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HL7 Attachments Workgroup (ASIG) Minutes (Draft)May 04 – 09, 2008 Phoenix, AZ

ASIG Co-Chairs1. Rob Root, PGBA2. Mike Cassidy, Siemens (out-going) 3. Durwin Day, BC/BS Illinois4. Wes Rishel, Gartner (out-going)5. Jim McKinley, (in-coming)

Attendees See file: ASIG 2008-05 Phoenix Sign-

in Sheets Final.xls, and (if reading these minutes as a PDF, the final page below)

The ZIP file containing the referenced presentations and other documents are available on the “Meeting Minutes” section of the www.hl7.org/asig web page.

Note 1: The end of this document contains a quick summary of motions, presentation file names, and new action items.

Note 2: The notation ‘ASIG’ will be retained to represent the HL7 Attachments Workgroup, formerly known as the HL7 Attachments Special Interest Group. (See TSC & Domains Experts Steering Division Update in Tue Q1.)

Monday (May 05) – Q1

Introductions

Agenda ReviewThe meeting agenda is the same one posted to the listserve last week. It is also available in the HL7 handout (yellow), the only differences are formatting.

NOTE: Durwin will be in the Structured Documents Technical Committee (SDTC) Tue & Thu, Q1 & Q2.

MON (May 5) Q1 – Administrative

January Working Group Meeting (WGM) minutes1. posted to website Sunday evening (05/04/2008)2. move this approval to Wed morning (Q1)

List of high priority work items and status Patient Information Unspecified Content (PIUC) ballot summary Introduce discussion: “How do we move forward?”

Q2 & Q3 - Final review of HIPAA documents Work sessions to ensure editor correctly applied all ballot comments to the

implementation guide and attachment specifications (Q3) Continue discussion: “How do we move forward?” (Q3) Co-chair elections : seats held by Wes Rishel and Mike Cassidy

Q4 - Host joint meeting with Structured Documents (SDTC); tentative topics… CA budget cuts require Penny to resign as co-chair. If someone were to champion the

CPHS attachment (June offered Kaiser), then the CA Medicaid should have someone to do the work.

AHIC has CPHS, EDST on their list Exchanging PHR/CCD among payers (update by Durwin Day)

o on SDTC agenda to reconcile ballot comments Tue & Thu morning, Q1o the ballot comments for PHR/CCD

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http://www.hl7.org/asig


16 spreadsheets were posted to the website desktop a combined spreadsheet was sent to the SDTC list on Friday

o ACTION ITEM Durwin will forward the PHR/CCD comments to the Attachments Workgroup attendees.

Harmonization of “look/feel” in the implementation guides (mike) OID Guidance Paper (this didn’t go to ballot; can we make progress?) Technical stuff (Mike Cassidy – examples, style sheets, etc.)

TUE (May 6)Q1 and Q2

Reconciliation of PIUC ballot comments Continue with final review of HIPAA documents if time allows

Q3 and Q4 – Multiple work sessions Continue final review of HIPAA documents Complete revisions to the 2003 Whitepaper Review/answer/sign-off on any new FAQS since the Feb 8 published document

Wed (May 7)Q1 and Q2 – Process, process, process

Process Improvement Committee (PIC) report (June Rosploch) Revised ASIG Decision Making Practice review/discussion/approval (Mike Cassidy) DSMO process review (Mike Cassidy & Maria Ward?) Complete the discussion: “How do we move forward?” Identify who is responsible for what Planning for September Plenary Meeting (Vancouver) and before

Q3 – Work sessions – may include: Continuation of HIPAA documents final review, and/or Whitepaper completion Periodontal attachment (placeholder, not sure if will be work or a simple presentation) OID Guidance paper: anticipated April ballot did not happen; can we make any progress

on it here? => needs guidance from Keith or SDTC implementersQ4 – Not having any agenda items for this quarter, expect work to continue from above

ADD: Workers Compensation: attachment control number : how are the software vendors assigning the attachment control number (Deb Meisner)

ADD: Other Workers Compensation topicsThursday (May 8) Half dayQ1 and Q2 –

Clean-up the big topics Address any “parking lot” tasks Re-cap of the week Adjournment until next meeting

PIUC: Mike is taking over the reconciliation comments of PIUC for Penny. A big part of PIUC is the separate list of the attachment types. Part of the ballot reconciliation will include the process: new attachments.

Rules & Responsibilities document: Penny was the liaison to Regenstrief (Clem, Kathy Mercer). Mike will handle it in the interim, but is looking for someone to handle it moving forward.

High Priority Work ItemsBy Mike Cassidy When the work item list was constructed (San Antonio WGM), each item was given a priority: A - now, B - not in the too far distant future, C - one-two years on the horizon. The high priority items are:

Children's Preventative Health Services (CPHS) – currently on hold PIUC using CDA R2: need to complete the ballot comments, update the specification,

and post to the listserve

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HIPAA Final Rule - OESS is dependent on the ASIG to complete the following tasks in order to get the final rule published

o editing of the documents (implementation guide & specifications)o identify/include anything from the ballot comments that may have been missedo goal is to complete by end-of-summer 2008

Attachment implementation white paper: will devote some time this week to review/update

Frequently Asked Questions (FAQ) document – ongoing task Collaboration with other organizations: process/education category BIN implementation issues: education category

o An issue that became apparent during the claims attachments pilot: data strings within the BIN segment can become so large they can’t be processed. The BIN size is the issue.

o The attachment implementation paper was written as a guidance paper identifying implementation issues/resolutions. Short on technical content, input is needed (from Kepa, Wes Rishel, Keith Boone, and others) to complete it.

The guidance paper was going to include a size recommendation, but the size hasn’t been determined (taskgroup of Maria Ward, Alan Scott, Wes Rishel, Kepa Zubeldia, Mary Lynn Bushman, and others?).

a WEDI sub-group (possibly claims attachments) may be the likely venue for the paper’s completion

Need explanations on size, multi-page docs, high resolution images, how big is too big, etc.

Content from the PHR implementation could prove beneficialo Durwin explained that for the Personal Health Record (PHR) pilot, the same

recommendation was used since there is only one PHR per BIN segment. Unless a person had a chronic illness, the file wouldn’t be too big.

When the file is too large, the recommendation is to send another BIN segment.

o The BIN issue impacts the plan-to-plan implementation OID issued in CDA R2 (Patient OIDS and Provider OIDS) Acknowledgement Project Proposal with X12 and possible WEDI interaction with

acknowledgement data model. o X12 with WEDI interaction to resolve thiso Mary Lynn Bushman added messages in the BIN segment

the paper was how to use the BIN segment, and explain the error messages

Mary Lynn is working with X12/WG20 to see what HL7 & X12 need to do.

Claims attachment workgroupBy Mary Lynn BushmanThe Claims Attachment workgroup has not met over the last several months. Katherine Schulten isn’t able to participate any longer, and Maria Ward has been ill. Mary Lynn hopes to get the workgroup restarted soon.

PIUC SummaryThere weren’t any negative votes in the ballot, and a very high number of affirmative votes. Seven voters provided comments. Tomorrow morning’s discussion will include the detail of these statistics.

[end of Q1]

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Monday – Q2

Co-chair stuff / ElectionsBy Durwin DayDurwin opened, sharing with the workgroup his thoughts on a different approach to the workload. Take into account where the ASIG is on the priority list, where the ASIG is as a group, the timing of the transaction as a final rule… Other HL7 committees have four co-chairs to share a workload. He feels the ASIG doesn’t need to meet four quarters every day of the working meeting. An agenda could be developed by topic/co-chair to allow members to attend ASIG quarters as well as other committees’ quarters. Doing so allows the members to attend topics that are interest to them throughout the ASIG organization. In order to make it happen, the co-chairs really need to communicate with each other.

Mike explained there hasn’t been a whole lot of communication among the past co-chairs. Maria has been ill; Penny has other priorities with her day job; Wes has other priorities. They allowed Mike the honor of taking the lead.

Jim McKinley shared his position on running for a co-chair position. After the January meeting in Atlanta, he mentioned the co-chair position to his manager, not wanting a position to go unfilled. He completed that conversation just 20 minutes ago, and she agreed to his running for the position as long as he can handle his other commitments. His only concern is that he is the third co-chair of an ‘all blues’ leadership team. He is also participating in other HL7 interests, i.e. PHR. Should it happen that Jim is elected co-chair, and Penny could assume her previous role, Jim would be willing to step down from his position.

June Rosploch appreciated Jim’s position on being a ‘third’ blues member. As co-chair of PIC, she would like to review the Decision Making Practices (DMP) before a vote is taken. She will discuss with Frieda Hall to alleviate any issue. It was noted from the floor that the three co-chairs/candidates are from different ‘blues’ companies with different focuses. Mike shared his thoughts on anyone wishing to run for a co-chair position: the ideal candidate would be HL7 savvy, staying on top of the ever-changing rules (GOM) with HL7. For the ASIG in particular, anyone who represents the provider side would bring good balance to the group (aside from all the payers in the group now).

Multiple Work SessionsIn November the NPRM comment database was sent to OESS. The ‘final’ database must be sent to CMS OESS (Lorraine & Elizabeth with cc: to HL7) as soon as the validation (that all comments have been included in the database) is complete. Penny was/is working on this. Following the database work is the gap analysis: to verify there isn’t a gap between what was said to be done and what was done. After a short discussion, it was decided the workgroup (in smaller taskgroups) could not assist in the database work. ACTION ITEM co-chairs are to ask Penny the progress (if any) on her review for gap analysis in order to move forward as a committee project.

Jim Leach: once OESS sends something back to the SDO, it is open to the SDO for discussion. An SDO’s answer is public domain.

Thru the next quarter, the ASIG will verify the HIPAA documents. Mike has one paper copy of ten different comment spreadsheets. Workgroups, consisting of 2-3 people, will compare the comment spreadsheets to the specification documents to ensure the comments have been addressed. Notations (verifying yes/no) are to be written on the paper spreadsheet.

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Work Group Breakout SessionsWorked thru the end of Q2 validating the comment spreadsheets against the attachment specification documents.

[end of Q2]

Monday – Q3

AGENDA REVIEWQ2 & Q3:

Add a few words about being a co-chair and our meeting schedules (Durwin Day)Q4: Add

OID Guidance Paper (Keith Boone) Harmonization of “look/feel” in our implementation guides (Liora Alschuler) Exchanging PHR/CCD among payers (Durwin Day) STRIKE: “Technical stuff (mike – examples, style sheets, etc)

Co-chair Elections(by Karen Van Hentenryck presided over the HL7 ASIG co-chair election. Jim McKinley was elected co-chair of the ASIG. Welcome Jim, and congratulations!

Wes shared his thanks to the past co-chairs for their dedication, hard work and work products. He suggested the ASIG, “Look for other ways to make attachments happen without HIPAA.”

Mike shared his appreciation to Wes noting, “Wes was THE person to get the ASIG to use CDA R2.”

Work Group Breakout SessionsWorked thru Q3 validating the comment spreadsheets against the attachment specification documents.

[end of Q3]

Monday – Q4

AGENDAThe agenda originally included CPHS for this quarter. The ASIG is trying to get the attachment upgraded to CDA R2. The CPHS sponsor will not be participating any longer, so the ASIG is looking for another sponsor. It will sit until someone volunteers.

Joint Session with SDTC

OID Guidance PaperBy Keith BooneKeith began an OID Guidance paper; the purpose: to provide small organizations an implementation guide on how to use OIDs. After his initial work, Keith realized that larger organizations didn’t know how to use OIDs either, and the project took on ‘scope creep’. A project statement has not been written yet. The project scope must be identified, and reviewed/discussed with the committee co-chairs (on a future call?). The committee must decide which organizations should be included, and identify the organizations’ needs. Once that is

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determined, an approach must be designed for small organizations and large organizations with sites across the country. Keith wasn’t able to determine the larger organizations’ needs.

An August ballot is not feasible. Keith will be happy to do the work, but cannot take on the organizational tasks (calls, project planning, etc). Rick will task someone to do that. A ballot is appropriate since the implementation guide is being balloted as an informative document. The core document is six pages and can be cleaned up rather quickly with a regularly scheduled conference call (every other week). An explanation of large scale versus small scale needs to be developed; Keith has the explanatory material.

ACTION ITEM Keith will work with Rick and send out a project proposal by the end of the week to the ASIG listserve. Mike Cassidy was concerned as to who would sponsor the project since the ASIG’s knowledge base is limited on this topic. Keith believes a joint project between the ASIG and the SDTC would work. After the August ballot, the content could be expanded (for plan-to-plan) in a follow-up project. [Post-WGM status: all of the above was resolved, and the OIDs Guidance document was subsequently balloted during August.]

Harmonization of “look/feel” in our IG By Liora Alschuler, Keith Boone, Durwin DayLiora began by stating she was not the person to be leading this discussion, and asked Keith Boone if he would do so. The SDTC made a decision to work with the Open Health Tools (OHT, see: www.openhealthtools.org) tooling collaborative to explore the XML development tool. Bob Dolin addressed the HL7 Board (in January) regarding tooling.

The AHIP and BCBS piloted a joint project (2006) to transfer health records from one plan to another plan. The pilot project was successful. Because of a lack of standards, the 275 envelope was utilized with the PHR data (CCD format) sent in the BIN segment. There were elements that were needed from the claim. After the pilot, the specification was submitted to the standards group for standardization. X12 closes their ballot on May 18, 2008. The SDTC assisted HL7 in assembling the HL7 ballot (16 spreadsheets) that just went out.DISCUSSION:

The original scope of the ballot was CCD with guidance on claim specific fields. Why not use CCD with a real user’s guide? There are few constraints on CCD in this IG.

Is this IG limited in scope to a plan sending a PHR instance to another plan, or should the ballot be evaluated for sending a PHR to/from any other organization?

o KEITH believes that looking at the exchange of PHR from a plan-to-plan perspective, is a good use of CCD. In other cases, payers exchanging PHR would be C32, like Medicare. More specific to C32: there may be intermediaries transporting PHR who would be interested in C32. In exchanging PHR information from any player to any player, we must be careful not to impose on standards already in place.

Is there a document that compares C32 to CCD? No. For clarification, C32 is a HITSP term, but C32 is not the same as CCD. ISO 3: registration medication summary in 2006 (V2.1) had problems: medication,

procedures, results, etc. Those items will be moved forward with CCD. The standard is CCD. Several comments were received that requested plan-to-plan (P2P) be made consistent

with CCD. o payer-to-payer is a stepping stone; not all payers are created equal.o It will be C32 compliant. The addition guidance specific to the plans as ballot, or

a guidance on top of C32. o Is the use limited to plan-to-plan, or should this specification be used between

provider/plan or provider/provider?

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http://www.openhealthtools.org/


the claim information would make it useful, but the focus is plan-to-plan (custodian of the PHR).

Each insurance company under BC will have their own PHR. The request is coming from AHIC and the association: their recommendation is to utilize the standards once they are in place.

plan-to-plan vs payer-to-payer: is there a difference?o Durwin does not believe so

Define the difference between a plan and payer:o the plan is at risko the payer is the administrator

The goal is to exchange the PHR between entities; it may be plans within the blues that are moving the PHR.

The players are identified in the guideo the insurer is the custodian of the PHR service. If a patient wants their service

moved to Aetna, the patient doesn’t have to print it off or key it in. o there are companies that may want to do this as well

The industry wants a PHR ‘somewhere’, with an application ‘somewhere’. For now, it won’t be “a google”, but the work could lend itself at some time in the future.

If the exchange was to be used for another intent, the purpose may be different. Time spent on plan-to-plan was intentional to avoid having to deal with other issues at the time.

The Plan-to-Plan PHR ballot reconciliation began during the joint session with the ASIG. The SDTC will continue reconciliation tomorrow and Thursday, and Wednesday if time permits.

Ballot reconciliation of the PLAN-TO-PLAN PHR Transaction by SDTCPresented by Brett MarquardJim McCain’s comment #1 on harmonization.MOTION: By Brett Marquard: To accept comment #1 as discussed. VOTE 19-0-12. MOTION CARRIED

Scott’s commentsComments 23, 24, 28, 47, 46MOTION To accept comments # 23, 24, 38, 47, 46 as discussed. VOTE 15-0-7. MOTION CARRIED

Keith Boone’s commentMOTION To accept Line 125 as discussed. VOTE 14-1-9. MOTION CARRIED

[end of Q4]

Tuesday (May 06) – Q1

Agenda Review New Attachment Capsule (Craig Gabron) Update from Maria Ward Brief update from last night’s TSC dinner meeting (Mike Cassidy) Q1 & Q2: Reconciliation of PIUC ballot comments

Branding of Claims Attachments By Craig Gabron[presentation: .jpg of Craig’s logo]Craig authored an article, “The Attachment Capsule”, which was published in the April 2008 HL7 News. Craig’s goal was to ‘brand’ the attachments standard utilizing an icon familiar to everyone

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in the healthcare industry. The logo represents movement of data through space (a space capsule), its payload being healthcare information (the shape of the space capsule is a pill) and its destination payers, providers, vendors (serving various needs). Thus, the birth of the ‘Attachment Capsule’. The capsule utilizes the BIN segment to transport computer decision variant (CDV) and human decision variant (HDV) between trading partners, etc. The logo is a physical representation of the work product, produced through the efforts of WEDI, HL7, and X12.

Craig is looking to establish a one-stop shop for claims attachments. A Google on ‘claims attachments’ does not return the HL7 website. Mike explained the ‘hit’ impact Google uses to display search lists. Craig feels the workgroup should establish a push to make a ‘hit’ happen. Mike Jolley suggested a link to pilots that are using claims attachments, to encourage its use. Thus, the question: Where is the true home for education? WEDI, X12, HL7? Maria answers that question in the next topic: Education.

EducationBy Maria WardHL7 provides different venues for education. Claims attachment education sessions (tutorials) are offered during the working group meetings (WGM) when the Education Committee sees a need, or Maria feels there is a need. The decision is based on the industry momentum at the time. The tutorials are always updated to reflect current events and issues. The second educational venue is the Educational Summit, held three times throughout the year. Both the WGM and Educational Summit will continue to offer educational training.

The Technical Steering Committee (TSC) discussed at last night’s meeting the fact that a tutorial could be presented in a committee meeting; the caveat being it may not be the complete tutorial, but it would prove educational for the committee. The ASIG had such an opportunity when Keith Boone presented the CDA in Amsterdam and again in Atlanta.

Education; the question is whose turf is it anyway? X12, HL7, WEDI, etc? HL7 signed an MOU with WEDI, and kicked off a joint project to work on claims attachments. It is a good match: HL7 doesn’t have the HIPAA audience WEDI does, and WEDI doesn’t have the technical expertise HL7 does. A series of six audiocasts were drafted. The audiocasts are a collaborative effort between HL7 and WEDI, and generate revenue for both organizations. As liaison to WEDI, and a Board member of HL7, Maria intends to continue this type of collaboration. ACTION ITEM Maria will send the proposal she wrote that was accepted by WEDI and HL7.

The first set of audiocasts will ‘air’ May 13 (Maria Ward with an Introduction to Claims Attachments), May 29 (Mary Lynn Bushman discussing X12 and Wes Rishel introducing CDA), and June xx (Keith Boone discussing the ‘guts’ of CDA). Wes Rishel will moderate, making introductions and fielding Q&A. The first audiocast had 51 participants as of last week. Typically, the biggest flux of registrants is just before the audiocast, so 51 is great! Maria thinks this is a new group of participants: folks new to the industry, or versed folks who now realize the transaction is moving forward. The second series of audiocasts will focus more on real world applications.

A by-product of the audiocasts is the list of participants, a good source document. While HL7 will receive a copy of the list, Maria isn’t sure the ASIG will be able to utilize it. Rob Root explained that his goal is only to get new material to the participants, whether the ASIG sends it or HL7 corporate sends it doesn’t matter.Another by-product of the audiocasts are the presentations. Maria explained the material is available to the audiocast participants only, and she does not believe WEDI posts the material after the fact. However, as an author, Maria has the right to share the material with whomever she wants.

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As independent organizations, HL7 develops the standards which WEDI helps implement. The WEDI claims attachment workgroup is co-chaired by Mary Lynn Bushman & Maria Ward. Maria believes the workgroup will provide education on claims attachments with HL7 involvement. HL7 has not executed any joint education with X12, nor is it in the midst of any such discussion. There has always been an over-arching strategy among all the organizations to get the word out. Another by-product of the audiocasts are the presentations. Maria explained the material is available to the audiocast participants only, and she does not believe WEDI posts the material after the fact. However, as an author, she has the right to share the material with whomever she wishes.

RHIOs (Regional Health Information Organizations) are coming into place around the country. Because of the rising interest, the demand for web access is growing as well.

Companion Global Healthcare and Blue Cross of South Carolina are venturing into the international market, seeking healthcare in HL7 accredited facilities. As global medical tourism increases, attachments could be implemented on the international level, particularly HDV.

The newspapers are reporting that this is becoming a BIG market, even internationally. WEDI & HL7, independently and jointly, continue to do what is needed for attachments. WEDI is the only group Maria is working with right now. She & Laurie Darst are presenting at the Western Claims Conference in June. Maria will do the introduction, Monique Harold (from X12) will talk about what GE is doing, Laurie Darst will present the Mayo pilot, followed by Maria, who will present the Empire pilot.

Laurie Darst explained the Minnesota legislation: every provider/payer in Minnesota will have to support electronic claims, eligibility and remits by July 2009. The legislation defines the players as anyone licensed to provide insurance in Minnesota, which impacts payers outside Minnesota as well. The legislation also states the coding must (be standardized to) match Medicare. The penalty is $100 per infraction. In essence, ‘no paper claims’ will be allowed. The provider will send in a PWK segment and identify how the attachment is being forwarded. The payer will have the burden of matching the information. They know the claims attachment will work, and will come back to (2010). Right now, everyone is in reaction mode.

TSC & Domains Experts Steering Division UpdateBy Mike CassidyThe TSC & Domain Experts Steering Division (DESD) dinner meeting was held last night. There was minimal time for Q&A. The DESD portion lasted two hours and was well attended. There are four steering divisions, with the Domain Experts division housing 18 committees. With the evolving changes within HL7, it was decided that, moving forward, every committee (SIG & TC) will be renamed to WORKGROUP. For example, the ASIG will now be the Attachments Workgroup. Each workgroup is to review their mission & charter, and change SIG or TC to WORKGROUP. The DESD will review the ‘new’ mission & charter first. It will then be forwarded to the TSC, and lastly to the Board. Additionally, the Attachment Workgroup is to come up with a list of issues the workgroup faces, known as SWOT: strengths, weaknesses, opportunities, threats, as well as a roadmap. ACTION ITEM Attachment Workgroup will produce the documents requested:

SWOT: to get an idea of what each committee is doing ROADMAP: what each workgroup intends to do over the next 1-3 years. Example was

an .xls spreadsheet timeline.

PIUC Ballot Reconciliationby Mike Cassidy[presentation: PIUC Ballot Results.ppt]

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Utilizing a .ppt presentation, Mike presented stats and facts related to the PIUC ballot. Highlights of that presentation follow.

The PIUC was initially balloted two years ago as a CDA R1 ballot. The PIUC attachment: “This document describes a way to electronically exchange

supplemental patient information using the HL7 CDA R2 Standard in conjunction with an ASC X12 275 transaction set. The approach is similar to that used for HIPAA Claims Attachments, but in this case is intended for use only in exchanging electronic attachments where the content and structured format for that attachment type has not yet been developed – that is, the current document describes a CDA Level-1 implementation which may be used until Level-2 or Level-3 implementations are devised for the same attachment types.”

Document name: Additional Information Specification 0009: Patient Information Unspecified Content (PIUC) Attachment

Ballot period: March 24 – April 28, 2008 o Previously balloted (Sept 2005) using CDA R1o now uses CDA R2 implementation guide

Ballot results:o 57 affirmative

six folks submitted spreadsheet comments totaling 51 line items Deb Belcher Mary Lynn Bushman Matt Greene / Freida Hall Mary Kay Mike Cassidy June Rosploch

one non-spreadsheet comment o 0 negativeo 16 abstain and 5 not voting

Ballot passed! Congratulations.

Comment Reconciliation Tuesday (tomorrow) morning None of the voters explicitly asked to be present when addressing their comments. See comment spreadsheets on memory stick (from Mike) When finished, updated copies of the spreadsheets will be uploaded to the HL7 Ballot

Desktop website (May 2008 ballot cycle).

The GOM has information on informative ballots: the rules, etc… The Attachments Workgroup (AWG) always ballots their documents as informative, but reviews the comments from a normative view (more strict than required by HL7).

Slide of comment spreadsheet file names, i.e. ASIG_INFOSPECS_PIUC_R2_I2_2008MAY.xls. The file names identify the submitter of the comment.[end presentation: PIUC Ballot Results.ppt]

[end of Q1]

Tuesday – Q2

PIUC Ballot Reconciliation (continued) By Mike Cassidy[AIS0009_PIUC_Attachment_Types_2008-02-21.xls (Compatibility Model)] As previously described, the PIUC provides a means to electronically exchange supplemental patient information as an attachment in the 275 where the content and structured format for that

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attachment has not been developed. A LOINC code is used to identify each attachment type. Attachment types that (still) aren’t clear to the ASIG, weren’t clear to Regenstrief when the LOINC requests were made. The ASIG is “still looking for a clear definition”. Until that happens, a LOINC code cannot be assigned. The goal, therefore, is to work thru some of the PIUC attachment definitions.

In the earlier part of the year (Jan/Feb 2008), Penny sent spreadsheets to Regenstrief (copying the ASIG listserve). The spreadsheets are artifacts that belong with the PIUC ballot. Also included are example files of how to do a vision prescription attachment => content since modified to be CDR R2 compliant.

Mike shared an XML example of an attachment OID, 2.16.840.1.113883.19.2744.9.2 where 19 means an example OID 2744 translates to the ASIG (as deciphered on a telephone keypad) 9 is the AIS number, and 2 is a more distinct classification.

He went on to explain how the OIDS are used in XML, and what the stylesheet looks like [CDA.xsl]. The .gif file is the image of the vision prescription. The stylesheet is just an example of what can be done. Mike recommended the use of a single stylesheet for everything you do. The stylesheet is not normative, which means it can be updated for the business application at hand. The source folder contains all the components to render the attachment. The ballot material includes the list of attachment types, the Word doc itself, and a note to the ballot reviewers. (Mike can clarify this last statement). [post-meeting on ‘reconciliation voting’: the ASIG established ballot reconciliation procedures/rules during previous reconciliations that were utilized during this reconciliation. The ASIG agreed to defer the vote on ballot comments until the quarter ends, or the ASIG completes a commenter’s spreadsheet, whichever occurs first. Also, the detailed discussions for each comment are stricken from the minutes since the completed spreadsheets will be uploaded to the HL7 website when the reconciliation is finished.]

The ASIG agreed to accept all typos as persuasive, with the updates to be made later.

JUNE ROSPLOCH’S COMMENTS Comment #4: outstanding. The nature of the request is not clear. ACTION ITEM Rob Root will find out if he can locate the source of this attachment request (via Penny). See Penny’s response below in Q3 discussion. MOTION Laurie Darst motioned that June’s comments #1, #2, #3, #5 be accepted as discussed & agreed upon by the ASIG. Mike Jolley seconded. Discussion: NONE. VOTE 19-0-0. MOTION CARRIED

MARY LYNN’S COMMENTS MOTION Marguerite Galloway motioned the ASIG accept Mary Lynn’s comments, #1, #2, #3, #4, as discussed and agreed upon by the ASIG. Meledie Meyer seconded. Discussion: NONE. VOTE 18-0-0. MOTION CARRIED

FREIDA HALL’S COMMENTS MOTION Rob Root motioned the ASIG accept Freida’s comments, #1, #2, as discussed and agreed upon by the ASIG. Seconded: Tom Hughes. DISCUSSION: none. VOTE 16-0-0. MOTION CARRIED

MARY KAY’S COMMENTS MOTION Meledie Meyer motioned the ASIG accept Mary Kay’s comments, #1, #2, #3, #4, #5, as discussed and agreed upon by the ASIG. Seconded: Tim Brown. DISCUSSION: none. VOTE 17-0-0. MOTION CARRIED

[end of Q2]

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Tuesday – Q3

Agenda ReviewComplete the ballot comments from Deb Belcher & Mike Cassidy.

PIUC Ballot Reconciliation (continued) DEB BELCHER’S COMMENTS Priority list (#13): The ASIG will follow-up with Deb Belcher and submit the requests into the process for creating new attachment types. We may require additional information from the submitter. MIKE CASSIDY – responsible party. [Post WGM update: Deb's new attachment types now have LOINC codes and are published in the final PIUC document and spreadsheet.]

MOTION Mary Lynn Bushman motioned the ASIG accept Deb’s comments, #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #13, as discussed and agreed upon by the ASIG. Larry Shorey seconded. Discussion: none. VOTE 18-0-0. MOTION CARRIED

JUNE’S COMMENT #4Regarding June’s Comment #4: Penny’s response to Rob Root’s inquiry on Eligibility:

“I can think of two circumstances where eligibility information might be required to come in with a claim. First off, if there is retroactive eligibility applied. I'm not sure this happens in a commercial plan environment, but often in Medicaid, eligibility can be issued retroactively. In this case, the provider could provide proof that the eligibility was applied retroactively (sometimes this is a piece of paper from the county eligibility office) and this will justify payment for the claim. This also could apply in an appeal or adjustment situation, where a claim is originally denied, but they provide proof of retroactive eligibility that is sent in with the claim.

The other situation is with presumptive eligibility. This is a situation, where a health plan presumes eligibility based on the patient meeting certain criteria. Here in CA Medicaid, we allow for presumptive eligibility for pregnancy services. We now have automated the presumptive eligibility process, but in the past, the provider would answer specific questions on a paper attachment and send in these answers with the claim to justify the presumption of eligibility. While CA has now automated this, I know there are some states who still use paper attachments.”

[end of Q3]

Tuesday – Q4

Agenda ReviewFour items in Q3 were not discussed.

MIKE CASSIDY’s COMMENTSMOTION June Rosploch motioned to accept Mike Cassidy’s comments as discussed and agreed upon by the ASIG. Tim Brown seconded. Discussion: NONE. VOTE 18-0-0. MOTION CARRIED

Except for a few follow-up items and some editing, the PIUC ballot reconciliation is complete. Mike hopes to have it ready on the website within a months time (plus/minus).

The standard attachments are available for use before being published.

Break-out sessions.

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Agenda review for Wednesday.

[end of Q4]

Wednesday (May 07) – Q1

Agenda Review Approval of San Antonio WGM minutes (moved from Monday Q1) Process Improvement Report: June’s update Complete the discussion: how do we move forward? Identify who is responsible for what ASIG Task list Planning for September meeting (Vancouver) and before DSMO process review (mike? Maria?) Revised ASIG Decision Making Practices

Approval of San Antonio MinutesMike Cassidy sent the San Antonio minutes to the listserve, Sunday, May 04, 2008. The attendees indicated they received them, and there weren’t any corrections from the floor.MOTION Mike Cassidy made a motion to approve the San Antonio minutes. Jim Leach seconded. VOTE 14-0-1. MOTION CARRIED

Moving Forwardby Durwin Day and Mike CassidyHopefully, this discussion (of Moving Forward) will coordinate with the planning for the September Plenary meeting in Vancouver. As we review the Priority Task list, keep two things in mind:

the new co-chairs have interests in other workgroups the ASIG’s lower level of urgency, as compared to the past

Perhaps tasks can be taken on little-by-little, giving members an opportunity to branch out into other workgroups. We can address what we will be working on Monday-Thursday, without having to use every quarter.

[ASIG Priority List 20080502.xls]Mike Cassidy displayed the Priority List for the review: The ASIG agreed that estimated time frames for the Priority List tasks would be helpful. Based on today’s discussion, (ACTION ITEM) Rob will use the task list to create a roadmap (three-year timeline) for HL7. Volunteers that take on any of Penny’s tasks need to know they won’t be starting from scratch. Penny is available (albeit, on her own time), can forward any material she has, and/or provide a brain dump.

[Planning for ASIG September 2008.doc] Mike displayed this working document which identifies a list of Decision Making Factors. Content added per discussion.

Labor Day is September 1 X12 trimester (Pittsburgh) is immediately after HL7, 9/21-26/2008 Any issues with attending in Canada? (straw poll of probably can attend vs. probably

cannot attend, vs. will not know until later) => straw poll resulted in all but 3 people in the room planning to attend the Vancouver Plenary meeting

Remember – May 2009 meeting is in Japan (begin your lobbying efforts now) Any ballots in August? If yes, need reconciliation time during meeting Any need to meet with other groups? If yes, need to negotiate NOW for time slot.

o Follow-up on publishing topic we had in January with SDTC+ICTCo coordinate our activities with WEDI’s & X12’s timeline

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When to begin, how many days, etc.? Note: This is a Plenary, so everyone is in the "big room" on Monday Q1-Q2.

Any tutorials offered which may determine ASIG times? Move forward the voluntary adoption of the standard and education of the industry

Focusing on the Priority List, the ‘A’ tasks should be addressed first:1. PIUC – (‘Z’ task) by September2. HIPAA Rule related tasks (‘A’ task): any final tasks for final rule: Mike hopes these

tasks will be finished before Sept (the feel is that the final rule will be out this fall => administration change)

3. White Paper: Attachment Implementation (for HIPAA): Preparing for Regulation4. BIN Implementation Issues (WEDI)5. FAQ: living document and will continue to be important over the years6. OID Guidance Paper (by Keith Boone). The authors are outside the ASIG although

the ASIG is the owner. Could be a ballot in August with reconciliation in September. Would need input from the authors. May need 1Q to address this topic.

7. Collaboration with other organizations8. Acknowledgment with 824 (line10 in .xls priority list)9. Promote voluntary adoption

a. the tools (CDA R2)b. who is doing it / lessons learnedc. list of recommendations to pass on to WEDI (Maria & Mary Lynn => WEDI is

the place to push voluntary adoption)10. Website migration plan11. Periodontal finalization: should be a ‘Z’ task by the Sept/Vancouver meeting12. Data Determination Coordination Process (DDCP) What is HL7, what is X12, etc13. (‘B’ task) Publishing Style & Methodology: Liora mentioned on Monday, and Bob last

WGM (San Antonio); should have a better feel of ‘how to get there’ by Sept.14. (‘B’ task) DSMO ASIG Process Definition: when the final rule is published, the ASIG

will have to be active in the DSMO process15. Attachments

a. DME is a huge effort; are there SME at CMS that could help with the outreach?

1. Matt Klischer: Brian is on the 837 team at CMS. 2. Bertha Ambriz-Crespin, Larry Shorey, Mary Lynn Bushman

volunteered to champion this effort from the ASIG perspectiveb. Liason for LOINC

1. (B) RELMA display for HIPAA attachments – coordination with LOINC committee

At this time, there isn’t any new work, and the ASIG needs to watch new work development to ensure it does not overlap with WEDI.

September Plenary Meeting: ASIG tentative agendaMON TUE WED THU

Q1 Plenary CPHS (A) June WC (A) Deb MeisnerWeb site migration

Collaborative outreachVoluntary adoption

Admin planning

Q2 Plenary DME attachment type

WEDI collaborationBIN implementation

issuesACK 824

CDALessons learned

DDCP: clm vs attach

Q3 Co-chair elections (joint session?) LOINC/RELMA (Clem) Not meeting

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PIUCPERIO

DSMO updates

P2P: DurwinPHR

Publishing OHT

Q4 HIPAA relatedWhite paper

FAQOID

Prepare for reg

(open) (open) Not meeting

???? Add DMP : review & vote

Add White Paper : breakout review

June Rosploch volunteered to facilitate the CPHS-CDA R2 task, and will begin work before any September activity. David Bass will assist June. Mary Kay McDaniel is also interested, and will put out a ‘call for volunteers’.

Worker’s Compensation (WC): Deb Meisner has asked WC to send her the forms. Durwin: a second ballot is planned for plan-to-plan (P2P). Rob Root: the OIDs comments will be received a week before the Sept Plenary WGM.

Any Q&A can/will be emailed to SD. The ASIG is meeting Mon Q3 – Thu Q2 during the September Plenary & WGM. Maria

Ward & Laurie Darst are leaving the conference on Wednesday.

AWG Conference Call ScheduleThe ASIG conference calls will continue as before: every other Tuesday, 2:30 – 3:30 PM Eastern.

DDCP (Data Determination Coordination Project)By June Rosploch The Data Determination Coordination Project (DDCP) is a coordination effort between HL7 and X12. The goal is to identify the best location for claim data when it exists in multiple places: in the claim (X12) as well as the attachment (HL7). The project began in the late nineties, but was quickly pushed to the back burner due to other commitments. It is expected the final rule will make reference to this SDO work. Although the project has been re-activated, there hasn’t been much progress on it. June, the DDCP facilitator, said she will get the project moving again, and be in touch with Maria Ward and Mary Lynn Bushman.

The DDCP created the committee’s Decision-Making Practices (DMP) that focused on identifying X12’s responsibilities and HL7’s responsibilities. That formal announcement is ready to go to HL7 and X12’s subject matter experts (SME) for review.

June Rosploch is the committee chair that represents HL7, and Mary Lynn Bushman and John Boch are committee chairs that represent X12.

Process Improvement Committee by June RosplochThe Process Improvement Committee (PIC) is the gatekeeper (suggestions, complaints, etc) between the HL7 members and the board. If a process doesn’t work, the PIC needs to know (contact info is on the HL7/PIC webpage). The PIC is also responsible for reviewing and approving or disapproving items the board develops before the items go out to the membership. Each committee must utilize the DMP template developed by PIC when developing a committee-level DMP. The template outlines required information. The committee then adds information unique to their function. Moving forward, the Attachment Workgroup will have a different division structure: it will not have a parent committee (was the SDTC), and the division lead will obtain the necessary approvals for the workgroup. There are a number of things to consider beyond the DMP, for example, rules:

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what is a committee, how to be fair, etc. The decision to go to ballot is now a joint decision between the ASIG and SD; not a submission to the SD. The PIC is creating new templates for the committees. Roadmaps (three-year projection) are being requested of all the committees. The roadmap aids in staying focused on the committee’s priorities.

[end of Q1]

Wednesday – Q2

AgendaComplete the discussion, “How do we move forward?”.

Moving Forward (cont.)[ASIG RolesAndResponsibilities 2008-04-28.doc]The ASIG ROLES & RESPONSIBILITIES document shows the current list of ASIG projects, major tasks, and the committee members who volunteered to lead and/or become involved in each effort.DISCUSSION:

Durwin would like the WGM agenda to:o allow attendees to explore other HL7 activitieso split the work among the co-chairs to facilitate attendance during specific

quarters, not the entire week. Mike will update the Roles & Responsibilities identifying the projects registered and not

registered with HL7o Projects not registered with HL7:

DME DDCP (June hopes to have it finished by the Fall)

Modeling facilitator volunteer:o the position is ‘liaison’ to someone who knows more about the topic at hand o Keith Boone is a knowledgeable contributor; anyone interested would have to

work closely with Keith Establish processes to maintain the guides once the final rule passes

o Requesting new LOINC codes Add DSMO Coordinator Add Technical Document Writer LOINC/Regenstrief Liaison - Mike Cassidy for the interim. Missy Jamison is familiar with

the process, and is willing to do the work. Gale Carter is willing to assist Missy. ACTION ITEM Mike & Rob will update the Roles & Responsibilities list, identifying the tasks involved for each responsibility. The completed document will be forwarded to the listserve.The ASIG’s hands-on activity is a good step in “moving forward”. Mike’s publishing facilitator role includes HIPAA docs and Perio. Ed Hammond assured Maria that a need in the ASIG will be filled; he just needs the ASIG to tell him so.

HL7 PROJECT SCOPE STATEMENT[HL7 Project Scope Statement_v1 2 12_with_instructions.doc]Mike displayed and explained the HL7 Project Scope statement Keith Boone sent to the listserv on May 6, 2008. Mike will ask Keith if the project name, “Can I have an OID Implementation Guide” should just be, “Implementation Guide”. Mike would prefer the ASIG approve his request now (via a vote) so it can be moved forward thru other levels of approval to ballot.Project Scope Statement: an example to the reference “… and other HL7 artifact instances.” would be OID usage in HL7 messages, i.e. driver’s license number.ACTION ITEM Add agenda item for July: SDTC/AWG review of Project Plan.Regarding “Project Resources = none” & “Industry Outreach = ASIG will do this”:

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For the ASIG to promote this, resources are needed. It is either a pre- or post- effort. Has it been done, or is it going to be done? An outreach exercise requires resources...

Rob & Mike believe Keith meant the remark as a publishing / notification exercise. Mike corrected the Industry Outreach statement to read: “ASIG will promote the post-

ballot document to early adopters of attachments via their normal processes.” The product is the Implementation Guide.

MOTION Mike Cassidy motioned the ASIG accept the Project Scope statement as revised. Larry Shorey seconded. Discussion: none. VOTE 18-0-2. MOTION CARRIED

DSMO: Important to HL7 & the ASIGby Maria WardIn the beginning days of HIPAA (1998/1999), a need was expressed by the Federal government to have a centralized location for data maintenance requests to the HIPAA implementation guides. Thus was the ‘birth’ of the Data Standards Maintenance Organization (DSMO), a group comprising of six organizations (HL7, X12, NUBC, NUCC, NCPDP, DCC) that serve as the central hub for maintenance requests. The six organizations comprising the DSMO were named in the Federal Register as the formal group to contact for maintenance requests. As public requests come in, the DSMO reviews them (for content only) to determine if they should be moved forward. The process involves a formal timeline, discussions, and a response to the requestor with a disposition. See: www.HIPAA-DSMO.org

Once the Attachments Final Rule is published, a request (e.g. that the Rehab attachment house four new fields) would have to be ‘approved’ by the six organizations before it could be implemented. As the HL7 liaison to DSMO, Maria’s approach in the past has been: if the content has nothing to do with attachments, she (HL7) would opt out of the process. Her hope is that the same level of respect will be shown to HL7 as attachment requests start coming in. It will take the industry a while (maybe a year after the Final Rule is published) to figure out how maintenance requests are handled. As in the case with other committees, new rules coming out of CMS may collide with the ASIG’s decision making practices (DMP). The importance for HL7 is the role/responsibility to serve the DSMO process as needed. The involvement is unpredictable.

Lorraine, as CMS liaison to the ASIG, has been re-assigned and will not be participating any longer. Unofficially, Lorraine will always answer your call/question, which will probably include a request to contact Elizabeth Holland, Lorraine’s replacement as liaison. What is problematic is that this is an election year: ‘slow’ will become ‘even slower’. Once the new administration is settled, Ed Hammond (HL7 Chair) may be able to get some meetings at CMS/OESS to get the rule through. Maria could always count on Stanley Nachimson to put her in touch with the right person/s.

Looking at Decision-making Practices Document, Version 1.2: [Draft 2008-04-28 ASIG DMP_v1.2.doc]By Mike Cassidy Four years ago, the ASIG used the HL7 template to develop its DMP. The first portion of the template contains standard content each committee uses. Currently under revision by HL7, points #9 (What is the decision-making practice when we have representation to other committees?) and #10 (a formal statement that requires the ASIG continue a list of ASIG projects) were added in December 2007. The big addition for the ASIG is Appendix B => 18 pages on additional ASIG-related processes. The links (MOU HL7 flow, MOU HL7 narr, HIPAA MOU Change Management Process) are located on the bottom of the HL7 Attachment’s web-page.There will be some changes, review and acceptance: ACTION ITEM Add September agenda item: review & accept the DMP document.

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http://www.HIPAA-DSMO.org/


Agenda Review Review Mission/Charter => carry forward to another quarter. Q4 today:

o Worker’s Compensationo RELMA with Clem McDonald

[end of Q2]

Wednesday – Q3Break-out sessions: updates to the HIPAA doc in smaller workgroups within the committee.

[end of Q3]

Wednesday – Q4

Workers Compensation “How is attachment control number assigned?”Deb Meisner is working with the IEIABC trying to determine how to join e-transactions in Worker’s Compensation (WC). WC is dependent on HIPAA transactions. Deb has been reviewing the TX companion guides with them because they are adopting the CA rules. They are trying to determine how to get the attachment control number to work for both the paper claim and the e-claim. Texas’ mandate was effective 01/01/2008.

Are different items in a medical record uniquely identified? If pulled from a medical record, how is it linked to the X275?

The discussion around this topic provided varied responses: the PWK in the 276 allows you to link the 275 The attachment control number “is just an assigned number”. The number is assigned in the 837 and is used when the claim is sent back. The provider knows an op report has to go… but the number isn’t in the op report! As unsolicited, some portion of the medical record is sent. The 837 has the number, and

they put the same number in the 275 (response). Assumes it is going to be some extension of the NPI; has to be unique to the payer. A concept of creating a CDA instance is that it is uniquely identified. The provider side

has to ensure uniqueness. How does it get in the 837 PWK06? How does the billing person know the number?

o The software vendor would assign it. If the software doesn’t exist, how do they do it?

o Right now, the paper claims are stapled together. They don’t have e-claims. Load the document into a document manager. At the time of upload, the software

assigns the number. Another model: send me the bill. I’ll let you know you need a number when you send the

attachment (e-clearinghouse is doing it for them). They will have to go back to their software vendor for this piece of data, and use it for the

837 & 275. It is a unique number that travels with the 837 & the 275. What about the medical record that only has one lab report?

o The ASIG doesn’t necessarily understand the use case. A provider system contains lots of data, and not necessarily documents, but there are

documents. They have a method to identify each document with a unique number in their system.

The attachment control number could be different for every single provider, a payer just needs a unique number in the 837/275.

o the missing piece is that it can’t be the only id the payer is not going to look at the id by itself

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There were never any constraints put around what that number needs to be because every payer system is different.

o WG9 in X12 removed the requirement that an attachment and a claim be bundled together.

Have their software vendor create a new field.o They aren’t using the 275 right now; they are faxing and getting a barcode off the

FAX sheet. The concept is basic document management 101: anyone who handles this knows how

to do it. NextGen used a document management system in the Empire pilot. Perhaps they could

help you. (Meisner) the Department of WC from CA & TX are requiring attachments and the use of

the attachment control number. They are the governing bodies writing their Implementation Guides.

o The irony is that there aren’t any pilots doing more than one provider at a time.o Perhaps X12 needs to have this as a discussion item.

A source at Mayo said they have to stop their scrubber process to put a number in the claims.

(Meisner) They don’t know they have a problem yet. My concern is that I’m not sure the process is in place as we understood it to be.

o You’ll have to throw up a flag that a document management system will be needed to make it work.

it doesn’t have to be a document management control system, just a process that isn’t in place right now.

The ASIG discussed this five years ago with Helen Gurevich. Input is needed with the people that are going to put it in place: NextGen or any vendor that could provide guidance.

Is this an HL7 or X12 question? It carries in both places. ACTION ITEM Mary Lynn Bushman will email the vendors for their input.

RELMABy Clem McDonaldThe new RELMA website [loinc.org/relma] works well, and was implemented just last week. The old website was problematic for the international affiliates. There will be a way to provide feedback on the website.

The RELMA demo shows a user how to select/copy into a spreadsheet. Allows an organization to pull out material for their reference.

Select HIPAA ATTACHMENTS: shows a list of the attachments. The screen is not tailored to the needs of the ASIG. Most terms will have a full common name: dropping special characters and using everyday terminology. The screen (called a panel) shows the answer parts in a nested format, with a maximum at six levels.

The LOINC code requests for the Periodontal attachment were submitted but Kathy haven’t been returned yet. If Kathy needs more information on an item before she can proceed, the task sometimes sits. Be proactive and bug her to get the project moving again.

Penny’s replacement as liaison to Regenstrief should be a seasoned candidate, one who can filter the LOINC requests before they reach Regenstrief.

Agenda ReviewFor Thursday:

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Meeting room is Sedona 3 Complete revisions to 2003 Whitepaper Continuation of HIPAA documents final review Clean-up the big topics Address any “parking lot” tasks Recap of the week Adjourn ‘til next meeting

[end of Q4]

Thursday (May 08) – Q1Reviewed the attachments theClinical Reports in Q2 today. June is available after lunch if need be.

Agenda1. review and sign-off on updated OID Project Scope statement

a. Mike confirmed the changes with Keith. He will review with the workgroup before we vote.

2. Review Mission & Chartera. Not a final review. We need to examine.

3. White Paper: nothing accomplished.4. Clinical Report AIS: 2nd quarter.5. Clean-up items

OID Project Scope by Mike CassidyMike asked the ASIG to review the changes he made to the Project Scope Statement. His goal was to sharpen the words in order to alleviate any doubt.

1. Item 1. Use to have ‘can I have an OID Implementation Guide’ to HL7 Implementation Guidance for Unique Object Identifiers (OIDs).

2. Item 5, which reads, “An informative document (IG) with the tentative title: HL7 Implementation Guidance for Unique Object Identifiers (OIDs).

3. Item 4. The scope of this project is to create an informative document that describes how to obtain and manage the OIDs used for identifiers in clinical document and other HL7 artifacts.

4. Added email addresses to name list, added Mike Cassidy’s name to keep ASIG in the loop (all other names are SDTC)

5. Implementers: added note, “this is not a DSTU; however, there is a committed party”6. Item 7: added vote stats

MOTION Mike Cassidy motioned the ASIG accept the Project Scope Statement as reviewed, which includes updates made since yesterday’s vote. June Rosploch seconded. Discussion: none. VOTE 12-0-0. MOTION CARRIED

The newly modified OID Project Scope statement must be uploaded to the PMO (only co-chairs can upload to the PMR). The document will be circulated for various reviews/approvals including the domain experts, the TSC (Jim Case/Austin Kreisler), and possibly other steering divisions (who are also TSC members). The reviews will continue while the ASIG moves the document forward for official approval (required to submit the intent to ballot). The goal is to have the statement ready for the August ballot (opens 08/04/2008 and closes 09/08/2008). Rob will submit the Intent to Ballot.

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Mission Statement (of Mission & Charter) by Mike CassidyMike took the opportunity to review the entire Attachments web page with the workgroup. Specific to the Mission/Charter: The Mission & Charter was last updated (required formal approval) two years ago. Mike copied the web page version into a Word document to facilitate today’s discussion. HL7 is changing the use of ‘SIG and ‘TC’ to ‘workgroup’. MOTION June Rosploch motioned that a minimal global change be made throughout the Mission & Charter to change ‘SIG’ to ‘workgroup’. Matt Klischer seconded. DISCUSSION: Marguerite suggested the workgroup consider whether the name will be appropriate as the workgroup moves forward. Mike suggested a vote on the ‘minimal change’ first, and then decide on a new name as discussion dictates. When Matt asked for clarification of other names used on the web page, Mike explained that HL7 will be making a mass change to the SIG/TC names across the entire website. The ASIG must decide on a name before moving forward. VOTE 12-0-0. MOTION CARRIED. It was suggested that a solicitation to the listserve for a new workgroup name could prove fruitful. In the meantime, the Attachments Workgroup will be used. Some background: the ASIG was originally known as the ‘Claims ASIG’. Early in the 21st century, the name was changed to ‘ASIG’, dropping ‘Claims’, since attachments were not limited to claims.

Moving forward, the ASIG must look at the Mission & Charter to determine if changes are needed throughout the entire document. What direction does the ASIG want to take? When the Claims Attachments Rule is final, what work lies ahead? Does the ASIG need to take a look at its future activity? NOTE: PHR is a different development than attachment development. PHR uses a modified form of the CCD, which is not within the scope of the ASIG’s work.

Is the ASIG looking to deliver a payload in another way besides the 275? Doing so could open different ways of pushing a payload. Mike felt that doing so ‘might’ violate an agreement somewhere. Jim McKinley mentioned the Health Information Exchange (HIE), an organization that HITSP supports. “While looking for another means to deliver our payload, we may eliminate the ASIG entirely (due to other methods that are available)”. June explained that the HL7 standard is open to anyone to use, and can be used without the 275/277 transaction. The ‘independent’ format would not contain any HIPAA information. Mike’s reply to June: “If it comes close to what the HIPAA definition is, it has to be (use) X12. The final rule will make the definition more clear.”Anyone can come to the ASIG with a use case, and ask the workgroup to support it. The workgroup would then ask/expect the requester to support the task as the content is moved forward. June sees this progression in other committees, and it works! (back to the Mission Statement) Discussion:

Mike read the Mission Statement, explaining universal realm, US realm, etc. The only interest in expanding “outside the US” is for military operations where the facility is “offshore” and the payer is in the US.

The last paragraph: “In addition, FICR support claims attachments globally.” => The Financial Management (FM) committee intends to directly reference claims attachments in FICR Release 2. This was something Kathleen Conner added when we revised the Mission & Charter in May 2006 so that the ASIG was under the SDTC (parent) instead of Orders/Observations.

The Financial Management TC will become the Financial Management Workgroup, but will be merged back into a committee they broke out of many years ago.

Korea offer HL7 classes, and can see them being interested in attachments. Related to the PAFM (Patient Administration): when Canada became interested in V3

methodology (Michael van Campen was an integral player), they built everything they needed (that the ASIG calls supplemental) into the native HL7 V3 standard. They didn’t

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need financial data or supplements to be defined; they decided to add a placement for the future (perhaps attachments, which is why Kathleen added her comment).

The reference to FICR & FM in the charter is to identify our formal relationships.Changes to the Mission Statement:

in the MISSION, after e-commerce transactions… add “primarily” … in the US FICR supports claim attachments globally => removes ‘s’ on claims, and added ‘s’ on

support. Changed and bulleted this sentence: “Important efforts, as guided by the Board of HL7, are to:

o Work jointly with ASC X12N (Insurance)o Assist in the implementation of the Administrative Simplification provision of

HIPAA mandateso Provide on-going supporto Represent HL7 in the HIPAA Designated Standards Maintenance Organization

(DSMO) efforts.”

Move the FICR and FM to the section ‘Formal Relationships with Other HL7 Groups’.MOTION June Rosploch made a motion to accept the changes to the Mission statement as discussed. Mattie Brown seconded. Discussion: NONE. VOTE 12-0-0. MOTION CARRIED

Agenda ReviewJim & Meledie have to add the LOINC codes in the Rehab document.

[end of Q1]

Thursday – Q2

Agenda Review

Project Scope The Project Scope statement approved earlier this morning has been modified to include Calvin Beebe (Mayo Clinic/Foundation) as an implementer. Calvin joins Keith Boone with this task. Calvin was also added as a contact. Mike has the e-copy of the final project scope statement. Rob felt the changes were not substantive, and being such, did not require another vote.

Charter (of Mission and Charter)In Q1 today, the ASIG completed their review and modification of the Mission statement. During Q2, the ASIG will address a complete review of the Charter. As previously discussed, the FICR and FM statement was moved from the Mission statement to the Charter. Mike read “The Work Products and Contributions to HL7 Processes”. The ASIG agreed that wordsmithing was needed, and a good place to start. Rob felt that approval by other groups will generate more questions. “Since its inception in 1997, the workgroup has created and balloted numerous specifications. This initial deliverable includes an implementation guide and detailed specs for six attachments types: these were incorporated into a notice of proposed rule-making (NPRM) under HIPAA in 2005. More recent attachment projects include, but are not limited to, Children’s Preventive Health Service, Drug Prior Authorization, Periodontal, Home Health, Durable Medical Equipment (DME) and Pre-Authorization/Referrals.”

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Phil Heinrich suggested we add our ‘previous identities’ in the Mission Statement area: ADDED NOTE: this workgroup was formerly known as the HL7 Attachments Special Interest Group (ASIG). Non-substantive change does not require another vote.

Formal Relationships with Other HL7 GroupsThe sponsoring Technical Committee is Structured Documents. Strikethrough changed to => The Attachments Workgroup has a strong working relationship with the Structured Documents Workgroup.ADDED: In addition., FICR supports claim attachment globally. The FM committee intends to directly reference claim attachment in FICR Release 2. => run by FM committee to determine if this sentence still applies. We need to determine who/what should be listed here.

Formal Relationships with Groups outside of HL7Spell out all the group names identified in the first sentence: “The Attachments Workgroup works jointly with ASC X12n (Insurance), ADA SCDI, NCPDP, and other standards development organizatons as guided by the Board of HL7.” ADDED: “The workgroup also collaborates with WEDI and the Regenstrief Institute in conjunction with the LOINC committee.”

Mike displayed the LOINC website: WWW.LOINC.ORG. Showed the new format, link/content to LOINC codes in Development. Dan Vreeman (from Regenstrief) was in attendance at the committee meeting. Using Internet Explorer, a right-click in the LOINC document (list) has a feature that allows a download of the LOINC content into an Excel spreadsheet (.xls).

The plan is to send/circulate the updated Mission/Charter to the ASIG & FM listserves soliciting input/objections to carrying this document forward. MOTION Mike motioned the ASIG accept all changes made to the Charter as discussed. Matt Klischer seconded. Discussion: NONE. VOTE 8-0-0. MOTION CARRIEDMike is going to suggest (at a future date) that all attachments listed in the Mission/Charter, except PIUC, be removed. ACTION ITEM Mike will forward the Project Scope Statement to the ASIG, SD, and Vocab listserves. ACTION ITEM Rob will upload the Project Scope Statement to the PMO website.

Agenda Review Continuation of the HIPAA documents final review

o Jim has Rehab, hasn’t started Clinical Reports White Paper

o Haven’t: started Clean up big topics No parking lot issues Recap: Accomplished a lot this week!

ASIG Roles and Responsibilities[ASIG RolesAndResponsibilities 2008-04-28.doc]Reviewed the updates Mike made. Did not cover all the responsibilities; didn’t get thru the DMP.

White PaperHIPAA and Claims Attachments: Preparing for Regulation. Brad Dumke started this whitepaper 4-5 years ago. Written for a CMS audience, the goal was to give them a ‘big picture’ understanding of claims attachments. With the pending Final Rule, the ASIG needs to review the content and bring it back in line. The ASIG worked on the white paper during the January 2008 WGM, and Sue Thompson updated it this past April. The document shows mark-up from both sources, which must be reviewed and accepted or rejected. It appears the updates end (after page 12 (toward the end of the document). The ASIG will continue its work on the white paper

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during the September Plenary & WGM meeting, utilizing breakout groups if feasible. Rob will review the paper and bring it to a good starting point (for review on conference calls, a page or two at a time, completing it at the September Plenary meeting.

AdjournmentMOTION Mike Cassidy made a motion to adjourn the meeting. Larry Shorey seconded. Discussion. VOTE 8-0-0. MOTION CARRIED

[end of Q2]

Summaries

Motions P2P Ballot Reconciliation: To accept Jim McCain’s comment #1 as discussed. Vote 19-

0-12. Motion Carried P2P Ballot Reconciliation: To accept Scott’s comments # 23, 24, 38, 47, 46 as discussed.

Vote 15-0-7. Motion Carried P2P Ballot Reconciliation: To accept Keith Boone’s comment (line 125) as discussed.

Vote 14-1-9. Motion Carried PIUC Ballot Reconciliation: To accept June’s comments #1, #2, #3, #5 as discussed.

Vote 19-0-0. Motion Carried PIUC Ballot Reconciliation: To accept Mary Lynn’s comments, #1, #2, #3, #4, as

discussed. Vote 18-0-0. Motion Carried PIUC Ballot Reconciliation: To accept Freida’s comments, #1, #2, as Vote 16-0-0.

Motion Carried PIUC Ballot Reconciliation: To accept Mary Kay’s comments, #1, #2, #3, #4, #5, as

discussed. Vote 17-0-0. Motion Carried PIUC Ballot Reconciliation: To accept Deb’s comments, #1, #2, #3, #4, #5, #6, #7, #8,

#9, #10, #11, #12, #13, as discussed Vote 18-0-0. Motion Carried PIUC Ballot Reconciliation: To accept Mike Cassidy’s comments as discussed. Vote

18-0-0. Motion Carried San Antonio Minutes: To accept the San Antonio minutes as submitted. Vote 14-0-1.

Motion Carried Project Scope Statement: To accept the Project Scope statement revisions as

discussed. Vote 18-0-2. Motion Carried Project Scope Statement: To accept the Project Scope Statement updates made since

yesterday’s vote. Vote 12-0-0. Motion Carried Mission & Charter: To accept a global, minimal name change througout the Mission &

Charter changing ‘SIG’ to ‘workgroup’ Vote 12-0-0. Motion Carried Mission Statement: To accept the changes to the Mission statement as discussed. Vote

12-0-0. Motion Carried Charter: To accept all changes made to the Charter as discussed. Vote 8-0-0 Motion

Carried Adjournment: To adjourn the meeting. VOTE 8-0-0. Motion Carried

Presentations .jpg of Craig’s log PIUC Ballot Results.ppt AIS0009_PIUC_Attachment_Types_2008-02-21.xls (Compatibility Model) CDA.xsl ASIG Priority List 20080502.xls Planning for ASIG September 2008.doc ASIG RolesAndResponsibilities 2008-04-28.doc

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HL7 Project Scope Statement_v1 2 12_with_instructions.doc Draft 2008-04-28 ASIG DMP_v1.2.doc

Action Items Durwin will forward the PHR/CCD ballot comments to the Attachments Workgroup

attendees. Co-chairs will ask Penny the status of her gap analysis which is needed before the

committee can move forward Keith will work with Rick and send out a project proposal by the end of the week to the

ASIG listserve = OID Guidance Paper discussion Maria will send the proposal she wrote that was accepted by WEDI and HL7 => related to

discussion on Education Attachment Workgroup will produce the documents requested:

o SWOT: to get an idea of what each committee is doingo ROADMAP: what each workgroup intends to do over the next 1-3 years.

Example was an .xls spreadsheet timeline. Rob Root will find out if he can locate the source of this attachment request (via Penny)

=> related to ballot reconciliation/Eligibility (Penny responded that day) Rob will use the task list to create a roadmap (three-year timeline) for HL7 Mike & Rob will update the Roles & Responsibilities list, identifying the tasks involved for

each responsibility. The completed document will be forwarded to the listserve. Add agenda item for July conference call: SDTC/AWG review of Project Plan Add September agenda item: review & accept the DMP document Mary Lynn Bushman will email the vendors for their input => related to Worker’s

Compensation discussion and assignment of the attachment control number. Mike will forward the Project Scope Statement to the ASIG, SD, and Vocab listserves Rob will upload the Project Scope Statement to the PMO website

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