Agree that this provide many options, but the variety of work flows in Healthcare require this flexibility in the core specificaton. We provide guidance in the notes section. Ultimately it is the responsibility the implementation communtity to determine the preferred approach on a use case by case basis through profiles and implementation guides. At this point we do not see a need to make a change the observation. However, to improve on the clarity, we plan to have regular meetings wtih OO, CQI, CDS, and CIMI to address challenges in boundaries between resources, create clarity, and involve the implementation community. Motion to take this approach.