%%DocumentSuppliedProcSets:A&L_3 0 0 %%E8 B   Continued on page 13    4 4 _ ,S _ @i /      3) /  GMM    ommittee4    " pp  + +   _ ,S _    C  p|    *              4 * 4   ? ? |  H ( T  E q +o;K[Ck{ #+  M (                 d      Version 3: Picking Up Speed    GMM  Q>              pp  E COMMITTEE           GMM future directions for the SIG will be the main topi6 * GMM     )     ut you are a member of one of the organizations listed below, you are eligible for the discounted HL7 member rate. Indicate the group in which you are a CURRENT member: IEEE HL7 Canada JWG-CDM HL7 Germany JWG-CDT GMM  (                 g you want) First Line: subscribe HL7 World Wide Web http://dumccss.mc.duke.edu:/ftp/standards.html (                 (317) 630-2606 email: mtucker_@regenstrief. iupui.edu Continued on page 15 Implementation Co-Chairs Cheryl Fontenot Lanier Healthcare Phone: (407) 724-3859 email: cfonteno@harris.com Jackie Donlan University Hospital - Denver Phone: (303) 372-2752 email: jdonlan@wookiee. uhcolorado.edu Deborah Murray Kaiser Permanente Phone: (510) 267-5626 email: debbie.murray@kp.org Medical Records/Information Management Co-Chairs Wayne Tracy SpaceLabs Medical Phone: (913) 685-0600 email: wrtracy@wrt.win.net Mary Brandt AHIMA Phone: (713) 668-3425 email: mbrandt@ahima.mhs. compuserve.com Order Entry/Ancillary Co-Chairs Clem McDonald, MD Regenstrief Institute for Healthcare Phone: (317) 630-7070 email: clem@regen.rg.iupui.edu Hans Buitendijk SMS Phone: (610) 219-2087 email: hans.buitendijk@ shrmed.com Patient Care Co-Chairs Karen Keeter IBM Healthcare Solutions Phone: (770) 835-7972 email: kkeeter@vnet.ibm.com Thomas Marlin SpaceLabs Medical, Inc. Phone: (206) 882-3755 email: tmarlin@delphi.comTimothy Snyder Productivity Innovations Phone: (406) 586-2347 Quality Assurance and Data Modeling Co-Chairs Mead Walker SMS-HDX Phone: (610) 219-1504 email: mwalker@sms-hdx.mhs. compuserve.com Ted Klein HBO & Company Phone: (516) 231-2578 email: tklein@interramp.com Abdul-Malik Shakir Kaiser Foundation Health Plan, Inc. Phone: (510) 271-6856 email: 74353.1431@ compuserve.com SPECIAL INTEREST GROUPS Automated Data Co-Chairs Wayne Tracy SpaceLabs Medical Phone: (913) 685-0600 email: wrtracy@wrt.win.net Fritz Friedhoff SpaceLabs Medical Phone: (206) 882-4095 email: fritzfo@slmd.com Decision Support Chair Karen Herzog HBO & Company Phone: (413) 549-7100 Home Health Co-Chairs Meg Infiorati Home Care Information Systems Phone: (201) 338-2020 Michael Wilkins Lewis Computer Services, Inc. Phone: (504) 927-3064 email: wilkins@lewis.com Image Management Co-Chairs W. Dean Bidgood Jr., MD Duke Uninversity Medical Information Phone: (919) 967-7922 email: bidgood@nlm.nih.gov Robb Keayes ALI Technologies, Inc. Phone: (604) 279-5422 email: robb@cetus.ali.bc.ca Object Broker Technologies Co-Chairs Wes Rishel Wes Rishel Consulting Phone: (510) 522-8135 email: wes@rishel.com Robert Seliger Hewlett-Packard Phone: (508) 659-4928 email: robs@an.hp.com Professional Certification Co-Chairs Cheryl Fontenot Lanier Healthcare Phone: (407) 724-3859 email: cfonteno@harris.com Diana LeBlanc Lahey Hitchcock Medical Center Phone: (617) 744-2318 email: diana.c.leblanc@ lahey.hitchcock.org Secure HL7 Transactions Interim Co-Chairs Jack Harrington Hewlett-Packard Phone: (508) 659-3517 email: jackh@an.hp.com Mary Kratz University of Michigan Medical CenterPathology Phone: (313) 763-6871 email: mkratz@umich.edu Knowing Your HL7 Member Benefits by Jim Adams, Director of Membership Services Duplication of HL7 Documents Did you know that an Organizational membership in HL7 provides authorization to duplicate the HL7 Standard Specification and Implementation Support Guide for internal use? Authorization to duplicate such HL7 copyrighted documents for internal use is truly a valuable benefit potentially providing both cost savings and greater flexibility to the member. Individual members, on the other hand, are not authorized to reproduce the HL7 Standard Specification and Implementation Support Guide for internal or external usage. As has always been the case, all HL7 members are strictly prohibited from sharing HL7 copyrighted material with nonmembers, including clients. Nonmembers interested in HL7 materials should be referred to HL7 headquarters. In fact, such referrals lead to a significant source of new HL7 memberships. Adherence to the above policies is expected from all HL7 members. Likewise, referring interested nonmembers to HL7 headquarters is very much appreciated. For additional benefits and information regarding Organizational or Individual memberships in HL7, please contact Health Level Seven at (313) 677-7777 or email at hq@hl7.org. State Zip Telephone Fax E-Mail Nickname for Badge Credit Card # Exp. Date Visa Mastercard AMEX Signature (credit card orders only)                     S     g v~@PR ighlights of the Working Group meeting are provided on pages 7-12 of this newsletter. As always, all HL7 members are also being sent the detailed meeting minutes on diskette. During the meeting, HL7 recognized its six Benefactors for their tremendous support of HL7. The firms and representatives that accepted the plaques included: Andersen Consulting - Kathryn Spector Eli Lilly & Company - David Huffman Ernst & Young - John Quinn Hewlett-Packard - Jack Harrington IDX Systems Corporation - Mary Rettig SpaceLabs Medical - Wayne Tracy On behalf of the HL7 Executive Committee, we extend a sincere thank you to the above Benefactors and all of HL7s 416 Organizational members (listed on pages 16-18) for their dedication and ongoing support of HL7. Best wishes for a great summer and I hope to see you in Washington, DC as we celebrate our 10th annual meeting. p  p  `  `    f Payment: Check enclosed Please charge my credit card (I have signed above) I will pay at the meeting.* *NOTE: Attendees are eligible for discounted meeting fees if, and only if, their payment is received at the HL7 office no later than July 29, 1996. Otherwise, late fee structure will apply. Also, registrations after August 12, 1996 are to be made on-site ONLY with payment. Mail Attendee Registration Form: Please note that for registration processing purposes, HL7 is using a registration service based in Cleveland, OH. Make attendee registration checks payable to Health Level Seven, and mail registration form, along with payment, to: HL7 Registration Center P.O. Box 75029 Cleveland, OH 44101-2199 If paying by credit card, this form may be faxed to (216) 963-0319. For meeting registration questions: Please direct your meeting registration-related questions to the registration service at (216) 425-8333. For HL7 Questions: Please direct your HL7-related and membership questions to HL7 Headquarters office at (313) 677-7777. LP   ities including an indoor pool and fully-equipped health club. And, when youre ready to see the town, follow the colonnade from the hotel lobby to the 100 shops and 18 restaurants and cafes of the Nation Place, or walk two blocks to The White House. If theatre is your interest, youll find the National Theatre, Warners, and Fords Theater all within an easy two-block walk. Only one block from the Metro Center (subway), the JW Marriott is just minutes away from all the main attractions. The JW Marriott is pleased to offer the following rates to all HL7 attendees: Single/Double Occupancy: $135 per night. For reservations, please call the JW Marriott at (202) 393-2000 or (800) 228-9290. For more information about the multitude of things to see and do while in the Nations capital, call the Washington, DC Convention & Visitors Association, (202) 789-7000. Local attractions include The White House, Lincoln Memorial, Washington Monument, Capitol Building and Smithsonian Castle. All photos courtesy of Washington, DC Convention & Visitors Association.   F &&&# GMM        nn  nn p p  p  `  `   z%  "     "    p,i    p $ " !  ! # & # ! " $  " % $ # ) p ' $   H L A   : A A y y    p  p  p p    p,i  hair Dave Carlson, Enterprise Systems, Inc. Phone: (708) 537-4800, ext. 7209 Fax: (708) 537-4866 email: dcarlson@esicorp.com Technical Committee Chair John Quinn, Ernst & Young Phone: (216) 737-1242 Fax: (216) 622-0198 email: john.quinn@ey.com Technical Committee Secretary Jeff Gautney, Ernst & Young Phone: (412) 644-5316 Fax: (412) 644-0676 email: jeff-gautney@poplar.anes.upm Membership Chair Mike Glickman, Computer Network Architects, Inc. Phone: (301) 340-7955 Fax: (301) 279-2211 email: mglickman@aol.com IAB Chair Frank Cavanaugh, Coopers & Lybrand Phone: (312) 701-5595 Fax: (312) 701-6540 email: fcavanau@reach.com HPAB Chair Sam Schultz II, Ph.D., University Hospital Consortium Phone: (708) 954-1700 Fax: (708) 954-5886 email: schultz%is@mailgate.uhc.eduLL7 Canada. Currently, 81 Canadian healthcare organizations and companies are members of HL7 through the U.S. CIHI will leverage this investment, enabling current Canadian members of HL7 U.S. and others interested in Canadian health information standards to participate in an organization based in Canada. HL7 Canada will channel members recommendations to tailor the HL7 Standard for Canadian requirements. An HL7 Canada representative with full voting privileges currently serves on the Executive Committee and will represent Canadian needs and issues with a single, strong voice. As a national body charged with coordinating Canadas healthcare information systems, CIHI has taken the lead in establishing national standards for health information. The formation of HL7 Canada coincides with the beginning of a new, collaborative effort to develop standards for Canadian health information exchangethe Partnership for Health Informatics/Telematics. Information exchange protocols, such as HL7, will be the focus of one of the six working groups in the Partnership. The HL7 Canada and Partnership initiative were launched successfully this April in conjunction with the Annual Conference of the Canadian Organization for the Advancement of Computers in Health (COACH) in Toronto. CIHI is currently accepting memberships in HL7 Canada. Membership benefits include: Opportunity to participate in both HL7 Canada and HL7 U.S. Technical Committees and Special Interest Groups. Discounts to attend HL7 and HL7 Canada meetings. HL7 and HL7 Canada communications. Savings on membership through payment in Canadian funds. Articulation of Canadian requirements and issues with a single voice to HL7. Regular HL7 benefits such as the most current version of the HL7 Standard, HL7 Implementation Support Guide, voting privileges and Working Group Meeting minutes. Canadas proximity to the U.S. allows HL7 Canada the unique opportunity to maintain a close relationship with HL7 and to continue the goodwill that was generated at the Denver Working Group Meetings. We look forward to collaborating for many years to come! For more information about HL7 Canada or to receive a membership form, please contact Shelagh Maloney at (416) 429-0464 or smaloney@cihi.ca.  ual Plenary Meeting August 19-23, 1996 J.W. Marriott Hotel Washington, DC The weeks activities include: Monday, 8/19 Tutorial: Introduction to HL7 Tuesday, 8/20 HL7s 10th Annual Plenary Meeting Wednesday - Friday, 8/21-8/23 HL7 Working Group Meetings Please refer to the meeting brochure for more details on the upcoming 10th annual event. April 96 Working Group Meeting HL7s April Working Group meeting that convened in Denver attracted over 250 attendees. Highlights of the Working Group meeting are provided on pages 7-12 of this newsletter. As always, all HL7 members are also being sent the detailed meeting minutes on diskette. During the meeting, HL7 recognized its six Benefactors for their tremendous support of HL7. The firms and representatives that accepted the plaques included: Andersen Consulting - Kathryn Spector Eli Lilly & Company - David Huffman Ernst & Young - John Quinn Hewlett-Packard - Jack Harrington IDX Systems Corporation - Mary Rettig SpaceLabs Medical - Wayne Tracy On behalf of the HL7 Executive Committee, we extend a sincere thank you to the above Benefactors and all of HL7s 416 Organization members (listed on pages 16-18) for their dedication and ongoing support of HL7. Best wishes for a great summer and I hope to see you in Washington, DC as we celebrate our 10th annual meeting. 3    GMM   p  * ) p ` % ` N N Argentina Center for Medical Informatics - Nanyang Polytechnic Centers for Disease Control & Prevention College of Healthcare Information Management Executives Computer-based Patient Record Institute, Inc. Data Interchange Standards Association/ ASC X12 Food & Drug Administration Healthcare Information & Management Systems Society Institute for Information Management - Robert Morris College Japanese Association of Healthcare Information Systems Industry (JAHIS) Joint Commission on Accreditation of Healthcare Organizations Los Alamos National Laboratory Medical Transcription Industry Alliance (MTIA) Minnesota Health Data Institute National Association for Home Care Pan American Health Organization/World Health Organization Pennsylvania Department of Health - Data Processing U.S. Department of Defense U.S. Department of Health & Human Services - HCFA University HealthSystem Consortium Payors Blue Cross Blue Shield - Alabama Blue Cross Blue Shield - Ohio Blue Cross of Western Pennsylvania Humana, Inc. Consultants American Management Systems, Inc. Andersen Consulting Bolder Heuristics, Inc. The Catalyst Group CITEC Clark Information Services Computer Network Architects, Inc. Coopers & Lybrand Ernst & Young First Consulting Group Gartner Group GSA Consulting Group HealthTek Solutions, Inc. J. Norman Consulting, Inc. The Kernel Group, Inc. OpTx 2000, Inc. Questra Consulting SmartHealth Wipfil Ullrich Bertelson Consulting Vendors Accucore ActaMed Corporation ADL Data Systems Advanced Professional Software, Inc. Air-Shields Information Systems ALI Technologies, Inc. ALLTEL Information Services, Inc. - Healthcare Division Ameritech Health Connections Amersham Medical Systems Ltd. AMS, Division of Standard Register Amtelco Apple Computer, Inc. Artefact Informatique, Inc. Articulate Systems, Inc. Automated Healthcare, Inc. AXOLOTL Corporation Baxter Healthcare Corporation BBN Software Products BDM Information Systems Ltd. Beacon Health Corporation Beacon Partners, Inc. BeyondNow Technologies, Inc. Bukstel & Halfpenny, Inc. CapMed Systems Corporation Care Management Science Corporation CareCentric Solutions, Inc. CEMAX-ICON, Inc. Central DuPage Hospital Century Analysis, Inc. Cerner Corporation CITATION Computer Systems, Inc. CLICK*VIEW Corporation ClinEffect Systems, Inc. Clinical MicroSystems, Inc. Clinidata Inc. CodeMaster Cascade College of American Pathologists Combeck Computer Design, Inc. Compucare Company CompuSense, Inc. Compute-RX, Inc. Computer Partner Paschmann Computrition, Inc. Concepts in Communications Creative Computer Applications, Inc. Crescendo Systems Corporation Custom Software Systems, Inc. CyCare Systems, Inc. Cygnet Laboratories Dairyland Computer & Consulting Data Innovations, Inc. Databreeze, Inc. Datamedic Clinical Systems Dawning Technologies, Inc. Delphic Medical Systems Ltd. Delta Health Systems Dictaphone Corporation Digital Dictation, Inc. Dolbey & Company DR Systems Dynamic Healthcare Technologies E-Systems Eli Lilly and Company EMTEK Enterprise Systems, Inc. Epsilon Systems, Inc. ERGO First Coast Systems, Inc. G.S.C. Data Corporation HBO & Company Health Cost Consultants Health Systems Technologies Healthcare Communications, Inc. HealthCom Healthdyne Information Enterprises, Inc. Healthsource, Inc. HealthVISION Corporation Healthware Technologies, Inc. Healthworks Alliance, Inc. Hewlett-Packard Hi-Care Ltd. Hickman-Kenyon Systems, Inc. Home Care Information Systems (HCIS) HUBLink, Inc. Hyundai Electronics i.e. Corporation IBM Healthcare Solutions IBS, Inc. IDEX, Inc. IDX Systems Corporation IFA Systems, Ltd. IMPAC Medical Systems Infodata Systems Inc. Integrated Medical Networks INTEGREX Systems Corporation Intelligent Medical Objects, Inc. Intelligent Optimization, L.C. IPN Network, LLC ISYS Technology Corporation Keane, Inc. - Healthcare Services Division Kestral Computing Pty Ltd KVM Technologies, Inc. Landacorp Lanier Healthcare Lattice, Inc. LCI Lewis Computer Services, Inc. LINK Medical Computing LinkTech, Inc. LOGICARE Corporation Long Term Computer Systems M/Management Systems, Inc. Management Software, Inc. Management Systems Associates, Inc. MarkCare Medical Systems, Inc. Med-E-Systems Medi-Comp Innovations Group Medi-Mouse Systems MedE AMERICA Medical Communications Systems, Inc. Medical Information Management Systems Medical Knowledge Systems, Inc. Medicus Systems Corporation Medintell Systems Corporation Medisoft International P/ Ltd. Meditrol Automation Systems MEDSAMERICA, Inc. MedSelect Systems, Division of Diebold Mennen Medical Merge Technologies, Inc. Micromedex, Inc. MicroScript Corporation Microsoft Corporation MIDS, Inc. MMA MSI Solutions Group NEC BCS (East), Inc. Nellcor Puritan Bennett - CIS Division New England Medical Services Oacis Healthcare Systems, Inc. Occupational Health Research Oceania OmniCell Technologies, Inc. ORCA Medical Systems PACE Health Management Systems, Inc. Personalized Programming, Inc. PHAMIS, Inc. PM Squared, Inc. Productive Data Management Productivity Innovations prompt! Medizinische Informationssysteme GmbH Protocol Systems, Inc. QS / 1 Data Systems Quadramed Corporation Quantitative Medicine, Inc. (QMI) Quantum Health Resources RADMAN Radiology Management Systems, Inc. RAET Gezondheidszorg en Welzyn B.V. Reuters Health Information Services, Inc. Rockwell International - CSD RTP, Inc. SECOM Co., Ltd. - Intelligent Systems Laboratory SMS Softactics, Inc. SOFTCON GmbH Software Technologies Corporation SpaceLabs Medical, Inc. Star Technologies Stellcom Technologies Stockell Information Systems The Stolas Group, Inc. Summit Medical Systems, Inc. Sunquest Information Systems, Inc. Synchronized Data Systems, Inc. Synergy Healthcare Systems Xcellence, Inc. Triple G Corporation U.S. Health Data Interchange (USHDI) Uniresearch AG Universal Hospital Services, Inc. Varian Oncology Systems VDI Technologies, Inc. Vectis ViewPoint Solutions Vital Software Wes Rishel Consulting WiSE Medical Systems, Inc. Healthcare Providers Advocate Healthcare Akron General Medical Center Allied Physicians Allina Health System ARUP, Inc. Asante Health System Ball Memorial Hospital Baptist HealthCare Baptist Memorial Healthcare System Baylor MedCare Bayshore Community Health Services Beth Israel Medical Center BJC Health System Bridgeport Hospital - Information Services Bristol Hospital BroMenn Healthcare Butterworth Hospital Care Systems, Inc. Carondelet Healthcare Corporation Catawba Memorial Hospital Catholic Health Partners Services Cedars-Sinai Medical Center Central Health Services Centre Hospitalier de Gatineau Centre Hospitalier Regional De Lanaudiere Childrens Hospital (Boston) Information Services Childrens Hospital Informatics Program The Childrens Memorial Hospital Cleveland Clinic Foundation Concord Hospital County of Fresno Computer Services Dept. Cypress Fairbanks Medical Center Dana-Farber Cancer Institute Davies Medical Center Day Kimball Hospital Deaconess Medical Center Department of Emergency Medicine - UIC Dept. of Veterans Affairs - Birmingham ISC  N  N  N (8 2c<c  #  3. IEEE P1157 Medical Data Interchange (MEDIX) The JWG CDM met on April 21 and 23 with ASC X12N and HL7. The group reviewed a new draft of the Standard Trial-Use Standard for Healthcare Data Interchange Information Model Methods. This draft of the IEEE P1157.1 Standard is available electronically in two files at Duke: http://www.mcis.duke.edu/standards/IEEE/JWG-MODEL/stdmain.pdf and stdanex.pdf. The JWD CDM planned the process for taking this Standard to ballot, including steps needed to assure that members of HL7 and X12N can join the ballot pool. The group also discussed in detail the tools necessary to develop, publish, and manage models developed in conformance to the draft Standard. The JWG CDM participated in a joint ASC X12N/HL7 discussion of data modeling and agreed to do an initial harmonization of models developed in the two organizations at its next meeting in August. Agenda items for August meeting: Meet jointly with ASC X12N to focus on harmonizing models across standards developing organizations, using X12N and HL7 ADT models as a trial case. Image Management The Image Management Special Interest Group (IMSIG) is developing a standard HL7 profile to simplify interfacing of HL7 Information Systems with DICOM Imaging Systems. Work continues on the HL7-DICOM mapping specification. The document will be organized according to guidelines being developed by the Technical Steering Committee for HL7 Version 3.0. Pertinent sections of HL7 will be expressed in a Version 3.0 Style and will be mapped item by item to the matching sections of DICOM. The initial scope of IMSIG mapping work is the transfer of Scheduled Procedure work lists from HL7 systems to imaging modality devices (e.g., CT or MRI Scanners). The next phase of the HL7-DICOM mapping project will include Observations. A joint meeting with the Orders and Results Committee opened discussion on reporting of complex interpretation procedures. A telephone conference is planned to follow up the April joint meeting. IMSIG also continued planning for a demonstration of HL7-DICOM Work in Progress at upcoming annual meetings of the Radiological Society of America. The RSNA will demonstrate only DICOM connectivity in 1996. A proposal for an expanded HL7-DICOM demonstration has been invited for the following year (with final specifications due in July, 1996). The first HL7-DICOM demonstration may occur as early as December, 1997. The 1997 date allows IMSIG to include Observations Reporting in the specifications. This will enable HL7 vendors to demonstrate a much wider variety of applications. Support for the IMSIG is strong in the professional societies that are allied with HL7. Members of the National Electrical Manufacturers Association, American College of Radiology, American Dental Association, and the American Society for Gastrointestinal Endoscopy participated in the Denver IMSIG meeting. The membership of IMSIG will meet with ACR-NEMA WG9 on May 13-14, 1996, at NEMA headquarters in Rosslyn, VA, and will meet during the week of August 21-23, 1996, at the HL7 meeting in Washington, DC. Agenda items for August meeting: Review the work-in-progress for the RSNA 97 Demonstration. Present the first draft of the HL7 IMSIG HL7-DICOM Interoperabil-ity Specification, incorporating the work of DICOM Supplement 10 (Modality Worklist) and DICOM Supplement 15 (Structured Reporting). Develop a partitioning of the real-world data model into functional domains, to be represented as chapters in the Specification. Finalize the proposal for transfer, reference and query of DICOM images in HL7. Implementation The Implementation Committee met all day on Wednesday and again on Thursday morning. Cheryl Fontenot and Jackie Donlan were elected Co-Chairs and will be joining current Co-Chair, Debbie Murray, in leadership roles. The committee also reviewed z segment usage guidelines, the implementation tutorial outline, and the generic implementation project plan. Finally, they developed an outline for the Version 3.0 Implementation Guide. Agenda for the August meeting: Develop guidelines for selecting an interface engine. Develop an interface engine RFP. Inter-Enterprise The Inter-Enterprise Subcommittee meeting began with an update of the activities of the HL7-X12 Joint Coordinating Committee (JCC). The JCC is a committee established by HL7 to work with corresponding members of the ASC X12N standards organization on message specification overlap issues. However, the JCC has been rather inactive for several meetings. No agenda or plans have been created yet, but we will be apprised of future events as they are planned. Inter-Enterprise also reviewed ballot responses for the Scheduling chapter (chapter 10) and the Referral chapter (chapter 11). The minutes contain the resolution of issues raised in the ballot comments. Ballot responses for the Referral chapter resulted in two significant changes to the content. A new segment allowing a loose general grouping of resources in an appointment was added to the Scheduling chapter. A conflicting message type code of SRM was identified in the Scheduling chapter and the Order Entry chapter. Robert Burkhead and Hans Buitendijk (Order Entry/Results Chapter Co-Chair) will resolve the conflict before the next ballot is distributed. During the remaining time, Inter-Enterprise discussed data modeling. George Beeler provided an overview of data modeling to the group and suggested a path to begin modeling both chapters. The group began developing a model with the Referral chapter. Robert Burkhead will continue the modeling effort between working group meetings, with assistance from George Beeler and Joe Peterson. Domain experts for both Referrals and Scheduling are strongly urged to attend the next working group meeting for the Inter-Enterprise Subcommittee to review and comment on the initial version of the model. After completing the review of edited draft chapters and discussing data modeling, the group drafted an agenda for the next meeting. Agenda items for August meeting: Update on HL7-X12 Joint Coordinating Committee. Review minutes from April meeting (Denver). Review Version 2.3 ballot responses for both chapters. Begin model review for Referral chapter. Continue review of model for both chapters. Address any new business. Draft an agenda for the next meeting (Tampa). Medical Records/ Information Management 5 5 # 5 ! 5  5  p "     p p S ? ? ?  |  H ( T  E q +o;K[Ck{ #+  MM d H H H H  p|           next meeting of HISB is a two-day meeting on June 20-21, 1996. The role of ANSI through the HISB is to coordinate the activities of the standards developer organizations (SDOs) which are members of the HISB. ANSIs role is only one of coordination. ANSI itself cannot create standards, and has no power except persuasion in dictating what each SDO must do. Harmonization must be accomplished through the organizations voluntarily, working for the total good of the healthcare industry to produce effective and non-competing standards. At the first meeting of the HISB, the activities of HL7 and NCPDP in defining messages for the interchange of data relating to prescription drugs were discussed in some detail. Some of the discussion seemed to imply that only one of the organizations should create those messages and that, if both HL7 and NCPDP created similar messages, this would be a duplication of effort resulting in competing standards. I disagree with this conclusion. In understanding the basis of my disagreement, it is important to remember the origin of each of the SDOs. HL7 was formed to deal with the interchange of clinical data. Early efforts were focused in the hospital setting, connecting the hospital information systems with the departmental specialty systems. HL7 continues to define standards for the interchange of clinical data, but the focus has changed with the expansion of the healthcare model into enterprise systems, integrated delivery systems, and community, geographic and statewide healthcare information systems. X12N began with a focus on the reimbursement process including claims, payments, and benefit plans. Early efforts were built around document transfer, mainly in the batch mode. While that areas remains the focus, the scope of the Standard has expanded to include real time interactions and the transmission of clinical data to support the claims process. ACR/NEMA has had as its focus the transmission of images, and now that focus has expanded to include pictures, slides and documents. Additionally, ACR/NEMA includes some additional data to identify the patient and support the parameters of the image creation. ASTMs data interchange standards include E-1238 for transmission of clinical observations, and E-1467 for the transmission of EEG waveforms. The domain of both of these standards is also included in the HL7 Standard. NCPDPs Standard defines the content and syntax for transmitting prescription drug data for purposes of reimbursement. The IEEE group defined the Medical Information Bus (MIB) Standard, and the MEDIX group was interested in defining a formal model for the transmission of all healthcare data. At the time of the formation of each of these groups, the underlying purpose of each SDO was clearly different. In most of these groups, the SDOs were formed by people with very different knowledge and experience. X12N includes people with expertise and experience in the insurance and business environment. NCPDP includes people from the pharmacy community. HL7 includes vendors and users from the clinical world. ACR/NEMA draws from the vendors with skills in imaging. IEEE includes engineers and computer scientists with skills in the interface and modeling areas. Each of the resulting standards is highly functional, and the quality of each Standard results from the expertise and the experience of those involved in creating a particular Standard. The progress made to date and the quality of the standards resulting from these multiple efforts is much better than would have been created by a single body. The implication that no two SDOs should have a message for sending the same type of information would, in my opinion, be unworkable. If we accept that model, a vendor would not only have to be skilled in all of the existing standards but also would have to use more than one Standard within a single clinical event. For example, to send the clinical data associated with an encounter, the lab orders might be sent by HL7 and the pharmacy orders by NCPDP. That, to me, is not what is required nor desired by harmonization. Instead, each group needs to define those messages which are required to carry out the goals of the organization. If I need information relating to a referring provider, I might use HL7 in a clinical scenario and X12N in a reimbursement scenario. There is no confusion as to which Standard should be used. A similar situation would exist in using the NCPDP message when transmitting prescription drug data for reimbursement and HL7 when sending the same data as part of a clinical scenario. Cooperation between the SDOs should define the same message for the same purpose. As each SDO expands its activities to meet the demands for standards within the scope of its mission, we need to understand the purpose and intent of each Standard. As the standards are being more widely implemented and used, the need for domain expansion continues. Nursing homes and home care, adverse event reporting, and immunization tracking are only a few of the new areas of interest. We need to avoid misunderstandings and turf wars between the different organizations. Each Standard should be written by the appropriate organization with the expertise and the need for that Standard. Some view HL7s domain as being that of just a hospital. That view is not correct. HL7s purview is that of transmission of clinical data or data used for clinical purposes. As the walls and interests of the institution have expanded, so do the requirements for the clinical exchange of data. The rewards of all of our efforts are not in the creating of the standards. The reward is being able to do the things we need to do in order to manage effectively the information required for optimum management of the health of people. We cannot accomplish those goals without adequate standards. Together we can fulfill those goals.2   S sues including disease management and problem-based data collection; and public health. A systematic, detailed approach to describing HL7 conformance that will improve the understanding between vendors and users of the actual extent of HL7 support. Greatly reduced time and costs for developing interfaces by tightening the Standard, making it easier to understand, reducing option-ality, and making its intent clearer. Improved implementation using modern, object-based technologies including CORBA and OLE while providing a means for interoperation with legacy systems that continue to use character stream messages very similar to those of current HL7. Increased harmonization with other healthcare messaging standards through the use of methodology consistent with that of the IEEE Joint Working Group for a Common Data Model. Improved ability to effectively describe the intent, context, and content of HL7 messages by using a methodology based on selected aspects of Object Oriented System Engineering during the development of messages and for their presentation in the Standard. Support for confidentiality, electronic signature, and authentication of messages and systems in e-mail, Internet and intranet environments. The industry will obtain these benefits while introducing Version 3.0 into existing networks in an evolutionary fashion. Version 3.0 applications will be able to interoperate with Version 2.X applications through the use of interface engines. Better Ends Require New Means These benefits could not be realistically achieved except by a ground-up rework of the methodology that HL7 uses to develop messages. We will use object-oriented analysis supported by computerized analytic tools. The figure (page 4) illustrates this by contrasting the deliverables of a Version 2.X HL7 Standard with Version 3.0. In Version 2.X, a functional chapter is comprised of trigger events, which map to messages as groups of segments, and a separate listing of the segments, which are fairly arbitrary groups of data fields. Except in some explanatory texts there is no discussion of the interrelationships among the trigger events. When data fields are described there is no formal stated relationship between a field and the concept it describes. When committees have used sub-fields to describe logical groupings of data, they did not have the option of describing the sub-fields with the same level of detail that is applied to fields. Because the same segment was re-used in many messages, all fields had to be described as optional. Compare this to Version 3.0. All data will be described in one place, the HL7 Reference Model, which relates data fields to the classes they describe. It also describes how the classes relate to one another. Placing all these descriptions together will assure that the fields are used consistently everywhere. It will also facilitate comparison with the work of other standards groups. Within a functional area, the Information Model is a subset of the Reference model specifying the classes of specific interest and their relationships to other interesting classes. The Interaction Model relates messages to trigger events. It also relates these to application profiles. An application profile, which might be named something like enterprise patient administration or departmental order filler, represents a contract to send and receive certain messages in response to certain trigger events. Many or most actual application systems Continued from page 3 may make several conformance claims. The Interaction Model says what application profile sends or receives what messages in response to a trigger event and how the trigger events inter-relate. The Hierarchical Message Descriptions (HMD) for a functional area describe the actual messages. They indicate which fields are sent. Because there is a separate HMD for each message/trigger event, they will be more specific about optionality than was possible in Version 2.X. The Implementable Message Specifications describe how the messages defined by the HMD will be sent in three different environments: printable character streams (like current HL7), OLE, and CORBA. It is important to note that although the technologies support different formats, the information content and timing of the messages are defined by the Information Model, Interaction Model, and HMDs. Messages in the three technologies are identical with respect to content and timing. The key to quickly developing Version 3.0 messages will be having a draft Reference Model available at the start of the process. To this end, we have issued a Call for Models, inviting HL7 Members and other Standards Developers Organizations to submit their models. These will be combined with the modeling work that has been done based on Version 2.2 and Version 2.3 to create the initial model. Interim meetings, in addition to the regular HL7 Working Group meetings, will be held with model sources and members of HL7 Technical Committees in order to have it ready for message development in January, 1997. New Means Require Money and Sweat By the time we begin developing Version 3.0 messages, HL7 and its members will have invested thousands of hours creating a development methodology that is sufficiently robust and well-documented to handle the challenge of integrating a wide functional scope into a consistent set of messages across object-oriented and legacy technologies. These volunteers will provide the membership with a comprehensive Message Development Framework document. Development will be supported by a combination of a commercial data modeling tool and software developed by volunteer members. HL7 will have invested more than $170,000 in meeting costs, travel, conference calls, purchase of data modeling software, and a limited amount of paid facilitation. This money is largely drawn from the fees paid by benefactors and other members, but the Executive Committee is currently seeking a grant to continue to support the process. It is this level of investment that gives us the confidence to claim that we will develop a more enforceable Standard that will substantially reduce implementation costs in a mere year and a half. In developing these documents we are very much indebted to the work of IEEE Joint Working Group for a Common Data Model and CEN TC251 Working Group 3 for much of the methodology. Film at Eleven We invite members and guests to attend a briefing on Version 3.0 to be held at the HL7 Plenary Meeting in August in Washington, DC. We will present the goals, methodology, and process and hold an open forum to discuss them.    l non-active voting members to regular membership status. If you were a voting member but did not return a vote for ballot #1, you have received a memo from me conveying this change in your status. As the memo indicates, this change does not affect your voting status on any committees in which you may participate, and you will continue to receive all materials on comprehensive drafts of Standards. It merely relieves you of the responsibility of returning a paper ballot. This action is not intended to penalize non-active voting members. HL7 values your vote and encourages all interested members to participate in the balloting process. If you received this memo but would like to remain on the list of active voters, please call (313-677-777), fax (313-677-6622) or e-mail (karen@kvan. win.net) a brief message to me. If your schedule and other commitments are such that you cannot fulfill your obligation to vote in ballot #2, remaining a regular (non-voting) member will help ensure that we meet the requirements to close a ballot as set forth in our bylaws. The message, of course, is that we need more active voting participation from our providers, consultant, general interest, and other non-vendor members. According to clause 14.3 of the Bylaws of Health Level Seven, a ballot cannot be closed unless at least 60% of the voting members return ballots. The good news is that, after extending the voting period for ballot #1 for several weeks, we finally achieved the 60% minimum required for a quorum. The bad news is that only 60.29% of our voting members responded. Had one less ballot been returned, we would not have reached the 60% required for a quorum. Besides requiring participation by at least 60% of our voting members, our bylaws stipulate that two additional requirements be met before our Standard is approved. Clause 14.3 requires that 90% of the combined affirmative and negative votes be affirmative. As was expected, we were not close to achieving that 90% for ballot #1 but are hopeful of meeting this requirement with ballot #2. The final, and perhaps most important, requirement for an organization such as ours is a balance of interest. Clause 3.3.4 of our Bylaws reads as follows: In any vote pertaining to approval or adoption of HL7 protocol specifications, or any portion thereof, . . . balance of interest requires that the combined number of voting user, consultant, and general interest classification members be equal to or greater than the number of voting vendor members. When all votes were tallied for ballot #1, 63.35 % of them were from vendors. In other words, had the other two requirements been meet, our Standard could not have been approved because vendors represented more than 50% of all responding voters. The message, of course, is that we need more active voting participation from our providers, consultant, general interest, and other non-vendor members. It is also noteworthy that vendor members need not submit multiple copies of the same ballot for each HL7 member within their organization. A single ballot with comments is handled the same way as multiple copies of the same ballot. In fact, given the current imbalance of interest, vendors who vote in blocks can actually make it more difficult for HL7 to get its standards approved. Again, HL7 values your vote and encourages all interested members to participate in ballot #2 for Version 2.3.usDept. of Veterans Affairs Medical Center - Philadelphia Diagnostic Laboratory Holdings Ltd. Dominican Santa Cruz Hospital Duke University Medical Center East Alabama Medical Center Eastern Health System, Inc. Forsyth Memorial Hospital Good Samaritan Hospital - Dayton Good Samaritan Hospital - Lebanon Group Health Cooperative - Information Services Hackley Hospital Halifax Medical Center Health First, Inc. Healthsource, Inc. Heidelberg Repatriation Hospital Hennepin County Medical Center Henry Ford Health System Hermann Hospital Hershey Medical Center Holy Redeemer Health System Hopital de lEnfant-Jesus Hopital du Sacre-Coeur de Montreal Hopital Notre-Dame Hopitaux Universitaires De Strasbourg The Hospital for Sick Children - IS Hospital of Saint Raphael Hospital Sisters Health System Indiana University Medical Center Jackson Hospital and Clinic, Inc. Kaiser Foundation Health Plan, Inc. Kalispell Regional Hospital Laboratory Corporation of America Lahey - Hitchcock Clinic Lakeland Regional Medical Center Legacy Health System Lexington Medical Center Los Angeles County Department of Health Services Loyola University Medical Center Luther Hospital Lutheran Health Systems Lutheran Hospital of Indiana, Inc. Marquette General Hospital Marshfield Clinic Mayo Foundation MDS Laboratories Medical Center Hospital The Medical Center of Central Massachusetts Medical Center of Ocean County Medical College of Ohio Memorial Health Alliance Memorial Hospital and Medical Center Memorial Hospital - Colorado Springs Memorial Medical Center Mercy Center for Healthcare Services Mercy Hospital - Iowa City Michigan Heart, P.C. Ministry of Health - British Columbia Mississippi Baptist Medical Center Montreal Childrens Hospital Moore Regional Hospital Moses Cone Health System Moses Taylor Hospital Mount Sinai Hospital Mt. Carmel Health NCH Healthcare System New England Medical Center New South Wales Health Department NHS Executive Headquarters - Information Management Group The North Carolina Baptist Hospitals, Inc. North Texas Healthcare Network Northwestern Memorial Hospital NYU Medical Center - MIS Department Obici Health Systems Ohio State University Medical Center - IS Oregon State Health Division Parkland Memorial Hospital Penrose-St. Francis Healthcare System Pocono Medical Center Providence Health System - SW WA Services Area Queensland Medical Laboratory Reading Rehab Hospital Regency Health Services, Inc. Rice Memorial Hospital The Riverdale Hospital Riverside Hospital Riverside Methodist Hospitals Rush-Presbyterian-St. Lukes Medical Center Sacred Heart Medical Center Saint Josephs Health System Saint Marys Health Network Salem Hospital Saskatoon District Health ServiceMaster Home Healthcare Services, Inc. Shadyside Hospital SSM Health Businesses Southeast Alabama Medical Center Southeastern Regional Medical Center Southern Ohio Medical Center Southwest Washington Medical Center Spartanburg Regional Medical Center Spectra Laboratories, Inc. St. Alphonsus Regional Medical Center St. Claires Hospital St. Francis Medical Center - Monroe St. Francis Medical Center - Peoria St. Johns Regional Medical Center St. Josephs Hospital St. Josephs Hospital Health Center St. Lukes Episcopal Hospital St. Mary Medical Center St. Vincents Hospital - Melbourne (I.S. Dept.) Stanford Health Services Texas Childrens Hospital TheraTx, Inc. Thomas Memorial Hospital Toronto East General Hospital Touro Infirmary Trinity Mother Frances Health Systems UniHealth Universal Standard Medical Laboratory University Hospital - Augusta University Hospital - Denver University of Arkansas for Medical Sciences University of California San Francisco - Clinical Enterprise Systems University of Chicago Hospitals University of Illinois at Chicago Medical Center University of Massachusetts Medical Center University of Michigan Medical Center University of Minnesota Hospital University of Missouri Hospital & Clinic University of Tennessee Medical Center University of Utah Hospital Upper Hudson Primary Care Consortium Vanderbilt University Medical Center Virginia Department of Health Welborn Baptist Hospital West Georgia Medical Center Western Pennsylvania Hospital Revised June, 1996 l St. Josephs Hosp,3     "   ` ! ` ' `  ` % * % *  *  * ) *  p  p      p  p , p  p  p  p * p  p p  p p * * $ p % p  p # p  p  p  p  p $ p  `  ` `  `  `  ` ! ` ' `  ` %   b    S  a   b    S  a p # p  p  p  p  p $ p  `  ` `  `  `  ` ! ` ' `  ` %  x  ment kept intact. The procedure proposed in this comment would compromise the integrity of computer-based patient records, put clinical decision-makers and patients at risk, and fail to meet common legal and regulatory practice and accreditation requirements. Committee members found the proposed change to be non-persuasive, with 21 voting against the proposed change, 2 voting for, and 1 abstaining. Two new trigger events were added to the chapter: one to notify and one to communicate the results of an edit to a document permitted if the document had not been made available for caregiver use. In order to clarify the usability and behavior of status fields, a state transition table was added to each of the major status fields associated with the document header (TXA) segment. All other negative ballot issues and suggestions were resolved or withdrawn by their authors. A preliminary data model of the contents of the chapter was distributed but not reviewed during the sessions. Agenda items for August meeting: Review Version 2.3 ballot responses. Review in earnest of the data model beginning with the development of use cases and continuing with the other process steps defined by the QA/Data Modeling Committee. Review other proposed topics including chart tracking, consents and release of information messaging. Object Broker Technologies SIGOBT met all day on Thursday, April 25. This was a particularly important meeting as the SIG established a plan to produce a comprehensive specification of a mapping of HL7 messages to CORBA and OLE objects. A first draft of this comprehensive mapping is targeted for completion by the August 1996 HL7 meeting. The decision to move forward on a comprehensive mapping was based upon the belief that most of the technical issues had been explored and resolved during the course of the last year. This exploration culminated with the review in the Thursday meeting of the third of three white papers that have described a successive set of refinements to the mapping approach. This paper, Refinements to the Mapping of HL7 Version 2.x to OLE and CORBA, is on the Duke server. It can most easily be accessed through the SIGOBT web page: http://dumccss.mc.duke.edu/standards/HL7/sigs/SIGOBT/obt.html or via anonymous FTP as a WinWord or Portable Document Format file: ftp://dumccss.mc.duke.edu/standards/HL7/sigs/SIGOBT/papers/hl7_obj2. doc ftp://dumccss.mc.duke.edu/standards/HL7/sigs/SIGOBT/papers/hl7_obj2. pdf While the review of this paper revealed additional refinements that need to be developed, they will be incorporated into the August draft Specification. There was enthusiastic agreement that it is now time to produce the comprehensive mapping. To this end, members agreed to focus their initial energies on mapping the messages defined in the Control/Query, ADT, Orders, and Observation Reporting chapters. The document will not re-explain the HL7 Specification. Instead, it will explain the mapping principles, and then provide complete mappings for the HL7 messages as CORBA objects and as OLE Automation objects. To spearhead the production of the mapping, ten SIGOBT members from nine organizations were grouped into four teams, one per chapter, and a series of interim teleconferences and exchanges of drafts-in-progress have been planned. The complete set of relevant dates is available in the SIGOBT meeting minutes, which will be also be posted on the Duke server. Finally, SIGOBT briefly discussed the HIMSS 1996 demonstration of the OLE mapping of HL7. Eighteen vendors participated in this demonstration, which was a definite technical success. Only three working days were needed to get the various systems to interoperate. This is in stark contrast to the weeks of work that were required for the original HL7 demonstration ten years ago! Unfortunately, some glitches with the network cabling detracted from the demonstration during the actual show. Nevertheless, the overall positive experience helped to catalyze the desire to move on and produce the specification described above. The August SIGOBT meeting should be an interesting one. Stay tuned! Agenda items for August meeting: Review first draft of mapping HL7 and CORBA objects (chapters 2, 3, 4, 7) GMM MM M  $ * * ( R    S  a  $ #   $     ##$&)+,,- -,, .$3':&@JLMOTZ]_ abcinruvx|2    fhhgd_YQ U$Q$O&L'I&I$K!O%U$U TPL F C A@=9: <<< $ 4 7:=??;::;999<?@BFJL%  p    /g * *  *  ! `  p 5 5  5 % 5  5  $     b    S  a * % *  *  * ) *  p  p      p  p , p  p  p  p * p p p  p * ! * * $ p % p  p # p  p  p  p  p $ p  `  ` `  `  `  ` ! ` ' `  ` %  (tentative). Patient Care The Patient Care Committee completed its review of negative ballots from Version 2.3. All of the changes requested via these ballots were adopted with minor amendments. One major ballot issue involved inclusion of path and variance segments and a pathway message. It was argued and agreed that there was substantial value in incorporating these items into chapter 12 for this ballot. In preparation for Version 3.0 modeling, Jackie Golder spent a half day educating the group on the case development methodology. Patient Care hopes to do some between-cycle development on the model using volunteers to develop initial use case synopses/descriptions. Agenda for August meeting: Review Version 2.3 ballot responses. Review use case modeling. Develop Patient Care scope. Quality Assurance/ Data Modeling The Quality Assurance/Data Modeling Committee began its activities by making a presentation at the Technical Steering Committee retreat on the Version 3.0 development process. The entire committee convened for all-day sessions on Wednesday and Thursday and met again on Friday morning, with their energies focused on modeling activities for Version 3.0. They defined the Reference Model Process and Structure, discussed scope, staffed the project, and issued a call for models. Additionally, QA/DM participated in a joint meeting with X12N modelers, and facilitated modeling activities under way in the Home Health, ADT, Finance, Patient Care, and Referrals committees. Other group modeling activities included reviewing and critiquing the process for use cases, identifying the set of tools that will be used for the rest of the year, discussing facilitation (process, structure, staff of facilitators, roles, goals), and discussing conventions and standards. QA/DM also discussed its QA responsibilities (currently an unaddressed role) and structure, including roles of Co-Chairs, and developed an agenda and schedule for the next meeting. Agenda items for August meeting: Organize and kick off the Quality subgroup (1/2 day). Run through methodology for small group (full-day): in-depth pilot run through of use case process. Discuss standards and conventions for modeling. Meet with JWG-CDM. Review methodology. Kick off facilitation. Review TC reference model (breakout). Review/analyze TC review breakout sessions with facilitators. Draft an agenda/schedule for the next meeting (Tampa). Secure Transactions People who are implementing HL7 in various Internet, intranet, and e-mail environments have frequently expressed concern about the security of transactions. John Lyons article EDI Over the Internet, Part II (E-Comm magazine, January 1996) addresses this issue by summarizing the requirements and several alternate approaches adapted in various messaging standards environments. HL7 affiliate groups in Germany and New Zealand have already adopted specific approaches. With these concerns in mind, a group of HL7 members held an organization meeting at the April Working Group Meeting in Denver where they created the necessary petition, gathered more than enough signatures, and presented the proposal to the Technical Steering Committee for approval. The text of the petition follows: The undersigned members of Health Level Seven petition the Technical Steering Committee to form the Special Interest Group on Secure HL7 Transactions (SIGSECURE). This group will focus on the use of HL7 in communications environments where there is a need for authentication, encryption, non-repudiation, and digital signature. This group will focus on the mechanism for secure HL7 transactions and not on standardizing security policies. It will, however, ensure that the mechanisms are present to implement security policies. It will report to HL7 on available options and recommend actions that the organization may take to address these needs. The early activities of the group will include reviewing the work of other standards groups in this area including, but not necessarily limited to, ASTM, CPRI, X3, X12, HL7 Germany, U.N. Edifact, and the general Internet community. Agenda items for August meeting: Hold first official meeting (pending Technical Steering Committee approval). "   + 5 5 5 5  5 p p ' " $ $     * ( * # * " * # * " *  * * *  *  * ! * $ *  * p p p ` `   ,,> ,,>:,=:, ,6>, ,AK ,AK:,K:, ,2K, /D/E/&E0+E$0&E.0 ;U.A;!.];!.;1.;1.;-;-;-<-2<-j<-~<-<-$=--8=,F=P,[= ;U.A;!.];!.;1.;1.;-;-;-<-2<-j<-~<-<-$=--8=,F=P,[= >04E>G2}>G2 ?!."?%.?%.?%. ?-.  0?x4)?4"?4?4 ?4  & * *  *  ! `  p 5 5  5 % 5  5  $     8.H}   ?5)?50?5>?5K?6Y? 6`?6`?6`?!6`?%6Y?6\D6~D 6D6D6~D}6\Du6`?u6R?u6R? 8~D8cD8?8?8?N 0 37?30?|3"?|3?|3?3>3>3>3>3>3>3> ~D5\D5R?5>?5K?5K?5K?5E?5>?50?5"?5?5?5>5>5>6>6 ?7u?7u?7n?7|?7cD7~D7D8D8D@ /%;Z/;/;N0:0:K1:?2:2:83:3 ;04;4,;%5O; ;>/:/:>0:0:;1:?2:2:3:3:4:4:5 ; /O;/A;0,;0%;/1;1;?2;2%;P3,;3:;`4O;4d;I5; *7`?&7Y?"7K?67K?"7K? 7K?7K?7n?6n?6g?6`?6R?6K?6>?60?6?6?6 ?6? the last meeting. Good preliminary models may now exist for both chapters. They also formed a sub committee to outline the process out of cycle. The committee resolved all major issues for both chapters as well as minor issues for chapter 3. Chapter 6 minor issues are still being resolved. Finally, there was discussion of splitting into concurrent ADT/Finance meetings. Agenda items for August meeting: Solicit nominations for and elect Co-Chairs. Review Version 2.3 ballot responses. Split into concurrent ADT/Finance working groups. Continue data modeling efforts. Automated Data Automated Data held a half-day joint meeting with IEEE P1073 on April 23. Average attendance was 15 (an attendance list is part of the meeting minutes). The joint session began with a discussion of the MIB contribution of coded elements (Excel spreadsheet of elements included in meeting minutes as adce_596.doc). Jan Wittenber described it as a work in progress which should be examined to determine if the form and general content are suitable for a joint submission to Loinc. Jan reviewed the derivation of the terms from atoms of interest, how the resultant 32-bit codes are encoded - including suffix codes. He also described a general tool they developed to build and operate on the database of coded elements. Jan agreed to make this tool available to those interested in evaluating the aspects of the submission not contained in the Excel spreadsheet. After some discussion, the following steps were identified as prerequisites to a joint submission to Loinc: Agree that the joint group should prepare a P1073-based set of coded elements for submission to Loinc. Define necessary components for each coded element included in submission. Ensure that submission is proper and terms are derived consistently. Complete term definitions and validate term titles vs. term definition. MIB agrees to include the following work products in the Automated Data SIG minutes: Excel spreadsheet of terms, codes, and their definitions. White paper and dictionary describing how the set of terms was derived. Individuals may also request copies of the database representation of the terms and a tool for viewing, searching, filtering, etc. the database of terms. The second topic of the joint session was Jan Wittenbers comparison of wave data representation between HL7 (Waveform Data proposal (Version 2.3 Appendix 7E)) and IEEE 1073.1. An electronic copy of the analysis is included with the minutes of the Automated Data SIG. Overall, the comparison concluded that the use models are quite different. The MIB focus is on connection-oriented/continuous/real-time medical device data acquisition. The HL7 focus is on connectionless, context-free patient centric clinic data management. However, Jan did identify several good candidates for normalization or alignment, including scaling, calibration, timing coordination, and waveform source identification. The joint group resolved to meet again at the August meeting in Washington, DC. The Automated Data SIG met twice to discuss negative ballots against the Appendix 7E proposal. On the afternoon of April 24, they held an informal meeting for those who could not attend the April 26 morning session. On the morning of April 26, they held a half-day meeting to resolve negative ballots. Average attendance was 10. The members agreed to the following changes: The Numeric array and Channel definition data type definitions will be moved from chapter 2 into Appendix 7E. Chapter 2 will list the data types with forward references to Appendix 7E. Several of the fields in the CHN data type were renamed to make them less EKG/EEG specific. A list of coded elements for waveform source will be included. The result type for Annotation category results was changed to a coded entry. An example of how to start and stop wave data arrays so that annotations can be placed adjacent to a specific sample in the wave array will be included. Agenda items for August meeting: Review Version 2.3 ballot responses. Begin development of use cases for Version 3.0 modeling. Meet jointly with IEEE to review MIB submission (focus on EKG lead labeling harmonization) and develop use cases and methods for gateway between MIB and HL7. Control/Query The Control/Query Committee met on April 24-26, spending the majority of its time responding to the ballots received as part of the recent HL7 Version 2.3 vote. During Wednesdays discussions, all negative ballots for chapters 2 and 8 were resolved. On Thursday morning, they reviewed the comments returned with affirmative ballots, with the committee discussing and agreeing to the needed edits. Thursday afternoon, representatives from ADT/Finance raised an issue with Control/Query regarding whether it is backwards compatible to use the action code/unique identifier update mode for existing repeating segments (i.e., segments that existed in HL7 prior to Version 2.3) The Control/Query Committee ruled that such use was not backwards compatible, but did not come to a clear consensus on whether it should be allowed in Version 2.3 as a special exception. In further discussions of this topic with the ADT/Finance committee Friday morning, both Control/Query and ADT/Finance agreed not to allow such non-backwards usage in Version 2.3, even on an exception basis. During the Thursday afternoon session, Professor Dudeck of HL7 Germany presented some excellent material on event/message categorizations which will be useful in the work for HL7 Version 3.0. Finally, Mark Tucker of the Regenstrief Institute was elected to be the third Co-Chair for the Control/Query Technical Committee. Agenda items for August meeting: Review Version 2.3 ballot responses. Work on Control/Query aspects of Version 3.0. Home Health The Home Health/Long Term Care SIG participated in an initial tutorial of the HL7 use case model creation. Following the tutorial, the group completed two use cases and started seven more that will be expanded over the intervening months. Additionally, the group elected Michael Wilkins of Lewis Computer Services, Inc., as modeling Co-Chair. Michael will coordinate all Home Health/Long Term Care model reconciliation activities with QA/DM. Agenda items for August meeting: Continue work on use cases. Develop a formal tutorial for Version 3.0. Begin developing an interaction and information model. Plan a joint meeting with representatives from X12 and ASTM to handle coordination of message development. IEEE P1073 Medical Information Bus The IEEE Standards Board announced approval of the IEEE 1073, and the group presented an overview of the first working draft of CEN TC251, WG5, PT 5-021, vital sign representation. The group also presented options for transport relay and 1073 bridge, reviewed the initial draft of the Standard for base object and infusion devices, and began designing base objects for ventilators and pulse oximeters. IEEE met jointly with the Automated Data SIG, where they presented device parameter nomenclature (included in Automated Data    GMM MM s Phone: (415) 925-4423 email: rburkhea@oacis.com Francine Kitchen, Ph.D Software Technologies Corporation Phone: (206) 283-5661 email: francine@stc.com Robert Evola ALLTEL Information Services, Inc. - Healthcare Division Phone: (404) 847-5304 email: bevola@atl.aishd.com Joe Peterson Wismer*Martin Phone: (509) 466-0396 email: jpeterson@corp.wismer.com Control/Query Co-Chairs Mark Shafarman Oacis Healthcare Systems, Inc. Phone: (415) 925-4570 email: mshafarm@oacis.com Pat Cahill Mayo Foundation Phone: (507) 284-2737 email: pcahill@mayo.edu Mark Tucker Regenstrief Institute for Healthcare Phone: (317) 630-2606 email: mtucker_@regenstrief. iupui.edu Continued on page 15 Implementation Co-Chairs Cheryl Fontenot Lanier Healthcare Phone: (407) 724-3859 email: cfonteno@harris.com Jackie Donlan University Hospital - Denver Phone: (303) 372-2752 email: jdonlan@wookiee. uhcolorado.edu Deborah Murray Kaiser Permanente Phone: (510) 926-5734 email: debbie.murray@kp.org Medical Records/Information Management Co-Chairs Wayne Tracy SpaceLabs Medical Phone: (913) 685-0600 email: wrtracy@wrt.win.net Mary Brandt AHIMA Phone: (713) 668-3425 email: mbrandt@ahima.mhs. compuserve.com Order Entry/Ancillary Co-Chairs Clem McDonald, MD Regenstrief Institute for Healthcare Phone: (317) 630-7070 email: clem@regen.rg.iupui.edu Hans Buitendijk SMS Phone: (610) 219-2087 email: hans.buitendijk@ shrmed.com Patient Care Co-Chairs Karen Keeter Healthcare Solutions Phone: (770) 835-7972 email: kkeeter@vnet.ibm.com Thomas Marlin SpaceLabs Medical, Inc. Phone: (206) 882-3755 email: tmarlin@delphi.com Timothy Snyder Productivity Innovations Phone: (406) 586-2347 Quality Assurance and Data Modeling Co-Chairs Mead Walker SMS-HDX Phone: (610) 219-1504 email: mwalker@sms-hdx.mhs. compuserve.com Ted Klein HBO & Company Phone: (516) 231-2578 email: tklein@interramp.com Abdul-Malik Shakir Kaiser Foundation Health Plan, Inc. Phone: (510) 271-6856 email: 74353.1431@ compuserve.com SPECIAL INTEREST GROUPS Automated Data Co-Chairs Wayne Tracy SpaceLabs Medical Phone: (913) 685-0600 email: wrtracy@wrt.win.net Fritz Friedhoff SpaceLabs Medical Phone: (206) 882-4095 email: fritzfo@slmd.com Decision Support Chair Karen Herzog HBO & Company Phone: (413) 549-7100 Home Health Co-Chairs Meg Infiorati Home Care Information Systems Phone: (201) 338-2020 Michael Wilkins Lewis Computer Services, Inc. Phone: (504) 927-3064 email: wilkins@lewis.com Image Management Co-Chairs W. Dean Bidgood Jr., MD Duke Uninversity Medical Information Phone: (919) 967-7922 email: bidgood@nlm.nih.gov Robb Keayes ALI Technologies, Inc. Phone: (604) 279-5422 email: robb@cetus.ali.bc.ca Object Broker Technologies Co-Chairs Wes Rishel Wes Rishel Consulting Phone: (510) 522-8135 email: wes@rishel.com Robert Seliger Hewlett-Packard Phone: (508) 659-4928 email: robs@an.hp.com Professional Certification Co-Chairs Cheryl Fontenot Lanier Healthcare Phone: (407) 724-3859 email: cfonteno@harris.com Diana LeBlanc Lahey Hitchcock Medical Center Phone: (617) 744-2318 email: diana.c.leblanc@ lahey.hitchcock.org Secure HL7 Transactions Interim Co-Chairs Jack Harrington Hewlett-Packard Phone: (508) 659-3517 email: jackh@an.hp.com Mary Kratz University of Michigan Medical CenterPathology Phone: (313) 763-6871 email: mkratz@umich.edu      .