Attendee - Health Level Seven International · Web viewFarhan Ahmad [email protected] √ √...
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Orders & Observations San Antonio Working Group Meeting January 2008 Meeting Minutes
Transcript of Attendee - Health Level Seven International · Web viewFarhan Ahmad [email protected] √ √...
Attendee
Orders & Observations
San Antonio Working Group Meeting
January 2008
Meeting Minutes
Table of Contents
3Attendees
10Monday Q1, Tuesday Q3, Friday Q1 – OO – V3 Ballot Reconciliation
11Monday, Q2 – OO/Pt Care/PHER/Pt Safety/Rx
11Exposure Report
11Substance Administration
12Immunization
13Monday Q3 – V2.7 Proposals
13Specimen Shipment
13Proposal 492 - Make OBX-8 CWE
13Proposal NN - Pharmacy Order Type
14Monday Q3 – OO/Pt Care/CDS
14Order Set Ballot Reconciliation
15Tuesday Q1 – OO/Rx/Lab
17Tuesday Q2 – OO/Rx/Lab – Dynamic Model
18Tuesday Q3 – OO/Pt Safety/BTO/PHER/Rx
18Immunization
20Wednesday Q1 – Implementation Guide
21Wednesday Q2
22Thursday Q1 – Genomics
22Pedigree
22Genotype
23Thursday Q3/Q4 - Clinical Statement
23Change Request
23Overall direction including:
23Topics/Common fragments - Larry McKnight
24T3F related discussion on content of Clinical Statement material
24CEN 13606 harmonisation - Charlie McCay
24Duplicated TargetOf/SourceOf relationships - Keith
24Ballot Reconciliation
25Friday Q1 – V3 Ballot Reconciliation
Attendees
Attendee
Company/E-Mail
Mon AM
Mon PM
Tue AM
Tue PM
Wed AM
Wed PM
Thu AM
Thu PM
Fri
Rett Addy
Farhan Ahmad
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Rita Altamore
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Kay Avant
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Fred Behlen
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Chad Bennett
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Bernd Blobel
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Scott Bolte
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Keith Boone
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Bill Braithwaite
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Louise Brown
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Sabine Brosch
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Hans Buitendijk
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Jim Case
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Howard Clark
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Lee Coller
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Todd Cooper
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Garry Cruickshank
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Karen Cuthbert
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Pat Distler
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Richard Dixon-Hughes
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Bob Dolin
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Dick Donker
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Gina Dube
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Robert Dunlop
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Jean-Henri Duteau
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Kristi Eckerson
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Anita Feeley
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Jamie Ferguson
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Jim Foss
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Woordrow Gandy
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Laura Gibson
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Hugh Glover
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Peter Goldschmidt
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William Goossen
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Grahame Grieve
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Rick Haddorff
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Rob Hallowell
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Peter Haug
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Dick Harding
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Anja van Haren
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John Hatem
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Peter Haug
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Rob Hausam
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Peter Hendler
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Rusty Henry
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Yan Heras
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Julie James
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Marta Jaremek
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Gaby Jewell
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Dave Johnson
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Mike Jolley
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Tom de Jong
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Reina Kalish
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Dan Kempf
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Jürgen Kerstna
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Gert Koelewijn
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Astrid Koenders
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Helmut König
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Austin Kreisler
Austin.kreisler@[email protected]
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John Kufuor-Boakye
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Joann Larson
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Ed Larsen
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Kip LeCrone
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Carolyn Logan
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Patrick Loyd
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Cecil Lynch
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David Markwell
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Susan Matney
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Koichiro Matsumoto
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Ken McCaslin
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Barbara McKinnon
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Larry McKnight
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Tim McNeil
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Mukesh Mehta
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Gary Meyer
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Linda Mook
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Matthew Moores
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Suzanne Nagami
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Elise Neill
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Masaharu Obayashi
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Frank Oemig
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Tom Oniki
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Madeline Palla
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Andrew Perry
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Vassil Peytchev
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Yvonne Pijnacker Hordijk
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Philip Pochon
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Andrea Poteat
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Doug Pratt
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Ali Rashidee
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Melvin Reynolds
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John Roberts
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Scott Robertson
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Craig Robinson
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June Rosploch
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Carlo Roxas
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Dan Russler
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Tod Ryal
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Rob Savage
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Gunther Schadow
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Paul Schluter
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Peter Schwarz
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Amnon Shabo
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Rik Smithies
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Harry Solomon
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Nicholas Steblay
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Steve Steindel
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Lise Stevens
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Walter Sujansky
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Heather Sutcliffe
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Michael Tan
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Greg Thomas
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Ian Townend
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Daniel Vreem
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Perry Vonk
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Steve Wagner
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Scott Whyte
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Grant Wood
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Ning Zhuo
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Communication with declared O&O participants can be done through [email protected]. You can sign up through the HL7 website, www.hl7.org. List servers for focused aspects of the O&O domain are: [email protected], [email protected], [email protected], [email protected], and [email protected].
Monday Q1/Q2 – OO – ELINCS Implementation Guide
Attached are the slides we stepped through to review key issues raised during the ELINCS IG guide ballot process.
D:\data\HL7\ELINCS\
Ambulatory Lab Results IG Resolution - San Antonio WGM.ppt
Monday Q3 – OO – Clinical Decision Support
Decision support TC presentation by Robert Dunlop and Barbara
McKinnon. Topics: Virtual Medical Record (vMR) and GELLO.
Project 1: vMR
· vMR is a term which people came to know over the past decade and they try to find it but do not find it
· posted storyboards to list and got feedback
· imortant secondary output would be to standardize CDS specific data as well as the vMR content (because they specify output).
· Discussed with many committees, including
· Clinical genomics
· ARB
· While many interesting discussions have happened, the group is currently not quite clear view as for who to use for the modeling
· It was suggested that Orders&Obs and Patient Care should be the partners to work with. The Clinical Statement group was also discussed, and it was understood that the vMR is related to the clinical statement. However, detail technical discussion and understanding should be sought in the committee first and then any new requirements for changes moved to the clinical statement group as concrete proposals if that would be necessary.
· patient care had "asked" for a get together with the co-chairs on the modeling
Timeline:
· 2008Q2 Gap analysis
· 2009 Q1 issue CDS recommendation on a vMR model
· 2009 Q2 test recommendation with @neurIST and Cocoon/RIGHT projects in Europe
· 2009 late: issue implementation guide.
Questions:
· how to model pro/con argumentation structures from recommendation.
· Some questions exist on the idea of a "state file", a record of all data and decisions that the clinical decision support (CDS) system would consider for its recommendations. This is more than just an audit log:
· this would contain data which the CDS system had been requesting of users (via forms)
· also contains the state of the guideline
· challenges are how to update interpretations on data where the changing body of knowledge yields more information.
The first question was most concrete and taken up. Pro/con argument structures would be modeled with ActRelationships for which new ActRelationship type codes would likely need to be proposed. The
structure would have (for example)
SubstanceAdministration
moodCode = RECOMMENDATION
- Participation
typeCode = CONSUMABLE
- Role..Entity
code = "HMG CoA Reductase Inhibitor"
- ActRelationship
typeCode = REASON
- Observation
moodCode = EVENT
code = medical problem
value = "Hyperlipidemia"
- ActRelationship
typeCode = PRO-ARGUMENT
- Observation
moodCode = GOAL (?)
code = life span ????
value = extended ????
- ActRelationship
typeCode = CONTRA-ARGUMENT
- Observation
moodCode = RISK
code = medical problem
value = "Rhabdomyolysis"
- ... potential links to literature evidence, and personal
genomics data....
For pro-argument we have considered the objective (final and continuing) act relationships but determined they would be for different purposes. The DSTC representatives were very familiar with the constructs in the RIM. So a preliminary agreement on the above model was easy to achieve.
Project 2: GELLO
· moving GELLO forward
· passed in 2005
· has not been widely implemented
· some companies IBM, MedReach, others have worked with it
· some problems had been found in the GELLO syntax
· seeking to revise and submit for DSTU ballot
· would often be implemented by mapping, e.g., to SQL
· important that it's aligned to the HL7 v3 RIM
2007-2008 Q1 worked on the issues and solutions
· issues encountered
· hl7's TC position
· maintaining alignment with OCL
2008 Q3 ballot
Questions:
· can operations be specified within HL7
· retain operations in Syntax?
· store operations in separate reference library?
moving towards reconciliation with OCL
Proposed that much of that OCL discussion should be had with the INM committee (especially Grahame Grieve) so that O&O may just need to be updated every once in a while without this being the place for deep discussions about the technical details.
Tuesday Q1/Q2 – OO/Rx/Lab – Dynamic Model
· Should we do anything here?
If so, how do we proceed?
Goals
· Overall Model
· Synchronize
· Guidelines
Activities in Progress:
1. MnM and SOA is getting together.
2. ARB has Dynamic Model on the plate
3. We may be premature
Agenda:
1. What are we trying to achieve with a Dynamic Model
2. Need to capture what we have done to date.
3. Define what we expect from ARB/MnM.
4. Guidelines
What are we trying to achieve with Dynamic Model?
· Get to a framework to determine what data is sent when, and who is responsible for what.
· Establish interaction patterns to enable that framework to be constructed
· Canada created pan-Canadian patterns that the jurisdictions can then be tailor to their needs.
· A profile contains Identification, Transactions Supported, Interactions Supported, and Story Board in table form.
· A couple hundred profiles.
· Described from the perspective of one role, rather then a pair, e.g., a Patient Health Condition Repository vs a Lab system. Almost application roles, but not quite at same level of granularity.
· Canada has no immediate need to be at same level of granularity, but everybody expressed a desire to be at the same level.
· At Jurisdictional project level is where further details is worked.
· While there was no specific pattern definition, could be re-engineered.
· Louise Brown willing to volunteer to create a set of patterns. Would be a subset of what HL7 may be interested in.
· Create guidelines on how to drill down from high-level to detail and/or how to build patterns together.
· Canada did not drill down.
· Add optional behaviors to Canadian model to further validate how it ties together.
· Eliminating optionality along the way.
· Lab’s approach/focus on building blocks very similar.
· Should we have a One Role, or Multi-Role interaction perspective?
· One Role was easier to communicate with, e.g., EHR provide, what their responsibilities are.
· Multi-Role establishes the full pattern. Deriving a set of patterns from the building blocks available now would show this aspect.
What are we looking at ARB/MnM for:
· How to document patterns?
· How to document building blocks?
· What tooling?
· How do we get the (business) transaction concept demonstrated by Canada into HL7 approach? Should it?
· Should we restrict V3 trigger events to real-world events, since interactions could handle this?
· Initial response is not.
· SOA is thinking of using CDL tooling, but has not been engaged with our discussions. Ask ARB to coordinate across groups to ensure everybody is involved.
· What artifact to use to document requirements and link HL7 stakeholder requirements to what we do?
Guidelines
· Focus on building blocks and general patterns.
· ??Do we need to allow for multiple levels of transactions or are then storyboards enough??
· Canadian transaction appears to have 1 V2 trigger event but can have multiple V3 trigger events.
· Customers do not see interactions, rather then transactions.
V3 Ballot ReconciliationOrder Pattern & Composite Order
Motion: All A-Ts dealt with by editor as appropriate. Patrick, Craig.
Against: 0; Abstain: 1; In Favor: 18
D:\data\HL7\V300\
2008 Jan\V3_OR_ORPTRN_R1_M1_2008JAN_Consolidated.xls
D:\data\HL7\V300\
2008 Jan\V3_OR_COMPORD_R1_M1_2008JAN_Consolidated.xls
Observation Request
Motion: All A-Ts dealt with by editor as appropriate. Patrick, Greg.
Against: 0; Abstain: 1; In Favor: 5
D:\data\HL7\V300\
2008 Jan\V3_OB_OBSREQ_R1_M1_2008JAN_Consolidated.xls
Tuesday Q3 – OO/Rx/Pt Safety/PHER
Agenda:
· BTO
· SPL
· Immunization
· Overview
· Rel with Med Model
· Ballot Reconciliation (Partial)
BTO
· Diana could not be here.
· Ballot reconciliation starting tomorrow, but not enough authors/domain experts available to complete.
· Question out as to what we want to do next. If we want to move faster, then need volunteers.
· Storyboards being filled out
SPL
· Patrick provided overview of SPL.
· Currently Release 4 ballot
· All regulated products are now in scope, not just medication. That creates harmonization challenges with medications to keep synced, as well as that Medication is also considered for removal.
· While there are no attribute differences, there are domain differences.
· ISCR dealt with product generically already.
· Needs further discussion.
· After ballot opened, already started making updates to address key issues.
· Concern with ActDefinition (top right) that code is CWE bound to ActCode. Does not follow HL7 practice. Agreed to change.
· MarketingAct and Highlight not modeled correctly. Will be fixed.
· Intent to deprecate use of lot number. Question is that a lot number is an identifier of an instance vs. an attribute/reference of another. Could also look at it as a production cycle that generated this, in which case a lot number is an identifier of an act. For now we will keep this as a known topic where there are two ways to solve the problem, both valid with pros/cons.
· Another challenge with the II data type for ProductInstance id. Need to confirm whether we need the root to make it unique.
· Member on ProductInstance and DeviceInstance is not sibling focuses.
· Concerned that kinds and instances are mixed. Change DeviceInstance ID to mandatory.
Immunization
· Annotation Indicator: discussion on whether a code is needed.
· Consider using Annotation
· Put class code into Annotation (CMET). Gunther, Patrick. Subtype of Act. Against: 0; Abstain: 0; In Favor: 40
Tuesday Q4 – OO – V2.7 Proposals
See document attached for cumulative set of proposals reviewed. During the San Antonio session we reviewed Proposals 505 onwards.
D:\data\HL7\V270\
V27 Proposal Topics.doc
Wednesday Q1 – OO – Implantable Devices
· Progressing with nomenclature development
· Expect in May to have final approval from HRS and then move into ballot IEE
· Initial focus V2 message
· Start after May with IHE to develop V2 profile.
· In parallel re-start V3
Problem with null flavor on observation value OBX.5
Wednesday Q2 – OO – BTO
Motion: Patrick/Greg – All A-Ts will be addressed by the editor as appropriate, and brought back to committee if in doubt. Against: 0; Abstain: 0; In Favor: 5
D:\data\HL7\V300\
2008 Jan\V3_BTO_DONATION_R1_C2_2008JAN_Consolidated.xls
II
Work in progress
· Discussion document in discussion.
· CDA – IG for conversion of DICOM SR to CDA documentation on way to working group 6. High probability for comment (DICOM) and ballot (HL7) next.
Next topics:
· Alignment of Order accession numbers and patient identifiers between DICOM and HL7. Mostly addition of fields in DICOM to harmonization.
Observation Request Walkthrough for Radiology
· Why is interpretationCode in Observation Request
· Performer – Not obvious from the model that it is the requested performer.
· Consultant – Not obvious from the model that it is the requested consultant.
· Location – Not obvious from the model that it is the requested location or the performed location.
· methodCode – Question whether it covers approach site (use case from Japan)
· Not likely able to get interventional Radiology, which would need a separate RMIM for Procedure Request (with all the necessary substance administration, etc. topics).
· However, how do we cover requested use of contrast? May not need that much detail to require all the additions.
· Will ask ACR/NEMA to come up with the messiest example or two to see whether it indeed holds, but initial take is that Obsv Request for diagnostic radiology should work.
Thursday Q1 – OO – Clinical Genomics
· Clinical Genomic Overview
· Variation data in ballot
· Expression data in the future.
· When we have more experience with topics, will re-create the DMIM and replace the DSTU. Will need phenotypes, but may not need proteomics.
· RCRIM using Clin Genomics as well, so after topics and RCRIM stabilize.
· Should consider that family history should be a separate model
· Phenotype expected to be available as CMET as well as part of overall model.
· Locus and Loci intended to be deprecated. Family history .
· Version 2.7
· Coding system references are not standard, e.g., SNOMED. Not structural,
· Need to ensure that V2 approach considers V2.5.1 (in light of HITSP/CCHIT direction) and V2.7 proposals.
· Clin Genomics + Clin Statement + Lab
· Too early to incorporate materials now. Wait for September Ballot Cycle materials before discussion should start.
· Would be helpful if in May ballot cycle we would have at least bare-bones CMET with a choice box that can be extended later. Otherwise Lab is moving from Committee to Membership. This approach can be applied to RCRIM as well.
· Differential Diagnosis
· Specimen Derivation
Thursday Q3/Q4 – OO/Pt Care/Struc Doc/PHER
· Where are we?
· What’s Next?
· Change Requests
· Clinical Statement CMETs
· Topic Model Approach
What’s next:
· Incorporation of Clin Statements into CDA (2010)
· Harmonize Clin Statement and Medication/Prescription
· Clin Statement + Clin Genomics
· Next ballot round not expected earlier then 1 year from last round (after Sept 2008 WGM).
· Process on how to manage extensions/documentation thereof/etc.
Change Request
CR-71
Motion to accept as proposed. Austin, William. Against: 0; Abstain: 9; In Favor: 20.
CR-72 - Withdrawn
CR -73
Motion to accept. Austin, Dick. Against: 0; Abstain: 10; In Favor: 19
CR-74
Concern with extensions and need use cases when to use what.
As part of DSTU process further learn how to delineate.
Motion to accept with use documentation to be provided. Austin, Dave. Against: 0; Abstain: 11: In Favor: 17
CR-75
Motion to accept. Austin, Patrick. Against: 0; Abstain: 16; In Favor: 13
CR-76
Withdraw substitution of R_Subject from ProviderOrPatientOrRelated. Keep PatientOrRelatedOrSpecimen.
Motion to swap. Austin, Patrick. Suggestion to go to the additive option requiring an inner choice box. Easier to describe what’s Public Health. Concern that other committees will not be considered conformant once in place.
Against: 3; Abstain: 14; In Favor: 11
CR-77 see wiki
CR-78 see wiki
Model Topics
· Keep it in sync
· Manual
· Automated – If committees add RMIM content then automatic added to Clin Statement. Can’t quite take on everything though.
· Patient Care uses Care Statement that is constrained from Clin Statement.
· IHE has an implementation of care record as well with three parties implementing.
· Keep DSTU as is to facilitate development streams without constant change.
· Challenge how we can reduce effort. Do we really need to be perfect to be the same?
· Apply and learn?
· Recreate chart.
· How do we provide guidance to somebody who wants to use Clin Statement and then communicate, e.g., a Micro correctly and synchronous with the Lab’s suggestion on how to send Micro.
Motion: When using CS and the topic at hand already exist in a CS-harmonized domain, then they should implement it according to that domain. This statement should appear in CS and referenced by every committee’s ballot that uses CS. Bob, William. Once adopted, should be moved towards ARB to further endorse and consider as part of the “checklist” project. Against: 1; Abstain: 5; In Favor: 16.
Clin Statement CMETs
· CMETs are out-of-sync with balloted materials.
· CMET should be in sync with what we have.
· Patrick to work with Charlie (Rik to contact) to update with target for May.
· Related note that we don’t have CMET descriptions that go down to the attribute level.
· Keith will attempt to get both care record and CS statements of truth to then see how much can be copied automatically.
1 Conference Call end of January and then as-needed.
V2.7 Friday
Table 0070 in OBR-15. Move to add table reference into the attribute table both in chapter 4 (4.5.3) and 7 (7.41.). Bill, Greg. Against: 0, Abstain: 0; In Favor: 6.
Motion to change 7.4.3.4 from CWE to CNE (HL7 Defined). Greg, Bill. Against: 0; Abstain: 1; In Favor: 4
Prefer that EVN is removed from others rather then adding it to QBP-Q11. Chapter 5 should have final decision. OO is flexible to add it in if requested. Frank, Bernd. Against: 0; Abstain: 1; In Favor: 4
Change in 0487 AUTOC, DRN, GRAFT
· ATTE
Environmental, Attest
· AUTOA
Environmental, Autoclave Ampule
· Remove 2 of 3 drains and keep one.
· GRAFTSGraft Site
Motion: Greg, Bill. Against: 0; Abstain: 0; In Favor: 5
Agreed to fix NP, NOSE, PAROT, THORA, UMBL to avoid duplicate codes for 0550. Frank, Bernd. Against: 0; Abstain: 0; In Favor: 5
Motion to deprecate Waveform sections 7.14 – 7.17. Frank, Bernd. Against: 0; Abstain: 0; In Favor: 5.
Motion to request ARB what to do in V2.x when an attribute is deprecated, while the table is still in use by other fields and where the table continues to evolve over time. How do we “freeze” the content for that field at time of deprecation OR accept that new values could be used. Needs to be addressed across the standard. This is also applicable to data types, data lengths, and message structures. Motion. Frank, Greg. Against: 0; Abstain: 0; In Favor: 5.
Section
Comment
Status
4.13.14:
vinserted [{NTE}] after RXE to be in sync with 4.13.64.13.6 is the master message definition. It seems that the change hasn't been applied to all occurrences.
EDITORIAL FIX.
_1261995435.xls
Submitter
BALLOT TITLE:HL7 Version 3 Standard: Orders; Composite Order, Release 1 (1st Membership Ballot)
SUBMITTED BY NAME:
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OVERALL BALLOT VOTE:Affirmative
If you submit an overall affirmative vote, please make sure you have not included negative line items on the Ballot worksheet
Enter Ballot Comments (Line Items)Instructions
&C&"Arial,Bold"&14V3 Ballot Submission/Resolution
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&L&F [&A]&C&P&RMarch 2003
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Enter Ballot Comments (Line Items)
Ballot
Ballot Comment SubmissionCommittee ResolutionBallot Comment Tracking
NumberBallot CommitteeArtifactArtifact IDChapterSectionBallotPubsVote and TypeExisting WordingProposed WordingCommentsIn person resolution requestedComment groupingDispositionWithdrawnDisposition CommitteeDisposition CommentResponsible PersonForAgainstAbstainChange AppliedSubstantive ChangeSubmitted ByOrganizationOn behalf ofOn Behalf of EmailSubmitter Tracking IDReferred ToReceived FromNotes
1OOTE3.2.4 Composite Order Resume (POOR_TE200905UV)A-TFocal Act: The end state of the focal act of the message is must be Active.Focal Act: The end state of the focal act of the message must be Active.Repeat comment from May 2007 ballot (not corrected).Freida HallVAMary Jarquin (VHIM)[email protected]
2OOTE3.2.5 Composite Order Abort (POOR_TE200903UV)A-TFocal Act: The end state of the focal act of the message is must be Aborted.Focal Act: The end state of the focal act of the message must be Aborted.Repeat comment from May 2007 ballot (not corrected).Freida HallVAMary Jarquin (VHIM)[email protected]
3OOTEPOOR_TE200904UV32.3A-SI think the diagram for SUSPEND (Component Acts) should have the following boxes grayed out: Aborted, Completed, Nullified, Obsoleted.John HatemOracle
4OOTEPOOR_TE200905UV32.4A-SThis means all orders are returned to the active state.This means all suspended orders are returned to the active state.John HatemOracle
5OOTEPOOR_TE200905UV32.4A-SI think the diagram for RESUME (Component Acts) should have the following boxes grayed out: Aborted, Completed, Nullified, Obsoleted.John HatemOracle
6OOTEPOOR_TE200903UV32.5A-SA cancel of a composite order cancels (aborts) all component orders.A cancel of a composite order cancels (aborts) all component orders in active or suspended state.John HatemOracle
7OOTEPOOR_TE200903UV32.5A-SI think the diagram for RESUME (Component Acts) should have the following boxes grayed out: Completed, Nullified, Obsoleted.John HatemOracle
8OORMComposite Order (POOR_RM200999UV)Neg-MjIn the previous ballot, OO found as persuasive the request to add the A_LaboratoryProccessingStep CMET to the Composit order RMIM. In this ballot, OO has fqailed to add that CMET. We (Lab SIG) feel that is it essential that OO live up to it's promise to add this CMET to the model. The CMET represents work Lab SIG has done to capture process step requirements it needs for order management. Apparently OO has interpreted the Persuasive disposition of the previous ballot item to really mean Persuasive with Mod, and actually implemented part of what Lab asked for by including a Processing Step class to the model. Unfortunately this change doesn't meet all of Lab SIG requirements in this area. A suitable compromise from Labs perspective to add a choice box to the model containing the solution OO put in place but also include the A_LaboratoryProcessingStep CMET.YesPersuasiveDid not get everything in as result of oversight. Will be completed by generizing what we have and include the Lab CMET as a choice. Patrick, Ken1503Austin KreislerSAIC
9OORMComposite Order (POOR_RM200999UV)Neg-MjThe direction of the InFullfillmenOf ActRelationship in the composite order model needs to be reversed. The source act fulfills the target act. In this case, the Promise or Event fulfill the original order. That means the AR needs to point from the FulfillmentChoice to the request choice.YesPersuasiveAdjust direction accordingly. Patrick, Austin1602Austin KreislerSAIC
10OORMComposite Order (POOR_RM200999UV)Neg-MjAlthough there is some attribute level documentation in the table view associated with the RMIM, particularly for the classes in the RequestChoice, there is inadequate attribute level documentation of attributes for participations, act relationships and other classes included in the model.YesPersuasiveAgreed, but need resources to help out. Will leverage between OO/Rx/Lab. Patrick, Rob1703Austin KreislerSAIC
11OOPOOR_RM200999UV3.3.1A-CI am trying to understand the relationship between ObervationRequest as it appears in this RMIM with a parent DMIM DM100000UV and ObservationRequest as it appears in RMIM POOB_RM210000UV which is supposed to have as its parent DMIM POOB_DM200000UV. This is discussed in the Observations domain. However, it is also the case that in spite of stating that its parent is POOB_DM200000UV, it looks more like a subset of the DMIM in the Orders domain. Please clarify.Joann LarsonKaiser Permanente
12OOPOOR_RM200999UV3.3.1Neg-MiThere needs to be a walk-through at the RMIM level here. The DMIM walk-through does not match the classes that are described in its diagram. Somewhere there needs to be a step by step walk-through that matches its corresponding diagram. If this does not occur at the DMIM level then it needs to be at the RMIM level.Not persuasive with modPublishingWe need to resolve appropriate documentation approach to avoid duplication as it otherwise would exists between walk-through and attribute level description. Need approach input from Publishing. Until that time we will continue with attribute level descriptions as the place to document these models. And add language to walktrhough to point to attribute descriptions. Patrick, Austin1604Joann LarsonKaiser Permanente
13OOPOOR_HD200999UV3.4.1Neg-MiThe HMD does not provide the necessary level of definition given that there is no walk-through at the RMIM level and the DMIM walk-through does not match its diagram.Pending input from submitterWe believe everything is there. However, we can adjust the first sentence in the paragraph on specialized act classes.Joann LarsonKaiser Permanente
14OOSTNeg-MjStoryboards missingAdd themStoryboards provide an illustrated use of the dynamic artifacts in a topic and when the narratives have interactions listed, they provide a clear overview of how the interactions work together allowing the reader to understand the dynamic model of the domain. Without storyboards, a domain or topic is missing a key piece of summary information explaining how the artifacts work in context. Even if this is a general "pattern" type domain, those more specific domains need the storyboards as a model for their specific uses. Any domain that specifies interactions needs storyboards, otherwise the reader - who has been taught to expect them (they are everywhere else) is going to get confused.PersuasiveWill do as soon as we have the resources to do it. Patrick, Greg500Virginia LorenziNewYork-Presbyterian Hospital
15OOTENeg-MiMissing V2 references on trigger eventsAdd themThis is the defacto standard across the publication, by leaving them out here, it reduces the overall quality/readability of the publication. V2 references on trigger events help the reader or implementor who is familiar with V2 understand the material. By leaving them out, you are implying there is no similar V2 artifact.Persuasive with modCurrently not a known requirement, but we will start to add this as we move along. Patrick, Greg500Virginia LorenziNewYork-Presbyterian Hospital
16OOINNeg-MjWhy aren't there any receiver responsibilities on the request type interactions???Add themI am still confused why we can't nail this down.PersuasiveWill do before we go to the next Membership ballot round. Patrick, Greg500Virginia LorenziNewYork-Presbyterian Hospital
17OOHDNeg-MjContext specific attributes level descriptions still missingAdd themWhile portions of the HMDs now have attributes level descriptions, many still have many attributes that do not have definitions, leaving the context specific meaning unclear which will lead to many different interpretations and perhaps unworkable ones.PersuasiveWill do before we go to the next Membership ballot round. Patrick, Greg500Virginia LorenziNewYork-Presbyterian Hospital
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&C&"Arial,Bold"&14V3 Ballot Submission/Resolution
Form
&L&F [&A]&C&P&RMarch 2003
Section
Vote and Type
Existing Wording
Proposed Wording
Comments
Disposition Comment
Artifact
Ballot
Number
Pubs
Disposition Committee
Responsible Person
Change Applied
For
Withdrawn
Substantive Change
Submitted By
Organization
On behalf of
Disposition
Comment grouping
Ballot Committee
In person resolution requested
Referred To
Received From
Notes
On Behalf of Email
Submitter Tracking ID
POOR_HD200999UV
Instructions
Return to Ballot
How to Use this Spreadsheet
Submitting a ballot:
SUBMITTER WORKSHEET:Please complete the Submitter worksheet noting your overall ballot vote. Please note if you have any negative line items, the ballot is considered negative overall. For Organization and Benefactor members, the designated contact must be one of your registered voters to conform with ANSI guidelines.
BALLOT WORKSHEET:Please complete all lavender columns as described below - columns in turquoise are for the committees to complete when reviewing ballot comments. Several columns utilize drop-down lists of valid values, denoted by a down-arrow to the right of the cell. Some columns utilize a filter which appears as a drop down in the gray row directly below the column header row. If you need to add a row, please do so near the bottom of the rows provided.If you encounter issues with the spreadsheet, please contact Karen VanHentenryck ([email protected]) at HL7 Headquarters.
Resolving a ballot:Please complete all green columns as described below - columns in blue are for the ballot submitters.You are required to send resolved ballots back to the ballot submitter, as denoted by the Submitter worksheet.
Submitting comments on behalf of another person:You can cut and paste other peoples comments into your spreadsheet and manually update the column titled "On behalf of" or you can use a worksheet with the amalgamation macro in it (available from HL7 Inc. or HL7 Canada ([email protected])). The amalgamation worksheet contains the necessary instructions to automatically populate the 'submitter', 'organization' and 'on behalf of' columns. This is very useful for organizational members or international affiliates who have one representative for ballot comments from a number of different people.
Column Headers
Ballot Submitter (sections in lavender)
NumberThis is an identifier used by HL7 Committees. Please do not alter.
Ballot CommitteeSelect the committee from the drop down list that will best be able to resolve the ballot comment.
In some situations, the ballot comment is general in nature and can best be resolved by a non-chapter specific committee. This can include MnM (Modeling and Methodology) & CQ (Control Query). Enter these committees if you feel the ballot can best be resolved by these groups. In some situations, chapter specific committees such as OO (Observation and Orders) and FM (Financial Management) will refer ballot comments to these committees if they are unable to resolve the ballot comment. An explanation of the 'codes' used to represent the Ballot Committees as well as the Ballots they are responsible for is included in the worksheet titled 'CodeReference'
ArtifactThe type of Artifact this Change affects.
HDHierarchical Message Definition
ARApplication Roles
RMRefined Message Information Model
INInteraction
TETrigger Event
MTMessage Type
DMDomain Message Information Model
STStoryboard
??Other
SectionSection of the ballot, e.g., 3.1.2. Note: This column can be filtered by the committee, for example, to consider all ballot line items reported against section 3.1.2.
BallotA collection of artifacts including messages, interactions, & storyboards that cover a specific interest area. Examples in HL7 are Pharmacy, Medical Devices, Patient Administration, Lab Order/Resulting, Medical Records, and Claims and Reimbursement.
Select from the drop down list the specific ballot that the comment pertains to. An explanation of the 'codes' used to represent the Ballots as well as the Ballot Committees that are are responsible for them is included in the worksheet titled 'CodeReference'. Please refer to the list of available ballots on the HL7 site for more descriptive information on current, open ballots.
PubsIf the submitter feels that the issue being raised directly relates to the formatting or publication of this document rather than the content of the document, flag this field with a "Y" value, otherwise leave it blank or "N".
Vote/TypeNegative Votes:
1. (Neg-Mj) Negative Vote with reason , Major. Use this in the situation where the content of the material is non-functional, incomplete or requires correction before final publication. All Neg-Mj votes must be resolved by committee.
2. (Neg-Mi) Negative Vote with reason, Minor Type. Use this when the comment needs to be resolved, but is not as significant as a negative major.
Affirmative Votes:
3. (A-S) Affirmative Vote with Comment - Suggestion. Use this if the committee is to consider a suggestion such as additional background information or justification for a particular solution.
4. (A-T) Affirmative Vote with Comment - Typo. If the material contains a typo such as misspelled words, enter A-T.
5. (A-Q) Affirmative Vote with Question.
6. (A-C) Affirmative Vote with Comment.
Existing WordingCopy and Paste from ballot materials.
Proposed WordingDenote desired changes.
CommentsReason for the Change. In the case of proposed wording, a note indicating where the changes are in the proposed wording plus a reason would be beneficial for the committee reviewing the ballot.
In Person Resolution Required?Submitters can use this field to indicate that they would appreciate discussing particular comments in person during a Committee Meeting. Co-Chairs can likewise mark this field to indicate comments they think should be discussed in person. Please note that due to time constraints not all comments can be reviewed at WGMs.
Committee Resolution (sections in turquoise)
Comment GroupingThis is a free text field that committees can use to track similar or identical ballot comments. For example, if a committee receives 10 identical or similar ballot comments the committee can place a code (e.g. C1) in this column beside each of the 10 ballot comments. The committee can then apply the sort filter to view all of the similar ballot comments at the same time.
DispositionThe instructions for selecting dispositions were too large for this section and have been moved to the worksheet titled "Instructions Cont.."
Withdraw(Negative BallotsOnly)WithdrawThis code is used when the submitter agrees to "Withdraw" the negative line item. The Process Improvement Committee is working with HL7 Headquarters to clarify the documentation on 'Withdraw" in the HL7 Inc. Bylaws and Policies and Procedures. To help balloters and co-chairs understand the use of "Withdraw", the following example scenarios have been included as examples of when "Withdraw" might be used: 1) the TC has agreed to make the requested change, 2) the TC has agreed to make the requested change, but with modification; 3) the TC has found the requested change to be persuasive but out-of scope for the particular ballot cycle and encourages the ballotter to submit the change for the next release; 4) the TC has found the requested change to be non-persuasive and has convinced the submitter. If the negative ballotter agrees to "Withdraw" a negative line item it must be recorded in the ballot spreadsheet.
The intent of this field is to help manage negative line items, but the TC may elect to manage affirmative suggestions and typos using this field if they so desire.
This field may be populated based on the ballotter's verbal statement in a WGM, in a teleconference or in a private conversation with a TC co-chair. The intention will be documented in minutes as appropriate and on this ballot spreadsheet. The entry must be dated if it occurs outside of a WGM or after the conclusion of WGM.
The field will be left unpopulated if the ballotter elects to not withdraw or retract the negative line item.
Note that a ballotter often withdraws a line item before a change is actually applied. The TC is obliged to do a cross check of the Disposition field with the Change Applied field to ensure that they have finished dealing with the line item appropriately.
RetractThe ballotter has been convinced by the committee to retract their ballot item. This may be due to a decision to make the change in a future version or a misunderstanding about the content.
NOTE: If the line item was previously referred, but withdrawn or retracted once the line item is dealt with in the subsequent committee update the disposition as appropriate when the line item is resolved.
Disposition CommitteeIf the Disposition is "Refer", then select the committee that is ultimately responsible for resolving the ballot comment. Otherwise, leave the column blank. If the Disposition is "Pending" for action by another committee, select the appropriate committee.
Disposition CommentEnter a reason for the disposition as well as the context. Some examples from the CQ committee include:20030910 CQ WGM: The request has been found Not Persuasive because....20031117 CQ Telecon: The group agreed to the proposed wording.20031117 CQ Telecon: Editor recommends that proposed wording be accepted.
Responsible PersonIdentifies a specific person in the committee (or disposition committee) that will ensure that any accepted changes are applied to subsequent materials published by the committee (e.g. updating storyboards, updating DMIMs, etc.).
For, Against, AbstainIn the event votes are taken to aid in your line item resolutions, there are three columns available for the number of each type of vote possible, for the proposed resolution, against it or abstain from the vote.
Change AppliedA Y/N indicator to be used by the committee chairs to indicate if the Responsible Person has indeed made the proposed change and submitted updated materials to the committee.
Substantive ChangeA Y/N indicator to be used by the committee chairs to indicate if the line item is a substantive change. NOTE: This is a placeholder in V3 pending definition of substantive change by the ARB.
Submitted ByThis column is auto filled from the Submitter Worksheet. It is used to refer back to the submitter for a given line item when all the ballot line items are combined into a single spreadsheet or database. For Organization and Benefactor members, the designated contact must be one of your registered voters to conform with ANSI guidelines.
OrganizationThis column is auto filled from the Submitter Worksheet. Submitter's should enter the name of the organization that they represent with respect to voting if different from the organization that they are employed by. It is used to link the submitter's name with the organization they are voting on behalf of for a given line item when all the ballot line items are combined into a single spreadsheet or database.
On Behalf OfThis column is autofilled from the Submitter Worksheet. It is used to track the original submitter of the line item. Many International Affiliates, Organizational, and Benefactor balloters pool comments from a variety of reviewers, which can be tracked using this column.
On Behalf Of EmailThis column is autofilled from the Submitter Worksheet. It is used to track the email address of the original submitter of the line item. Many International Affiliates, Organizational, and Benefactor balloters pool comments from a variety of reviewers, which can be tracked using this column.
Submitter Tracking ID #Internal identifier (internal to the organization submitting the ballot). This should be a meaningful number to the organization that allows them to track comments. This can be something as simple as the reviewer’s initials followed by a number for each comment, i.e. JD-1, or even more complex such as ‘001XXhsJul03’ where ‘001’ is the unique item number, ‘XX’ is the reviewer's initials, ‘hs’ is the company initials, and ‘Jul03’ is the date the ballot was released. If additional rows are added, please do so after the last row in the ballot spreadsheet and ensure that the sequential numbers are maintained.
Referred ToUse this column to indicate the committee to which you have referred this ballot comment to.
Received FromUse this column to indicate the committee to which you have received this ballot comment from.
NotesThis is a free text field that committees can use to add comments regarding the current status of referred or received item.
&C&"Arial,Bold"&14Ballot Submission/Resolution
Instructions
&L&F [&A]&RAugust, 2002
Return to Ballot
The instructions for selecting dispositions were too large for
this section and have been moved to the worksheet titled
"Instructions Cont.."
Instructions Cont..
Ballot instructions continued...Back to ballotBack to instructions
&C&"Arial,Bold"&14Ballot Submission/Resolution
Instructions
&L&F [&A]&RAugust, 2002
For the column titled "Disposition" please select one of the following:
Applicable to All Ballot Comments (Affirmative and Negative)1. Persuasive. The committee has accepted the ballot comment as submitted and will make the appropriate change in the next ballot cycle. At this point the comment is considered withdrawn and the corresponding cell from the column titled ‘Withdrawn’ should be marked appropriately. Section 14.06.03.04 of the HL7 Bylaws states that if a ballot comment is to be withdrawn that there must be “…agreement without objection that the negative vote is persuasive” and therefore TCs must take a vote to accept the comment as persuasive. 2. Persuasive with Mod. The committee believes the ballot comment has merit, but has changed the proposed solution given by the voter. Example scenarios include, but are not limited to;-The TC has accepted the intent of the ballot comment, but has changed the proposed solution -The TC has accepted part of the ballot comment, and will make a change to the standard; the other part is not persuasive -The TC has accepted part of the ballot comment, and will make a change to the standard; the other part may be persuasive but is out of scope The standard will be changed accordingly in the next ballot cycle. The nature of, or reason for, the modification is reflected in the Disposition Comments. At this point the comment is considered withdrawn and the corresponding cell from the column titled ‘Withdrawn’ should be marked appropriately. Section 14.06.03.04 of the HL7 Bylaws states that if a ballot comment is to be withdrawn that there must be “…agreement without objection that the negative vote is persuasive” and therefore TCs must take a vote to accept the comment as persuasive. 3. Not Persuasive. The committee does not believe the ballot comment has merit or is unclear. Section 14.06.03.03 of the HL7 Bylaws states that “A motion or ballot to declare a negative response ‘not persuasive,’ requires an affirmative vote of at least two-thirds of the combined affirmative and negative votes cast by the Technical Committee members on the action for approval.” A change will not be made to the standard or proposed standard. The committee must indicate a specific reason why the ballot comment is rejected in the Disposition Comments. The ballot submitter has the option to appeal this decision following HL7 procedures as defined in section 15.10 of the HL7 Bylaws. Example scenarios include, but are not limited to;- the submitter has provided a recommendation or comment that the committee does not feel is valid- the submitter has not provided a recommendation/solution; the submitter is encouraged to submit a proposal for a future ballot - the recommendation/solution provided by the submitter is not clear; the submitter is encouraged to submit a proposal for a future ballot
4. Not Related. The TC has determined that the ballot comment is not relevant to the domain at this point in the ballot cycle. Section 14.06.03.02 of the HL7 Bylaws states that “A motion or ballot to declare a negative response ‘not related’ to the item being balloted requires an affirmative vote of at least two-thirds of the combined affirmative and negative votes cast by the Technical Committee members on the action for approval.” Example scenarios include, but are not limited to;- the submitter is commenting on a portion of the standard, or proposed standard, that is not part of the current ballot - the submitter's comments may be persuasive but beyond what can be accomplished at this point in the ballot cycle without creating potential controversy. - the submitter is commenting on something that is not part of the domain
5. Referred and Tracked. This should be used in circumstances when a comment was submitted to your TC in error and should have been submitted to another TC. If you use this disposition you should also select the name of the TC you referred the comment to under the Column "Referred To".
6. Pending Input from Submitter. This should be used when the TC has read the comment but didn't quite understand it or needs to get more input from the submitter. By selecting "Pending Input from Submitter" the TC can track and sort their dispositions more accurately.
7. Pending Input from other Committee. The TC has determined that they cannot give the comment a disposition with out further input or a final decision from another Committee. This should be used for comments that do belong to your TC but you require a decision from another Committee such as ARB or MnM. Applicable only to Affirmative Ballot Comments8. Considered for future use. The TC, or a representative of the TC (editor or task force), has reviewed the item and has determined that no change will be made to the standard at this point in time. This is in keeping with ANSI requirements. The reviewer should comment on the result of the ballot comment consideration. An Example comment is included here:- the suggestion is persuasive, but outside the scope of the ballot cycle; the submitter is encouraged to submit a proposal to the committee using the agreed upon procedures.
9. Considered-Question answered. The TC, or a representative of the TC (editor or task force), has reviewed the item and has answered the question posed. In so doing, the TC has determined that no change will be made to the standard at this point in time. This is in keeping with ANSI requirements.
10. Considered-No action required. Occasionally people will submit an affirmative comment that does not require an action. For example, some TC's have received comments of praise for a job well done. This comment doesn't require any further action on the TC's part, other than to keep up the good work.
Back to ballot
Back to instructions
Format Guidelines
&C&"Arial,Bold"&14V3 Ballot Submission/Resolution
Form
&L&F [&A]&C&P&RMarch 2003
Note on entering large bodies of text:------------------------------------------------------------------When entering a large body of text in an Excel spreadsheet cell:
1) The cell is pre-set to word wrap
2) You can expand the column if you would like to see more of the available data
3) There is a limit to the amount of text you can enter into a "comment" text column so keep things brief. -For verbose text, we recommend a separate word document; reference the file name here and include it (zipped) with your ballot.
4) To include a paragraph space in your lengthly text, use Alt + Enter on your keyboard.
5) To create "bullets", simply use a dash "-" space for each item you want to"bullet" and use two paragraph marks between them (Alt + Enter as describedabove).------------------------------------------------------------------
Co-Chair Guidelines
&C&"Arial,Bold"&14V3 Ballot Submission/Resolution
Form
&L&F [&A]&C&P&RMarch 2003
Note: This section is a placeholder for Q&A/Helpful Hints for ballot resolution. (These notes are from Cleveland Co-Chair meeting; needs to be edited, or replaced by use cases)
Marked ballotsIssue For second and subsequent membership ballots HL7 ballots only the substantive changes that were added since the last ballot, with the instructions that ballots returned on unmarked items will be found “not related”. How do you handle obvious errors that were not marked, for example, the address for an external reference (e.g. DICOM) is incorrect? Response You can correct the obvious typographical errors as long as it is not a substantive change, even if it is unmarked. We recommend conservation interpretation of “obvious error” as you do not want to make a change that will questioned, or perceived to show favoritism. If you are unclear if the item is an “obvious error” consult the TSC Chair or ARB. Comment With the progression of ballots from Committee - > Membership the closer you get to final member ballot, the more conservative you should be in adding content. In the early stages of committee ballot, it may be acceptable to adding new content (if endorsed by the committee) as wider audiences will review/critique in membership ballot. The Bylaws require two levels of ballot for new content (refer to Section 14.01). Exceptions must approved by the TSC Char.
Non-persuasiveIssue Use with discretion· Attempt to contact the voter before you declare their vote non-persuasive· Fixing a problem (e.g. typo) in effect makes the negative vote non-persuasive.· In all cases, the voter must be informed of the TC’s action.Response The preferred outcome is for the voter to withdraw a negative ballot; It is within a chair’s prerogative to declare an item non-persuasive. However, it does not make sense to declare non-persuasive without attempting to contact the voter to discuss why you are declaring non-persuasive. If you correct a typo, the item is no longer (in effect) non-persuasive once you have adopted their recommended change, however the voter should then willingly withdraw their negative as you have made their suggestion correction.. In all cases, you must inform the voter.Comment
Non-relatedIssue Use with discretion· Used, for example, if the ballot item is out of scope, e.g. on a marked ballot the voter has submitted a comment on an area not subject to vote.· Out of scope itemsResponse Comment
Non-standard ballot responses are receivedIssue The ballot spreadsheet allows invalid combination, such as negative typo.Response Revise the ballot spreadsheets to support only the ANSI defined votes, plus “minor” and “major” negative as requested by the committees for use as a management tool. Question will be removed. Suggestion will be retainedComment Separate Affirmative/Abstain and Negative ballots will be created. Affirmative ballots will support: naffirmativenaffirmative with commentnaffirmative with comment – typonaffirmative with comment – suggestionnabstainNegative ballots will support:nnegative with reason – majornnegative with reason – minorNote: “major” “minor” need definition
Substantive changes must be noted in ballot reconciliationIssue Who determines whether a ballot goes forward?Response Substantive changes in a member ballot will result in a subsequent ballot. These should be identified on the ballot reconciliation form. (Refer to Bylaws 15.07.03). The TSC Chair will determine whether the ballot goes forward to another member ballot, or back to committee ballot.Comment · Co-chairs and Editors need a working knowledge of “substantive change” as defined on the Arb website.·
What Reconciliation Documentation Should Be Retained?Issue · By-Laws Section 14.04.01 states: “All comments accompanying affirmative ballots shall be considered by the Technical Committee.” This means each line item must be reviewed. You can use the disposition "considered" to mark affirmative comments that have been reviewed. Committees are encouraged to include in the comment section what they thing of the affirmative comment and whether or not they think action should be taken, and by who.Response · Comment
How do you handle negatives without comment?Issue How do you handle a negative ballot is submitted without comments?Response The co-chair attempts to contact the voter, indicating “x” days to respond. If there is no response, the vote becomes 'not persuasive' and the co-chair must notify the ballotter of this disposition.
AppealsIssue How are appeals handled?Response · Negative votes could be appealed to the TSC or Board· Affirmative votes cannot be appealedComment
Some information is not being retainedIssue · The disposition of the line item as to whether or not a change request has been accepted needs to be retained. · The status of the line item as it pertains to whether or not the respondent has withdrawn the line item is a separate matter and needs to be recorded in the column titled "withdrawn'
Some information is not being retainedIssue By-Laws Section 14.04.01 states: “All comments accompanying affirmative ballots shall be considered by the Technical Committee.”· There is divided opinion as to whether or not Technical Committee’s need to review all line items in a ballot.· Should there be a statement on the reconciliation document noting what the TC decided?Response “. . .considered” does not mean the committee has to take a vote on each line item. However, a record needs to be kept as to the disposition. There are other ways to review, e.g. send to the committee for review offline, and then discuss in conference call. The review could be asynchronous, then coordinated in a conference call. The ballot has to get to a level where the committee could vote on the item. The committee might utilize a triage process to manage line items. Comment Action Item: Add to the ballot spreadsheet a checkoff for “considered; this would not require, but does not prohibit, documentation of the relative discussion.
Withdrawing NegativesTo withdraw a negative ballot or vote, HQ must be formally notified. Typically, the ballotter notifies HQ in writing of this intent. If, however, the ballotter has verbally expressed the intention to withdraw the entire negative ballot in the TC meeting, this intent must be documented in the minutes. The meeting minutes can then be sent via e-mail to the negative voter with a note indicating that this is confirmation that he/she withdrew their negative as stated in the attached meeting minutes and that their vote will be considered withdrawn unless they respond otherwise within five (5) days.
The ballotter may also submit a written statement to the TC. The submitter's withdrawal must be documented and a copy retained by the co-chairs and a copy sent to HL7 HQ by email or fax.
Two weeks (14 days) prior to the scheduled opening of the next ballot, the co-chairs must have shared the reconciliation package or disposition of the negative votes with the negative balloters. The negative balloters then have 7 days to withdraw their negative vote. If, 7 days prior to the scheduled opening of the next ballot the negative vote is not withdrawn, it will go outwith the subsequent ballot as an outstanding negative.
Changes applied are not mapped to a specific responseIssue Changes are sometimes applied to the standard that are not mapped directly to a specific ballot response , due to editing requirementsResponse: A column to record substantive changes and to track whether the change has been applied was added.
Asking for negative vote withdrawal:Please include the unique ballot ID in all requests to ballot submitters. E.g. if asking a ballot submitter to withdraw a negative please use the ballot ID to reference the ballot.
The following sections contain known outstanding issues. These have not been resolved because they require a 'ruling' on interpretations of the Bylaws and the Policies and Procedures as well as updating of those documents. If you ever in doubt on how to proceed on an item, take a proposal for a method of action, then take a vote on that proposal of action and record it in the spreadsheet and in the minutes.
Tracking duplicate ballot issues is a challengeIssue Multiple voters submit the same ballot item.Response While items may be “combined” for purposes of committee review, each ballot must be responded to independently.Comment
Editorial licenseIssue There is divided opinion as to the boundaries of "editorial license".Response Comment
Divided opinion on what requires a voteIssue Response · Do all negative line items require inspection/vote of the TC? – Yes, but you can group· Do all substantive line items require inspection/vote of the TC? Yes· How should non-substantive changes be evaluated for potential controversy that would require inspection and vote of the TC? Prerogative of Chair, if so empoweredComment
Ballet Reconciliation Process SuggestionIssue It might be useful to map the proposed change to the ARB Substantive Change document. This would involve encoding the ARB document and making allowances for “Guideline Not Found”.Response ARB is updating their Substantive Change document; this process might elicit additional changes.Comment Action Item? This would require an additional column on the spreadsheet
How are line item dispositions handled?Issue Line items are not handled consistentlyResponse · A Withdrawn negative is counted as an affirmative (this is preferable to non-persuasive.)· A Not related remains negative in the ballot pool for quorum purposes, but does not impede the ballot, e.g. it does not count as a negative in the 90% rule.· A Not persuasive remains negative in the ballot pool for quorum purposes, but does not impede the ballot, e.g. it does not count as a negative in the 90% rule.· Every negative needs a response; not every negative needs to be “I agree with your proposed change.” The goal is to get enough negatives resolved in order to get the ballot to pass, while producing a quality standard.Comment
How should negative line items in an “Affirmative Ballot” be handled?Issue Affirmative Ballots are received that contained negative line items. The current practice is to err on the side of caution and treat the negative line item as a true negative (i.e. negative ballot).Response · If a member votes “Affirm with Negative line item” the negative line item is treated as a comment but the ballot overall is affirmative.· Action Item: This must be added to the Ballot InstructionComment Revising the ballot spreadsheet to eliminate invalid responses will minimize this issue. Note on the ballot spread
Difference Between Withdraw and RetractIf a ballot submitter offers to withdraw the negative line item the ‘negative’ still counts towards the total number of affirmative and negative votes received for the ballot (as it currently seems to state in the bylaws). If the submitter offers to retract their negative then it does not count towards the overall affirmative and negative votes received for the ballot.
CodeReference
Ballot Committee CodeBallot Committee NameBallot Code NameMeaningType of Document
CQControl/QueryCTVersion 3: (CMET) Common Message Elements, Release 1, 2, 3Domain
XML-ITS DataTypesVersion 3: XML Implementation Technology Specification - Data Types, Release 1Foundation
XML-ITS StructuresVersion 3: XML Implementation Technology Specification - Structures, Release 1Foundation
Datatypes AbstractVersion 3: Data Types - Abstract Specification, Release 1Foundation
MTVersion 3: Shared Messages, Release 1, 2Domain
TRANSPORTVersion 3: Transport ProtocolsFoundations
UML-ITS DataTypesVersion 3: UML Implementation Technology Specification - Data Types, Release 1Foundation
CI, AI, QIVersion 3: Infrastructure Management, Release 1Domains
MIVersion 3: Master File/Registry Infrastructure, Release 1Domain
FMFinancial ManagementABVersion 3: Accounting and Billing, Release 1Domain
CRVersion 3: Claims and Reimbursement, Release 1, 2, 3Domain
M and MModelling and MethodologyRIMVersion 3: Reference Information ModelFoundation
RefinementVersion 3: Refinement, Extensibility and Conformance, Release 1, 2Foundation
MedRecMedical RecordsMRVersion 3: Medical Records, Release 1Domain
OOOrders and ObservationsLBVersion 3: Laboratory, Release 1Domain
OOVersion 3: Orders and Observations, Release 1Domain
RXVersion 3: Pharmacy, Release 1Domain
BBVersion 3: Blood Bank, Release 1Domain
MEVersion 3: Medication, Release 1Domain
PAPatient AdministrationPAVersion 3: Patient Administration, Release 1, 2Domain
PCPatient CarePCVersion 3: Patient Care, Release 1Domain
PublishingPublishingV3 Help Guide (ref)Version 3: GuideReference
Backbone (ref)Version 3: BackboneReference
RCRIMRegulated Clinical Research Information ManagementRRVersion 3: Public Health Reporting, Release 1Domain
RTVersion 3: Regulated Studies, Release 1Domain
SchedSchedulingSCVersion 3: Scheduling, Release 1, 2Domain
VocabVocabularyVocabulary (ref)Version 3: VocabularyFoundation
Glossary (ref)Version 3: GlossaryReference
ARBArchitectural Review Board
CCOWClinical Context Object Workgroup
CDSClinical Decision Support
StructDocsStructured Documents
PMPersonnel ManagementPM
EdEducation
Setup
This page reserved for HL7 HQ. DO NOT EDIT.
AffirmativeNegative
If you submit an overall affirmative vote, please make sure you have not included negative line items on the Ballot worksheet
Please be sure that your overall negative vote has supporting negative comments with explanations on the Ballot worksheet
You have indicated that you will be attending the Working Group Meeting and that you would like to discuss at least one of your comments with the responsible Committee during that time. Please note that due to time constraints not all comments can be reviewed at WGMs and that it is your responsibility to find out when this ballot comment can be scheduled for discussion.
YesNo
PersuasivePersuasive with modNot persuasiveNot persuasive with modNot relatedConsidered for future useAnsweredConsidered-No action requiredConsidered-Question AnsweredRefered and trackedPending input from submitterPending decision from other Committee
HD
AR
RM
IN
TE
MT
DM
ST
??
ARB,Attach,Cardio,CCBC,CCOW,CDS,CG,Conform,Ed,EHR,FM,II,Implementation,InM,ITS,Lab,M and M,M and M/ CMETs,M and M/ Templates,M and M/ Tooling,MedRec,OO,PA,PC,PHER,PM,PS,Publishing,RCRIM,RX,Sched,Security,SOA,StructDocs,Vocab
&C&"Arial,Bold"&14V3 Ballot Submission/Resolution
Form
&L&F [&A]&C&P&RMarch 2003
_1271437422.xls
Submitter
BALLOT TITLE:HL7 Version 3 Standard: Observations; Observation Request, Release 1 (1st Membership Ballot)
SUBMITTED BY NAME:
SUBMITTED BY EMAIL:
SUBMITTED BY PHONE:
SUBMITTED BY ORGANIZATION (if applicable):
SUBMISSION DATE:
SUBMITTED BY IDENTIFIER:
OVERALL BALLOT VOTE:
0.0
Enter Ballot Comments (Line Items)Instructions
&C&"Arial,Bold"&14V3 Ballot Submission/Resolution
Form
&L&F [&A]&C&P&RMarch 2003
Instructions
Enter Ballot Comments (Line Items)
Ballot
Ballot Comment SubmissionCommittee ResolutionBallot Comment Tracking
NumberBallot CommitteeArtifactArtifact IDChapterSectionBallotPubsVote and TypeExisting WordingProposed WordingCommentsIn person resolution requestedComment groupingDispositionWithdrawnDisposition CommitteeDisposition CommentResponsible PersonForAgainstAbstainChange AppliedSubstantive ChangeSubmitted ByOrganizationOn behalf ofOn Behalf of EmailSubmitter Tracking IDReferred ToReceived FromNotes
1OOPending input from submitterNeed to check whether any comments were lost.Don KacherOracle Corporation
1OOARPOOB_AR000009UV2.1.3A-TThe PlacerNumber Assigner is an application capable of satisfying a request to assign an placer observation order id.The PlacerNumber Assigner is an application capable of satisfying a request to assign a placer observation order id.Freida HallVeterans AffairsMary Jarquin (VHIM)[email protected]
2OOTEPOOB_TE210002UV2.2.2A-TThe state of the focal object does not change as a result of this trigger event..The state of the focal object does not change as a result of this trigger event.Freida HallVeterans AffairsMary Jarquin (VHIM)[email protected]
3OOTEPOOB_TE210004UV2.2.3A-TFocal Act: The end state of the focal act of the message is must be Suspended.Focal Act: The end state of the focal act of the message must be Suspended.Freida HallVeterans AffairsMary Jarquin (VHIM)[email protected]
4OOTEPOOB_TE210005UV2.2.4A-TFocal Act: The end state of the focal act of the message is must be Active.Focal Act: The end state of the focal act of the message must be Active.Freida HallVeterans AffairsMary Jarquin (VHIM)[email protected]
5OOTEPOOB_TE210003UV2.2.5A-TFocal Act: The end state of the focal act of the message is must be Aborted.Focal Act: The end state of the focal act of the message must be Aborted.Freida HallVeterans AffairsMary Jarquin (VHIM)[email protected]
6OOINPOOB_IN210004UV2.5.3A-TThis interaction used to communicate when an Observation Request is suspended.This interaction is used to communicate when an Observation Request is suspended.Freida HallVeterans AffairsMary Jarquin (VHIM)[email protected]
7OOINPOOB_IN210005UV2.5.4A-TThis interaction used to communicate when a previously suspended Observation Request is resumed.This interaction is used to communicate when a previously suspended Observation Request is resumed.Freida HallVeterans AffairsMary Jarquin (VHIM)[email protected]
8OONeg-MiRefer to negative comments submitted by Kaiser PermaneteNot persuasiveNeed to review individual comments to determine that we can dispose of them correctly. Patrick, Greg401Freida HallVeterans AffairsFreida [email protected]
1OO2Neg-Mjordering of basic patient observations such as vital signs.This should be in the Orders domain, not Observations. It is within the scope of Orders ("ordering of basic healthcare services including basic nursing services (vital signs), therapy services (physical therapy), diagnostic imaging (radiology), and materials (supplies) related to patient care.") Its inclusion in Observations is confusing and contradictory.Persuasive with modThere are two dimensions that are helpful to a reader to get to the right information: By Order or Observation (mood) or by Domain (General, Rx, Lab, etc.). Currently we are not consistent in our organization in any of the areas to support this (e.g., Rx has a Common Order topic), nor are names consistent. We therefore need to work across workgroups to harmonize approach and will work with Publishing how we can achieve these multiple views based on orientation. This may take some time to achieve. Patrick, Greg401Harry SolomonGE Healthcare
1OORM2.3.1Neg-MiDesign Walk-throughThere is not a design walk-through and we believe there should be before this topic is published. This could happen one of 3 ways:1. Preferably in this section where it should be in the standard walk-through format. 2. Reference to the DMIM walk-through, but the DMIM walk-through would have to be fixed. See next line item.3. Clear reference to the table and spreadsheet where one would find good definitions. See line item below.Joann LarsonKaiser Permanente
2DM1.2Neg-MiObservations Domain Information Model ClassesEntry into the DMIM is through the RequestChoice choice box. There are two classes within the choice box: PlacerGroup and Observation.Observations Domain Information Model ClassesEntry into the DMIM is through the ActChoice choice box. There are two classes within the choice box: Grouper and Observation.There is an inconsistency between the Walk-through and POOB_DM200000UV. We feel these inconsistencies need to be corrected before the Observation Request topic is published. The DMIM might not be considered part of the current ballot, but since the RMIM is dependent on it, we consider it fair game to comment on.Joann LarsonKaiser Permanente
3RMPOOB_RM210000UV2.3.1A-CI am having difficulty getting from the DMIM to the RMIM. Is Placer Group a specialization or clone of Grouper? Did the DMIM originally have a class called Placer Group which has ben replaced by Grouper? Is this a typo?Joann LarsonKaiser Permanente
4HDPOOB_HD210000UV2.4A-SDefinition: The party that the RequestChoice "is for". A patient may be a person or animal (non-person living thing). Patient information is specified with the R_Subject CMET.Definition: The patient or party that the RequestChoice "is for". A patient may be a person or animal (non-person living thing). The identifier is analogous to the PID-3 in HL7 v2. Patient information is specified with the R_Subject CMET.Although the definitions in the spreadsheet view are better than in some topics or domains, there is still considerable room for improvement. Probably the single most helpful thing would be to specify the v2 equivalent as some other domains have done. For example, row 2 could read something like our proposed change. These definitions certainly do not take the place of the RMIM walk-through.Joann LarsonKaiser Permanente
52.1.3Observation Request Placer Number Assigner (POOB_AR000009UV)A-TThe PlacerNumber Assigner is an application capable of satisfying a request to assign an placer observation order idThe PlacerNumber Assigner is an application capable of satisfying a request to assign a placer observation order idJoann LarsonKaiser PermanenteJune [email protected]
62.2.1Observation Request Activate (POOB_TE210001UV)A-TStructured Name: Observation Request Request ActivateStructured Name: Observation Request ActivateJoann LarsonKaiser PermanenteJune [email protected]
72.2.2Observation Request Revision (POOB_TE210002UV)A-TStructured Name: Observation Request Request ReviseStructured Name: Observation Request ReviseJoann LarsonKaiser PermanenteJune [email protected]
82.3.2Observation Request Suspend (POOB_TE210004UV)A-TStructured Name: Observation Request Request SuspendStructured Name: Observation Request SuspendJoann LarsonKaiser PermanenteJune [email protected]
9 2.2.4Observation Request Resume (POOB_TE210005UV)A-TStructured Name: Observation Request Request ResumeStructured Name: Observation Request ResumeJoann LarsonKaiser PermanenteJune [email protected]
10 2.2.5Observation Request Abort (POOB_TE210003UV)A-TStructured Name: Observation Request Request AbortStructured Name: Observation Request AbortJoann LarsonKaiser PermanenteJune [email protected]
11 2.2.6Observation Request Complete (POOB_TE210008UV)A-TStructured Name: Observation Request Request CompleteStructured Name: Observation Request Request CompleteJoann LarsonKaiser PermanenteJune [email protected]
12 2.2.7Observation Request Nullify (POOB_TE210006UV)A-TStructured Name: Observation Request Request NullifyStructured Name: Observation Request NullifyJoann LarsonKaiser PermanenteJune [email protected]
132.2.8Placer Observation Request Number Assigned (POOB_TE210011UV)A-TStructured Name: Observation Request Request Placer Number AssignedStructured Name: Observation Request Placer Number AssignedJoann LarsonKaiser PermanenteJune [email protected]
142.2.9, 2.2.10, 2.5.1, 2.5.2, 2.5.3, 2.5.4, 2.5.5, 2.5.6, 2.5.7, 2.5.8, 2.5.9, 2.5.10A-TSame as above: Request Request ……Request …..Joann LarsonKaiser PermanenteJune [email protected]
1OOIN2.5.10, 2.5.9, 2.5.7, 2.5.6, 2.5.4, 2.5.5Neg-MjReceiver responsibilities are missingAdd themVirginia LorenziNewYork-Presbyterian Hospital
2OOTE2.2Neg-MiV2 references missingAdd themThere is a precedent that all trigger events that map to V2 have V2 references listed. Please add these in. Very helpful to those transitioning from V2 to V3 and keeps the publication having a standard look and feel. If you leave them out, it looks like you're saying there are no V2 equivalents.Virginia LorenziNewYork-Presbyterian Hospital
3OOIN2.4.1Neg-MjContext specific attribute level descriptions missing on ParameterList attributesAdd them.While some attribute descriptions are provided, a good amount are still missing, leaving the evaluator or implementor guessing as to their meaning.Virginia LorenziNewYork-Presbyterian Hospital
4OOSTNeg-MjStoryboards missingAdd themWithout storyboards, how is someone supposed to get a decent overview on the dynamic model of this topic and get dynamic examples of its usage? Storyboards need to include narrative with embedded interactions and interaction linkes as well as interaction diagrams.Virginia LorenziNewYork-Presbyterian Hospital
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