1. © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Attachments Workgroup

2. © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Tasks for this week Complete gap analysis for remaining current types Evaluate if any of the current types are still needed? Identify other attachment types being requested in the industry, that are not already included in CCDA templates Collaborate with Regensteif on LOINC list for unstructured attachments Review/restructure solicited model (request at document level)

3. © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. HL7 Jan. Meeting Summary Completed Gap analysis of AIS booklets to Consolidated CDA Templates and others  Ambulance data will be in ASC X12 837 – eliminating Ambulance AIS; EMS Run Trip Report will be an unstructured document  ASC X12 TG2 WG9 needs to review value set in 275 CAT02 Agreed that solicited requests will be LOINC codes at the document level only – nature of clinical reports Developed a format for a ‘Panel’ on the LOINC DB that will function as an external code set for unstructured and structured attachment documents – replaces PIUC  Update from DOD/VA their project to implement CDA Consolidated Guide Outreach to re-evaluate the need of current attachment types and for additional attachment type used today – WEDI survey results expected in March Developing list of requirements for a rewrite of the AIS Implementation Guide Information exchange with HL7 RM-ES project and relationship to ESMD initiative Developed a time line for 2012 – target September ballot for HL7

4. © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Tasks for this week – Complete gap analysis for remaining current types  Clinical Rpts; OB Ultrasound – document level LOINC is in CCDA; add 100+ elements?, Cardio Echo Study – document level LOINC is in CCDA; add details?, EKG – not in Diagnostic Image Report table of CCDA; need to add to table X-rays – 8 specific types in AIS; each consists of 7 common detail elements  Medications, Dynamic value set; Details are matching; Does ‘Current’ = ‘Admission’ for Discharge Meds?  Lab Results, Dynamic value set  Rehab. Therapies 10 types; 24 common details in each type; need to verify date fields and if Treatment Plan = Plan of Care?  Ambulance – Data elements to be included in X12 837; need to create an unstructured document LOINC code for EMS Run Report

5. © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Tasks for this week Identify if other attachment types being requested throughout the industry, that are not included in CCDA templates  Outreach via WEDI Survey and Winter Forum; Results due in March. Collaborate with Regensteif on LOINC list for unstructured attachments  We will create 3 classifications of LOINC codes in a Panel on Relma; Panel will need to be named in Regulation like an external code set Unstructured, Unstructured for HIPAA, (may have children LOINCs) Structured (details are defined in a quide) Review/restructure solicited model (request at document level)  Agreed to change requests to document level only for clinical attachments

6. © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Tasks for this week – Evaluate: are the current types still needed? Evaluate: are any of the current types still needed?  Ambulance  Lab Results  Medications  Rehabilitative Services Alcohol-Substance Abuse, Cardiac, Medical Social Services Occupational Therapy, Physical Therapy, Psychiatric, Respiratory Therapy, Pulmonary Therapy, Skilled Nursing, Speech Therapy  Clinical Reports Cardiac Diagnostic Studies: Cardiac Echo Study, EKG Study Obstetrical Studies:OB Ultrasound Study Clinical Notes/Reports Physician Hospital Discharge Summary Operative Note Provider Unspecified History and Physical Note Radiology Studies (8 x-ray types) Members to respond asap, outreach via WEDI survey by March

7. © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. 2012 timeline By end of Jan. meeting  Create list of data not in CDA Consolidate Templates  Consensus on solicited request - document level only  Defined format of LOINC DB for unstructured/structured attachments By March  Finalize list of Attachment needs Response on needs from gaps and current types Updated list of any new attachment types from outreach Begin writing guide, templates and LOINC descriptions By May meeting  Writing template requirements and Implementation Guide  Determine if out-of-cycle meeting is needed By September meeting  Prepared ballot