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					Memo:

From:      Mark Shafarman and Laura Sato
To:        HL7 International Affiliates
Date:      September 28, 1998
Subject:   Highlights from the International Committee Meeting at HL7 Plenary, San Diego, September 13 & 15,
           1998.

This was our best attended HL7 International Committee meeting to date. We had 17 attendees from 6 affiliate
countries (Australia, Canada, Finland, Germany, Japan, the Netherlands) , as well as 6 attendees from the US. We
could not cover all the issues in the allotted time, so we had to schedule an additional, early morning session.

Topics covered included:

1) a report/discussion concerning the recent EDIFACT meeting

           The overall consensus was that the EDIFACT clinical information messages are not currently very widely
           used (except in the UK); and that EDIFACT doesn‟t yet have plans for an overall information model such
           as is being developed by HL7. The EDIFACT messages are mainly used for healthcare reimbursements
           and there are official decisions endorsing this usage in several countries. As HL7 we need to encourage
           harmonization at the information model level (as is being done with the X12N model in the US).

2) a report on the recent meeting of the new ISO TC 215 on Healthcare Informatics

           Woody Beeler represented HL7 at the recent (August 1998) first meeting of the ISO Technical Committee
                  215 on health informatics standards.. As a result of this meeting, four Working Groups were
                  formed:
                   Messaging & Communication (convened by the USA). Ed Hammond has been elected as the
                      chair of this WG.
                   Concept Representation (convened by the UK)
                   Security (convened by Sweden which holds the chair) (but secretariat held by Japan)
                   Modeling Coordination & Medical Records (convened by Australia).

           Woody advised that the ISO unlikely to be an effective development forum, but should be productive in
                  endorsing complete or near-to-complete standards developed elsewhere. For this reason, it was
                  suggested that international development/input to HL7 be done in the HL7 International
                  Committee, rather than at ISO. The main discussion resolutions were that HL7 should participate
                  in ISO (acknowledging the challenge of "constructive engagement without distraction" from HL7
                  development efforts) and that HL7's international affiliates were encouraged to participate in the
                  ISO TC 215 process.

3) a report on the recent Argentine/Latin American Meeting

           Mead Walker gave a presentation on HL7 at a joint Argentine Informatics Association/Latin American
                 Association for Informatics and Operations Research meeting. In Argentina, HL7 is mainly used
                 between payors and providers. Mead encouraged them to set up an HL7 Committee/Affiliate.
                 There was also interest in a Spanish language version of HL7.

4) status reports from each of the attending HL7 Affiliates

           Each of the affiliates gave a presentation covering their affiliate's organizational structure and activities,
                    including details of their use of HL7, issues that they were bringing to share with other
                    international affiliates, and issues that needed further attention by HL7.

           (Very) brief affiliate status highlights (in order of presentation) include:


HL7 International Committee Highlights                   9/13 & 9/15 1998
Page: 1
         Japan: our newest affiliate. V 2.3 has been translated in Japanese, and a Japanese language HL7 textbook is
                  planned. Proposals for including Japanese character sets have been accepted as part of 2.3.1

         Australia: Official Australian versions for ADT and clinical orders/results have been published; pharmacy
                  is in process. In July, a very successful 5-city educational tour was sponsored by Standards
                  Australia.

         Canada: HL7 Canada is sponsored by the Canadian Institute for Health Information (CIHI). HL7 is the 'de
                 facto' national standard. During the next 18 months HL7 Canada will focus on implementation,
                 modeling and vocabulary.

         Finland: EDIFACT and HL7 coexist, but HL7 usage is growing more rapidly. SIGs have been started for
                  laboratory, radiology, new technologies (XML, CORBA) For next year they plan to update
                  materials for version 2.3.1.

         Russia: Not yet an affiliate, but HL7 Germany has offered to support Russia's HL7 users and to help them
                  form a Russian affiliate.

         Germany: HL7 is now the most common standard used in Germany. A German version of v. 2.3 is
                available as a CD-rom, as well as an HTML database covering v 2.1-2.3. At the annual meeting
                they will have tutorials on 2.3, v 3, and XML.

         The Netherlands: They have produced national implementation guidelines (in the Dutch language) and
                 offer a free Help Desk to their members. They hold yearly conferences. Last year started to give
                 HL7 courses. Market penetration is roughly 70% of all hospitals.

         The detailed reports from the affiliates can be read in the minutes, and the presentations given at the HL7
                 Plenary meeting will be made available shortly on the International Committee website.

5) the appointment of an International Facilitator (Jane Curry of Canada) to the RIM harmonization process

         Since all new messages for Version 3 must map to the RIM, the current RIM harmonization process
                   provides the International Affiliates a unique opportunity to influence Version 3 development. To
                   expedite and coordinate internationalization/localization requests, the International Committee
                   now has it's own facilitator.

6) better coordination of participation in HL7 ballots for International Affiliates

         Many international affiliates have had problems meeting HL7 balloting deadlines, not only because of
                 distance, but also because of the time required for consultation within the affiliate memberships.
                 Three suggestions will be brought forward to headquarters:

         *        Post a 'ballot calendar' on the HL7 website, to provide a "heads up" for upcoming ballot
                  issues/deadlines.
         *        Ensure that the electronic ballot clearly distinguishes between a vote on behalf of an Affiliate
                  versus that of an individual member of HL7 (some Affiliate representatives are both).
         *        Send ballots and accompanying documents on diskette to each Affiliate via express mail. (If cost
                  is an issue, some Affiliates would be willing to pay for this.)

7) Localizations and Internationalization: how to maintain and describe consistency and compatibility between
         affiliate 'versions' of HL7.

         The issue of the appropriate naming of the "family" of national documents being created in conjunction
                  with the HL7 Standard was discussed. Many Affiliates refer to national "implementation guides",
                  which may be confused with HL7's Implementation Guides for Versions 2.2 and 2.3 (which have
                  different, less 'normative' mandates).

HL7 International Committee Highlights                 9/13 & 9/15 1998
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           It was suggested that the key information to be included in all of these documents is:

           *        Who generated/developed it; and
           *        What its "mandate" is.

           Bert Kabbes volunteered to draft a proposal for standardizing the names of the (growing) family of
                   international informative/normative documents related to the HL7 Standard..

8) HL7's response to the MEDSEC project

           MEDSEC is a consortium funded by the EC that has created a general healthcare security framework
                document, with wide support from EU Healthcare Informatics SDO's. Bernd Blobel presented
                issues concerning MEDSEC's framework document on security issues, needs, and protocols
                (infrastructure).

           It was suggested that the MEDSEC documents be distributed to all International Affiliates and to the HL7
                    Security SIG with the goal of having the affiliates and HL7 review the MEDSEC documents
                    both for action items for HL7 and for feedback to MEDSEC.

9) adding Personnel Management and Credentialing to HL7 v3

           Frank Oemig suggested that the HL7 v3 concept of role could be expanded to support personnel
                   management and credentialing applications. The International Committee recommended that
                   Frank present a proposal regarding personnel management/credentialing to the PAFM Technical
                   Committee.


10) Planning for the January HL7 Meeting

           Meeting time: Due to increased volume of HL7 international activity, the meeting time for the next meeting
                   will be doubled. The next meeting will be held in Orlando, Florida on Sunday, January 24, 1999
                   from 10:00-1300 hours and from 14:00-17:00 hours (lunch from 13:00-14:00 hours)

           Tutorial: the International Committee will organize a tutorial on internationalization issues at the next
                    Working Group Meeting in Orlando, Florida (Jan.25-29, 1999). Rather than try and give many
                    brief status reports, a single theme or internationalization issue will be explored.

11) Website issues: postponed to email discussions between now and the next meeting.
Memo:

From:      Mark Shafarman and Laura Sato
To:        HL7 International Affiliates
Date:      September 28, 1998
Subject:   Minutes from the International Committee Meeting at HL7 Plenary, San Diego, September 13 & 15, 1998.

Sunday afternoon 13 September 98

Attendees: (NB: attendees names marked with an asterisk were also present at the Tuesday, 15 September,
continuation meeting)

Australia:

Stephen Dippy                Error! Reference source not found.Error! Reference source not found.
David Rowed                  Error! Reference source not found.Error! Reference source not found.
Meno Schilling*              mschi@doh.health.nw.gov.au

HL7 International Committee Highlights                 9/13 & 9/15 1998
Page: 3
Klaus Viel*               kveil@compuserve.com

Canada:

Jane Curry*               Error! Reference source not found.Error! Reference source not found.
Shelagh Maloney*                  Error! Reference source not found.Error! Reference source not found.
Lauro Sato*               lsato@cihi.ca


Germany:

Bernd Blobel*             Error! Reference source not found.Error! Reference source not found.
Joachim Dudeck*           jwd@uni-giessen.de
Frank Oemig*              frank.oemig@pcm.bosch.de

Japan:

Michio Kimura             Error! Reference source not found.Error! Reference source not found.
Norihiro Sakamoto         Error! Reference source not found.Error! Reference source not found.

Netherlands:

Bert Kabbes*              Error! Reference source not found.Error! Reference source not found.
Bas Van Poppel*           Error! Reference source not found.Error! Reference source not found.
Ed Rovers                 Error! Reference source not found.Error! Reference source not found.
?Stichting                stichtingHL7NL@dynamick.nl <Editor's note: needs first name...>

Finland:

Timo Tarhonen*            timo.tarhonen@nuch.fi

U.S.A.

Woody Beeler*             Error! Reference source not found.Error! Reference source not found.
Ed Butler                 Error! Reference source not found.Error! Reference source not found.
Al Figler                 al-figler@idx.com
Freida Hall               Error! Reference source not found.Error! Reference source not found.
Gunther Schadow           Error! Reference source not found.Error! Reference source not found. (US email
address….)
Mark Shafarman*           Error! Reference source not found.Error! Reference source not found.
Anne Shanney              anne_shanney@idx.com


After introductions and approval of the agenda, the following reprots were presented and discussed.

1. report/discussion concerening the recent EDIFACT meeting.

         Ed Butler, HL7's UN/EDIFACT liaison, reported on EDIFACT's recent meeting in Brussels, Sep.7-11.
                 EDIFACT is a permanent working group of the UN-sponsored, international trade organization,
                 CEFACT. CEFACT has many committees; its "D" committee covers the spectrum of economic
                 trade. The D11 Subcommittee deals with healthcare. Regional updates to this Subcommittee in
                 Brussels were heard from Australia (eligibility and claims), the USA (HIPAA), France (Smart
                 Cards), and Columbia (local legal obstacles to EDI). Liaison issues with ISO TC 215, XML, and
                 HL7 were discussed. UN/EDIFACT's development process has recently been streamlined so that
                 message development continues within regional bodies or countries, but approval has been
                 'collapsed' into a single process. A resolution was made to map EDIFACT messages to XML

HL7 International Committee Highlights              9/13 & 9/15 1998
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                  syntax and to deliver this to the WWW consortium. EDIFACT's Message Development
                  Framework Version 5 was passed this week; they now have a greater emphasis on modeling and
                  'QA' up-front (rather than back-end clean-up). They are currently committed to being
                  backwards-compatible.

         Meno Schilling pointed out the need to watch for redundancies between this effort and HL7's. Ed agreed
                that minimizing overlap was a goal. Gunther Schadrow asked who was the 'driving force' behind
                D11 efforts, and Ed (and various Committee members) responded that the UK, France, and
                Denmark seemed particularly supportive of EDIFACT. The idea of mapping EDIFACT to HL7
                was discussed. Woody Beeler reported that a business proposal to do this had been made to the
                Board (for a charge of $50 000 USD) some time ago, but the Board was not convinced this effort
                was worth the cost. Joachim Dudeck suggested that it might be better to map both standards to
                XML. Klaus Veil and Meno Schillling reported that the EDIFACT versus HL7 issue in Australia
                was comparable to the X12 versus HL7 issue in the USA. Standards Australia currently
                (preliminarily) endorses both ways of communicating finance/billing. Jane Curry suggested that
                the overlap in standards suggested the need to develop a "global health information model".

         Overall consensus was that the EDIFACT clinical information messages are not currently very widely used
                  (except in the UK); and that they don‟t yet have plans for an overall information model such as is
                  being developed by HL7. The EDIFACT messages are mainly used for healthcare
                  reimbursements and there are official decisions endorsing this usage in several countries. As HL7
                  we need to encourage harmonization at the information model level (as is being done with the
                  X12N model in the US).

         Editor‟s comment: When there is need for clinical information to support reimbursement messages in the
                  EDIFACT format, HL7 should encourage the use of HL7 rather than the reinvention of the
                  information structures needed to transmit clinical information. At the very least HL7 should
                  encourage the “wrapping” of the HL7 structures within an EDIFACT message: this is the
                  approach being used by the Claims Attachment SIG (US). With version 3 supporting several
                  encoding structures, the question of a particular syntax (such as EDIFACT) should be less
                  important in the future. However, we need to continue to monitor the use and evolution of
                  EDIFACT in the healthcare domain.

2.   ISO TC 215 on Healthcare Informatics

     Woody Beeler reported on the recent (August 1998) first meeting of the ISO Technical Committee 215 on
              health informatics standards. Woody represented HL7 at this meeting, in place of Ed Hammond who
              had other commitments at that time. As a result of this meeting, four Working Groups were formed:
     Messaging & Communication (convened by the USA)
     Concept Representation (convened by the UK)
     Security (convened by Sweden which holds the chair) (but secretariat held by Japan)
     Modeling Coordination & Medical Records (convened by Australia).

     Ed Hammond is one of two candidates (with Bob Kenelly of IEEE P1073) to Chair the Messaging &
           Communication WG. (Editor‟s note: as of September 25, Ed Hammond has been chosen as the Chair).
           HL7's V2.3 was submitted for ISO approval (V3 is not yet mature enough for submission). Woody
           advised that the ISO unlikely to be an effective development forum, but should be productive in
           endorsing complete or near-to-complete standards developed elsewhere. For this reason, it was
           suggested that international development/input to HL7 be done in this Committee, rather than at ISO.
           The main discussion resolutions were that HL7 should participate in ISO (acknowledging the
           challenge of "constructive engagement without distraction" from internal development efforts) and that
           HL7's international affiliates were encouraged to participate in the ISO TC 215 process.

     In addition to the 4 WGs, ISO TC 215 formed two ad hoc committees to investigate Imaging and Smart Card
              standards. The next meeting of ISO TC 215 will be from April 12-16, 1999 in Berlin. The first 2 of
              4 days will be WG Meetings. In addtion to the TC meeting schedule, WGs will have 1 or 2

HL7 International Committee Highlights              9/13 & 9/15 1998
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            out-of-cycle meetings (TCs are on a roughly 9-month meeting schedule, and WGs are on a roughly
            3-month meeting schedule). The TC Meetings have been scheduled through 2001, including
            Nov.2000 in Japan and Jun.2000 in Vancouver, Canada.


3. Argentine/Latin American Meeting Report

        Mead Walker reported on a joint Argentine Informatics Association/Latin American Association for
              Informatics and Operations Research meeting in Argentina he attended recently. One day of this
              conference was focused on informatics in healthcare, and Mead presented about HL7. In
              Argentina, HL7 is mainly used between payors and providers. Mead encouraged them to set up
              an HL7 Committee/Affiliate. Some interest in a Spanish language version of HL7 was expressed,
              not just in Argentina, but also in Brazil.

4.   HL7 Affiliates Reports

4.1 Japan

        HL7 Japan launched in July 1998. Currently has 33 individual and 41 corporate members. Its Technical
               Committee is convened by JAMI (Japanese Association for Medical Informatics); its Steering
               Committee is convened by JAHIS (Japanese Association for Health Information Systems, a
               vendor association).

                *        The complete Version 2.3 Standard has been translated into Japanese and distributed to
                         their members.
                *        In November, they will be hosting a seminar at a joint conference on Medical
                         Informatics.
                *        By the end of this fiscal year (to March 1999), they plan to publish an HL7 textbook in
                         Japanese, based on tutorial materials.
                *        Their proposals for accommodating Japanese characters in HL7 have been accepted for
                         Version 2.3.1.

4.2 Australia

        *       Standards Australia is independent, non-profit corporation, government-chartered. It has a well
                developed process for implementing standards.
                           In HL7 terms, Standards Australia is implementing a single 'domain' area at a time.
                               Within a chosen domain, Standards Australia forms a working group consisting of
                               stakeholders with broad geographic representation from both the public and private
                               sectors. The working group studies available standards and recommends a „viable‟
                               standard in its area. The working group then creates an Australian Implementation
                               Standard, which documents the use of the standard in Australia.
                           this allows them to create an Australian version of a particular domain within the
                               HL7 standard in approximately a year's time.
        *       For HL7, Standards Australia recommends using the HL7 Standard, Implementation Guide, and
                Australian Implementation Standard documents for each HL7 version. In addition, the various
                states and territories within Australia may develop their own "local" implementation guides.
        *       Standards Australia has recently developed a Community-Based Code Set for allied health
                services, which they will be inputting to the Vocabulary Technical Committee.
        *       As of February, 1997 Australia (and New Zealand) governments have endorsed HL7 for
                clinical and patient administrative information
        *       "IT 14", the Australian Health Informatics Committee has been focused on ADT, Pathology
                Orders/Results, Drug Prescriptions, and Finance/Billing to date. IT 14 oversees 6 active working
                groups, including one on HL7 "compliance".




HL7 International Committee Highlights            9/13 & 9/15 1998
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                            Currently ADT, Clinical Pathology Orders/Results (for all "lab" orders and results)
                             are adopted HL7 standards, and HL7 Pharmacy is in the final stages of
                             publication/approval.
                            Recent HL7 activities include the July 98 HL7 'Road Show', with presentations on
                             versions 2.3 and version 3, presented by Woody Beeler and Mark Shafarman, and
                             presentations on the Australian HL7 experience by Meno Schilling and Peter
                             Treseder; and a keynote address on HL7 at the Australia Medical Informatics
                             Conference by Woody Beeler.

4.3 Canada

        *       Launched in 1996, HL7 Canada now has roughly 100 members at the organizational or individual
                levels.
        *       HL7 Canada is sponsored by the Canadian Institute for Health Information (CIHI), a
                not-for-profit, non-governmental organization with a mandate to coordinate the development and
                maintenance of a Canadian health information system.
                 CIHI is a national body that works with the Canadian provinces to encourage and facilitate the
                     use of standards at the provincial level. Several provinces have officially adopted HL7.
                 CIHI's process is similar to that used by Standards Australia.
        *       HL7 has been adopted by CIHI as a 'de facto' national standard within Canada.
        *       CIHI's foci for the next 12-18 months will be on:
                  Implementation.
                      HL7 Canada will be further developing a (currently prototype) web-based Vendor
                          Specification Statement, which steps users through the Standard, asking them to specify
                          the implementation options they've taken
                      HL7 Canada will be coordinating discussion, proposals, and balloting regarding potential
                          "Canadianization" recommendations for the Standard's use in Canada.
                  Modeling
                      HL7 Canada will continue to work with the Partnership for Health
                          Informatics/Telematics (another CIHI initiative) to continue developing (and hopefully
                          inputting into the RIM where appropriate) a Canadian national health data model at the
                          conceptual level.
                  Vocabulary issues
                      HL7 Canada is interested in helping leverage some local activity in this area, while
                          keeping up-to-date with HL7's new Vocabulary TC and bringing forward proposals to it
                          where applicable.

4.4 Finland

        *       Most HL7 use in Finland is within hospitals, while EDIFACT is used between organizations.
        *       Other standards of interest in Finland include CORBA, DICOM3, and XML (Finland is also
                interested in investigating XML as a potential "convergence tool" among standards). Edifact and
                HL7 coexist, but HL7 usage is growing more rapidly.
        *       HL7 Finland has 44 members, including vendors and hospital districts.
        *       Selling a "localized" version of the HL7 Standard has been their major revenue source.
                          For version 2.3, chapters 1,2,3,4,7,11 have been localized for Finland, including
                               verification of localizations, tables, and implementation guide. HL7 Finland has also
                               created rules for localizations

                            Sigs have been started for laboratory, radiology, new technologies (xml, corba).
                            User conferences have been held.
                            For next year they plan to update materials for version 2.3.1;

        *       HL7 Finland's website is: Error! Reference source not found.Error! Reference source not
                found.

HL7 International Committee Highlights             9/13 & 9/15 1998
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4.5 Russia (reported by Prof. Dudeck)

        *       Although not yet an affiliate, HL7 is being used to connect hospitals, especially those using
                equipment developed in Western countries.
        *       HL7 Germany has offered to support Russia's HL7 users and to help them form a Russian HL7
                affiliate.

4.6 Germany

        *       HL7 Germany, founded in 1993, is completely privately-driven (with no direct government
                involvement). It was created to encourage both vendors and users to accet the HL7 Standard in
                Germany.
        *       HL7 is now the most common standard used in Germany (EDIFACT is used only between some
                hospitals and insurance companies).




HL7 International Committee Highlights            9/13 & 9/15 1998
Page: 8
         *        A German version of v. 2.3 is available as a CD-rom (as with the HTML database, they have
                  only translated the segment and field tables, and created German localization versions of the field
                  notes.
         *        At the annual meeting they will have tutorials on 2.3, v 3, xml, application servers, and corbamed
                  as well.
         *        A website has been operational since October, but a new version is currently under construction
                  (see Error! Reference source not found.Error! Reference source not found. in the near future).
         *        In Germany, there is close cooperation between HL7 and CEN (the European standards
                  organization). A CEN task force has been created to address the use of XML as an interchange
                  format.
         *        A web-based database of the HL7 Standard was demonstrated at the plenary session. HL7
                  Germany hopes to make this tool available to the whole (international) HL7 community.

4.7 Netherlands

         *        Founded in 1993, HL7 Netherlands now has roughly 125 members (35 vendors, 70 hospitals, 20
                  general), a Board of 3 people, and a Technical Committee of 12 people.
         *        They have produced national implementation guidelines (in the Dutch language) and offer a free
                  Help Desk to their members. They hold yearly conferences. Last year started to give HL7 courses.
         *        Roughly 70% of hospitals in the Netherlands use HL7 for Control/Query, ADT, Results, Finance,
                  and Pharmacy. The widespread use of the interface engine vendors has been key to the
                  implementation of HL7 in the Netherlands.
         *        HL7 Netherlands is a member of the National Medical Informatics committee which reviews all
                  Cen and Iso guidelines.

5. International Facilitator to the RIM harmonization process.

         Woody provided some background to the creation of a new International Facilitator role. As all new
                messages for Version 3 must map to the RIM, the current RIM harmonization process provides a
                unique opportunity to influence Version 3 development. To provide input for RIM
                harmonization, two paths may be taken by International Committee members: 1) present a
                proposal to the relevant Technical Committee and work through their facilitator; or 2) present a
                proposal directly to Jane Curry, the International Committee's new facilitator. After discussion it
                was decided a Version 3 tutorial be presented to the International Committee. Meanwhile,
                members wanting to make proposals through Jane Curry or to a Technical Committee should
                contact Jane to get the RIM change templates for documenting their submissions.


At this point in the afternoon, we realized that we still had several important agenda items to complete, so we picked
a time later in the week (8-10 Tuesday morning) to continue. (Members who were able to attend this meeting are
marked with an asterisk in the attendee list above.) We also realized that the sharing of events between groups was
very important, but with the increased number of affiliates and activities, that a 3 hour meeting would no longer
suffice. Thus, we decided that at future HL7 meetings we would meet 10 a.m. to1 p.m. and 2 p.m. to 5 p.m. on the
Sunday prior to the meeting.

(The following are the minutes from the continuation meeting Tuesday 8-10 a.m.)

6. Balloting

         Many international affiliates have had problems meeting HL7 balloting deadlines, not only because of
                 distance, but also because of the time required for consultation within the affiliate memberships.
                 Three suggestions will be brought forward to headquarters:

         *        Post a 'ballot calendar' on the HL7 website, to provide a "heads up" for upcoming ballot
                  issues/deadlines.



HL7 International Committee Highlights               9/13 & 9/15 1998
Page: 9
        *       Ensure that the electronic ballot clearly distinguishes between a vote on behalf of an Affiliate
                versus that of an individual member of HL7 (some Affiliate representatives are both).
        *       Send ballots and accompanying documents on diskette to each Affiliate via express mail. (If cost
                is an issue, some Affiliates would be willing to pay for this.)

        We also discussed allowing a ballot extension for Affiliate voting. In general the consensus was that this
                would not be necessary, given the other three initiatives. However, as ballot deadlines are often
                extended, an Affiliate that needs extra time could always make a request for same to headquarters,
                on an 'as-needed' basis.

7. Consistency/Compatibility Between National 'Versions'

        The issue of the appropriate naming of the "family" of national documents being created in conjunction
                 with the HL7 Standard was discussed. Many Affiliates refer to national "implementation guides",
                 which may be confused with HL7's Implementation Guides for Versions 2.2 and 2.3 (which have
                 different, less 'normative' mandates). Australia prefers the name "Australian Implementation
                 Standard" for its national guidelines, whereas Canada has suggested the term "Canadian
                 Specification" for a similar type of document in development. The term "profile" was also
                 discussed, which might be applicable at the national or even organizational level. A 3-level
                 pyramid diagram was drawn to clarify the various conceptual layers, showing successive
                 "localizations/internationalizations" applied to HL7:




                                        HL7
                                      Affiliate
                                     Site Profile
                                     (normative)

                                    HL7 Affiliate
                               Specification/profile
                               (normative + informative)


                                HL7 V 2.3 Standard
                              + Implementation Guided
                             (normative + informative)




         It was suggested that the key information to be included in all of these documents is:

        *       Who generated/developed it; and
        *       What its "mandate" is.

        Bert Kabbes volunteered to draft a proposal for standardizing the names of the (growing) family of
                international informative/normative documents related to the HL7 Standard..

8. MEDSEC


HL7 International Committee Highlights              9/13 & 9/15 1998
Page: 10
        MEDSEC is a consortium funded by the EC that has created a general healthcare security framework
             document, with wide support from EU Healthcare Informatics SDO's. Bernd Blobel presented
             issues concerning MEDSEC's framework document on security issues, needs, and protocols
             (infrastructure). This document includes the latest IETF (Internet Engineering Task Force) draft
             of the HL7's "secure HL7 messaging via the internet" email protocol. The document also
             includes some specific suggestions for improving HL7 security functionality within the general
             MEDSEC framework. If HL7 is able to adopt the MEDSEC security framework, HL7 is, in effect,
             guaranteed harmonization with European SDO's using the MEDSEC framework. Bernd would
             like to explore formal channels for getting feedback and approval on the MEDSEC approach from
             HL7. He suggested the following possibilities:

                     HL7 improves MEDSEC's and/or it's own security infrastructure framework
                     HL7 ballots the MEDSEC framework (and/or the current HL7 Security framework document,
                      as improved after study of the MEDSEC document)
                     HL7 looks for other near term security implementation opportunities (such as the current
                      secure HL7 messaging via the internet IETF draft)
                     HL7 works to make MEDSEC an official security framework within the US.

        It was suggested that it be distributed to all International Affiliates, and to the Security SIG, and that it be
                 communicated to the Board that HL7 is reviewing this. <Editor's note: Need to update with HL7
                 Board actions on this as well...>

9. Personnel Management and Credentialing

        Frank Oemig opened discussion concerning Version 3's modeling of "persons" including not only patients,
                doctors, nurses, etc. but the various roles each person may take on. The concept of role could be
                expanded to support personnel management and credentialing applications. These applications
                have not been part of the scope of HL7 versions 2.x. Representing or communicating expanded
                personnel information may also facilitate the management of information access/security. Frank
                asked the Committee how this idea might be further investigated (e.g. Is it in the scope of HL7?
                Is it in the RIM?) The Committee recommended that Frank present a proposal regarding
                personnel management/credentialing to the PAFM Technical Committee. In addition, an update
                on this issue should be presented at the next International Committee meeting.

10. Next International Committee Meeting

        The next Meeting will be held in Orlando, Florida on Sunday, January 24, 1999 from 10:00-1300 hours and
                from 14:00-17:00 hours (lunch from 13:00-14:00 hours). It was suggested that a current issue for
                all Affiliates is: distinguishing between normative and informative work and then to place it
                appropriately (i.e. within the spheres of either HL7 TCs/SIGs or the International Committee).

11. International Tutorial in Orlando

        It was suggested that the International Committee organize a tutorial on internationalization issues at the
                 next Working Group Meeting in Orlando, Florida (Jan.25-29, 1999). It was suggested that
                 international issues be "triaged" into blocks (e.g. the EDIFACT/HL7 issue). It was also suggested
                 that 2 or 3 vendors who do multi-national business be invited to present on their
                 internationalization issues. Joachim offered to organize the agenda for the Tutorial and will
                 contact headquarters for their proposal deadline for the January sessions.

12. Website

        This issue was tabled for email discussion.



HL7 International Committee Highlights                9/13 & 9/15 1998
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