October 17, 2017 CBCP Conference Call

Community-Based Care and Privacy (CBCP) Working Group Meeting

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Meeting Information

Dial-in Number:  (515) 604-9861;  Access Code: 429554
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Attendees

	Member Name		x	Member Name		x	Member Name		x	Member Name
x	Johnathan ColemanCBCP Co-Chair		x	Suzanne Gonzales-Webb CBCP Co-Chair		x	Jim Kretz CBCP Co-Chair		x	David Pyke CBCP Co-Chair
x	Kathleen Connor Security Co-Chair		.	Mike Davis		.	John Moehrke Security Co-Chair		.	Diana Proud-Madruga SOA Co-Chair
.	Mohammed Jafari		x	Ali Khan		.	Ken Salyards		.	Ken Sinn
x	David Staggs		.	Steve Eichner		.	Ioana Singureanu		.	Beth Pumo
x	Chris Shawn		x	Neelima Chennamaraja		.	Joe Lamy		.	Joseph Quinn
.	[Irina Connelly ]		.			.			.

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Agenda

1. (05 min) Roll Call, Approve Agenda
   • Approve Meeting Minutes for October 10th call.
2. (05 min) CBCC FHIR FRIDAY call at 2:00 ET // FHIR Consent Directive Project Wiki, Main page... new day/time?
   • FHIR Consent discussion
   • FHIR Consent CPs are located: link to ALL Change requests
3. (05 min) Security and Privacy Impact Assessment Cookbook (SPIA) - SUR definition - Suzanne
4. Behavioral Health special Interest Group (BH-SIG) - "Condition" FHIR resource discussion (Piper Ranallo in November)
5. Patient Choice Technical Project
6. September 2017 CBCC Working Group Meeting - San Diego, California USA, September 10-15, 2017 DRAFT MEETING MINUTES
7. January 2018 CBCP Working Group Meeting - New Orleans, Louisiana USA, January xx-xx, 2018 DRAFT Agenda

Please contact a CBCC Co-chair if you wish to add agenda items! Thank you!

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Meeting Minutes (DRAFT)

• Suzanne chaired.
• Reviewed minutes, and approved.
• Agenda had addition of Johnathan report out on Patient Choice Technical Project for Research.
• Dave Pyke reported on FHIR Consent -More attendees perhaps because of changed time. Discussion about Advanced Directives, about whether to link to CDA Advanced Directive, point to Care Plan or Order, and point to FHIR Contract for the signed legally binding Advanced Directives, e.g., personal representatives. Appropriate searches. Dave to create an example.
• Suzanne: No update on SUR review by TSC. If they disagree, then CBCP will drop the term from the SPIA.
• Johnathan: No update from Piper on BH-SIG. JC read email. Planned to attend today but unexpected travel. Plan to meet with CBCP until Nov. 24th. Would like a joint at January WGM Thursday Q2.
• Suzanne - Irina email requesting joint at January WGM.
• Johnathan - Patient Choice Technical Project - Met with REACHnet - their research project going well. Encouraged them to share with the FHIR Consent WG. Last community meeting, presentations on September Consumer Centric Data Entry Connectathon Track by Aaron Seib, Bo Dagnall, and Debi Willis.
• Johnathan asked Suzanne about status of TSC review of requested extension of the DPROV CDA IG DSTU comment period.
• Call transitioned to review of FHIR Consent CRs
• CR 13359 - recommended changing Consent.provision.code data type from coding to codeable concept for when no code is known or appropriate. Jim raised the issue of text not being interoperable. Kathleen argued that use of codeable concept rather than coding, and that it supports situations where no code is available because text can be used instead. Kathleen pointed out that the by Consent.provision.code definition "If this code is found in an instance, then the rule applies", use of text would not be allowed. David asked for other's opinions. Neelima concurred. Kathleen moved to change coding to codeable concept , Suzanne seconded. Motion approved: 8-0-0
• CR 13420 John's comment: "

We have discussed in years past that Australia had a Privacy Consent where break-glass was not allowed. We understand that has changed to allow break-glass. Thus we didn't know of a case where a Consent forbid break-glass... I have been made aware of Utah HIE that has a checkbox on their Consent to forbid break-glass. This is a consent only for HIE, not for within a hospital environment; but it is relevant to our FHIR consent (and CDA consent) work. Thus I think it is useful for us to provide it as an example, and work through how it might be expressed." David noted that John had only the UTAH HIE example so this requirement might not be in the 80%. Kathleen noted that she's seen other HIEs that make an opt-out inclusive of emergency treatment. David asked if we had any international examples. Decision was that CBCP should send out to the list to get an understanding of how wide spread a break-glass prohibition ability exists.

• CR 10692 John commented "With the addition of Treatment, AD, and Research; it becomes more important to show how a group of Consents would be treated as one. For example a Research Consent is often a treatment consent, and a privacy consent. Thus I would expect to see two Consent records to cover these specific perspectives, and one more object that groups these together to assure that they are executed as one." After discussion, the motion was made that rather than add multiple consent directives into the Consent Resource, use Bundle for use cases where there is a need for a compound consent. Suzanne moved to approve decision to use Bundle. Johnathan seconded. Motion approved: 8-0-0
• CR 13778 John commented that "I can't come up with a use-case where a consent would be created, but one does not yet know what kind of a consent it is going to be. The category is so critical to differentiate between the major consent types (Privacy, treatment, advanced directives, etc.) that it must be filled out." John proposed to change Consent.category (A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements) from 0…* to 1…1 because the addition of Consent.scope and its definition (A selector of the type of consent being presented among the four possible: ADR, Privacy, Treatment, Research) removes the need to more than one category, and the category must be known) makes category mandatory. Kathleen argued that multiple categories should be allowed because some HIE consent forms combined multiple consent directives, which on their own have different policy parameters and legal basis.
• Suzanne moved to approve modification to the CR request, making Consent.category 1..*. Jim Kretz seconded. Motion approved: 8-0-0.
• Meeting adjourned.