2012-01-18 PA WGM Minutes

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Patient Administration Work Group Minutes - Wednesday January 18, 2012

Wednesday Q1

HL7 Patient Administration Meeting Minutes

Location: Garden Terrace, Suite 137

Date: 2012-01-18
Time: Wednesday Q1
Facilitator Alex de Leon Note taker Alex de Leon
Attendee Name Affiliation
X Alex de Leon Kaiser Permanente
X Irma Jongeneel HL7 Netherlands
Quorum Requirements Met (Chair + 4 members): No

Agenda

Agenda Topics

  • V2.8 - New proposals

Supporting Documents

Minutes

Minutes/Conclusions Reached:

There were no new v2.x proposals. The WG decided to continue with the reconciliation of the ballot comments for encounter. Having no quorum, the members decided to review and enter proposed dispositions and disposition comments looking forward to when the WG will have quorum and be able to formally vote on the dispositions. .

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • .
Next Meeting/Preliminary Agenda Items
  • .

Wednesday Q2

HL7 Patient Administration Meeting Minutes

Location: Garden Terrace, Suite #137

Date: 2012-01-18
Time: Wednesday Q2
Facilitator Irma Jongeneel Note taker Alex de Leon
Attendee Name Affiliation
X Line Saele Helse Vest IKT Norway
X Alex de Leon Kaiser Permanente
X Irma Jongeneel HL7 Netherlands
X Rene Spronk HL7 Netherlands
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

  1. V3 - Scheduling domain

Supporting Documents

Minutes

Minutes/Conclusions Reached:

There were neither stakeholders nor any new items for the scheduling domain.

The WG therefore decided to continue with the encounter ballot reconciliation.

In discussing the UB92 Line Item, there were questions about whether there should be US Realm notes, especially with regard to updates to the billing forms, electronic fields for billing (X12 837). The WG decided that the documentation should not retain such references. Therefore, the WG decided to remove all references to the UB form in the encounter domain specs.

In discussion of the item which contains the following text under the Existing Wording Column: “I am worried that the domain does not properly support a change in encounter type where the encounter id stays the same (out to in transfer)”, the WG recognizes the valid use case and has decided to mark this for future use, since the change of ID from fixed (along with other considered solutions) will have a significant impact on the current models. It will be put on the WG worklist.

Action Item: Put this on the worklist. Responsible: Alex de Leon

All typographic errors, the WG agreed would be voted upon as a whole.

A motion was made by Rene to accept all typographic errors within the reconciliation spreadsheet. Line seconded. No discussion

Vote (For/Against/Abstain): 3/0/0

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Place on the WGs worklist an item that addresses the comment upon the Patient Encounter Topic, Interactions (Sections 6.6.7-6.6.12) having to do with the use case in which the same Encounter ID is preserved, despite the change in patient status. For instance, how could an encounter ID be retained throughout changes of that encounter from "Out Patient" to "In Patient" or "In Patient" to "Out Patient" or other type of change (emergency to "In" or "Out", etc.). The Encounter ID is currently "fixed" per encounter. Responsible: Alex de Leon.
Next Meeting/Preliminary Agenda Items
  • .

Wednesday Q3

HL7 Patient Administration Meeting Minutes

Location: Garden Terrace, Suite #137

Date: 2012-01-18
Time: Wednesday Q3
Facilitator Alex de Leon Note taker Alex de Leon
Attendee Name Affiliation
X Wendy Huang Canada Infoway
X Line Saele Helse Vest IKT Norway
X Alex de Leon Kaiser Permanente
X Irma Jongeneel HL7 Netherlands
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

  1. Approve San Diego minutes
  2. Plan next meeting Draft Agenda
  3. V3 Work - Harmonization proposals

Supporting Documents

Minutes

Minutes/Conclusions Reached:

Our facilitator came to the WG meeting and asked to discuss the following ítems:
• Core principles
• V2 code tables migration V3 terminology model
• Migration to SNOMED CT
• Harmonization Process

Before delving into these topics, the WG engaged in some clarification/validation regarding the current facilitators. The following roles are being filled by the following WG members:

MnM (modeling facilitator) - Alexander Henkett
Publishing Facilitator – Alexander Henkett
Vocabulary Facilitator - Wendy Huang

In working with the vocabulary facilitator, Irma spoke about the work she is doing to harmonize the DMIMs from PA (Encounter) and PC (Care Provision). Within this harmonization, the idea was discussed to consider the care provision and encounter DMIM (after harmonization) as a joint responsibility and ownership, if this is possible. Our vocabulary facilitator clarified that HL7 generally prefers one point-of-contact for an effort, even if the responsibilities on that item are shared. Wendy will present the sharing of the DMIM to the MnM facilitator’s roundtable.

Action Item: Present to the facilitator's round-table, the idea of sharing the single DMIM containing the encounter/care provision topics between the PAWG and Patient Care. Responsible person: Wendy Huang

The WG presented to the vocabulary facilitator an item that came up while doing the Encounter Topic ballot reconciliation regarding linked encounters. We currently have two interactions one for mother/child and one for donor/recipient using the same encounter link RMIM. It was agreed to create a generic model that will need to differentiate those types of interactions in a code. This was presented to our vocab facilitator. The intention is to add an act relationship with a code to allow for these (and other) interactions to be defined.

  • Core Principles documentation – just informative now but will be normative. Joint between MnM and Vocab. This can currently be found on the website in foundation… core principles. Vocab section is coded model elements and their attributes. Coded Model Elments and their Vocabularies.
  • V2 code tables migration to v3 term model have been reviewing all tables in V2 (from all versions) to see how they can align better to the V3 principles such as code systems/value sets, etc. Also, identifiers will be assigned to code systems and value sets. Value sets are code sets pulled from various other code set tables for use in a particular instance.
  • Migration to SNOMED CT for V2 or V3. Historically, HL7 vocabulary has typically defined concepts when someone is trying to implement some codes only after the suggestion to look into other coding systems (e.g. SNOMED CT). Once not found there, HL7 has defined the concepts. The idea in vocabulary is to have all concepts that are in HL7 migrated to SNOMED CT. Vocabulary WG is looking for pilot WGs, to migrate their vocabulary concepts to SNOMED CT. Rather than volunteer to be a pilot for this work, the PA WG decided to monitor the work being done.

The WG was then presented with a harmonization item: Identifiers IM Design Pattern. This is a proposal for an identifier pattern. In HL7, identifiers are conveyed by the II datatype. However, this datatype only provides information needed to resolve unique identity. However, it does not provide any contextual information needed by humans, such as who issued the identifier, what type of identifier it is, etc. While this information is not always needed, it's commonly required. As well, when collections of identifiers are present it's often necessary to be able to distinguish the purpose of each of the identifiers.

Action Item: Our modeling facilitator to review http://wiki.hl7.org/index.php?title=Identifiers_IM_Design_Pattern to consider it's implications for the WG. Responsible Person: Alexander Henkett

  • Harmonization Process . There was a proposal made by Austin to the TSC that the harmonization meeting representation be part of the work group health metric. The outcome from today’s meeting is that the wording of the WG health metric say… if the WG has a proposal at harmonization, then the WG is required to send a representative. If there are no such proposals, then the presence is not required. This will then work into the health metric of the WG.

The WG reviewed the Link encounters – We might need a type code and a link. The type code will be fixed to “link” with the codes defining what type of link. Instead having a type code and a code, it could be a hierarchy under link, with type code values. This is really a modeling decision.

Action item: Wendy to look up the vocabulary relationship types for an appropriate element to use for linking encounters. Responsible person: Wendy Huang

Action Item: A touch-base call to discuss modeling items with Alexander Henkett. Proposed Feb 16th or Feb 20th. Responsible person: Alexander de Leon

Action Item: Intent to ballot the Patient Encounter Topic Responsible person: Alexander de Leon

The WG then proceeded to plan the next meeting (Vancouver)- Joint meetings
Patient Care – Tuesday Q1 PC to host.
No joint meeting with PS. Next meeting.
No joint meeting with SOA, however, they will be expecting a representative from PA to attend for 5-10 minutes during Q1 on Monday, at the Vancouver WGM, for status update on shared concerns. At this point, this would be around the Interdependent Registries project.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action Item: Present to the facilitator's round-table, the idea of sharing the single DMIM containing the encounter/care provision topics between the PAWG and Patient Care. Responsible person: Wendy Huang.
  • Action Item: Our modeling facilitator to review http://wiki.hl7.org/index.php?title=Identifiers_IM_Design_Pattern to consider it's implications for the WG. Responsible Person: Alexander Henkett
  • Action item: Wendy to look up the vocabulary relationship types for an appropriate element to use for linking encounters. Responsible person: Wendy Huang
  • Action Item: A touch-base call to discuss modeling items with Alexander Henkett. Proposed Feb 16th or Feb 20th. Responsible person: Alexander de Leon
  • Action Item: Intent to ballot the Patient Encounter Topic. Responsible person: Alexander de Leon
Next Meeting/Preliminary Agenda Items
  • Follow up from our vocabulary facilitator from the facilitator's round-table regarding sharing of a single encounter DMIM with Patient Care
  • Modeling Facilitator's feedback on the Identifiers IM Design Pattern
  • Link Encounter proposed element and codes.

Wednesday Q4

HL7 Patient Administration Meeting Minutes

Location: Garden Terrace, Suite #137

Date: 2012-01-18
Time: Wednesday Q4
Facilitator Alex de Leon Note taker Alex de Leon
Attendee Name Affiliation
X John Roberts Tennessee Department of Health
X Alex de Leon Kaiser Permanente
X Irma Jongeneel HL7 Netherlands
X Amit Popat EPIC
Quorum Requirements Met (Chair + 4 members): Yes

Agenda

Agenda Topics

  1. V3 Harmonization proposals
  2. AdministrativeContactRoletype concept domain [1]
  3. ServiceDeliveryLocation concept domains

Supporting Documents

Minutes

Minutes/Conclusions Reached:

The WG continued with the encounter ballot reconciliation.

When reviewing the comment for interactions section (6.6.7-6.6.12), in which the reviewer states: “None of these interactions talk about a reason for change or cancelation to be given. I am guessing the reason is actually in the ControlEvent. I think if so, the domain should describe the role the ControlEvent takes in sending important domain related fields.”,

The working group agrees that the clarifying that the reason for any interactions is in the ControlAct wrapper, but the pubs database doesn’t allow introduction working at the start of the interaction section.

When reviewing the comment regarding that begins “It seems that in all the cases of narrative around cancels and nullifies in which an error caused it, the only error described is "wrong patient" and there is always a right patient that then needs to be chosen…” The WG agreed creating an action item.

Action Item: Update 2 or 3 of the cancel or nullify narratives to have the reason be “wrongly created a visit” rather than "wrong patient". Responsible Person: Alexander Henkett

Comment that reads “Recommend adding stories for field and virtual encounters.”

Action Item: Add stories for field and virtual encounters. Responsible Person: Alexander Henkett

The WG adjourned.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action Item: Update 2 or 3 of the cancel or nullify narratives to have the reason be “wrongly created a visit” rather than "wrong patient". Responsible Person: Alexander Henkett
  • Action Item: Add stories for field and virtual encounters. Responsible Person: Alexander Henkett
Next Meeting/Preliminary Agenda Items
  • Review narratives for wrongly created a visit.
  • Review stories for field and virtual encounters.

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