HL7 delivers healthcare interoperability standards

HL7 UK Chairman's Report of HL7 International Working Group Meeting 2013

 

04 February 2013

Introduction

The January 2013 WGM was held in Phoenix, Arizona. Several HL7 UK members attended the WGM and other UK representatives attended the overlapping CIMI meeting held nearby.

International Council – Sunday, Monday

The International Council comprises the chairs of all HL7 national affiliates and a US representative. It meets for most of the day on Sunday and all of Thursday afternoon. This time we held an additional meeting on Monday morning to prepare our contribution to the Board discussions about the plans for freely licensing HL7 IP. I am currently one of the three co-chairs of the Council (specifically responsible for HQ liaison and the Council’s budget), the others being Helen Stevens Love (re-elected as co-chair and secretary of the Council) and Michael van Campen (just elected as co-chair responsible for affiliate liaison). Helen and Michael are both from Canada.

The Sunday meeting was attended in person or by proxy by 19 of the 36 members of the International Council. Introductory presentations were given by Chuck Jaffe (CEO, HL7 International) and John Quinn (CTO, HL7 International). John Ritter and Ron Parker from the International Mentoring Committee then presented on initiatives to support eHealth programs in low income countries and we discussed how affiliates might participate. We heard a detailed report from Germany, Austria and Switzerland about their collaborative work on localizing HL7 standards for use in German-speaking countries and the challenges they face in their various national and regional programmes. Reports were also presented from the global “regions” – Europe, Asia and Latin America – where there is significant trans-national eHealth activity.

I reported on the Sunday meeting to the WGM general session on Monday morning and the slides are available under “January 2013 WGM Presentations” on the HL7.org website. The presentation includes some HL7 headlines from around the world and a list of global events in 2013-14 where HL7 will be involved.

The Council’s Monday meeting was attended by 16 affiliate chairs or their proxies. We had been invited to attend Q1 of the HL7 Board meeting on the Tuesday so this meeting was to crystallize affiliate thinking about the IP policy changes and identify where there was consensus or divergence of views based on national context. The result was a presentation which Helen (who is also an affiliate director on the Board) presented at the Tuesday meeting.

Board discussions – Tuesday

The main topic at this WGM was the change in IP policy: its precise definition, implementation and impact. The Board had formed a Membership Task Force (MTF) and I was invited to be one of the affiliate representatives on the group (the others were Diego Kaminker from Argentina and Richard Dixon-Hughes from Australia). The focus of the MTF was membership benefits and pricing for HL7 International, so did not directly affect affiliate membership. However we needed to be sure that the scope of what MTF recommended was clear and to ensure it was constructed in a way that did not constrain or harm affiliate interests. The MTF recommendations were put to the Board on Tuesday along with the affiliate presentation. The Board then met in closed session for the remainder of the day. A key issue was whether the scope of freely licensed IP included balloted implementation guides (IGs).

Freely licensed IP announcement

The Board’s decisions were presented by Don Mon (Chair, HL7 International) to the WGM general session on Wednesday morning. (His slides are available from the same location as mine, given above.) Many details remain to be resolved but the Board had agreed that “Any Universal or US realm IG that contains conformance profiles be licensed free of charge in the same way as standards. Access to standards and IGs will be delayed for three months from publication for non-members. The delay decision will be reviewed within two years.”

There is provision for exceptions to this rule. “A WG can submit to TSC, via project scope statement, a request for an exception to the 3 month delay in releasing the IP to non-members. The request for exception requires review and approval by the Executive Committee.”

No decision has yet been made about machine-processable artefacts, pending advice from the Technical Steering Committee, but it is expected that access to these will be an organizational member benefit.

The aim remains to implement the freely licensed IP from the end of March 2013 once all the necessary changes to by-laws and the Governance and Operations Manual have been made.

International Council – Thursday

The Council’s second regular meeting included a financial report, a presentation from the EHR workgroup about usability standards and discussion about the IHIC 2013 conference in Australia.

The Council re-formed the Affiliate Agreement Task Force (AATF) to revise the agreement (our “contract” with HL7 International) in the light of the IP policy changes. I will be chairing this group.

We also set up a group to articulate affiliate membership benefits, building on work already started in Germany and the UK. Michael will be leading this group.

 

Dr Philip Scott

Chair, HL7 UK

1 February 2013


 

TC Chair’s Report

 

I attended the first two sessions of the International Council meeting (see Chair’s report), and felt the discussion was open and fair.  One additional point: there was mention of an emerging priority in the World Health Organization regarding eHealth and including standards and interoperability as an essential enabler, with a formal announcement of a WHO activity in this area expected in May 2013.

During the rest of the week I attended a range of Working Group (WG) sessions (specific points of interest per WG are noted below). In general, there was more optimism and positive “buzz” than in recent WGMs, in particular around Fast Healthcare Interoperability Resources (FHIR – pronounced “fire”) (see www.fhir.org). Hugh Glover from the HL7 UK Board is formally involved in the governance structure for FHIR, & others from the UK including myself and Richard Kavanagh from the NHS are watching it closely, as it is maturing rapidly (for HL7!) from a “new initiative” into an integral part of the work of HL7 International. I noticed in particular that work on FHIR “resources” has now become a routine part of the work in progress across a range of WGs; considerable thought is being given to how these relate to existing artefacts such as D-MIMs and R-MIMs, with the principle generally being to reframe existing work into the new format, thus retaining a clear link back to the RIM. As a result of this wide-ranging work across WGs I would expect a range of substantive FHIR content in the HL7 International ballots during 2013. I encourage HL7 members to follow FHIR as a very significant development, and to provide feedback to inform HL7 UK ballot responses. An HL7 UK TC meeting on FHIR is being planned.

CDA – the international picture

CDA discussion was low-key this time, however it was mentioned in the regional reports in the International Council, and is still integral to US Realm programs that include profiles of CDA. Of particular interest with respect to recent discussions in the HL7 UK TC were regional reports and subsequent discussion in the International Council concerning the importance of Realm profiling for adoption. There was broad consensus that CDA is an effective and deployable current HL7 standard provided that the work of profiling to meet local needs is done well and also provided that good support is available in the form of training, documentation and available expertise. The majority of these local profiles (pretty well all except for US realm profiles) have been relatively invisible outside their own countries since they have not been formally balloted in the HL7 International ballot pack. It was good to have the opportunity to see in more detail how CDA is being implemented internationally, and the extent to which CDA is a commonly used base standard that yields its value because it can be adapted in this way to provide a locally relevant communication repertoire within a base standard either in a formal Realm, or for a major programme. I am sure that there will be further discussion of this in HL7 UK; however to me it is reassuring to see how UK experience to date is aligned with general international implementation of CDA at this time.

EHR WG: concern for safety and usability

A new concern for safety and usability in HL7 standards emerged in the EHR WG, from Don Mon, co-chair and Chair of HL7. He acknowledged earlier UK efforts – especially by Maureen Baker – to bring these issues into HL7 standards development.  His main focus was on maintaining consistency of key items of information across different uses and communications, and suggested that this would be an appropriate area of work for the EHR WG, at its level of abstraction. This is one to watch IMO.

Activities with other SDOs

I attended the meeting held on Sunday following the International Council. The practical difficulties of aligning and harmonising work across multiple SDOs is evident, despite the valiant efforts of individuals – and it is largely individuals - committed to making it happen. I raised the issue of future convergence across ISO and European models of EHR communication (ISO 13606) and HL7 models, in particular CDA, however there was no substantive discussion.

There was also discussion of the “standards collaborative” model for Realm-scale cross-SDO collaboration, principally from the point of view of growing such a capability from scratch in low and medium income countries. I didn’t feel it offered anything new from a UK perspective.

SOA and Vocabulary WGs: Common Terminology Services 2

This project (in which I have been personally involved as a friendly arms-length reviewer of the technical specification) is now reaching maturity, with a completed technical specification (published by OMG, see http://www.omg.org/spec/CTS2/1.0/ ) and a growing range of implementations and some open source tools (see http://informatics.mayo.edu/cts2/index.php/Main_Page ).

Patient Care WG: Care Planning

Work on a domain model for multidisciplinary care plans, FHIR resource for a care plan, and a care planning co-ordination service specification, are all either ongoing or planned to start work between now and the May WGM. The care co-ordination service is being developed in collaboration with the SOA WG.

Mobile Health: Scenarios

I led the delivery of a tutorial on “Mobile Health” for the mHealth WG. The tutorial includes a set of scenarios illustrating current uses of mobile technology in healthcare delivery. I am grateful to members of HL7 UK who contributed to the development of these scenarios. One concerning assisted living draws heavily on the work of the “dallas” programme in the UK (which was presented to the HL7 UK TC in May 2012 by John Eaglesham of ADI-UK). Another scenario focuses on using mobile platforms to improve access to patient records in secondary care, and includes contributions from Sláinte Healthcare (Dublin), who are also members of HL7 UK. The tutorial slides as a whole are not available outside the HL7 educational program, however the scenarios were also presented at the Mobile Health WG during the WGM and will be published as part of the meeting minutes. This scenario set is embedded below for the benefit of HL7 UK members.


Ann Wrightson

TC Chair, HL7 UK

1 February 2013

 

 

Last modified 02/06/13