2010-03-04 Call Minutes

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HL7 Ambulatory Oncology Functional Profile Meeting

Meeting Logistics

Date/Time: Thursday, March 4, 2010 / 1:00 PM – 2:30 PM EST
Location: Telecon 866 564 2805 x9306830#
  • Helen Stevens (co-chair)
  • John Ritter (co-chair HL7 EHR Workgroup)
  • Christine Bester (scribe)
  • Dr. Peter Harrison
  • Andrew Johnson
  • Dr. Kevin Hughes
  • Dr. Marla Hawkins, MD
  • Mollie Ullman-Cullere
  • Sandy Stuart


  1. Welcome and Introductions
  2. Agenda review and approval
  3. Approval of minutes from previous calls: February 24th
    • Approved with one abstention
  4. Update on approval of HL7 Intent to Ballot
    • Helen provided the update that the Intent to Ballot was successfully filed with HL7 opening the opportunity for us to ballot in this next cycle if we wish to do so.
    • Peter expressed concern around going to ballot now as the profile has been developed to this point by a small group and he felt that the review by the rest of the HL7 members would take a long time. He is concerned that a broad enough audience has not had input yet.
    • Helen suggested that a benefit to going to ballot now would be that a broader audience will get to review and have input back on the AO FP.
    • Peter expressed concern that ballot will expose to that broader audience that are not necessarily stakeholders and impact outcomes
    • Kevin suggest our review would allow for changing the conformance statements from SHALL to SHOULD where appropriate if that would make it more palatable to a wider audience.
    • Agreement on if we should ballot this cycle was not reached, but it was agreed that we would continue with our aggressive schedule in March to review the material as much as possible.
  5. Upcoming call schedule
    • Helen reviewed the additional calls scheduled for the next month - March 18, 25, 1 and April 8 which is the deadline for ballot submission.
  6. Review Actions from previous meeting(s)
    February 11th Call
    1. ACTION: All team members to review glossary and submit changes/comments for next call.
      • Open – Helen has received additions to the glossary from Marla; however, there are still several terms that need to be defined and reviewed.
    2. ACTION: Christine will add “Nurse Navigator” to the glossary as it compares to “Care Coordinator”.
      • Open – Christine is awaiting a response from the nursing association for the formal definition.
    February 25th Call
    1. ACTION: John Ritter to setup conference calls for the additional dates (same time and other logistics).
      • Completed – thank you.
    2. ACTION: Helen to contact International Council members and see if there is any interest to participate in the project before the ballot.
      • Open
    3. ACTION: All attendees to email Helen (helen.stevens@shaw.ca) their organizations/affiliations for inclusion in the FP Acknowledgements.
      • Recieved from some, but not all.
    4. ACTION: Molly to document the capabilities of Decision Support tools and Clinical Genomic tools and send to Helen for inclusion in the Storyboard or as part of the FP Overview.
      • Completed – see below
    5. ACTION: Marla Hawkins and John Ellerton will review the glossary and send Helen updates by March 3rd.
      • Marla has submitted comments (see below).
  7. Document Review Session
    1. Marla Hawkins Storyboard Submission
      • Marla reviewed her additions to the storyboard to reflect the use of Clinical Decision Support Tools.
      • Are these the only places for CDS in the narrative? No - No they are just a few examples.
      • Suggestion to remove the "if available" clauses – Helen made edits during the call and changes were approved.
      • Mollie is concerned that there is a disconnect between this narrative and Kevin, Mollie personalized genetic medicine personalized genetic used case based on core data standards for family history and personalized genetic data that is approved by HITSP. CCHIT would potentially end up with two separate stories; this way they will avoid any future collisions by combining components from both.
      • Mollie and Kevin will work offline to ensure that the narrative reflects this appropriately and will submit suggested changes.
    2. Glossary
      • Glossary - Marla Hawkins Submission
        • Marla has identified a list of terms to be included but we will need definitions to be provided for them.
        • ACTION: Christine to follow up with John E regarding his input/review of the Glossary
        • ACTION: Marla to continue adding definitions to the Glossary for new terms
        • Suggestion to change immunotherapy to biologic therapy - decision to retain both terms
    3. Direct Care Section (DC.1)
      • Peter Harrison Submission
      • Marla Hawkins Submission
        • Helen has amalgamated Peter and Marla's comments into a single document Direct Care Section (DC.1) Work in Progress.
        • Row#1: Issue with the functionality to admit a patient into hospital. Is this a referral? Not typically seen as a referral in the traditional sense rather orders are created and sent to the inpatient facility. Could be captured as a referral or transfer of care
        • Row#1: Ancillary Notes, Special Progress Notes - is covered by DC.1.8.5
        • Row#1: Returned to clinic after referral - captured under external documents such as discharge summary. Add to the description of the requirement or create a normative narrative to ensure any nuances of the functionality are captured correctly
        • Row#1: Radiation Therapy - captured as summary information
        • Row#1: Research Visits - need to be capture as separate than a clinical visit. Often requests to distinguish between patient encounter and research specific tasks… plays largely into billing so that patient's insurance is not billed for research activity. Impacts patient care because they may be on a protocol which adheres to a strict set of rules. There is some financial functionality in the support section of the functional profile such as S.3.2.2.
        • Row#1: Narrative maybe required to ensure that patients on a protocol capture all necessary protocol rules are available
        • Row#1: Case Reporting - there is functionality for customizable reporting such as standard report generation S.2.2 and extract reporting IN.2.4
        • Row#1: Tracking Dose Modifications/Toxicities. Is there functionality to support tracking of dose modifications and toxicities? Especially with agents that are restricted life time doses.
        • Row#6, 7, 13, 14, 16, 17, 20, 21, 23: DC1.0 cc 5 re: IN1.6 to make the change here is redundant;
          • John Ritter as co-chair of the EHR WG recommended to validate without stakeholders that if data is exchanged outside of a secure network then it is an applicable criteria. There are instances of closed systems; but the condition still has validity. Principle is that the conditionality just in case there is a system out there the doesn't need it. Recommendation to cover this issue in the overview section regarding the exchange secure data.
        • Helen suggests that we need to establish some guiding principles regarding the level of change and constraint we should make to the FP. For example, if we are confident that all ambulatory oncology EHR implementations are going to meet a constraint – such as be used to "extract data for analysis and reporting" as in row#13 - then we can remove the conditionality statement.
        • ACTION: Peter to submit guiding principle statement that can be included in the Overview and used to guide the editing.
      • Helen expressed that having spent 30 minutes discussing just a couple of comments above – it is apparent that a line-by-line review during calls is going to take a very long time. This has also been the experience of the EHR WG working on Release 2.0.
      • Mollie asked if it possible to triage the proposed changes or do we need to discuss each change as a group?
      • Peter felt that the entire group needs to be considered as these are changes from the EHR-S FM
      • Mollie asked if consideration can be given to those of us that only care about certain sections of the document as this is a huge time commitment that all participants can't commit to.
      • Helen suggested that over the next two weeks the group commit to going through and reviewing all the Direct Care functions. She encouraged members to use the list service to conduct discussions that supports the development of principles that will help guide the detailed review.
  8. Decision on document review for next meeting
    • Continued additions and refinement of the glossary
    • Direct Care sections (DC.1, DC.2 and DC.3)
  9. Other business
    • Unfortunately Kevin was not able to stay on the call to this point.
    • Mollie requested that the agenda be provided well in advance of the call with strict timelines so those participants who can only attend specific discussions will know when to join the call. Also asked that the discussions submitted be put ahead of the documents review on the agenda.
    • Helen apologized for letting the discussions run over and will commit to making these changes to the agenda and meeting going forward.
    • ACTION: Helen to add EHR Module Certification and discussion of family history and personalized genetics to March 18th conference call.
    • Helen asked if adding a meeting on March 11th would work to support this discussion. No there is potentially a conflict with AMIA conference.
  10. Agenda for next meeting (March 18th):
    • Discussion from Dr. Kevin Hughes - EHR Module Certification
    • Discussion from Dr. Kevin Hughes and Mollie Ullman-Cullere on the impact of family history and personalized genetics standards and relation to the oncology functional profile.
    • NCI caBIG project use of standards discussion
      • Guest: Dr. Juli Klemm, Associate Director, Integrative Cancer Research Products and Programs, NCI Center for Bioinformatics
      • Guest: John Speakman, Associate Director, Clinical Products and Programs, NCI Center for Biomedical Informatics and Information Technology
  11. Meeting adjourned at 3:32 pm EST