Clinicians on FHIR 2015 - October: Atlanta

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Introduction

The October 2015 Clinicians on FHIR event will be held on Friday 9 October at Atlanta (http://www.hl7.org/events/wgm102015/).
This is following a series of successful similar events which started as the Clinical Connectathon event in September 2014 WGM at Chicago
The key objectives of this event are to facilitate the engagement of clinicians to provide:

  • a forum for testing of FHIR resources for clinical "fitness-for-purpose"
  • clinical inputs to the design and continuous quality improvement of FHIR resources (mainly clinical resources, but may provide inputs to administrative resources where appropriate
  • advance clinicians expertise in FHIR so that they can support development, testing and implementation of FHIR resources and profiles


The Participants
This event is open to all clinicians attending the October 2015 HL7 WGM in San Antonio.
Clinicians who are interested will need to register for the clinician connectathon (Friday, xx/10/2015 Event) when signing up for the October 2015 WGM.
Registration is required so that HL7 HQ knows how many to expect and organise the required infrastructure and catering.
Some web sessions may be planned before the meeting to prepare participants.

Note - the Clinicians on FHIR event is intended for clinician participants to test and review FHIR resources against clinical requirements defined in the clinical storyboards/scripts.
Non clinician participants interested in Clinicians on FHIR event can join the technical connectathon event. Details of FHIR technical connectathon are available here:

  • .... Placeholder for URL


Participants:

- The October 2015 Clinicians on FHIR event participation will be limited to clinicians.
- Proposal to admit non-clinician as observers at the Clinicians on FHIR event will be reviewed leading up to future events


Date:

Friday 9 October 2015 - Clinicians on FHIR event (registration required)
Orientation lunch -- will be held on Wednesday October 7 from 12:30 - 1:30 in Georgia 2 for registered participants. Please grab your lunch and familiarize yourself with the tools and use cases that will be used during the Clinicians on FHIR Friday event.


Registration/Participation Fee
No additional fee will be charged for clinician participants who registered for the full October 2015 WGM event.
For future clinician connecthaton, decision on registration fee will be reviewed and decided by HL7 HQ. Further information will be available when HL7 HQ has determined the relevant policy decision.


Clinicians on FHIR event Streams/Groups

It is planned that a number of streams/groups will be run during the October 2015 Clinician on FHIR event. Clinicians participating in the event can self select into one stream/group to test drive the resource(s) assigned to these streams/groups.

  • Resource 1: Care Plan:(Laura)
- (details to come in here)
- (more details)
(http://www.hl7.org/fhir/careplan.html)
(http://www.hl7.org/fhir/goal.html)


  • Resource 2: Procedure - ERCP:(Stephen)
- History
o a 42 year-old Caucasian female with past medical history of irritable bowel syndrome
o Current complaint:
~ diffuse abdominal pain accompanied by subjective fevers and chills and nausea and vomiting for 2 days
- Physical exam:
o guarding in the RUQ; exquisite diffuse tenderness over the entire abdomen; no rebound; Murphy’s sign +ve; mild scleral icterus
o Vital signs: febrile, mild hypotensive; tachycardia and techypnoea
- Blood work: leukocytosis; elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and amylase
o CT Abdomen: cholelithiasis with a thin-walled gall bladder; choledocholithiasis with common bile duct dilated to 14 mm
- Diagnosis: cholelithiasis, choledocholithiasis, with pancreatitis
- Procedure: ERCP with sphincterotomy and stone extraction
- Outcome: no complication
(http://www.hl7.org/fhir/procedurerequest.html)
(http://www.hl7.org/fhir/procedure.html)


  • Resource 3: Condition:(Russ)
- (details to come in here)
- (more details)
(http://www.hl7.org/fhir/condition.html)


  • Resource 4: Family History: (John Holt, Scott Bolte, Viet Nguyen, Keith Campbell)
- Three generation scenario with likely genetic predisposion:

For extra credit, make use of a family from the Canonical Pedigree Project. The HAPI server has been pre-populated with the Green and Brown families.

CPP-Scenario 2-Jane Green-Pedigree 2-annotated.png
Simplified Family Tree for the Greens and the Browns
Index Name Gender DOB Died Notes
1 Peter Green male 1936-10-28
2 Bertha Green female 1937-10-28
3 Eric Brown male 1935-10-29
4 Mary Brown female 1936-10-28
5 Harry Green male 1960-10-22
6 Cindy Green female 1962-10-22 2005-10-22 Dx Breast Cancer, age 36
7 Paula Brown female 1960-10-22 2005-10-22 Dx Breast Cancer, age 37
8 Amy Brown female 1958-10-23 2006-10-23 Dx Breast Cancer, age 42
9 Frank Brown male 1956-10-23 2001-10-23 Dx Prostate Cancer, age 39
10 Jane Green female 1985-10-16
  • Dx Breast Cancer, age 30.
  • Likely BRCA1 variation that predisposes carriers to breast, ovarian, and prostate cancer.
  • Mutation risk, according to BRCAPRO, is 35%.
- Minimal History:
o Genetic family members diagnosed with a condition (e.g. breast cancer) at certain age (e.g. age 25)
o Outcome (e.g. in remission for 23 years with no sign of relapse)
- Risk assessment:
o Blood draw (e.g. for genetic profiling)
o Assessment (e.g. level of risk)
- Action plan:
o Patient education (e.g. breast self assessment ...)
o Referral for genetic counselling
(http://www.hl7.org/fhir/familymemberhistory.html)


  • Resource 5: Medication: (Emma and Pharmacy)
- Variations of PRN medication prescriptions
- Ibuprofen 600mg oral tablet - take 1 tablet Q6h PRN
- Ibuprofen 600mg oral tablet - take 1 tablet QID PRN as directed
- Ibuprofen 600mg oral tablet - take 1 tablet QID PRN as needed for knee pain
- Ibuprofen 600mg oral tablet - take 1 tablet QID for shoulder pain
- Insulin sliding scale medication order (Regular insulin SQ)
- Blood Sugar < 60 - follow routine hypoglycemia orders, obtain stat glucose and notify MD
- 151-200 = 4 units Regular Insulin SQ
- 201-250 = 6 units Regular Insulin SQ
- 251-300 = 8 units Regular Insulin SQ
- 301-350 = 10 units Regular Insulin SQ
- 351-400 = 12 units Regular Insulin SQ
- 401-450 = 14 units Regular Insulin SQ
- 451-500 = 16 units Regular Insulin SQ
- >500 give 16 units, obtain stat glucose and notify MD


- Medications stopped or held (for a reason)
- Female Caucasian, 72 years old with symptoms: fever, confusion,
blood + urine microbiology results: Pseudomonas and E.Coli +ve
body weight 64 kg, height 163cm (5'4")
eGFR = 58
- Gentamicin single dose: 4mg/kg (St Vincent Hospital protocol for patient >60yo)
dose: 4 x 64 = 256mg; rounded down to the nearest 40mg = 240mg in 100ml NS by IV infusion
~ Next dose in 36 hours (St Vincent protocol for eGFR <60)
~ hold if pre-dose serum gentamicin level = or > 1mg/litre


- Medications stopped because of allergy reason
- Amoxcillin 500 mg PO BID discontinued due to allergic reaction (wheezing)


- Medication with tapered or loading dosing
- Azithromycin 250mg Oral Tablet: 2 tablets on day 1, 1 tablet on days 2-5


FHIR Medication Resources links:
(http://www.hl7.org/fhir/medication.html)
(http://www.hl7.org/fhir/medicationorder.html)
(http://www.hl7.org/fhir/medicationdispense.html)
(http://www.hl7.org/fhir/medicationadministration.html)


  • Resource 6: Allergy/Intolerance and Adverse Reactions:(Elaine and Russ)
- (details to come in here)
- (more details)
(http://www.hl7.org/fhir/allergyintolerance.html)


  • Common Theme: Negation: (Rob Hausam and Laura)
- (details to come in here)
- (more details)



Suggested Groupings for Clinician on FHIR day:

  • Group 1
- Care Plan + Procedure + Negation


  • Group 2
- Family History + Condition + Negation


Group 3

- Medication +Allergy/Intolerance and Adverse Reactions + Negation


Recommended Preparations Prior to October 2015 Clinician on FHIR

To optimize the outcome the Clinician on FHIR day, participants are encouraged to engage in the following events/activities:

  • Familiarization with FHIR clinical resources by exploration through FHIR web tooling environment:
http://clinfhir.com/


  • clinFHIR Posts by David Hay
- http://fhirblog.com/tag/clinfhir/ (review in reverse order)
It is recommended that clinicians subscribe to this blog to get updates


  • Participate in the Fortnightly Clinician on FHIR conference calls:
- First call commenced on Tuesday 18 August at 5:00 pm US Eastern
- Second call: 1 September
- Third call: 15 September
- Fourth call: 29 September
- Note: additional conference calls may be scheduled where necessary (Tuesday at 5:00 pm US Eastern)
- Details (audio and webex) will be announce through the HL7 Patient Care Listserv


  • Placeholder for other activities ...



Reference Materials


The following documents are important/useful reference materials for clinicians interested in participating at the Clinician on FHIR event:

- please note that this is a working document and the contents will change leading up to the October 2015 Clinician on FHIR event


  • Clinical Storyboard:
- Participants or members interested in clinical storyboards developed to test FHIR clinical resources can access the documents through the following links:
http://wiki.hl7.org/index.php?title=Clinician_Connectathon_Storyboards_and_Clinical_Scripts



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