2018-03-21 Learning Health Systems Call

Facilitator	Russell Leftwich	Note taker(s)	Emma Jones
Attendee	Name	Affiliation
X	Russell Leftwich	InterSystems
	John Roberts	Tennessee Department of Health
X	Stephen Chu	Individual
X	Evelyn Gallego	ONC
	Kathy Walsh	LabCorp
	Asim Muhammad	Philips Research Europe
	Laura Heermann-Langford	Intermountain Healthcare
X	Emma Jones	Allscripts
	Jeff Brown	Cancerlinq
X	Lisa Nelson	Individual
	Dave Carlson	VA
X	Chris Melo	Phillips Healthcare
	Michelle Miller	Cerner
	Benjamin Kummer	Columbia University
	Matt Rhan
	Michael Padula
	Joseph Quinn
	Thomson Kuhn
	Rob Hausum
	Serafina Versaggi	VA
	Ann Whiz
	Kathleen Conner
	Bridget McCabe
	Lisa Gonzalez
X	Bridget Burke
X	Claude Nanjo

Minutes

• Chair: Russell Leftwich
• Scribe: Emma Jones

• Motion to approve March 14 call minutes: Stephen moved ,Emma second

Agenda SNOMED codes for starter value set CIMI Modeling Other business

SNOMED codes for starter value set

• Rob McClure has provided a template to submit to SNOMED
• After approval from HCA the concepts will be uploaded
• Some SNOMED codes in the started set does exist but SNOMED is reviewing of the occupation role code because they are UK centric. SNOMED is planning on retiring some of the codes.
  • Hierachy we looked at will not be used going forward
• We need to fill in the template with the definitions we created.
• Example definitions are not available from SNOMED for us to use.
• Suggest using the definitions Stephen provided because SNOMED doesn't have guidance for us to follow. Per Stephen - in past have not been able to find fully descriptive concepts from SNOMED.
  • Their guidance around definitional clinical concepts does not help.
• There will be time for Rob McClure to look at what we submit before sending to SNOMED
• March 29th is the deadline - Stephen will put some effort in it this weekend. Will look at the template and do the copying and pasting.We need to work on it off line because next conference all is the date of the next HCA meeting.

CIMI Modeling presented by Claude

• Reviewed some of the use cases
  • Selected a few as good candidates
• We need to start diving into parts of CIMI that are more relevant for this work.
• CIMI has 3 levels - Core, Foundation, Clinical layer
• Will start with current patterns but keep in mind that the patterns have not been tested - ideally would like it tested in the field
• Entity - real workd things that can exist independently - generaly have identifiers in the real world. Different from FHIR in that FHIR - practitioner for example - some attributes related to the individual, a record and the role the individual plays

Patient identifier can be multiple things - ID in relation to the record at a specific organization, can be idintifier unique to the person - Soc Number, can be DL number, etc

• Suggestion to make CIMI more aligned with FHIR - but there are also discussion in FHIR to make changes in FHIR. Goal is for CIMI and FHIR to work together.
• FHIR telecom serves for all types of electronic communication - this is also true for CDA. Qualifier allows for all of this. Is there a qualifier for FHIR endPoint?
• CIMI aligns with FHIR and if CIMI have attributes FHIR does not have, is made into FHIR extensions.
• CIMI provides a logical model to be able to provide attributes against the logical model.
• Explanation of CIMI entities and classes of attributes
  • entities are not always limited to health care.
• Party can either be an entity or a role. Party can be related to other party. Role have actors
• CIMI Clinical: Role - discussion provided.
• FHIR is a flattened model so if trying to go from FHIR to CIMI, need to understand where it would go.
  • All resources have structured definition. When mapping CIMI to FHIR, have to define how to get from FHIR back to CIMI
• Detailed person in CIMI - have been modeled as demographin as a bundle
• Unable to have adress as an observation in FHIR because the value element does not support.
• Discussion about the need of creating a different model from FHIR.
  • Suggest modeling as this group see fit and then go from there to see what changes may be needed by FHIR.
• Limitations of FHIR is observation is narrow. This makes it difficult to use it for social determinant of health.