu q2 (all)

 review current work items and turn them into a formal project (all) – this has been scheduled in the September 2011 WGM agenda Next Meeting / Preliminary Agenda Items  arrange schedule for January Meeting

9.4. Supporting Documents

10. Wednesday – Q2 (11:15am – 12:15pm)

Implementation Conformance Meeting Minutes Date: May 18, 2011 Location: Room 5.06 Time: 11:15 am – 12:15 pm

Facilitator Frank Oemig Note taker(s) Wendy Huang

Rob Snelick r Rob. [email protected] NIST

Peter Hendler Kaiser Permanente

Sasha Bojicic [email protected] Canada Health Infoway

Jane Curry [email protected]

Adri Burggraaff [email protected] HL7 NL

Nick Radov [email protected] Axolotl

Michael Oldlil

Yunwei Wong

Yes. Quorum achieved as defined in the Work Group Decision Making Practices – 2 members plus the Co-Chair

# Key Description Presenter Action Needed Time 1 Call to Order 2 Review of scope and responsibility of Peter RIMBAA CGIT documents review Frank 072506ee3accd0d3d3d1b8374d69940c.doc Page 15 of 19 Implementation Conformance Working Group Meeting – January 2011

3 Adjournment

10.2. Review of scope and responsibility of RIMBAA Discussion ensued on conformance of application testing. RIMBAA would not be concerned with the conformance aspect of RIM-based applications. The guidance would be provided by the CGIT work group.

It was raised who would be responsible to indicate to application should be indicating validation rules beyond the structure as this would preserve the integrity of the information. RIMBAA confirmed they would use this as a ‘screening’ question.

At an international level, patient safety is concerned as the information is preserved throughout the interaction between applications.

Use of OIDs should be employed to uniquely identify the concepts being transpired.

In reference to the technology matrix (URL below); RIMBAA is looking at persistent representation on RIM model, and RIM constrained information model (RP, CP)

V2 implementations are not in RIMBAA scope. Mapping from V2 to V3 is not in scope of RIMBAA. Whether the integration involve ANTLER parser or XSLT is up to the application vendor. It was suggested RIMBAA should be the liaison to ensure that kind of question passed on to the right group if they are not.

White paper include how to generate objects that represent the RIM, how to build and maintain the objects.

RCnL document – to be updated and localization may concern of RIMBAA.

Actions  RIMBAA to review RCnL and raise requirements/content to be updated.  CGIT to send a draft project scope statement o RIMBAA to provide input to the project scope statement Next Meeting / Preliminary Agenda Items  Connect on joint teleconference call prior to WGM.  Book next WGM Wednesday Q2 – this has been scheduled in the September 2011 WGM agenda.

10.4. Supporting Documents Diagram section 1.2 RIMBAA technology matrix: http://www.ringholm.de/docs/03100_en.htm

11. Thursday – Q1 – Hosted by Vocab

Implementation Conformance Meeting Minutes Date: May 19 2011 Location: Lilly Time:

Facilitator James (Vocab) Note taker(s) Rob (Vocab)

Ted Klein [email protected] Ted Klein Consulting Inc.

Beverly Knight [email protected] Canada Health Infoway

Sarah Ryan

Heather Grain [email protected]

Rob Hausam [email protected]

Quorum Requirements Met: (yes/No) – Yes

IC was hosted by Vocab - Vocab DMP quorum was met.

# Key Description Presenter Action Needed Time 1 Call to Order 2 ISO Conformance Technical report Beverly 3 V2.x standard terminology Ted 4 Adjournment

11.2.1. ISO Conformance Technical Report

This ISO conformance document is an ISO Technical Report. Proposed process: open 1 month review after the ISO meeting. Comments will be reviewed after the review period is closed. Vocab and CGITIC to have a joint call to determine next step.

This is a review for vocab work group. CGIT can provide input on existing through Vocab work group. For additional work or expansion of content, CGIT would define this separately for ISO consideration.

11.2.2. V2.8 Standard Terminology Goal to harmonize the structure (shared terminology model), binding, skill set, and knowledge required to maintain both version 3 and version 2 terminology.

V2 Terminology – enhancing and updating the V2 vocabulary model to the V3 terminology model.

V2 Terminology currently consist of 3 types of tables 1. HL7 tables – a list of values allowed (enforced) to be used o A value set with an underlying code system o Original mechanism to assign OIDs o coding strength CNE 2. User defined tables – have suggested values o Suggested values map exactly to value sets with a representative binding . No complete set? This would be example binding o coding strength CWE 3. User defined tables – no suggested values o This is a concept domain that needs to be bound before implementation o Similar to no constraints or attributes other than what is asserted in the implementation guide

Changing the meaning of the code or relationship in the code system could result in a new code system. However generally, adding new codes does not automatically mean the code system is changed.

In the example of Gender code table, v2.1 to v2.3.1 is one code system OID. For v2.4 to 2.7 another code system OID is necessary. For other tables like Event codes (0003) only new versions are released.

Guidance statement or algorithm for assigning code system OIDs is required without having to manual reviewing 400+ code tables.

CDA terminology – value set definition is incomplete in CDA implementation guide such as versioning. HL7 declared versioning out of scope for value set expansion. Hence, implementers have been resistant to inserting value set definition.

OID strategy for type 1 and type 2 tables: Chosen: Option 2 of proposal #677: consecutive numbers of a new OID substree e.g. aaaa.bb.cc, where: aaa=HL7 root OID bb=new subtype (perhaps 18?) cc=code system identifier (consecutive numbers) Pro: the OID is independent from the contents Con: tedious examination of table values Example: aaa.bb.1, 111.bb.2, aaa.bb.3

OIDs to be derived from V2.x code table, mechanism to be enabled from the HL7 OID registry.

Managing null flavors – they are unknown, other, unreported, anonymous, etc. In version 2 we publish them, but in IGuide, when people are constructing value sets, exclude these flavors of null from the value set and point to the Version 3 code system of null flavour.

Motion to create a new OID type for v2 code system, review v2 code table using mechanism to make the consecutive numbers of a new OID subtree where the OID is independent from the content with involves tedious examination of table values, and indicate a known issue in the September ballot for management of null flavors that will be resolved pending further discussion.

This is linked to proposal #677 Moved by: Ted Klein Seconded by: Frank Oemig Affirmative: 9 Abstain: 0 Against: 0

11.2.3. Core Principles Binding and Conformance

Vocabulary Binding from Core Principles was reviewed. It was re-iterated value set OID is intended to be used for the value set definition, not the value set expansion. However in realistic implementations, the value set OID is sometimes for value set expansion.

Actions  HL7 OID registry administrator (Ted) to create a new OID type in the HL7 OID registry  CGIT to review the conformance document  CGIT to generate the OIDs required for V2 code systems Next Meeting / Preliminary Agenda Items  Include joint meeting with Vocab on agenda for Orlando WGM – Vocab to host IC

11.4. Supporting Documents Core Principles (time sensitive – URL below changes dynamically, however at the time of the minutes, it was the May 2011 Ballot cycle): http://www.hl7.org/v3ballot/html/infrastructure/coreprinciples/v3modelcoreprinciples.html

072506ee3accd0d3d3d1b8374d69940c.doc Page 19 of 19