IT-014 Health Informatics Committee

Transcription

1 Health Informatics Committee Executive Summary HL7 Working Group Meeting 9 th - 14 th September, 2012 (Baltimore, USA) Version: FINAL 1.0 Date Issued: 11/10/12 Lead Author: Dr Patricia Williams Collated by: Standards Australia With input from Australian Delegation and other employer funded Australians at the meeting: Dr Trish Williams, Ph.D. (Delegate and Report Coordinator) Heather Grain (Delegate) Richard Dixon Hughes (Delegate) Dr Hugh Leslie, MB BS, FRACGP, FACHI (Delegate) Dr David Rowed, MB BS, BEng, FRACGP (Delegate) Dr Vincent McCauley, MB BS, Ph.D. (Delegate) Nat Wong (Delegate) Amy Mayer (Mentored Position Delegate) Dr Andy Bond () Ph.D. Dr Stephen Chu ()MB ChB, Ph.D. Vin Sekar () Meya Achdiat (Standards Australia)

2 TABLE OF CONTENTS 1. Introduction Objectives of the Meeting Relevance to programs Meeting Logistics Recommendations Arising from the Meeting Funding Sources Summary and Australian Attendance Australian Leadership Positions Acronym List

3 1. INTRODUCTION HL7 is an international organisation with its origins in the USA, and an expanding group of international users participating in its standards development processes. HL7 provides international standards for inter-system and inter-organisation messaging, decision support, clinical text documents mark-up, user interface integration, EHR/PHR systems functionality as well as for a health data model and message development methodology. It produces global health informatics standards through a process of collaboration, which involves its local affiliate,. HL7 International Working Group Meetings (WGMs) are held three times per year at varying locations. These WGMs serve two important purposes: giving the HL7 International work groups a chance to meet face-to-face to work on standards, as well as the opportunity to network with industry leaders from around the world; and providing an invaluable educational resource for the healthcare IT community. HL7 standards are the dominant health-messaging standards in the USA, Canada, Germany, Holland, Finland, Japan, Korea, Taiwan, New Zealand, and Australia, and are being adopted as health-messaging standards by many other countries. The September 2012 HL7 International Plenary and Working Group Meeting was held in Baltimore, Maryland, USA, with activities scheduled over 6.5 days. There were 507 attendees at this meeting. The main activities ran from Sunday, 9 September to Friday, 14 September, On weekdays formal meetings were scheduled from 9am to 5pm; however, some meetings were scheduled from 7am and ran as late as 10pm. Over the last nine months, HL7 has been examining its priorities and principles. This period has seen significant changes and growth and has culminated in the announcement of HL7 free access to Intellectual Property (IP) 1. This meeting welcomed the new membership caregivers category and saw the Mobile Health Work Group, established in May, realise more interest and engagement with the community. The plenary session that focused on HL7 in the Era of Patient Empowerment was held on Monday, 10 September and is reported on separately in the HL7 September Final Report. It should be noted that the HL7 International standards work is not structured as "Work Items" that are put forward to the HL7 body for approval; rather, most projects arise from the work within the many domain specific and specialist committees. However, these proposed projects need to be well-defined and documented and require approval by the relevant Steering Division and the Technical Steering Committee to ensure appropriate internal (HL7) and external (international standards development organisations) harmonisation. This report summarises the committee proceedings, issues and actions for consideration by Australia arising from this HL7 International Standards and Education Meeting. 2. OBJECTIVES OF THE MEETING HL7 meetings are true working meetings, not conferences, with many experts and individual groups meeting to develop, discuss and improve HL7 standards, processes and implementation guides and to determine the most effective way to meet the needs 1 Further information can be found in the HL7 September Final Report. 3

4 of the stakeholders both those present at the meeting and those in the wider community of interest. While HL7 engagement with stakeholders in other forums is also strong (through regular, often weekly, teleconferences), the ability to influence the work program, outcomes and strategic direction requires physical presence at working group meetings. The overarching objectives of HL7 meetings are to benefit the Australian health system and wider community by: Improving Australian capacity to implement health informatics standards and e- health systems, through expanding local knowledge and expertise based on international best practice; Promoting free trade and its benefits to health ICT, by lowering the cost of integrating and implementing local health information systems, many of which are imported, and by reducing costs to Australian exporters; both of these outcomes require Australian requirements to be embedded in global standards so that they can be adopted in Australia, rather than having different standards across domestic and international markets; and Improving Australian health information systems by facilitating a standardsbased approach to development and implementation, and achieving interoperability between systems. Other more specific objectives for Australian engagement in international standardisation via HL7 International include: Monitoring and influencing HL7 s strategic positioning as a global SDO, encouraging its collaboration with other international and global SDOs and assessing and contributing to the strategic positioning of its key products (HL7 V2.x, V3, CDA, EHR, etc.) so as to encompass Australia s health information interchange and related requirements. Negotiating the inclusion of Australian healthcare messaging requirements into HL7 V2.8, CDA and V3 specifications for: Patient administration; Diagnostics (pathology, radiology); and Collaborative care initiatives, such as, but not limited to, e-discharge and e-referral, so that Australian requirements become a formal part of these Standards. Negotiating the inclusion of Australian health sector requirements in the HL7 Standards so that Australian EHR developments are supported by the upcoming HL7 and related ISO EHR Standards. Negotiating the harmonisation of ISO, HL7, CEN and other established standards development organisations (SDO) to achieve progressive inter-sdo e-health standards, with the long-term goal of a unified set of global health informatics standards. Monitoring, and influencing as necessary, new initiatives for standardising clinical data content so as to improve Australia s ability to unambiguously and safely exchange semantically interoperable clinical data. 4

5 Assessing and influencing HL7 s work on service oriented architectures (SOA), as required by Australia s national direction setting, and negotiating the inclusion of Australian health sector requirements (in particular, those described by ) into service specifications being jointly developed by HL7. Assessing and influencing the positioning, development, implementation, utility and effectiveness of CDA (including CDA Release 3), to support Australia s interest in CDA in its national ehealth program. Assessing, exploring and proposing approaches to the embedding and transportation of archetypes in HL7 V2.x messages for referral, diagnostic results and collaborative care to support Australian interest in the use of archetypes for the exchange of clinical information. Progressing the international harmonisation of common data types and vocabulary for healthcare information that will meet Australia s identified requirements. Additional Australian interests may be pursued opportunistically as and where formally agreed upon by the community, Standards Australia and the Department of Health and Aging (DoHA). Additional specific objectives may arise from time to time as a result of the development of Australia s national ehealth agenda and other national interests. 2.1 RELEVANCE TO PROGRAMS has endorsed a range of Australian Standards derived from international standards work by including them in the National e-health Standards Catalogue. As the implementation of s domain-specific initiatives are based on many of these standards, it is important that Australia continues to be involved in the international forums that develop, manage and maintain these, and other potentially relevant, health informatics standards. 3. MEETING LOGISTICS The table below shows the meeting schedule for all of the meeting groups. Most USA based meetings have more than 60 separate working groups and committee meetings. In addition to the working groups listed, members also attended tutorials and project specific workshops. The Australian delegation is denoted as follows in the table below: AB Andy Bond HG - Heather Grain SC Stephen Chu AM Amy Mayer MA- Meya Achdiat TW - Trish Williams DR - David Rowed NW - Nat Wong VM - Vince McCauley HL - Hugh Leslie RDH - Richard Dixon Hughes VS Vin Sekar 5

6 Working Group Sat Sun Mon Tue Wed Thu Fri Affiliate Due Diligence RDH Committee Ambassador Presentation Anatomic Pathology Architecture Review Board (ArB) AB AB AB Arden Syntax DR DR Board of Directors Meeting RDH, MA Clinical Decision Support Clinical Genomics Clinical Interoperability Council Clinical Statement Co-Chair Information Session HL, RDH, TW, VM TW AM, DR HL AM, DR, MA SC TW, VM Community Based Collaborative Care Conformance and Guidance for VM HG Implementation/Testing Detailed Clinical Models HL HL HL HL Education (&marketing) HG HG HG, NW Electronic Health Records Electronic Services Emergency Care FHIR Connectathon AM, NW, RDH SC, VS FHIR Project DR DR VM, Fresh Look Taskforce Governance & Operations GS1 Education Session HL7 Activities with other SDOs RDH, TW, MA NW MA AM VS AM, TW, SC HL7/OMG Joint Meeting VM Health Care Devices VS VM Imaging Integration Implementation Technology Specification Infrastructure and Messaging International Council & Affiliate Chairs International Membership & Affiliation Taskforce AM, DR, HL, NW, RDH, TW, VM, HG, MA, VS, SC VM VS NW RDH RDH, MA NW RDH RDH 6

7 Working Group Sat Sun Mon Tue Wed Thu Fri Joint Initiative Council (JIC) liaison Marketing Mobile Health Modelling and Methodology (MnM) Open Health Tools Orders and Observations OO/Lab/Composite Order SC SC Patient Administration AM, NW, MA Patient Care HL, HL, SC SC Patient Safety Plenary Session VM RDH AB, MA DR HL RDH NW AM, NW HL, SC AM, NW, MA HL, MA, VS, SC AM, AB, DR, RDH, TW, VM, MA, NW, HG SC, VS Pharmacy SC SC SC Physician s Meeting DR Public Health Emergency Response Publishing NW HG NW Regulated Clinical Research Information Management & CDISC/BRIDG Services Aware Interop DR AB Architecture Security TW TW TW, VM Services Oriented Architecture AB, AB, TW, VM VM VM NW Steering Divisions Domain Expert, Foundations & Tech, Structure & Semantic, Tech Services Structured Documents VS VS AM, VS Templates Terminfo Project / Terminology HG Tooling Vocabulary HG HG AM, HG, VM, MA VS TW VM VS, SC VS HG AM, TW, VM VS 7

8 Tutorials are also offered and these are of great value, both to newcomers and to older hands, to bring them up to date on generic changes made that may not be discussed in their individual committee areas. At this meeting 30 tutorial sessions were held concurrently with 56 work group and task force meetings. Additionally, there were meetings for the Ambassador Program, Co-Chairs, Board of Directors, First Time Attendees, GS1 Education session, and HL7 Activities with other SDOs. The number of concurrent sessions makes it difficult for a small delegation to effectively follow all the issues and to influence change. It is noted that delegates funded by their employer, or individually, to international meetings have no obligation to work with or relate information back to the Australian delegation, though some have done so in the past. It is clearly desirable that there be a cohesive Australian position. Given the participatory natures of the HL7 committee work, it is vital that Australians are present, and participate in the committee work. Intensive work is done in the committees, and often two or three Australian subject matter experts are required to get the Australian requirements into the consensus-based processes. In most cases, preparation beforehand of "Australian positions" on the matters to be worked on is not effective, as the discussions and views often substantially change during the consensus-building process. Most of the work done in committee is "leading edge" standards development work that often cannot be locally previewed, assessed and commented on beforehand. As a result, the selection process of the funded participants focuses on their expertise and interests as well as their ability to effectively communicate complex technical issues and achieve the desired outcomes for Australia in a collaborative, consensus-based committee environment. As is customary, the Australian participants met on a daily basis to plan and monitor their involvement, identify any additional sessions and/or activities that should be covered and identify emerging issues, particularly those that are relevant to Standards Australia and/or work plans. Australian participants also coordinate their activities through Skype. 8

9 4. RECOMMENDATIONS ARISING FROM THE MEETING The principal issues/actions and recommendations identified by the Australian delegation at the September 2012 HL7 Meeting are summarised in this section. The alignment to the Committee Structure is also listed. Topic Issue / Action / Recommendations for Australia Recommended for Action by Advisory Council input: FHIR Issue: Application and investigation of Fast Health Interoperability Resource (FHIR) in the Australian context. Action: Discussion and investigation of the application and development of FHIR in the Australia context. Action: Investigate the possibility of establishing a FHIR interest group. Action: Continue to monitor and contribute to the development of FHIR resources through active participation and support of the Patient Administration work group. Action: Monitor the Healthcare Community Services Directory to inform decisions about code set use. Affiliate Due Diligence Committee Architecture Review Board (ARB): Business Architecture Model (BAM) Arden Syntax: Version 3.0 Issue: Continuing support by of the work of the ADDC through Richard Dixon Hughes as an active member. Action: to note progress with ADDC activity at HL7 International and assist with follow up in Indo-Pacific region where requested. Issue: Governance of HL7 International Products and Product Lines. Action: Monitor development of BAM so that HL7 governance of products meets Australian requirements. Issue: Arden 2.9 is an extremely comprehensive standard for knowledge representation as well as procedural processing with workflow support and clear identification of integration points for external applications. Its utility is not well understood across the health informatics community. Action: Review Arden 2.9 and identify and support new requirements for version 3.0, particularly: - Transition from its informative to normative XML representation; and - Development of simplifying, task-suitable reduced sets of Arden covering its operators as well as declarative representations and work-flow functionality. Action: Contribute to the new Arden Implementation Guide Project and monitor the Why Arden authoring. Richard Dixon Hughes -013 RACGP NSC for ehealth Other professional colleges MSIA 9

10 Topic Issue / Action / Recommendations for Australia Recommended for Action by Arden Syntax: Version 3.0 Issue: Arden has capability to provide standards-based CDS as currently needed in immunisation, Drug-Drug Interaction, (DDI) and clinical guidelines by Australian primary care and nursing practitioners. Action: Identify and engage Knowledge suppliers in high priority areas including immunisation, DDI, pathology ordering, therapeutic guidelines, and travel health, and encourage them to consider Arden representation for interoperable knowledge deployment and application workflow integration RACGP NSC for ehealth Other professional colleges MSIA Arden Syntax: Version 3.0 Issue: To date there has been inadequate input of Australian requirements and validation of the Arden Standard against Australian needs. Action: Circulate and take part in ballot for version FHIR Project Lead (Australian) Arden Syntax: Version 3.0 Issue: Arden is not aligned with the HL7 v3 RIM, although this has often been explored. Such alignment is under consideration as is alignment with FHIR, the latter appearing to offer more promise for Australia, but being untested in CDS applications. HL7 Board: Free IP HL7 Board (CEO Report): Formation of HL7 Asia Action: Advocate for thorough assessment of FHIR for Arden and CDS generally by standards working groups and the FHIR project. Issue: Access to HL7 IP has normally been available only to HL7 members. This has been the primary driver for many organisations and individuals joining a local Affiliate. Free access to this HL7 IP will likely impact Affiliate membership, and may impact on s corporate documents and contractual relationships. Action: to analyse the impact of free IP on its membership model. Action: Provide a statement on the impact of this announcement to the community noting under which circumstances free IP can be used. Action: to review its Governance and Operations documents and MoUs to assess the impact of free HL7 IP. Issue: HL7 International has entered into negotiations with North Asian countries about the formation of HL7 Asia. It is proposed that it be based in Japan and include HL7 China, HL7 Hong Kong, HL7 Japan, HL7 Korea and HL7 Taiwan. The North Asian countries had previously extended to the Chair of the courtesy of advising him of their plans to do this on a local basis, and there is some interest among the Australian, NZ and Singapore Chairs on forming an Indo-Pacific or South East Asian grouping. Action: to note the proposed establishment of HL7 Asia, with an initial focus on North Asian affiliates, and consider the potential for greater collaboration among affiliates in Southern Asia and Oceania. 10

11 Topic Issue / Action / Recommendations for Australia Recommended for Action by HL7 Board: Making standards and other IP available without charge CDS: Clinical System capabilities to enable Services Oriented CDS operation CDS: Current standards for Order Sets, vmr and Infobutton CDS: Harmonisation with HL7 Standards and ISO work items CDS: Health e-decision Standards and Interoperability Framework Initiative Issue: HL7 International has announced that it will make all of its standards and some other selected intellectual property available without charge from early This is a significant change from the current position where anyone using HL7 Standards in developing systems or delivering product was required to be a paid-up member of HL7 International or one of the affiliates. The change therefore has potential significant impact on the business models of both HL7 International and the affiliates (including ). The Chair and CEO have invited a small group of leading HL7 members to assist in redefining HL7 International member benefits. Richard Dixon Hughes is among that group, and will participate. Action: is aware of the change and has publicly supported it. The sub-licensing arrangement between Standards Australia (SA) and for use of parts of HL7 intellectual property in SA publications still requires action. Action: Richard Dixon Hughes to participate in HL7 International's Membership Task Force, advising HL7 Board on restructure of member benefits following HL7 decision to make its standards available without charge. Issue: CDS deployments must work-in with point of care systems both at the levels of standardised data interchange and the more difficult area of workflow integration. The CDS WG has researched and identified the key services and capabilities of clinical information systems to enable this deployment. This is in the form of a paper for presentation at American Informatics Association (AMIA) and not yet a HL7 publication. It needs to be a HL7 product. Action: Support and facilitate the development of this work as a HL7 publication, preferably a DSTU. Circulate the current WG s paper to the Australian CDS community where it aligns with one of the proposed -13 projects that it will facilitate. Issue: These standards are in varying stages of development (normative and DSTU in later releases). They are ready for purpose and adoption by implementers but need to be better understood and assessed for different purposes. Action: Monitor uptake and further work. Consider comparatively in the CDS implementation Guide project and the related -13 project proposal. Issue: Coordination with existing HL7 publications and ISO work items. Action: Identify how this harmonisation is to occur and who has responsibility. Issue: To identify and harmonise standards that facilitate the emergence of systems and services whereby sharable CDS interventions can be implemented. Action: Monitor this project for potential application to an Australian context. and Standards Australia Richard Dixon Hughes (in progress) -13 MSIA

12 Topic Issue / Action / Recommendations for Australia Recommended for Action by CDS: Health Quality Measure Format (HQMF) Release 2 Implementation Guide Issue: HQMF is relevant to CDS in population-based applications and knowledge development that affects pro-active care and resourcing. EHR systems need to be appropriately structured to represent quality measures, especially to support queries around these. The implications for Australia include that HQMF could provide input to EHR requirements for quality and CDS. Standards Australia -13 CDS: Implementation Guide (IG) for CDS CDS: OpenCDS CDS: OpenCDS Immunisation Calculation Engine (ICE) CDS: Virtual Medical Record (vmr) for Clinical Decision Support Action: Alert Safety monitoring groups to this work and offer engagement. Monitor the project to gain a clearer picture of how process and outcome based quality measures are queryable when represented in EHRs and used for CDS. Issue: There are several unrelated HL7 CDS standards with overlapping functionality and task suitability, making it difficult for knowledge authors and vendors to adopt the best for their purposes. The ONC has recently specified very comprehensive requirements to be met by a unified approach. Australia is greenfield with respect to CDS standards adoption and stands to benefit from a CDS roadmap and Implementation Guide Action: Review and contribute to the IG Project Scope Statement and actively take part in the consequent project. Engage industry, professional colleges, and academic stakeholders. Issue: OpenCDS uses standards, with a modern services approach, and is aligned to MU3. It provides a low cost entry to interoperable CDS for vendors whether they are established or new to CDS. It accommodates different knowledge bases and can be used for a wide variety of clinical needs. It is being used successfully with immunisation CDS. Action: Review OpenCDS at -13 and advice implementers. Monitor the immunisation implementation. Issue: The Immunisation Calculation Engine (ICE) is an immunisation evaluation and forecasting engine using opencds. This project informs the needs of CDS standards and facilitation of systems design and deployment. Action: Monitor project development. Issue: CDS systems rely on data in EHRs and on inputs and outputs in different formats. Standards for content are required to bridge this gap. The vmr forms the basis of one project proposal coming through IT This project is important in ensuring that Australia s initiatives across messaging, CDA, EHR can be brought together to enable improved care and safety through standardised CDS. Action: In light of recent proposals concerning clinical content of v2 messages to HL7, and the work of -13 on v2 messaging, review the CDS vmr HL7 specification to access impact on Australia s v2 messaging requirements for clinical content. -13 Professional Colleges Knowledge Authors MSIA -13 MSIA

13 Topic Issue / Action / Recommendations for Australia Recommended for Action by CDS with Patient Care and SOA: Health Care Coordination Project CDS/SOA: Cross-paradigm interoperability implementation guide for Immunization CDS/SOA: Cross-paradigm interoperability implementation guide for Immunization Conformance and Guidance (CGIT): HL7 V2 table content quality review and v3 / CDA harmonisation Issue: Care planning is an important process in Australian primary care, where it attracts significant government funding both at GP and allied health levels; however, current implementations are not standards-based and rarely employ electronic communications. There is a need for functional modularity via services at the point of care and integration with CDS. Australia does not use v3 messaging so deliverables as abstract models are important. Action: Monitor this project via members (including Co-Chairs) of PC, CDA and SOA, the 3 WGs sponsoring the project, and ensure our Care Planning work takes this into account. Ensure the project has useful deliverables at the DAM level. Action: Engage and -13 in the Patient Care Services co-ordination project to leverage it for our projects and ensure it meets our requirements. Issue: Immunisation is monitored and recommended by GP point-ofcare systems, but the underpinning knowledge is complex and expected to be difficult for general system vendors to provide. Jurisdictions and health advisory bodies provide guidelines for this and some have in the past provided on-line recommendations including those in the problematic areas of catch-ups. A group of standardized services available to point-of-care applications could improve overall achievement of immunisation targets. Australia could benefit from international resources being committed here. Action: -013 to continue consideration of a project in this area to bring Australian requirements into this work with view to deployment into point-of-care systems, immunisation registries, and knowledge source applications. Issue: As there is no decision support in v2 standards, this raises the question of whether v2 referral messages may be a candidate for decision support in Australia, and how international developments relate to this. Action: Discussion on and possible development of decision support for V2 referral messages within the Australian context. Issue: During a harmonisation review and comparison with v3 data model and content, there were some errors found in existing v2 tables. Consistency is required to support migration and integration with legacy systems as well as information exchange. Problems identified include actual errors as well as poor data structure and content. Action: Review of the problems identified in the spreadsheet (this was provided to Heather Grain at the WGM) should be undertaken by the -06 and to identify appropriate actions required for updating Australian standards. Consideration should also be given to whether Australia specific existing standards require review. It is noted that this may require some assistance with vocabulary expertise HL7 Delegates to PC, CDA, SOA WGs -013 MSIA Jurisdictions Immunisation Guideline Authorities

14 Topic Issue / Action / Recommendations for Australia Recommended for Action by Conformance and Guidance (CGIT): HL7 v2.8/2.9 Conformance Requirements Conformance and Guidance (CGIT): HL7 V2 table content quality review and v3 / CDA harmonisation Education and Marketing: Communication and development of understanding and skills Education: Strategic Plan Education: Strategic Plan Issue: New segment proposals for v2.9 will be finalised at the May 2013 WGM. Action: Consider submission for signature segment and display narrative segment by the January 2013 WGM. Submit Standards Australia ATR on HL7 v2 signatures as part of documentation. Issue: Need for alignment of code sets, value sets and vocabulary models used in v2 and v3/cda to facilitate interoperability. Action: Australia to obtain master spreadsheet (this was provided to Heather Grain at the WGM) to track v2 errors and resolve where necessary. Issue: Quality of HL7 education. Education is being recognised as different to presentations or information sessions in that it aims to develop a specific set of skills. provides many presentation and information sessions, but if considering moving towards education provision, should consider how to ensure the skills of presenters. Heather Grain is happy to provide the free tutorial in Australia if this is seen as helpful. Action: Consider the needs to develop educator skills within the HL7 community in Australia to support improved education provision. Issue: Tools for use when training. Action: Identify and inform the next HL7 delegation (January Meeting) through Standards Australia or Heather Grain (member of Education WG) the tools required for training about HL7 standards in Australia and our priorities for their use. Issue: The development and offer of an Australianised version of HL7 International e-learning courses. Action: Decide whether to proceed with e-learning for HL7 and determine method and partner/s to achieve this. -06 (community to consider priority for Australia) Education and Marketing: Communication and development of understanding and skills Electronic Health Record (EHR): Personal Health Record System Functional Model (PHR-S FM) Issue: Education requirement specification. Action: Identification of the roles and related competency requirements in the Australian health messaging environment need to be determined in order to prioritise the development and availability of educational materials, courses and competencies. Heather Grain is able to assist HL7 in this activity. Issue: Privacy and security direction and advice are needed by HL7 International as part of the Personal Health Record System Functional Model development. Other issues identified to date include: - Jurisdiction-specific legislative issues regarding privacy and security. - Storage, management and retrieval of extremely large amounts of data generated by a life-long PHR. Action: Monitor the lessons learnt from the PCEHR development to support progress of the international standard. Consideration by, DoHA and 14

15 Topic Issue / Action / Recommendations for Australia Recommended for Action by Electronic Health Record (EHR): Allergies and Intolerances Electronic Services: HL7 CRM System management of members of affiliates Governance & Operations: Documents International Council: IHIC 2013 International Council: Leadership International Membership & Affiliation Task Force (IMATF): International Council Membership rights survey Issue: Despite the presence of Australian Co-Chairs driving this project, its visibility to Australian Software Developers is limited. Action: Increase awareness of this Domain Analysis Model. Issue: HL7 s International electronic services platform is not sufficiently flexible to retain the details of members of affiliates when they are nominated as voters for. Action: to participate in HL7 s International Electronic Services working group and seek resolution on problems affecting voting members of international affiliates. Issue: Changes to the HL7 International Bylaws and Governance documents may impact the equivalent documents of International Affiliates. Action: Pending receipt of the updates to the GOM and Bylaws, needs to review this in relation to its Constitution and other Governance documents. Issue: explored International Council interest in conducting IHIC 2013 in Sydney in a time period either prior to or preceding the ISO/TC215 meeting planned for October This suggestion was considered and strongly supported by the International Council, with agreement that should develop the concept and formally request funding support of up to US$5,000 from the International Council toward running the event. Action: to proceed with consideration of running IHIC 2013 in Australia in October 2013 either prior to or preceding the proposed ISO/TC215 meeting and to submit request for International Council budget submission. Issue: Heather Grain has been requested by a number of the current members from different countries (Canada and UK in particular), to stand as a Co-Chair of the International Council to represent the interests of improved process, education quality and overall governance. Action: Identify priority and provide guidance on proposal to stand for Co-Chair of the International Council. Issue: Richard Dixon Hughes to submit updated final version of International Council membership/customer survey. Action: Richard Dixon Hughes to submit updated final version of International Council membership/customer rights survey on behalf of and assist in compiling results. MSIA (Nat Wong) Richard Dixon Hughes 15

16 Topic Issue / Action / Recommendations for Australia Recommended for Action by International Membership & Affiliation Task Force (IMATF) Joint Initiative Council (JIC): IHE Issue: Given the extent of changes brought about by the HL7 International decision to make its standards and related IP available free of charge and the formation of a Membership Task Force at HL7 Board level, the IMATF resolved to recommend to the International Council that the IMATF be disbanded, which was done. Action: Standards Australia to delete IMATF from list of activities for future delegations. Issue: The establishment of IHE as an SDO now puts the IHE specifications on the same international level as HL7. Action: should examine IHE specifications and consider their relevance and applicability in the Australian context e.g. CDA content for ETP, referral care planning as well as, infrastructure such as XDS.b and XDR. Standards Australia Modelling and Methodology (MnM): FHIR Modelling and Methodology (MnM): FHIR Project Collaborative Care Messaging Issue: Emergence of FHIR as a disruptive modelling and technical approach. Action: Australia needs to invest in some early R&D support behind the FHIR initiative both to grow recognition of the Australian origin of FHIR and to prepare itself for the emergence of FHIR commercially. Issue: HL7 v2 is implemented widely in systems deployed in Australia where we have Australian Standard Implementation Guides for Referral and Discharge. Its messaging capabilities, and implied dynamic model, with defined sender receiver responsibilities, is adequate for our existing use cases in Collaborative Care Communications. It is inadequate for Clinical Content representation and no agreed solution has been found. Action: Assess FHIR messaging capabilities and content solutions at the level of segment mapping against our collaborative care requirements, particularly for concepts of Problem-Diagnosis, Goal, Pathway, and their contexts and relationships Modelling and Methodology (MnM): FHIR Project Clinical Decision Support Issue: Clinical Decision Support needs Clinical Data Mapping for its access to health information in the EHR, most notably through the vmr Standard and the Arden curly braces inter-operation path as well as resources in the form of data structures such as Medical Logic Modules. Much of this is greenfield, as HL7 RIM-based models have made limited inroads into Arden and other HL7 CDS, with the resulting need for harmonisation across CDS standards. Action: Assess FHIR for CDS needs and ensure that, if it is to go forward as a major representation in HL7, that CDS is wellcovered. -13 HL7 Delegates to CDS, Arden Syntax, and MnM WGs 16

17 Topic Issue / Action / Recommendations for Australia Recommended for Action by Modelling and Methodology (MnM): FHIR Project Clinical Requirements Issue: Clinical resources need to be developed as soon as possible to prove FHIR s capability and to ensure an early switch over to FHIR, if it this turns out to be the way forward. There has been some clinical engagement to date but work has been initiated for some resources and needs to be picked up by a wider group of experts. Action: Influence HL7 Clinical WGs, particularly PC, Arden Syntax, and CDS to engage with the FHIR project (via. joint sessions) to identify their clinical resources needs and jointly develop these resources. This engagement should begin with Condition, Health Issue, Health Asset, Problem, Diagnosis, Goal and Care Plan. HL7 Delegates to PC, CDS, and Arden Syntax WGs FHIR Project Lead Modelling and Methodology (MnM): Orders & Observations (OO) Modelling and Methodology (MnM): FHIR Resources Orders and Observations: Laboratory Order Specification Patient Administration: FHIR Patient Care: Allergies and Adverse Reactions Issue: Australian is not actively represented in the Orders & Observations WG, resulting in Australia requirements for Pathology and Radiology Ordering and Reporting not being advocated for. Action: Increase focus on the OO WG through future Australian delegations to HL7 WGMs. Standards Australia to be aware of this gap in expertise. Issue: Australian participation in development of FHIR Resources is limited to Grahame Grieve. Action: Encourage Australian representation in WGs developing FHIR resources. Issue: Need to ensure that the contents of the laboratory order and reporting model and specifications can be profiled into templates for use in CDA implementation guides for use in Australia to avoid retrofitting Australian work into the new HL7 International standards downstream. Action: and to work closely with and provide inputs to the ongoing work on this new Laboratory Order modelling and specification project. Issue: FHIR Patient Administration resource development needs Australian participation. Action: Notify committee members of FHIR resource development, and encourage participation in HL7 PA teleconferences and mailing lists. Issue: The HL7 allergy/intolerance model is likely to become a standard way of sharing this critical clinical content. Action: Australia should continue to be involved in development of this clinical model for use in sharing allergy information. IT , , -13 and should monitor progress of this project closely and contribute actively to the development of the allergy/intolerance model and related contents. -06 should consider taking on a cross subcommittee coordinating role. Future HL7 delegates Standards Australia MSIA Standards Australia (through Stephen Chu) Standards Australia Hugh Leslie & Stephen Chu to consider cross coordination role 17

18 Topic Issue / Action / Recommendations for Australia Recommended for Action by Patient Care: Detailed Clinical Models Patient Care: Care Plan Topic Issue: HL7 DCM representation for CIMI models. Action: Australia to contribute and be involved in this task. IT , , , -13, and should provide Australian representatives with inputs for active contributions to CIMI modelling works. -09 should consider taking on a cross subcommittee coordination role. Issue: International involvement is required. Action: Australia to continue to be involved in developing this standard. This project has high relevance to care plan projects initiated and currently underway in Australia jurisdictions (e.g. North Territories and Victoria) and -09 should take on coordinating roles to coordinate inputs from Australia and inputs via Australian delegates to this international project. Hugh Leslie & Stephen Chu to consider cross coordination role Stephen Chu Patient Care: FHIR clinical content Pharmacy Issue: Clinical content for FHIR needs a process for clinical review that is unlikely to be met by the HL7 ballot process. Action: Australia to work with the FHIR working group to develop a better way to develop clinical content. Issue: Alignment between Australia s medication management programs and HL7 / IHE pharmacy model, technical specifications and profiles are required. Action: Australia should stay highly engaged with HL7 and IHE Pharmacy project works. They are extremely important to development of national electronic medication management programs and should collaborate closely to provide coordinated inputs to international pharmacy projects. Hugh Leslie Pharmacy: ISO WG6 Issue: Almost complete disconnect between ISO WG6 projects and new project proposals from other international works in this domain, resulting in duplication or even divergence of work with highly counterproductive outcomes. Action: and must liaise more closely with Australian ISO delegates to prevent such counter-productive divergence between the groups Future ISO Delegates to WG6 Pharmacy: R2 Ballot Issue: Pharmacy topics R2 (Jan 2013) ballot requires Australian inputs. Action: should collaborate with to provide ballot comments to Pharmacy topics R2 ballot

19 Topic Issue / Action / Recommendations for Australia Recommended for Action by Pharmacy: V3 Nutritional Order Clinical Message Pharmacy: Patient Medication Profile Physicians Group: New group Policy Advisory Committee Security Workgroup: Data Segmentation for Privacy (DS4P) Issue: Substantial international development is taking place within the realm of HIT for nutrition and dietetics. Action: Introduction of HL7 work on nutrition to Dietetics Association of Australia (DAA) via Allied Health Professions Australia (AHPA) may support development in Australia. AHPA to be made aware of this work. Action: to monitor the ongoing developments of nutrition models internationally and consider application to Australia. Issue: Medication Profile modelling direction needs broad international inputs to ensure universal usability. Action: This project is highly relevant to Australia / electronic medication management program. Australia should play a leadership role and should work with to provide significant contributions to the HL7 and IHE work on this topic. Issue: The mutual benefits of HL7 and non-technical clinicians coming together are not adequately realised. HL7 needs to promote its benefits to non-technical clinicians and to gain their input via its clinicianfocused standards. Action: All future HL7 delegates who are physicians to be encouraged to attend the Physicians WG session at the next meeting. Standards Australia to be aware of this in order to assist logistically. Action: Advocate for greater pre-registration promotion of the meeting by HL7 HQ. Identify HL7 products that might be of interest to Australian physicians, such as Functional Profiles, with a view to alerting the communities to their availability. Promote local Care Giver membership of HL7. Issue: The HL7 Policy Advisory Committee is seeking input from Affiliates on security and privacy issues as well as governance of secondary use of data from Affiliates. Action: Provide a briefing document on Australian policy in these areas Issue: Whilst Australia is not yet in a position to embrace data segmentation in the national ehealth system, as the system evolves it will become increasingly important due to privacy concerns relating to the sharing of patient healthcare and personal information. Action: should review the DS4P pilot project to anticipate the use of its concepts for the Australia ehealth system. Action: Standards Australia should note that the DS4P is being developed through HL7 and taken to ISO with a view to being formulated into an international specification in the future. Allied Health Professions Australia Standards Australia DoHA Richard Dixon- Hughes -04 Standards Australia 19

20 Topic Issue / Action / Recommendations for Australia Recommended for Action by Security Workgroup: Data Segmentation for Privacy (DS4P) Security Workgroup: Security and Privacy Ontology - Project No: 646 Security Workgroup: e-measures and Quailty. Security: New Co-Chair SOA: Cross Platform Interoperability Implementation Guide for Immunisation. (Sponsor SOA, Co- Sponsor PHER & ArB). SOA: Cross Platform Interoperability Implementation Guide for Immunisation. Sponsor SOA, cosponsor with PHER, ArB. SOA/Pharmacy: Medication Statement Service Issue: The Australian healthcare and health informatics community should be made more aware of the issues and potential solutions of both primary and subsequent data sharing, and the data segmentation terminology and concepts being developed worldwide. Action: should consider an awareness and education program on DS4P concepts and potential impacts for the healthcare community. Issue: Recommencement of the project and international input requested. Action: -04 to be advised of the project status and to provide feedback through the HL7 Security WG Co-Chair or though HL7 Security WG List. Issue: In Australia, e-measures and quality measurement is not being addressed. Action: and -04 to review the e-measures project for consideration of adoption and input to international work in this area. Issue: New Co-Chair position recording. Action: Standards Australia and to note election of Dr Trish Williams to HL7 Security WG Co-Chair. Issue: This project provides both a generalised guide to implementing SOA for legacy systems and a specific demonstration of how to apply the approach to immunisation use cases. Action: Seek wider Australian comment on the next ballot cycle from Government and e-health industry. This will need to be coordinated by. Issue: Commence discussion of how immunisation data should be aggregated and managed with this project as a potential guide to doing this in the Australian context. Action: Circulate balloted document for information and discussion at Issue: This DSTU is now complete and provides a useful mechanism for accessing medications. Additionally, potentially, it is a servicebased approach to medication management. Action: Circulate to for discussion and potential adoption Standards Australia Standards Australia

21 Topic Issue / Action / Recommendations for Australia Recommended for Action by SOA: Healthcare and Community Services Provider Directory Service (HCSPD) SOA: Healthcare and Community Services Provider Directory Service (HCSPD) SOA: Record Locate Update Service (RLUS) SOA: SOA Service Ontology SOA: PASS SOA: PASS Issue: ELS needs to be submitted to the OMG. Action: and Standards Australia to provide the ELS specification to OMG. Issue: HCSPD needs to be adopted as an Australian Standard. Action: to consider the adoption of the HL7 HCSPD DSTU as an Australian ATS. Issue: This HL7 standard is now available and provides a general service based capability for managing Health data. It should be considered for local adoption. Action: to consider adoption of the HL7 RLUS Standard. Infrastructure services such as the RLUS Standard do not, at present, have a natural home within the structure. Consideration may need to be given to forming a new Services Committee to mirror the HL7 SOA committee. Issue: This important white paper will pave the way for the development of a rich set of discoverable and interactive electronic services. When balloted it needs to be explained, discussed, socialised and commented upon by a wide audience within the health standards and software community. is a co-author of this paper. Action: Plan a seminar to present this paper in December to prompt feedback and comment. This may be best managed by establishing a new committee or task force to mirror the HL7 SOA committee. to review how best to approach this task. to manage a seminar in conjunction with, as part of its education program and marshal ballot response. Issue: Expertise in security required to review the SOA Audit project within PASS. Decision to be made on progression or removal of project. Action: Trish Williams is reviewing the SOA Audit project on behalf of -04 to ensure that the project is not relevant for Australia or not catered for elsewhere. Issue: Advanced access control features using metadata tags that move with the data would provide a rich mechanism for maintaining data privacy following download from shared data stores such as the PCEHR. Action: -04, and DoHA need to be aware of this work and its potential ramifications for Australian healthcare data security and privacy. Standards Australia Standards Australia -04 Trish Williams, HL7 Security WG Co- Chair & -04 Co-Chair, to report to on this work Standards Australia to organise an educational seminar for /DoHA on this topic 21

22 Topic Issue / Action / Recommendations for Australia Recommended for Action by SOA: Patient Care Services Co-ordination Project Structured Documents: CDA R3 Issue: CCS Project statement to be finalised and potential implementers engaged. Action: to request expressions of interest from the Australian community in contributing to this project. Issue: CDA R3 is logical successor to CDA R2, retaining the tight focus on patient centric document requirements which supports participation CMETs (Common Message Element Type) such as subject, participation, informant assigneddevice, accreditedlocation etc. to satisfy exchange of financial, veterinary, public / population health, medical device, and credentialing requirements. Action: and Australia should monitor the development of CDA R3 closely to ensure that the known Australian requirements are catered for. Especially the new project for consolidated clinical templates for CDA R3; this new project may serve the upcoming requirements for financial, veterinary and Medical devices Structured Documents: CDA R3 Structured Documents: CDA R3 Structured Documents: Implementation Guide for CDA Release 3 - anaesthetic record Structured Documents: Patient Authored Note Issue: The CDA R3 includes many use case specific (RIM) ACT classes / attribute like Container and Non Person Living Subject. This will cater the requirements of capturing of fine-grained structured information for some use cases without the need for Australian Extension (Ex: like Pathology Investigation information). Action: The adoption of CDA R3 specification will eliminate the drawbacks experienced in the current CDA R2 model. Australia should actively contribute to the CDA R3 CCD templates development and perform a R&D work around applying CDA R3 and its templates to the existing / new use cases. Issue: Australian extension included in CDA R3. Action: CDA R3 includes some of the Australian CDA extension added to CDA R2; thus the adoption of CDA R3 will enable e- Health system across the world to syntactically and semantically recognize Australian CDA R2 extensions. Issue: Development of Anaesthetic Implementation Guide. Action: Monitor project development and implementation guides for CDA Release 3 and their relevance to Australia. Issue: Capacity for recording and capturing provider vs. patient authored information. The existence and process of developing Australian unique health identifiers and health provider IDs may contribute to this discussion. Action: Potential incorporation of patient authored data in Australian e-health programs. 22