2013-03-18 PA Call Minutes

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Patient Administration Call

Meeting Information

PA Work Group Meeting

Minutes
Phone Number: +1 770-657-9270
Participant Passcode: 986210
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Date: Monday

March 18, 2013
Time: 01:00 PM (US Pacific Time, GMT -7)

Facilitator Line Saele Note taker Alex de Leon
Attendee Name Affiliation
X Line Saele HL7 Norway
X Brad Fonseca Canada Health Infoway, Canada
X Ewout Kramer Furore, Netherlands
X Alexander Henket HL7 Netherlands
X Irma Jongeneel Nictiz, Netherlands
X Alex de Leon Kaiser Permanente, USA

Agenda

Agenda Topics

  1. PSS to reaffirm v3 Scheduling R1
  2. PSS to reaffirm v3 Personnel Management R1
  3. FHIR - Encounter/Visit

Supporting Documents

Minutes

Minutes/Conclusions Reached:
The work group has been made aware by Lynn Kaasko that two domains within the scope of our workgroup need to be reaffirmed. Thease are for v3 Encounter release 1 and v3 Scheduling release 1.

Project scope statements were presented.

Alex de Leon moved to accept the project scope statement (PSS) to reaffirm v3 Scheduling, Release 1, for submission to the proper HL7 channels. Irma seconded.
Discussion: The PSS was displayed for the workgroup to see on a shared desktop, highlighting the scope which reads:
Reaffirmation of normative standard for HL7 Version 3 Standard: Scheduling, Release 1. This standard reached its 5-year ANSI anniversary 12/2/08. An R2 project was started and so this was not reaffirmed at its anniversary, but the R2 project did not progress and was withdrawn in October 2012 resulting in the need to re-affirm R1.
There was no further discussion.

Vote (for/against/abstain): 4/0/1

Alex de Leon moved to accept the project scope statement (PSS) to reaffirm v3 Personnel Management, Release 1, for submission to the proper HL7 channels. Irma seconded.
Discussion: The PSS was displayed for the workgroup to see on a shared desktop, highlighting the scope which reads:
Reaffirmation of normative standard for HL7 Version 3 Standard: Personnel Management, Release 1. This standard reached its 5-year ANSI anniversary 10/28/2005. An R2 project was started and so this was not reaffirmed at its anniversary, but the R2 project did not progress and was withdrawn in October 2012 resulting in the need to re-affirm R1
There was no further discussion.

Vote (for/against/abstain): 4/0/1

The WG continued with FHIR Encounter Resource.

“Encounter” was changed to “Visit” last week.

The group discussed being able to use the term “visit” to address when a patient visits the doctor or when the doctor visits the patient (at home, for instance).

Ewout then moved on to discuss the scope of the “visit” resource. Do we retain the encounter scope which currently the defines its scope as ranging from short home visits to long-term care. Most seem to agree that outpatient visits and inpatient stays are all encounter, therefore will be subsumed into the new term of “visit”.

Encounter mainly an administration or logistic concept, or does it include responsibility? Irma asked why it has to be “or”. Perhaps it can be all those concepts. Ewout stated that it may affect what attributes we assign to the “visit” resource. Ewout showed a model from the PA domain; however, Irma advised that we look at the Care Provision DMIM as a result of the harmonization with Patient Care. Unfortunately, when we navigated there, it was missing attributes, pointing to the PA attributes. However, after navigating around we were able to find the correct model to talk about attributes for “Visit” in fire (and it’s attributes). This was all in the context of trying to define whether the VISIT a concept that encompasses responsibility as well. Irma suggested that the “visit” encompasses administrative, logistic, and responsibility. Ewout was concerned that during a chronic episode of care may necessitate differing responsibilities.

Encounters, according to this definition, overlap in time and scope. How do we relate them, e.g. Do we wish to see a doctor visit an inpatient as an encounter within an encounter? Does moving a patient from a medium care ward to an intensive care ward start a new encounter? What about referring a patient to another specialty for consultation? What about an outpatient visiting multiple facilities?

Line suggested that we submit the question of episode of care versus visit to the listserve. After considering whether the group would be able to move forward with a lively discussion on the listserve, the group decided to move forward with a simplified version of the “visit” which means that it will encompass administration, logistics and some responsibility.

Ewout continued on to whether encounters have several levels based on what is currently defined in the V3 models or not. The WG then examined the DMIM for encounter. One example had to do with location. If the location changes, is that considered a new “visit”? It seems it would be, although might be considered the same “episode of care”. The WG then considered “nested” encounters. It was discussed that if we want to cover the 80%, we may not want to include nesting. So the WG agreed that we should define the visits as atomic events, with the ability to convene these into one “episode of care”, or not – as they may be separate, unrelated, visits.

There is one more question: CCDA and CCR limit Encounter to “events”, the V3 Normative Edition under Patient Administration distinguishes between “Encounter” (=EVN mood) and Appointment (=APT mood). However, there’s also scheduling (agendas, slots, etc.) Which of these are in scope? What this refers to is do we want to have different resources for the actual thing that’s happening and the appointment for that same thing. Many attributes are the same, but some meanings might be different. This seems to be a difficult thing to separate: whether these are fundamentally different structures or not. After discussion, it seems it would be worthwhile to try to research how systems are actually implemented. Now that we all understand this, we can actually discuss/focus on this during a following meeting.

So, the group moved on to try to plan the next meeting, both when it would occur and what we would discuss.

The group decided to have a meeting next week and discuss these two items, despite the fact that Ewout and Line would not be able to join due to national holidays.

Alex will send an message to the listserve advising the list what will be covered based on this discussion on the 25th. This would be:

  • Scope for single visits (encounters) versus visits embedded into one or more episodes of care.
  • Combining the concepts of appointment and visit into one resource or creating a separate resource for each concept.

Encourage all to attend to provide feedback.

Adjourned: 1:18 PM PST.

Meeting Outcomes

Next Meeting/Preliminary Agenda Items
  • Next telecom meeting Monday, February 18, 2013

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