2010-03-18 Call Minutes

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HL7 Ambulatory Oncology Functional Profile Meeting

Meeting Logistics

Date/Time: Thursday, March 18, 2010 / 1:00 PM – 2:30 PM EST

Location: Phone: 1- 770-657-9270; Passcode: 510269

URL: http://mt202.centra.com/main/Customers/ncicb/ EventID: HL7

Attendees

• Helen Stevens (co-chair & Scribe)
• John Ritter (co-chair HL7 EHR Workgroup)
• Christine Bester
• Dr. Kevin Hughes
• Dr. John Ellerton
• Dr. Peter Harrison
• Marjorie van der pas
• Cliff Thompson

Minutes

1. Welcome and Introductions
2. Agenda review and approval
3. Minutes approved from previous calls: March 4th
4. Review Actions from previous meeting(s)

   February 11th Call

   1. ACTION: All team members to review glossary and submit changes/comments for next call.
      • Closed – Helen has received additions to the glossary from Marla and Dr. John. This specific action will be closed and the glossary will be part of the document review activity below.
   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: Helen to contact International Council members and see if there is any interest to participate in the project before the ballot.
      • Open – Helen to request addition to agenda for the HL7 IC meeting in Rio.

   March 4th Call

   1. ACTION: Christine to follow up with John E regarding his input/review of the Glossary
      • Closed – completed and input received.
   2. ACTION: Marla to continue adding definitions to the Glossary for new terms
      • Closed – glossary additions/changes incorporated into document review below.
   3. ACTION: Peter to submit guiding principle statement that can be included in the Overview and used to guide the editing.
      • Open – Peter to work with Helen on language to be added to the overview document.
   4. ACTION: Helen to add EHR Module Certification and discussion of family history and personalized genetics to March 18th conference call.
      • Completed.
5. Special Discussion Topics (1:15 - 2:00)
   • This section has been added, as requested, to the start of the agenda to allow for time boxed discussions on specific topics to support the development of principles that guide the detailed analysis.
   1. EHR Module Certification – Dr. Kevin Hughes (1:15 – 1:30)
      • Dr. Kevin introduced the topic and spoke to the importance of regocnizing that in the oncology EHR world there is a role and need for specialized modules that support specific oncology requirements. Examples include Chemotherapy dosage calculators and Adjuvant Online that is a module that supports Clinical Decision Support. The issue is that currently these modules are not included in EHR requirements and/or EHR systems do not integrate with them necessitating the re-entry of clinical information into the module that already exists in the EHR.
      • Is the certification of modules such as these part of the CCHIT mandate and the new directives regarding EHR module certification? The reference to CPOE (Computerized Physician Order Entry) modules could be general – but could it also apply to an oncology specific CPOE module that supports chemotherapy requirements? How do we identify types of CPOE?
      • How can the requirements for these modules be reflected in the FP requirements? John Ritter suggested that the Oncology FP should articulate all the requirements for the oncology systems including the specialized requirements (perhaps as separate conformance criteria or requirements). However, it should stay mute on the topic of if these functions should be satisfied by separate specialized modules, or included in the core EHR. This would be the decision of the implementation.
      • Suggestion that we include language in our Overview document that speaks to the necessity for the EHR to support these requirements; however, that they could (and maybe should) be supported through appropriate (standards based where available) integration with the EHR. Helen pointed to some language that has already been added to the Overview (sections 1.4 and 1.5) on this topic.
      • ACTION: Dr. Kevin to review Overview section 1.4 and 1.5 and update to reflect the expectation of support for the Oncology requirements either through a single EHR system, or through interoperability with a specialized modules.
      • ACTION: John Ritter to provide language to include in the Overview document that speaks to the different uses of the Functional Profile.
   2. Family History and Personalized Genetics – Dr. Kevin Hughes (1:30 – 1:45)
      • 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.
      • Dr. Kevin introduced the topic and discussed the importance of including in the functional profile specific references to key standards that need to be supported. These include some AHIC and HL7 standards as well as some ISO standards. Helen suggested that we could include general language in the functional profile requirement conformance criteria "use of current jurisdictionally approved standards such as HL7, ISO and AHIC" – but then include in the Overview document a specific list of standards with references that are current at time of publication. That will allow us to be specific, but also accommodate updates to standards over time.
      • ACTION: Kevin to put together an initial list of standards that should be included in the overview document including: Standard Name, Reference (e.g. id number, URL), description of where/how it should be used.
   3. Ballot Strategy Proposal - Helen Stevens (1:45 - 2:00)
      • Discussion of proposal for phased balloting to address concerns raised by team members and also enable incorporation of additional input from NCI.
      • Helen introduced the topic as having come from the discussion on the previous conference call. Helen suggested the need to balance several drivers:
        • The need to show progress and to actually progress the functional profile development – sensitive to the need of the industry for a solution in the next year. This is not a profile that will be relevant if it is not delivered for 2 years.
        • Recognition that some members do want to do a line-by-line review and discuss the details of the functional profile and conformance criteria. Note: John Ritter clarified that it is not a requirement prior to go to ballot that all members of the workgroup participate in this level of review.
        • Recognition that some members of the work group do not have the band-width to participate in weekly calls and to do a line-by-line review of the functional profile but would rather participate in discussions that set 'guiding principles' that are followed in the detail requirements.
        • Recognizing that we have limited participation in the WG (no international yet) and that we need to encourage additional interest; however the pool of available experts is very shallow. A ballot cycle may generate some interest.
      • Helen suggested that we proceed with publishing the Overview document in this ballot cycle as a Draft for Comment and not include the detailed requirements and conformance criteria. The benefit of this will be that we will have a ballot cycle to generate interest and show progress so far; the Overview gives a good description of the profile including the Storyboard and Glossary that has undergone work group review; and voter attention will not be diluted by the Requirements sections that are not ready for review – so we should have better comments on the Overview document (i.e. minimizes voter fatigue).
      • John Ritter expressed support for this approach and identified the advantage of minimizing voter fatigue by only putting forward the Overview.
      • Peter Harrison also felt it was a good approach; however, continues to have concerns over ensuring that detail line-by-line review of the Requirements continue in an open forum.
      • A straw vote was held and there were no objections to this adjusted balloting strategy.
      • ACTION: Helen to work with EHR WG and HL7 HQ to adjust the ballot strategy as discussed.
      • Peter suggested that we alternate the weekly conference call to support detail review and high level discussions on alternate weeks. Helen agreed – after the April 9th deadline for the Overview section to be submitted to HL7 for the current ballot. Peter agreed and a schedule was agreed upon.
      • ACTION: Helen to setup conference call schedule and highlight on the wiki the topic of discussions. March 25, April 1 and April 8 focus on preparing the Overview for ballot. April 15 Detail Requirements review (DC1); April 22 Regular team call etc...
6. Document Review Session (2:00 – 2:30)
   1. Glossary
      • Glossary was briefly reviewed with several attendees self-identifying to continue to make updates.
      • Also reviewed the Overview document and identified sections to be reviewed for next call.
   2. The Direct Care sections were not reviewed, but it was noted that Peter had submitted input to the DC.1 and DC.2 sections. These will be reviewed offline by Helen and Peter in preparation for the April 15th conference call.
7. Decision on document review for next meeting
   1. Next meeting will focus on the Overview document Section #1.
      • 1 Introduction (Reference)

        1.1 Functional Profile Scope

        1.1.1 Medical Oncology

        1.1.2 Surgical Oncology

        1.1.3 Radiation Oncology

        1.1.4 Pediatric Oncology

        1.1.5 Geriatric Oncology

        1.2 Background

        1.2.1 HL7 Electronic Health Record Functional Requirements

        1.2.2 Certification Commission on Health Information Technology

        1.2.3 National Cancer Institute - Cancer Electronic Health Record Project

        1.2.4 Project Methods and Project Plan

        1.3 Standards Basis

        1.4 Systems, Components and Applications

        1.5 EHR Interoperability – Family History Example

        1.5.1 Personal Health Record Interoperability

        1.5.2 Niche Program Interoperability

        1.6 Interoperability

        1.7 Language

        1.7.1 Glossary

8. Other business
   • None
9. Meeting adjourned 2:32pm EST.