Clinicians on FHIR - Sept 2017, San Diego

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Introduction

The September 2017 Clinician-on-FHIR event will be hosted on Friday September 15, 2017.


Conference calls


Weekly preparatory conference calls are being hosted on Tuesdays at 5:00 - 6:00 pm US Eastern.

First Clinician-on-FHIR call starts: Tuesday May 23, 2017

Conference call details: please see HL7 email broadcast Phone Number: +1 770-657-9270 Participant Passcode: 943377

https://intermountainmeetings.webex.com/intermountainmeetings/j.php?MTID=m285042c1dfaad164ef45fcf2b7aa8619


Planning

Planning Calendar and Meeting Minutes


Goal = create at least one (or more if possible) meaningful example(s) (actual JSON resource instance) for each FHIR resource otherwise the limitation of the FHIR resource is identified.


Resources

Demo Videos

- Useful demo video
- ClinFHIR Demo 2017-09-05 for San Diego CoF
- Useful information on document building capabilities


Powerpoint Slides


Tooling and Supporting Information

  • Tool
- Participants registered for the Clinician-on-FHIR event are strongly recommended to familiarise themselves with the clinFHIR tool
- A new user interface has been created to support creation of clinical story built from a set of FHIR resources based on the clinical scenario described in the Tracks section below
- Logon to the clinFHIR site:
- [clinFHIR.com/]
- Connect to the FHIR servers by selecting the appropriate Data Server (e.g. Public HAPI DSTU3), Conformance Server and Terminology Server
- click on the "Tool" icon on the top right hand corner of the clinFHIR page and select "simple builder" option
(Note - "simple builder" will soon be changed to "scenario builder")


  • Supporting Information
- To be included



Clinician-on-FHIR Tracks


Track 1

Introductory

  • Track lead: Viet Nguyen and Russ Leftwich
  • Details - TBA on the day
  • Preparations: - view the demo videos


Track 2

Track 2a: Diagnostic

  • Track lead: Rob Hausam
  • Clinical Scenario
- Type 2 Diabetes patient
- PCS instructs patient to perform the following at home as per CarePlan
- BSL x 3/day; BP x 1/day; Body weigh x1/week
- At follow-up consultation in 4 weeks, PCP reassess patient and requested:
- Fasting blood glucose, Fasting lipids
- At follow-up consultation, patient also complains of productive cough (greenish sputum) and fever
- PCP requested: sputum for microbiology test
- PCP makes a diagnosis
  • FHIR Resources used:
Observation, DiagnosticRequest, Condition


Track 2b: Medication

  • Track leads: Melva/John Hatem
  • Clinical Scenario
- Type 2 DM patient
- PCP reviews patient's medication history, performs medication reconciliation where necessary, requests diabetic medications (and other relevant medications, e.g. antibiotics for respiratory infection), updates medication list, medications dispensed by pharmacist, and administered by patient
  • FHIR Resources used:
Medication, MedicationRequest, MedicationDispense, MedicationAdministration, MedicationStatement, MedicationList (List resource)
  • Questions: what about new instructions to patient? recommendation to prescriber?
Plan medication management in CarePlan resource: medication order through to administration



Track 3

CarePlan

  • Track lead: Emma Jones/Laura
  • Webex
  • Clinical Secenario
- Patient with Type 2 Diabetes managed by multi-disciplinary care team with PCP as care coordinator
- Multi-disciplinary care plan created by PCP after discussions with patient to coordinate care management
  • FHIR resources used in this track:
- CarePlan which references the following resources:
CareTeam, Goal, Condition, Observation, DiagnosticRequest, ReferralRequest, MedicationRequest
+/- Vaccination
Issue to be resolved - what to use for Patient Instruction?
* Diabetic Care Plan Test Data
* Clinical Workflow needs and the use of planDefinition to drive care planning



.....

Report Out

Care Plan

Worked on the use of workflow resources (ActivityDefinition and PlanDefinition) to generate a care plan for a patient.
also looked at a CDA representation of Care Plan and made some progress on moving the CDA care plan document to FHIR care plan 'document'.
reported some gForge items - 1) Ability for carePlan resource to reference activities that have ocurred, not just request type activities 2) goal extension is mis-named
would be nice to have a tool that is a storyboard builder - not just a static point in time builder. Want to be able to build the story over time.

Medications

were playing with Scenario builder a bit. like the idea of hte storyboard builder. Want to be able to flow resources together to tell the story of the medicaiton process. Dosage was not completely specified in ClinFHIR so unable to see it fully built out in ClinFHIR. Cannot create a detected issue resource to add into the medication resource. It is not in the list of resources. spent quite a bit of time at the table talking about the resources and what they do. Also played with the query and need to to more to look at all the parameters of the query function.

Adverse Event

tested but not to the extent they would like
group was 2 people - worked great - recommend it for the future too. even if more then one group at a table.
the ClinFHIR tool - scenario builder is excellent - was able to visualize it.
Some of the elements - value set needs to be extended. Adverse event needs a better value set.
have started a google doc wth what they have done - get the link and put it here
the work did identify a gap in the resource and they will put a gforge item in.

Diagnostic Ordering and Reporting

started out with a basic order (lab test)
Then started breaking out into small groups and worked in paraell.
took a little bit to get the hang of using the tool again.
discovered some value set bindings that are not correct - would be nice to be able to select LOINC codes - currently limited to snomed.... need to get note to David Hay
when they did see and get a LOINC list - it was collapsed into one long list.... not hierarchical as in LOINC
the scenario builder - only the one who created it could save to it. Others could not add to the same scenario.
taking existing patient resource and the linked resources to that patient can be brought into another persons scenario.
when trying to link observations into diagnostic reports - could see a plus sign - but couldn't see the specific item data (that it was the sodium observation..)
the dosage element for the resource - had some glitches with "click here to..." and nothing really clicked.
in general attending this helps clinicians learn to use FHIR - but what does the FHIR team want to gain from this....Viet - 1st - gforge feedback to improve the standard, Lloyd - we get to see what the problems are with the resources if they are not meeting the clinical requirements, we get more people to understand FHIR and they can be more productive, address change requests etc.


Newbie Session

appreciated the one on one time
could slow it down
Seems like a lot of people got lost really quickly - need handouts for those who got distracted and needed to catch up.
need to put the URLs on a handout.
Looked at clinical outsome... working rom the diagnosis an dtreatemnt but also getting the cuastions and trying to crate a measure to see if the patient has gotten better. Not sure you can do this in FHIR / CHIR resources.
Looked at Vitamin D deficiencies and the altittude.... CDS at ClinonFHIR???


general=

create a patient repository that we could just pull patients into scenarios
cannot differentiate from conditions when linking to a resource. need to use the text field... perhaps could help find it.
we need to be careful and clear about issues with the resources and issues with the tool. sometimes the tool is not quite there yet to do what we want it to do. May need to have both tools open at the same time.
Need to break this into two tracks - newbies and the other work.
David Hay was not available to do the tutorial this week.
have you though of surverying the FHIR work groups for what they want to know from the clinicians?
This event is called clinicians on FHIR - the point is to tap into the knowledge of the clinicians. - having said that we have opened it up to technical people and we work side by side with them - and we learn from that - it should remain a focus on the clinical input - may need to consider a 3rd avenue - for the track not met with the technical weekend and the clinicians
don't overload this day with all these other activities.
Test cases - think "can you create and example that does....X".
need to do work with the ClinFHIR tool on the Tuesday at 5 ET call so we can have a better collective knowledge of the tool.
don't forget to use Zulip for communicating tool issues to David Hay as well.


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