e CR Update Laura Conn Sarah Gaunt Rick

e. CR Update Laura Conn, Sarah Gaunt, Rick Geimer, KP Sethi, and John Loonsk HL 7 Public Health Work Group June 21, 2018

e. CR Update • September e. CR FHIR STU ballot • Public Health HL 7 Connectathon track • Pregnancy status C-CDA templates

FHIR Electronic Case Reporting (e. CR) • Some EHR vendors are waiting for FHIR to do e. CR • We are advancing a FHIR ballot for September • Some have also implemented the CDA e. ICR • We are committed to making transforms available for e. ICR and RR to facilitate CDA / FHIR conversions • Will align CDA and FHIR e. ICR as much as possible going forward • Some data (i. e. vital signs and eventually pregnancy status) that would like to add to e. ICR for decision support and reporting • “Unsolicited push” and “messaging” are unequal FHIR partners with RESTful query right now and need promotion

FHIR Electronic Case Reporting (e. CR) • Policy reasons to distribute more business logic as it becomes possible • FHIR will eventually enable a number of new possibilities for distributed business logic execution • Are actually a number of needed FHIR design elements: • Triggering, business logic, unsolicited push, supplemental data access / electronic investigation, feedback to providers / reporters and PHAs • Implications for Reportability Response and trigger code distribution transactions

Trigger Codes + • Several EHR vendors have expressed interest in a more advanced distribution method for trigger codes than spreadsheets • XML / JSON value sets were specified in the FHIR e. CR “for comment” ballot along with FHIR subscription services • Subscription would enable public health communication of routine and emergent updates • Such a distribution approach supports, but does not require, FHIR on the EHR / clinical care side • Subscription can support very simple timed “pull” as well • FHIR offers the “Plan. Definition” construct to bundle value sets, line-up for distributing more complex business logic (CQL), add other triggering parameters, and eventually align with guideline work • September Connectathon we will work subscription, data specifications

Pregnancy Status C-CDA Templates • Successful balloting of pregnancy status C-CDA templates • 97 out of 140 comments have been dispositioned in Structured Documents Work Group • Is an inflection point related to whether the value set for pregnancy status can be opened up as an errata • Would avoid a potential patient safety issue and make for a simpler product • SD has voted to approve the value set change as errata and the HL 7 CTO has tentatively agreed to the errata approach • Once published, these C-CDA templates can be used in the next update to the CDA e. ICR and then added to the FHIR e. ICR