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2017-01-26 Patient Care FHIR Call
Contents
- 1 Meeting Information
- 2 Agenda
- 3 Supporting Information
- 4 Minutes
- 4.1 STU3 Action Items
- 4.2 Defer Ballot Comments
- 4.3 TOP Priority -- AllergyIntolerance, Condition, and Procedure -- QA Warnings/Information (desire FMM = 3)
- 4.4 MEDIUM Priority -- CareTeam, CarePlan, and Goal -- QA Warnings (desire FMM > 0 means we address all warnings)
- 4.5 MEDIUM Priority -- CareTeam, CarePlan, and Goal -- QA Information (desire FMM = 3 means we address all information)
- 4.6 LOW Priority -- All other resources -- QA Warnings (desire FMM > 0 means we address all warnings)
- 4.7 Block Vote (Thurs, Feb 2)
- 4.8 Adjourn
- 5 Meeting Outcomes
Meeting Information
| Patient Care FHIR Resources Conference Call Location: Conference Call |
Date: 2017-01-26 Time: 5-6:30pm ET | ||
| Facilitator | Michelle M Miller | Note taker(s) | Michelle M Miller |
| Attendee | Name | Affiliation
| |
| Elaine Ayres | NIH/Department of Clinical Research Informatics | ||
| X | Stephen Chu | The Australian Digital Health Agency (ADHA) | |
| Evelyn Gallego | EMI Advisors LLC | ||
| X | Eric Haas | Haas Consulting | |
| X | Rob Hausam | Hausam Consulting LLC | |
| X | Laura Heermann-Langford | Intermountain Healthcare | |
| X | Emma Jones | Allscripts | |
| X | Russ Leftwich | InterSystems | |
| Tony Little | Optum 360 | ||
| Jay Lyle | Ockham Information Services LLC, VA | ||
| Russell McDonell | Telstra Health | ||
| Lloyd McKenzie | Gevity (HL7 Canada) | ||
| Larry McKnight | Cerner | ||
| X | Michelle M Miller | Cerner | |
| Lisa Nelson | Life Over Time Solutions | ||
| Viet Nguyen | Lockheed Martin, Systems Made Simple | ||
| M'Lynda Owens | Cognosante | ||
| Craig Parker | Intermountain Healthcare | ||
| X | Joe Quinn | Optum | |
| X | Simon Sum | Academy of Nutrition and Dietetics | |
| Iona Thraen | Dept of Veterans Affairs | ||
| Serafina Versaggi | Dept of Veterans Affairs | ||
| X | Tracey Coleman | Allscripts | |
| X | Amit Popat | Epic | |
| Quorum Requirements Met: yes | |||
Agenda
Agenda Topics
- Agenda review
- Approve previous meeting minutes 2017-01-12_Patient_Care_FHIR_Call and 2017-01-25_Patient_Care_FHIR_Call
- Motion: Russ/Emma
- Prior Action Item Follow-up
- gForge change request
Supporting Information
STU 3 Timeline
From FHIR_Ballot_Prep
- Sun. Feb. 5 Ballot reconciliation deadline - All ballot comments must be reconciled, tracker issue report must be clean
- Sun. Feb. 19 Publication substantive resource freeze
- Sun. Feb 26 Publication total freeze
- Mon. Feb 27 QA period opens
- Tue. Feb 28 FMM QA spreadsheet updated for all WG resources
- Sun. Mar. 13 QA period closes
- Sun. Mar. 20 All QA applied
The "following week" STU 3 is published!
Minutes
STU3 Action Items
- Review Tracker Issues - https://docs.google.com/a/lmckenzie.com/uc?id=0B285oCHDUr09Mzh3b09rMFhEV1E
- Defer 12 ballot comments that won't get resolved by Feb 5 (see below for discussion today)
- Resolve QA Warnings to have resource FMM > 0
- Resolve QA Information messages to achieve FMM = 3
- Update QA checklist for resources that we want to be FMM = 3
- Review workflow gap analysis per GF#10293
- Block Vote (see below) scheduled for next week for low hanging fruit, i.e. non-ballot comments
- Apply changes (all "substantive" changes have been applied, except allergy, care team invariant, and workflow patterns)
Defer Ballot Comments
Motion: Russ/Rob H: 8-0-0
- GF#7185 2015May core #244 - ClinicalImpression is poorly thought out (Clem McDonald) Waiting for Input
- GF#10387 CommunicationRequest needs ability to describe the location that the communication is about (John Moehrke)
- GF#10621 QA 4a: Consider whether CarePlan.activity.detail.category should be bound to an external code system (Michelle Miller)
- GF#10622 QA 4a: Consider whether Goal.category should be bound to codes from an external code system (Michelle Miller)
- GF#10623 QA: Goal CodeableConcept elements are missing a binding to a value set (Michelle Miller) -- QA WARNING!
- GF#10635 QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller)
- GF#11026 Relationship between Condition and Observation - 2016-09 core #45 (Jay Lyle)
- GF#11209 Feedback on ClinicalImpression - 2016-09 core #363 (Riki Merrick)
- GF#11355 CarePlan category value set is out of date or wrong - 2016-09 core #513 (Robert McClure)
- GF#11357 Re-use the procedure value set instead of wrapping it - 2016-09 core #515 (Robert McClure)
- GF#11358 Should not make a new value set ehre - use the Problem value set that also includes Events and SWEC concepts. - 2016-09 core #516 (Robert McClure)
- GF#11359 Why only one medication in an activity? And the value set is problematic (but example) - 2016-09 core #517 (Robert McClure)
TOP Priority -- AllergyIntolerance, Condition, and Procedure -- QA Warnings/Information (desire FMM = 3)
- AllergyIntolerance
- Rob Hausam is helping with RIM mappings (clinicalStatus and verificationStatus)
- Rob Hausam is using data Elaine sent to see if we can curate the SNOMED CT Clinical Findings to a smaller subset. If not, then we'll update the binding for AllergyIntolerance.reaction.manifestation to use the same valueset-clinical-findings
- Duplicate Valueset Names: manifestation-codes (SNOMED CT Clinical Findings) & clinical-findings (SNOMED CT Clinical Findings)
- AllergyIntolerance.reaction.manifestation -- http://build.fhir.org/valueset-manifestation-codes.html
- DiagnosticReport.codedDiagnosis (and profiles) -- http://build.fhir.org/valueset-clinical-findings.html
- Resolved gForges, not applied yet
- GF#11020 Need use-case for reaction.certainty - 2016-09 core #39 (Jay Lyle) Resolved - Change required
Will move Reaction.certainty to an extension at least for now.
- GF#11021 Increase cardinality of substance and make certainty relation to substance not reaction - 2016-09 core #40 (Jay Lyle) Resolved - Change required
AllergyIntolerance.reaction should be removed and replaced with a choice of references to either a CodeableConcept ORÂ a new AdverseReaction resource. RCRIM agreed with the need for 2 new resources: AdverseEvent (such as patient falling out of bed) - RCRIM owned and AdverseReaction (such as drug/drug interaction) - PC owned
- GF#11023 Why isn't AllergyIntolerance.reaction an Observation? - 2016-09 core #42 (Jay Lyle) Resolved - Change required
Neither Observation nor Condition are well-suited to capturing the mixture of information about the substance administered the effect on the patient and inferences around timing and causality. As well such linking is not commonly supported by existing systems. Will define an extension that allows the reaction to point to an Observation or Condition record that provides further details about the reaction instance.
- GF#11354 Substance identified in both AllergyIntolerance.code and reaction.substance is problematic - 2016-09 core #512 (Robert McClure) Resolved - Change required
- Create an extension for the condition finding code (to raise visibility around needing a terminology service to extract out the substance from the finding/condition code) and remove findings semantic type from the AllergyIntolerance.code value set and add it to the extension's value set. (Negated codes can remain in the value set)
- The possible conflict between AllergyIntolerance.reaction.substance and AllergyIntolerance.code is mitigated by the existing comments in the specification "Identification of the specific substance (or pharmaceutical product) considered to be responsible for the Adverse Reaction event. Note: the substance for a specific reaction may be different from the substance identified as the cause of the risk but it must be consistent with it. For instance it may be a more specific substance (e.g. a brand medication) or a composite product that includes the identified substance. It must be clinically safe to only process the 'code' and ignore the 'reaction.substance'."
- GF#11020 Need use-case for reaction.certainty - 2016-09 core #39 (Jay Lyle) Resolved - Change required
- Condition is clean on the QA report!
- QA Checklist: GF#10635 QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller) -- deferred
- Procedure is clean on the QA report!
MEDIUM Priority -- CareTeam, CarePlan, and Goal -- QA Warnings (desire FMM > 0 means we address all warnings)
- CarePlan
- MnM exemptions requested for element names should be singular (addresses and replaces)
- Goal
- MnM exemption requested for element names should be singular (addresses)
- PCWG needs to address GF#10623
- WARNING:Goal.target.detail[x] Need to provide a binding
- WARNING:Goal.outcomeCodeableConcept Need to provide a binding
- WARNING:Goal.description Need to provide a binding
- WARNING:Goal.outcomeCodeableConcept Element has a todo associated with it (Define a proper value set for this.)
- GF#12718
MEDIUM Priority -- CareTeam, CarePlan, and Goal -- QA Information (desire FMM = 3 means we address all information)
- CareTeam
- RIM Mapping
- Goal
- RIM Mapping
- QA Checklist: GF#10622 QA 4a: Consider whether Goal.category should be bound to codes from an external code system (Michelle Miller)
- CarePlan
- RIM Mapping
- Examples
- CarePlan/activity/detail/definition Path had no found values in any example. Consider reviewing the path
- CarePlan/activity/detail/quantity Path had no found values in any example. Consider reviewing the path
- CarePlan/activity/detail/reasonCode Path had no found values in any example. Consider reviewing the path
- CarePlan/activity/detail/reasonReference Path had no found values in any example. Consider reviewing the path
- CarePlan/supportingInfo Path had no found values in any example. Consider reviewing the path
- QA Checklist: GF#10621 QA 4a: Consider whether CarePlan.activity.detail.category should be bound to an external code system (Michelle Miller)
LOW Priority -- All other resources -- QA Warnings (desire FMM > 0 means we address all warnings)
- ClinicalImpression
- Stephen Chu will work on examples to cover all elements
- ClinicalImpression.action Search Parameter 'ClinicalImpression.action' had no found values in any example. Consider reviewing the expression (ClinicalImpression.action)
- ClinicalImpression.previous Search Parameter 'ClinicalImpression.previous' had no found values in any example. Consider reviewing the expression (ClinicalImpression.previous)
- PCWG: ClinicalImpression.code Need to provide a binding
- Stephen Chu will work on examples to cover all elements
- Communication & CommunicationRequest
- PCWG: category Need to provide a binding
- PCWG: workflow could resolve GF#10293
- A resource must have an 'entered in error' status
- CommunicationRequest.subject Elements with name 'subject' cannot be a reference to just a patient
- FamilyMemberHistory
- PCWG: FamilyMemberHistory.condition.onset[x] Element has a todo associated with it (Define/find appropriate observation code.)
- ReferralRequest
- PCWG: Bindings/Value Sets
- ReferralRequest.type Need to provide a binding
- ReferralRequest.reason Need to provide a binding
- pc:ValueSetComparison Duplicate Valueset Names: v2-0284 (v2 Referral Category) & referralcategory (ReferralCategory) (name: [referrals, categories] / [referrals, categories]))
- pc:ValueSetComparison Duplicate Valueset Names: v2-0283 (v2 Referral Status) & referralstatus (ReferralStatus) (name: [referrals, statuses] / [referrals, statuses]))
- PCWG: ReferralRequest.description Element has a todo associated with it (This would be a good candidate for a 'markdown' data type.)
- Examples
- ReferralRequest.context Search Parameter 'ReferralRequest.context' had no found values in any example. Consider reviewing the expression (ReferralRequest.context)
- ReferralRequest.group-identifier Search Parameter 'ReferralRequest.group-identifier' had no found values in any example. Consider reviewing the expression (ReferralRequest.groupIdentifier)
- PCWG: Bindings/Value Sets
- Linkage
- PCWG: Linkage A resource must have an 'entered in error' status
- PCWG: Linkage All resources should have an identifier
- PCWG: Linkage.item Element has a todo associated with it (Make this 2..*.)
Block Vote (Thurs, Feb 2)
Non-ballot comments
- GF#12585 Add Goal.target.measure invariant (Michelle Miller) Persuasive
- GF#12645 CarePlan.activity.reference includes ProcessRequest (Dave Carlson) Persuasive
- GF#12646 Add "careplan-title" extension (Dave Carlson) Persuasive with Mod
- GF#12668 ClinFHIR: extension-condition-partof - add support for referencing Condition (Michelle Miller) Persuasive
- GF#12669 Please add note element to careTeam (Emma Jones) Persuasive
Adjourn
Adjourned at <hh:mm am/pm> <timezone>.
Meeting Outcomes
| Actions
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Next Meeting/Preliminary Agenda Items
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