2013-05-07 PA WGM Minutes

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Patient Administration WG Minutes - Tuesday May 07, 2013

Tuesday Q1

HL7 Patient Administration Meeting Minutes

Location: Atlanta Room #12

Date: 2013-05-07
Time: Tuesday Q1
Facilitator Line Saele Scribe Barry Guinn
Attendee Name Affiliation
X Line Saele HL7 Norway
X Toril Reite HL7 Norway.
X Gaby Jewell Cerner
X Tod Ryal Cerner
X Steve Fine Cerner
X Barry Guinn EPIC
X Nat Wong HL7 Australia
X Iryna Roy GP Informatics
X Rolim Cabrita Interfaceware
X Christian Hay GP1
X Ewout Kramer Furore
X Alexander Henket E. Novation
Quorum Requirements Met (Chair + 3 members): Yes

Agenda

Agenda Topics

  • V3 FHIR Comment Ballot Reconciliation

Supporting Documents

Minutes

Minutes/Conclusions Reached:
GS1 GSRN update from Line
The steering division recommended that we rewrite the project scope statement to describe where to use the GS1 GSRN standard within the HL7 v2 standard as a starting point, talk to InM to get a cosponsor, and add a risk analysis.
"FHIR Work"

Work on the Visit (formerly Encounter) resource
Reviewed Summary of the discussion and answers.
New question: When systems keep track of Visits at different levels of granularity, do most of them also keep track of the links between them, so, e.g. do systems keep track which doctor visits were done during which hospitalization?

Some vendor input
Inpatient: Generally don’t track separate visits (contact with a provider) within the overall inpatient encounter. Some vendors will track separate encounters, typically for ancillary services, within the overall inpatient visit.
Outpatient: Visits may need to be grouped for billing purposes (account?) or for clinical purposes (episode of care?).

Naming it an Encounter or a Visit:
Motion by Ewout: Rename Visit to Encounter and assign Visit as an alias. Seconded by Iryna
For:10; Abstain:0; Against:1

Meeting Outcomes

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

Tuesday Q2

HL7 Patient Administration Meeting Minutes

Location: Atlanta Room #12

Date: 2013-05-07
Time: Tuesday Q2
Facilitator Line Saele Scribe Alex de Leon
Attendee Name Affiliation
X Line Saele HL7 Norway
X Toril Reite HL7 Norway
X Tod Ryal Cerner
X Barry Guinn EPIC
X Steve Fine Cerner
X Nat Wong HL7 Australia
X Christian Hay HL7 GS1
X Jason Kratz EPIC
X Rik Smithies HL7 UK
X Sadamu Tabasaka HL7 Japan
X Yukinori Konishi HL7 Japan
X Masaaki Hirai HL7 Japan
X Alexander Henket HL7 Netherlands
X Graham Greive HL7 Australia
X Ewout Kramer Furore
X Sasha Bojicic Canada Health Infoway
X Dick Donker CSC
X Craig Parker
X Alex de Leon Kaiser Permanente
Quorum Requirements Met (Chair + 3 members): Yes

Agenda

Agenda Topics

  • V3 FHIR Comment Ballot Reconciliation

Supporting Documents

Minutes

Minutes/Conclusions Reached:
The WG continued with attempting to define the attributes for Encounter in FHIR. A brainstorm of items were discussed,
Indentifier
State – active aborted, finished. This spawned a discussion about whether this is the status of the resource or the status of the encounter. This attribute will be changed to status to mean the workflow status of the encounter.
Type – is included in the model. The typical codes are inpatient, ambulatory, home, field emergency, virtual, office, nursing. This is more meant to convey the type of encounter. It seems that type should be used as a sort of class
Setting – this will be discussed later to see if it is still needed for more granular information about the type of encounter.
Subject – should be a reference Patient resource.. Currently the cardinality shows as 0..1. The question came up as to whether this should be 1...1, meaning that there should always be a subject. Graham brought up that while in the real world there may always be a subject (real or made up), however, there may be situations where you don’t know the patient systematically. For instance, in clinical studies, you may know that a patient was seen but you have no information about that patient. Activity based reporting could be an example… where the focus is on the process of the admission, but not about the patient… so the patient information is not known and not needed. The WG decided that this was a methodology issue which should be handled later after the attributes are finalized.
Responsible – currently refers to the practitioner. Could be 0…1
Fulfills – refers to the resource appointment
Period – Period. from the beginning and the end of the visit. Excludes leave of absence.
Length – Duration. quantity of time the visit lasted.
Contact – this is the contact for this particular visit that may or may not be the same as the patient contact. Does this refer to a resource (practitioner, relatedperson).
Indication – refers to any resource. Reason for encounter. However, the WG wanted to be sure that this can handle coded and not coded situations.
The WG removed diet from the patient so the WG opted to include it on the encounter level, especially in the light that patients can change their dietary preferences or restrictions from one encounter to another.
The Encounter has associations to Admission, Location, and Discharge.
The discussion was about whether the Admission should be separate from the discharge or whether there should be one class association for encounter. It was decided that there was value in keeping them separate.
For location, there is a responsible attribute to a practitioner resource for that visit. It shows bed which might need to show ward or unit (ICU).
Ewout asked if CIMI had some items.
Iryna responded with a view to their vocabulary. The following items were reviewed:
Discharge disposition.
Preadmission,
Test indicator.
Priority
Special arrangements
Courtesy code
VIP indicator
For now, it seems that most of the attributes for CIMI have been covered.
Indications will be changed to reason.

Meeting Outcomes

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

Tuesday Q3

HL7 Patient Administration Meeting Minutes

Location: Atlanta Room #12

Date: 2013-05-07
Time: Tuesday Q3
Facilitator Line Saele Scribe Alex de Leon
Attendee Name Affiliation
X Line Saele HL7 Norway
X Ben West EPIC
X Nat Wong HL7 Australia
X Jason Katz EPIC
X Steve Fine Cerner
X Dick Donker CSC
X Barry Guinn EPIC
X Christian Hay GS1
X Lloyd McKenzie GP Informatics
X Ewout Kramer Furore
X Alexander Henket E. Novation
X Alex de Leon Kaiser Permanente
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

  • FHIR Discussion - Next Steps

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions.
The WG continued with the encounter resource for FHIR.
Visit Resource Definition Speadsheet
Description – not included as an attribute.
Instructions – not included as an attribute.
Consent – included as an attribute, but it must be revisited to clarify
Visit Type – included.
PriorLocation – before admission. Not location
For Attending, Referring and Consulting, participant will be used but we must be able to type the participation.
Movement – an identifier for the movement, a start/end and a responsible ward
This lead the WG into a discussion about the location resource associated to the encounter. This is intended to be the assigned location.
The WG discussed the physical location versus the administration or assigned location.
Physical Location Class – where the patient is. Location and period. 0..*.
Accomodation Class – location, period, responsible

Admission block – only used for inpatient.
Facility will be added to encounter. This presented problems
Physical location.
Service location for the visit level and physical location for the class beneath.

Devices – items associated with the admission/encounter.
Previous encounter -

Meeting Outcomes

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

Tuesday Q4

HL7 Patient Administration Meeting Minutes

Location: Atlanta Room# 12

Date: 2013-05-07
Time: Tuesday Q4
Facilitator Line Saele Scribe Alex de Leon
Attendee Name Affiliation
X Line Saele HL7 Norway
X Iryna Roy GP Informatics
X Ben West EPIC
X Barry Guinn EPIC
X Wendy Huang Candada Health Infoway
X Ewout Kramer Furore
X Alexander Henket E. Novation
X Nat Wong HL7 Australia
X Alex de Leon Kaiser Permanente
Quorum Requirements Met (Chair + 3 members): Yes

Agenda

Agenda Topics

  • FHIR

Supporting Documents

Minutes

Minutes/Conclusions Reached:
The WG continued with the attributes for encounter/visit.
Encounter type for v3.
The WG went over the harmonization that Wendy had done for V3, wherein she added an encounter type of PreAdmit to make it it’s own type. This did not exactly fit into the discussions for FHIR encounter types, wherein a preadmit is set merely to a “planned” inpatient encounter.
After much discussion consulting vendors in the room and uses, the following concepts were identified for encounter metadata:
Encounter Class – high level classification of an encounter

  • Inpatient
  • Outpatient (GP visits)
  • Emergency
  • Home health
  • Preadmit
  • Ambulatory
  • FieldShort Stay
  • Virtual

Meeting adjourned at 5:02PM

Meeting Outcomes

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

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