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2018-05-17 PA WGM Minutes

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Patient Administration Work Group Minutes - May 17, 2018

Thursday Q1

HL7 Patient Administration Meeting Minutes

Location: Maritime Hotel, Cologne, Salon 20 Fulda

Date: 2018-05-17
Time: Thursday Q1
Facilitator Line Saele Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Alex de Leon Kaiser Permanente
X Line Saele HL7 Norway
X Brian Postlethwaite HealthConnex, Australia
X Cooper Thompson EPIC, USA
X Simone Heckmann HL7 Germany
X Drew Torres Cerner, USA
X Christian Hay GS1, Switzerland
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
Welcome/introductions

  • Wrap up

Approve San Diego Minutes

  • Go To Monday Minutes
  • Go To Tuesday Minutes
  • Go To Wednesday Minutes
  • Go To Thursday Minutes
  • Approve next ballot
  • FHIR Planning
  • Address PBX matrix
  • Work Group Health
  • 3 year work plan

FHIR work Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions

The WG discussed the planning before the San Diego Minutes to be assure work is handled.
The PAWG discussed moving the conference calls to every other week and on Wednesdays. However with the varied needs of the work, more discussion was had. The decision was made to “split” the work and calls.

The FHIR content will need the next three weeks as well.

  • FHIR calls will be Wednesday 3EST starting next week
  • V2 will do Tuesday 3EST starting next week

The WG then moved on to the rest of the agenda. The next ballot
PBX matrix and work group health is good. We also covered the 3 year work plan.
Next ballot provider directory im the WG will decide whether to ballot just before the deadline. FHIR there is no need. Patient is the normative content.
Action: Update Tuesday Q1 September 12, 2017 minutes. Alex
Irma moves to accept the minutes, Christian seconds to approve the minutes.
Vote 7/0/0

FHIR Planning All tracker items that will be dealt with on Zulip, Cooper will be charged with putting them therer. C –
D -

  1. 14725 –


  1. 14803


  1. 14836 –


  1. 14826
  1. 14837 - : Billing Provider concept (Ex. Specialty license, State license, UPIN etc) field can be introduced. - 2018-Jan Core #177


To be discussed on the call

  1. 14838 –

C – Use identifiers.

  1. 14839 -


  1. 14841 –

Service Category c

  1. 14842 –

C

  1. 14843 – Type should go to specialty not to service type

Dupicate 14846 and 14847

  1. 14844 - active which specified where the schedule is active or not should be made mandatory.

This is what profiling is for. You can
C

  1. 14879 – Type

Changes need to be applied

  1. 14393 –

Discuss at WGM

  1. 14451 –
  2. 14413 – Clean up.
  3. 14835 - search by abbreviation
  4. 14680 – Can a pending appt timeout of have a default> If not can we say timeout not defined?

Discuss

  1. 14727 – Use compositional approach for Person/Patient/Composition

The FHIR Person resource is neither entity nor record. Rather, it is a mix of both. I would highly recommend that the person resource represent a person and that the Composition resource be used to represent a patient record. At the very least, the Person resource should be renamed to PatientRecord if that is its intent. Also, Person and Patient share a number of fields in common. I would recommend a more compositional approach whereby a person may assume a patient role. It is unclear how Person currently relates to Patient or to Composition.
Not Persuasive

  1. 14771 –

C

  1. 14891 - Practitioner and Organization definitions should be updated to include Payer/Insurer

Not persuasive. To be discussed in next quarter.

  1. 14880 –
  2. 14827 – Add “all” to days of week

Not persuasive.

  1. 13495 – Location.address has a comment. No further change from fixing comment.
  2. 14725 – C

Having completed the ballot related trackers, the WG moved on to review other tracker items:

  1. 14482 –

The WG reviewd the descriptions that Cooper updated. These descriptions handled the needs for gender/sex, etc.
Brian moved to disposition this as Persuasive , Cooper seconded.
Discussion: None
Vote: 7/0/0

  1. 14416 - ...to be linked OR be inactivated?

Patient
... A record does not need to be linked to be inactivated.
The WG considers the original text to be clear. Patient records can be inactive for many reason, not just for when linked. So the “to” is appropriate.
Irma moves to disposition this as Non Persuasive, Drew seconds
Discussion: None Vote: 7/0/0

  1. 14333 – Duplicate of 14482


  1. 15106 - Link type value-set causes a circular linkage

Patient
http://build.fhir.org/valueset-link-type.html contains code "replaces" and "replaced-by". In this situation you would have 2 patient resources that points to each other. This violates QA guideline if I understand correctly.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action:
Next Meeting/Preliminary Agenda Items
  • .

Thursday Q2

HL7 Patient Administration Meeting Minutes

Location: Maritime Hotel, Cologne, Salon 20 Fulda

Date: 2018-05-17
Time: Thursday Q2
Facilitator Irma Jongeneel Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Alex de Leon Kaiser Permanente, USA
X Brian Postlethwaite HealthConnex, Australia
X Line Saele HL7 Norway
X Tricia Chitwood Cerner, USA
X MaryKay McDaniel Congosante
X Christian Hay GS1, Switzerland
X Drew Torres Cerner, USA
X Peter Gilbert Meridian Health Plan, uSA
X Simone Heckmann HL7 Germany
X Paul Knapp HL7 Canada
X Louis Bedor Cognosante, USA
X Cooper Thompson EPIC, USA
X Beat Heggli HL7 Switzerland
X Mark Scrimshire CMS, USA
X Robert Dieterle Enablecare, USA
X Viet Nguyen Stratametrics, USA
Quorum Requirements Met (Chair +2 members): Yes

Agenda

Agenda Topics

  1. FHIR (joint meeting with Financial Management)

Disussion on draft FHIR resource - Invoice

  • 14891 - Practitioner and Organization definitions should be updated to include Payer/Insurer - 2018-Jan Core #310
  • 12275 - Request to improve description of Account
  • 11367 - Change description of Coverage - 2016-09 core #525
  • 13910 - Add cost center/revenue center property to ChargeItem
  • ProductPlan resource review

Supporting Documents

  • 14891 - Practitioner and Organization definitions should be updated to include Payer/Insurer - 2018-Jan Core #310
  • 12275 - Request to improve description of Account
  • 11367 - Change description of Coverage - 2016-09 core #525
  • 13910 - Add cost center/revenue center property to ChargeItem

Minutes

Minutes/Conclusions Reached:
Introductions
Introductions
Joint session with Financial Management

  1. 12275 - Request to improve description of Account

The current description notes "In the healthcare field, used to track charges for a patient, cost centres, etc." It seems to me that payments and adjustments should be referred to as well.
The PAWG expressed that the hesitation here was whether further concepts might be expressed with further resources.
After discussion, the two WGs considered the addition of clarifying text for Payments and Adjustments within the textual description. These resources will be later defined.
Brian moves to disposition this as persuasive, Paul Knapp seconds.
Vote: 15/0/1

  1. 14891 - Practitioner and Organization definitions should be updated to include Payer/Insurer
  • Practitioner
  • Organization

After struggling with the request as written, the WGs would like more clarification on the request. Requesting clarification and use case that this is trying to cover.

  1. 13910 - Add cost center/revenue center property to ChargeItem

Based on some discussion at the WGM in San Diego, we wanted to look at adding a property to the ChargeItem resource that indicates which Organization should get the money for the ChargeItem.
Epic uses the term "cost center", but the meaning of that term is sort backwards from the traditional finance instrustry term (revenue center). Regardless of the name of the property, the data of interest is the "Organization that has ownership of the (potential, future) revenue".
New property added to costCenter to ChargeItem.
“The financial cost center permits the tracking of charge attributions”
The WG discussed whether this would be a reference (Organization|OrganizationRole). This seems the most appropriate to provide the flexibility of either a code or organization.
With cardinality of 0..1.
Comments will include guidance noting that the either use reference to the arg where it makes sense or simply a value in the id which may inlucde asystem to differentiate id assigners.
Tricia Chitwood moved to disposition this as Persuasive, Paul seconded.
Discussion: None
Vote: 16/0/0

  1. 11367 - Change description of Coverage

Account
Change description of Coverage to not refer to them as responsible for the payment of the account as that is the role of the guarantor(s).
The WG Discussed the various coverage processes in US, Germany, Australia, etc.
The WG also reviewed the http://build.fhir.org/administration-module, 8.0.2.2 Clinical Categorization Resources Where the realtionships between EpisodeOfCare, Encounter, Account, Patient, RelatedPerson and Organization are represented.
[Administrative-module-interactions.jpg | Administrative Module Interactions]

Irma clarified that 2 new tracker items might be needed for discussed needs.
For this tracker item, it will be deferred until FM can review the boundaries between coverage and account.
Self pay, insurances, and aotehr payers (that are not isurers).
To address this tracker, this will be deferred.
FM and PA will need to meet on this to discuss and resolve before FHIR content delivery.

FM and PA will discuss this on Wednesday (2/14/18) at 3pm EST.
With the time left, the PAWG reviewed the ProductPlan resource.
<< http://build.fhir.org/productplan>>
IT was reviewed by both WGs. Examples were requested by PA to FM.
Next steps
Action: Describe the value sets. Bob Dieterle FM
Action: Create examples. Bob Dieterle FM
Next WGM joint session we will meet again.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action:
Next Meeting/Preliminary Agenda Items
  • .

Thursday Q3

HL7 Patient Administration Meeting Minutes

Location: Maritime Hotel, Cologne, Salon 20 Fulda

Date: 2018-05-17
Time: Thursday Q3|- 		Facilitator Brian Postlethwaite Scribe Cooper Thompson
Attendee Name Affiliation
X Irma Jongeneel HL7 The Netherlands
X Tricia Chitwood Cerner, USA
X Christian Hay GS1, Switzerland
X Brian Postlethwaite HealthConnex, Australia
X Simone Heckmann HL7 Germany
X Cooper Thompson EPIC, USA
X Lloyd McKenzie Gevity ,Canada
X Brian Postlethwaite Telstra Health, Australia
X Eric Haas Health eData Inc., USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

  1. FHIR Work

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions

Lloyd joined the WG to discuss moving animal out of Patient.
Tracker: 14880

Three main areas for discussion:

  • Is modifier
  • Maturity
  • Psychological impact


There is a separate discussion going on about default values. The question about animal would likely imply that the default is “human”, and the animal property would indicate that the resource is a non-human.

For the pharmacy and laboratory areas, it is unclear whether Patient.animal is relevant. Does a pharmacy care that the prescription is for a dog vs. human in order to dispense it? For Laboratory, the issues around reference ranges, etc. apply even beyond the scope of just animal, i.e. for other non-Patient specimens.

Lloyd has big concerns about removing animal being an indication to the community that veterinary is not in scope. the WG counter to that is that we always intended to have guidance in the patient scope section indicating that veterinary is fully in scope.

One potential option is adding a core property that indicates if the patient is human or not, with values of (human, animal, unspecified)

Lloyd had to leave to PC

Within PA, there was some difference of opinion around a “isHuman” flag. Some like it as a compromise, however others object as it is inconsistent with other areas of they FHIR spec where you just omit the property if you don’t know or care about it.

To account for the request to create an Animal resource, we suggest that Animal is just a profile on Patient.

Eric Haas joined

For pharmacy scenarios, it seems more appropriate for the Canine indicator to be on the order.
For large herd inoculation, you wouldn’t have 250 patients. You’d just have a single client or group instead.

Tracker: 14880
Motion: Move animal to a standard, non modifier, extension

               Cooper Thompson/Andrew Torres: 7-0-0

Action: Brian to bring up Patient.animal at FMG and talk with Grahame as the product directory. Proposal is to move animal to a standard, non-modifier, extension.

Tracker: 15106 - linked/merged patients
Scenarios: Chart Advisories for letting users see that a patient was merged. In v2, this was done via the A18, but RESTful FHIR isn’t messaging oriented, so the only way for a system to know they should let a user know of a merge is to see a property.
Motion: Not Persuasive - The replaces/replaced-by link is special enough that we want an exception from the QA check

               Cooper Thompson / Irma Jongeneel: 6-0-1


Tracker: 14826 - phonetic searching on organization
Motion: Non-persuasive - implementing a phonetic search is up to the implementer, and not something the spec will mandate

               Andrew Torres / Cooper Thompson: 5-0-2


Tracker: 14836 - add job title to PractitionerRole
Initially we like adding a job title to practitionerRole, however once we got into discussion about what data type, we tried to find a use case, had some trouble, and considered an extension. However given that we had no real use case for this, we opted to kick it back to the “Chat” for discussion.

Motion to adjourn by Cooper Thompson

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • .
Next Meeting/Preliminary Agenda Items
  • .

Thursday Q4

HL7 Patient Administration Meeting Minutes

Location: Maritime Hotel, Cologne, Salon 20 Fulda

Date: 2018-05-17
Time: Thursday Q4
Facilitator None Scribe None
Attendee Name Affiliation
X None None
Quorum Requirements Met (Chair + 2 members): No

Agenda

Agenda Topics

  1. Meeting Cancelled

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Meeting Cancelled

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • .
Next Meeting/Preliminary Agenda Items
  • .

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