1. Health eDecisions (HeD) All Hands Meeting July 11th, 2013

2. Meeting Etiquette Remember: If you are not speaking, please keep your phone on mute Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call Hold = Elevator Music = frustrated speakers and participants This meeting is being recorded Another reason to keep your phone on mute when not speaking Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know. Send comments to All Panelists so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute All Panelists

3. Agenda TopicTime Allotted Announcements5 minutes Work Stream 1 Update: HL7 Meeting Update 5 minutes Work Stream 2 Update: Pilots5 minutes Work Stream 3: Use Case 2 IG discussion 65 minutes Wrap up/Questions10 minutes

4. Announcements We submitted the NIB for our UC 2 HL7 Ballot We officially have 3.5 weeks until our HL7 Ballot for UC 2 is submitted

5. Weekly Meeting Schedule Stay tuned for additional working meetings to ensure we meet the HL7 Ballot deadline (3.5 weeks and counting….) WeekdayMeetingTime MondayPilots (UC 1)1-2:30 ET MondayVocabulary and Terminology12-1:00 ET TuesdayCDS-HeD Working Meeting3:00-4:00 ET TuesdayVocabulary and Terminology4:00-5:00 ET WednesdayStandards Sub work Group Call1:00-2:00 ET ThursdayAll Community Call11:00-12:30 ET

6. HL7 Update We have completed a working final Draft of the IG – it is being circulated to the support team once we are finished we will put it out on the wiki for comment and review The Vocabulary and Terminology work for UC 1 will now be rolled into a “Master HeD” terminology spreadsheet that will include Data Elements and mappings for all of UC 1 and 2

7. HeD Pilots Update – WE ARE DONE!!!!!!!!!!!!!!!! We met this week to review findings Pilots Update –CDC and AllScripts–ECA Rule --- DONE –NewMentor and AllScripts – ECA Rule DONE –Zynx and DesignClinicals - Order Set DONE –VA and Wolters Kluwer - Documentation Template DONE Please come to our open house to support to see what we have accomplished and the major milestone for the HeD initiative we have just crossed!!! (invite your friends)

8. HeD Pilots Open House We had the first ever S&I and HeD virtual Pilots Open House on Monday July 8 th, 2013 are having a pilots open house July 8 th from 1:00-2:00 165 Participants attended Materials and recording posted on HeD Wiki homepage: http://wiki.siframework.org/Health+eDecisions+Homepage http://wiki.siframework.org/Health+eDecisions+Homepage EHRArea of InterestMatches Design ClinicalsOrder SetsZynx AllScriptsNQF – 068 Million Hearts ECA Rule NewMentor AllScriptsSan Diego Pertussis ECA RuleCDC VAUTI Documentation Template Wolters Kluwer

9. Timeline 10/11/20119 We are Here Goal & Activities EST. Time DatesDeliverables Kickoff /Establish Goals & Partnerships: - Review HeD Initiative Goals - Review Piloting Process & Resources - Define Value Statement - Define HeD Pilot Goals & Success Metrics - Establish & Approve Pilots - Develop Pilot Briefs 4 wks. (reality 5 weeks) 1/07-2/25 (we missed 2 meetings in January pushing our Dates back) -Wiki Capturing Pilot Deliverables -Established Partnerships -Documented Value Statements and Success Metrics -Documented Pilot Briefs Pilot Configuration: - Establish Pilot Test Environment & Resources - Establish Pilot Implementation & Testing Process - Develop & Review Pilot Configuration 2 wks. (reality- 4 weeks) 2/25-3/25 -Use Case is Updated with HL7 Comments (3/4) -Approved Pilot Briefs -Committed Pilot Resources -Documented & Reviewed Pilot Configuration Guide -Weekly Feedback on Use-Cases & IG Alignment Pilot Development : - Setup & Develop Pilot Prototypes - Review prototypes 6 wks. or less depending on Pilot activity 3/25 – 5/6 -Use Case is Updated with HL7 Comments (3/4) -Weekly Pilot Development Status Updates -Weekly Feedback on Use-Cases & IG Alignment -Updates to Pilot Configuration Guides Pilot Testing & Showcase : - Complete Testing - Prepare Solution Showcase 2wks (In Reality this was closer to 10 weeks 5/6 -5/20-Weekly Pilot Testing Updates & KPIs -Showcase -Prepare for HL7 Pilot Wrap-up : - Develop Lessons Learned an ONC Feedback - Review Initiative Goal Alignment - Establish Next-Steps 2 wks.6/10– 6/24-Documented ONC Feedback - Next Steps Action Plan

10. Use Case 2

11. SDS & Harmonization HeD Timeline Overview HeD UC2 vMR Mapping Template Update Ballot Work Products Update DSS IG Review 11

12. 12 vMR Extension & Alignment DSS HeD UC2 Guidance Community Review & Ballot Preparations DSS Update & Profile Development 6/4-7/12 Jun ‘13Jul ‘13Aug ‘13 Update Mapping with C- CDA/QRDA data elements, cardinality, data type, value restrictions 6/17-7/1 Develop vMR Container/ Payload Profiles 6/19-7/3 Update vMR DAM with Harmonized Semantics 7/11-7/18 Include vMR templates and mapping in IG 7/26-7/31 Determine Functional Interaction Type Examples 6/17-6/19 New DSS IG and vMR Template IG Review & Packaging 7/22-8/2 vMR XML IG Review & Packaging 7/22-8/2 Extend vMR for HeD UC2 7/1-7/18 Develop Mapping Template 6/4-6/13 Harmonize vMR with CCDA/QRDA 7/1-7/17 Update Mapping with HeD UC2 data elements, cardinality 6/17-6/28 Today (7/11) Update Mapping with vMR data elements, cardinality, data types 6/10-6/21 Update Mapping with vMR/HeD Value restrictions 6/18-6/28 Add DSS profiles to IGalong with place holders for vMR mapping and vMR profiles 6/26-7/9 Finalize context and section introductions within IG 7/12-7/21 HL7 NIB Prep & Submission 6/25-7/7 HL7 Final Submission Deadline (Aug 4) HL7 Notification of Intent to Ballot (July 7) HL7 Initial Content Deadline (July 14) Incorporate vMR DAM changes 6/28-7/11 Update vMR XML IG 7/12-7/17 Update HeD UC1 IG 7/12-7/17 DSS Update & Profile Review & Packaging 6/25-7/18 vMR XML & HeD UC1 IG Review & Packaging 7/22-8/2 vMR DAM & Profile Review & Packaging 7/10-7/25 HL7 Initial Content Prep & Submission 7/5-7/14 HeD Use Case 2 Timeline

13. Key Milestone Dates for September Ballot Administrative Deadlines: HL7 Notification of Intent to Ballot (NIB): July 7 – COMPLETE –6 NIBs submitted HL7 Initial Content Deadline: July 14 Content Deadlines: HL7 Final Content Deadline: August 4 HL7 Examples Deadline: August 19 HeD Consensus Review Period: August 19 – September 2 –Comments will be received during balloting from August 19 – August 26 –Comments will be vetted by the community Submit Comments to HL7 on September 3 13

14. SDS & Harmonization HeD Timeline Overview HeD UC2 vMR Mapping Template Update Ballot Work Products Update DSS IG Review 14

15. HeD UC2 vMR Mapping 15 WorkstreamOwner & Resources Current StatusUpdate & Next Steps CCDA Mapping HeD Internal Team CCDA mapping is completen/a QRDA Mapping Mark Roche QRDA mapping is completen/a vMR MappingHeD Internal Team and Vocab and Terminology Work Group Business Friendly names populated by support team with some gaps identified Update Next Steps: Validate business friendly name population and confirm gaps with David Shields HeD UC2 Mapping Bryn Rhodes and HeD Internal Team Initial mapping of clinical data elements complete Updates to the vMR DAM were completed Bryn to complete mapping of non-clinical data elements and changes from vMR DAM Container and response changes were needed Update In progress Next Steps: Proposed Templates Dave Shields and HeD Community Contains 94 templates Harmonization began 7/1 and two working sessions were held last week Templates were assigned to smaller groups to complete work offline and working sessions on 7/9 and 7/10 Update Next Steps: Continue review of Templates Validate business friendly name population and confirm gaps with David Shields

16. HeD UC2 vMR Templates Harmonization 16 Proposed Templates StatusTotal 0. Not Started31 1. Drafted36 2. Initial Review In Process5 3. Ready for Standards SWG Review3 4. Complete21 Grand Total94 Definition of “Status” Types: 0. Not Started – Template has been created, but is blank 1. Drafted – populated with content and ready for assigned team to begin work 2. Initial Review in Process – work is being done by the assigned team 3. Ready for Standards SWG Review – assigned team has completed work and requests entire SWG review for any feedback 4. Complete – ready for incorporation into the vMR IG Priority: Represents the suggested order for harmonizing the vMR Templates PriorityTotal High24 Low48 Complete21 Deleted5 Deferred1 Grand Total99

17. Open Discussion 17 Issue: For the HeD UC2 vMR Mapping Template Mappings Google doc, we need to make sure that the 9 Category tabs (e.g., for Problems, Substance Administration, etc.) have the latest vMR data elements, cardinality, and data types – Proposed action: Bryn is working on this? Issue: We need to decide whether we are going to attempt to provide normative guidance on EVERY data element in the vMR with respect to value restriction, etc. (the notion of creating the “Mega Tab”). Good to have, but we probably need to prioritize given the time pressures – Proposed action: Focus on those data elements to be included in published Templates first. Work on other data elements later with a goal of complete coverage. This MAY occur before ballot materials are due or it MAY occur after that date (e.g., submitted through ballot comments and reconciliation)

18. Open Discussion cont. 18 Issue: We need to decide on the location of the source of truth. (3 potential locations – separate V&T SWG document, the Proposed Templates tab, or the 9 Category tabs – Proposed action: All relevant terminology SWG content are moved into the Templates Google Doc in the 9 Category tabs The primary value set restrictions will be done in the 9 Category tabs (e.g., observation focus is LOINC code) – This means that the Template development work MUST be synchronized with what is in the 9 Category tabs. For example, if a template needs to use LOINC, but the Category tab only allows SNOMED CT at the moment, update the Category tab to allow both LOINC and SNOMED CT. This should either be done by one of the V&T SWG members (e.g., Rob, Mark, and David Tao) or it should be discussed with them prior to making the change – Any initial content provided by Dave S. in the Template’s value restrictions are strictly strawman and intended to be reviewed/edited All terminology restrictions in the Proposed Templates must be compatible with the terminology restrictions in the 9 Category tabs (e.g., observation focus is LOINC code, LOINC code for systolic BP, etc.) I.e., the value restrictions in the 9 Category tabs MUST be the union/superset of the value restrictions in the Templates tab

19. SDS & Harmonization HeD Timeline Overview HeD UC2 vMR Mapping Template Update Ballot Work Products Update DSS IG Review 19

20. Ballot Work Products Update Work Product Product Readiness OwnerCurrent StatusUpdate & Next Steps Decision Support Service (DSS) IG Development: Atanu Sen Packaging for HL7: Saunya Williams Template for IG has been drafted Support team have included Bryn’s initial content and are updating introductory sections Sections remaining: SOAP Example – Dave Shields REST Example – Bryn Exception Example - Bryn Semantic Signifier – Bryn Request & Response Containers – Aziz & Dave Shields Warning Container – Bryn Clinical Data Representation – Copy of vMR Templates Supported Functional Interaction Types – Bryn Update Next Steps: vMR Templates IG Development: Atanu Sen, Ken Kawamoto Packaging for HL7: Saunya Williams IG outline drafted Ken drafting write-ups for each section this week (due 7/12) Templates being drafted now will be copied and pasted into a designated section of this IG Update Next Steps: Receive updated draft from Ken Incorporate finalized templates Updated DSS Standard Development: Dave Shields & Bryn Rhodes Packaging for HL7: Dave Shields & Ken Kawamoto David Shields & Bryn Rhodes conducted initial analysis to identify updates and specified the 7 artifacts/documents that will be submitted as part of this ballot This work has been paused while both David & Bryn focus on vMR Templates development Update Next Steps: Resume updates after Harmonization is complete Legend: Not Started; In progress; Ready

21. Work Product Product Readiness OwnerCurrent StatusUpdate & Next Steps Updated vMR DAM Development: Aziz Boxwala, Claude Nanjo, & Dave Shields Packaging for HL7: Claude Nanjo Updates to vMR DAM finalized last week based on UC1 ballot & pilot feedback No additional changes to the vMR DAM are planned Update In progress Next Steps: Updated vMR XML IG Development: Aziz Boxwala, Claude Nanjo, & Dave Shields Packaging for HL7: Claude Nanjo vMR DAM has been updated based on UC1 updates/feedback vMR XML files will be automatically regenerated from vMR DAM Update In progress Next Steps: Updated HeD UC1 IG Development: Aziz Boxwala, Claude Nanjo, & Bryn Rhodes Packaging for HL7: Aziz Boxwala &Bryn Rhodes vMR DAM has been updated based on UC1 updates/feedback vMR XML files will be automatically regenerated from vMR DAM Update In progress Next Steps: Ballot Work Products Update Legend: Not Started; In progress; Ready

22. SDS & Harmonization HeD Timeline Overview HeD UC2 vMR Mapping Template Update Ballot Work Products Update DSS IG Review 22

23. DSS IG Review Review the “Implementation Approach” section of the DSS IG 23

24. Next Steps WeekdayMeetingTimeTopicsDetails July 15thPilots (UC 1)1-2:30 ETReview additional Pilot findings Review IG http://wiki.siframework.org/He alth+eDecisions+Homepag July 15thVocabulary and Terminology 12-1:00 EThttp://wiki.siframework.org/He alth+eDecisions+Homepage July 16thCDS-HeD Working Meeting 3:00-4:00 EThttp://wiki.siframework.org/He alth+eDecisions+Homepage July 16thVocabulary and Terminology 4:00-5:00 EThttp://wiki.siframework.org/He alth+eDecisions+Homepage July 17thStandards Sub work Group Call 1:00-2:00 EThttp://wiki.siframework.org/He alth+eDecisions+Homepage July 18thAll Community Call 11:00-12:30 ET http://wiki.siframework.org/He alth+eDecisions+Homepage

25. Questions?

26. Contact Information For questions, please contact your support leads –Coordinator: Ken Kawamoto: kensaku.kawamoto@utah.edukensaku.kawamoto@utah.edu –Co-Coordinators: Aziz Boxwala: aziz.boxwala@meliorix.comaziz.boxwala@meliorix.com Bryn Rhodes: bryn@veracitysolutions.combryn@veracitysolutions.com –ONC Leadership: Alicia Morton: alicia.morton@hhs.govalicia.morton@hhs.gov –Project Management: Jamie Parker: jamie.parker@esacinc.comjamie.parker@esacinc.com –Use Case 2: Dave Shevlin: d.s.shevlin@accenturefederal.comd.s.shevlin@accenturefederal.com Virginia Rhiel: virginia.riehl@verizon.netvirginia.riehl@verizon.net –Harmonization: Lynette Elliot: lynette.elliott@esacinc.comlynette.elliott@esacinc.com Anna Langhans: anna.langhans@accenture.comanna.langhans@accenture.com

27. Useful Links Wiki –http://wiki.siframework.org/Health+eDecisions+Homepagehttp://wiki.siframework.org/Health+eDecisions+Homepage Use Case 1& 2 –http://wiki.siframework.org/Health+eDecisions+Use+Casehttp://wiki.siframework.org/Health+eDecisions+Use+Case –UC 2: Use Case 2: http://wiki.siframework.org/UC+2+- +CDS+Guidance+Servicehttp://wiki.siframework.org/UC+2+- +CDS+Guidance+Service Pilots –http://wiki.siframework.org/Health+eDecisions+Pilotshttp://wiki.siframework.org/Health+eDecisions+Pilots HL7 Ballot Submission: –http://wiki.siframework.org/Health+eDecisions+Reference+Materials #Ballothttp://wiki.siframework.org/Health+eDecisions+Reference+Materials #Ballot UC 1 Harmonization and IG: –http://wiki.siframework.org/Health+eDecisions+Harmonization+and+ Standards+%28Implementation%29http://wiki.siframework.org/Health+eDecisions+Harmonization+and+ Standards+%28Implementation%29 HeD Glossary –http://wiki.siframework.org/HeD+Glossaryhttp://wiki.siframework.org/HeD+Glossary