2015-10-06 PA WGM Minutes

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Patient Administration Work Group Minutes - October 6, 2015

Tuesday Q1

HL7 Patient Administration Meeting Minutes

Location: Georgia 12 Conference Room

Date: 2015-10-06
Time: Tuesday Q1
Facilitator Line Saele Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Alex de Leon Kaiser Permanente
X Line Saele
X Brian Postlethwaite HealthConnex, Australia
X Gevity, Canada
X Christian Hay GS1
X Alexander Henket EPIC
X EPIC
X
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
FHIR

Minutes

Minutes/Conclusions Reached:
Introductions
This is supposed to be meeting with the FHIR core team, however, it has been changed due to the change in the FHIR core team agenda. Therefore, we will cover the core team collaboration in Q2.
The WG will continue with the DSTU 2 ballot reconciliation. However frist the WG announced the desire to have a 4th co-chair to support the FHIR efforts.
A motion was made, by Irma, to add a fourth co-chair to the PAWG. Alex d. seconded.
Discussion: Alexander H., asked if this was in order to get a title to give weight to his participation in the work group. The WG discussed this and agreed that this is a good consideration.
Vote (for/against/abstain): 10/0/0
Motion passes.
Irma moved to set Brian Postlethwaite as interim co-chair with the above change. Alex seconded.
Vote (for/against/abstain): 9/0/1
The interim co-chair (Brian) reminded us that Introductions have yet to be done. The WG had done introductions.
The WG then moved on to DSTU 2 ballot reconciliation starting with reviewing the FHIR QA guidelines.
Brian reviewed the timeline for next steps. The current status of the spec is 2.0. The next versions are 2.1 and 3.0.
There were a group of resources that did not make it to 2.0 (FM). Instead of waiting for a year, 2.1 was decided upon. There are some resources that are “frozen” as a subset of 2.0 DSTU. For those we clarify, add examples, and
do mapping, for example but can’t change the core content, including value set. Alex d. asked if we could start by defining the criteria by which we can raise the levels of our resuorces.
Brian showed the explanations in the DSTU2 QA guidelines that show the explanations of the levels.
http://www.hl7.org/implement/standards/fhir/resource.html#maturity
The WG discussed Value Sets and decided that Wendy as our vocabulary facilitator
Action: Contact Wendy to solicit her participation in covering FHIR vocabulary with the assistance of Alexander H. Owner: Alex d. Due: ASAP.
Brian and Alexander and Wendy will work together to support FHIR vocab content with Wendy as the lead as her role defines.
Action: Brian to talk to FMG to potentially change the wording of level 1 “production ready” to “ready for trial use”.
Alex clarified that the DSTU QA guidelines on the FHIR website (http://wiki.hl7.org/index.php?title=DSTU_2_QA_guidelines#DSTU2_QA_Tracker_Spreadsheet) definitions begin on level 3 of the spreadsheet for clarifications.
Irma noted that we are not necessarily aware of when the resources are a focus of the connectathon (level 2). Currently, our method of knowing this is through Brian’s participation. Irma suggested that we update the agenda to
include a report back of which ones of our resources are a focus of a connectathon.
Action: Update the next WGM agenda to include a space for connectathon reporting back. Owner: Line. Due: Before January WGM agenda development.
Brian reviewed the latest FHIR Connectathon results, or participants, sheet. This is available on the FHIR website at:

There were over 102 participants, the largest attendance so far. About 60% new participants. There was only one topic that ended up in the “hot topics” section: How to craft a resource reference from an implementation guide to conformance resource? Gforge is currently no longer using location paths, but cannonical URLs.
Brian continued to review the results.
Required or recommended value set on a locked resources are also frozen. The WG can define work to be done, but not apply until 2.1 goes out for review. However, examples can be updated.
The WG reviewed the maturity levels.
Under Elements “The W5 column must be filled in with all matching elements. w5 elements not present in the resource should be evaluated as to whether they make sense for the resource and fall within the 80%.” The WG asked to
review this at some point.
Irma asked what the focus of the WG should be: raise resources beyond level 3 or perhaps raising Patient, which is at level 3, but seems poised to move to a higher level, which would require approval from WG to move to FMM 4.
Officially, this is the definition reads:
FMM4 - FMM3 + he artifact has been tested across its scope (see below), published in a formal publication (e.g. DSTU), and implemented in multiple prototype projects. As well, the responsible work group agrees the resource is
sufficiently stable to require implementer consensus for subsequent non-backward compatible changes.

In reviewing the status of the Patient resource, it seems that it is poised to move to FMM4. In fact, there are 4 production systems of 5 that are required for FMM5.
To consider moving patient to a FMM4, the WG should cover, in a subsequent meeting, the MPI query and the merge/link scenarios, which are not fully developed.
Action: Include the MPI query and merge/link scenarios for the Patient resource. The WG considered the following questions to review with the FMG: 1) Can we change FMM levels of our existing resources that are “locked”? 2) Is the scope defined by the WG for the resource (e.g. Patient, ) well defined or
mature enough to move to FMM4? Can you add scope if it’s already locked?

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action: Contact Wendy to solicit her participation in covering FHIR vocabulary with the assistance of Alexander H. Owner: Alex d. Due: ASAP
  • Action: Update the next WGM agenda to include a space for connectathon reporting back. Owner: Line. Due: Before January WGM agenda development.
  • Action: Include the MPI query and merge/link scenarios for the Patient resource. The WG considered the following questions to review with the FMG: 1) Can we change FMM levels of our existing resources that are “locked”? 2) Is the scope defined by the WG for the resource (e.g. Patient, ) well defined or

mature enough to move to FMM4? Can you add scope if it’s already locked?

Next Meeting/Preliminary Agenda Items
  • .

Tuesday Q2

HL7 Patient Administration Meeting Minutes

Location: Room # 1367

Date: 2014-05-05
Time: Tuesday Q2
Facilitator Irma Jongeneel Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Alex de Leon Kaiser Permanente, USA
X Brian Postlethwaite Kaiser Permanente, USA
X Daniel Lowenstein EPIC
X Alexander Henket Nictiz
X Iryna Roy HL7 Canada
X Christian Hay GS1
X Younjian Bao GE Healthcare
Quorum Requirements Met (Chair +2 members): Yes

Agenda

Agenda Topics

  1. FHIR – Scheduling Resource

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions
Irma took the chair as Line was feeling under the weather.
The WG reviewed the “frozen” resources.

The WG considered the following questions to review with the FMG: 1) Can we change FMM levels of our existing resources that are “locked”? 2) Is the scope defined by the WG for the resource (e.g. Patient, ) well defined or mature enough to move to FMM4? Can you add scope if it’s already locked?
The other issue was having to do with veterinary scope that is currently included in the scope for Patient. The WG discussed with the FMG about raising Patient to FMM4. The two groups that might have some movement in this area are Pharmacy and Pathology. Brian suggested that these groups be contacted to see if they have plans to participate in a connectathon any time soon. Alex d. noted that the 2 choices to try to move the patient resource to FMM4, would be either to reduce the scope to not include veterinary use, or to encourage participation from one or more of these groups. The WG reviewed the proposed “frozen” resources. Irma brought up the risk of having “frozen” resources when they have not been tested at all. Encounter was a focus of this kind of situation. The WG has not received feedback regarding use of this with an actual system (e.g. connectathon). The discussion went forward focused on Encounter. The FMG representatives clarified that to take this off the list, the WG should help push participation in a connectathon. EPIC has stated an interest in participation in the connectathon for Encounter. If the WG can communicate to the FMG that there is intention to have the encounter resource used in a connectathon to be sure it is more mature, then it would be a better justification for not “freezing” this resource.
Action: Send a message to the listerve and the fhir implementors group for people to participate in the next FHIR connectathon. Owner: Brian Due:
Action: Ask FMG to remove the Encounter resource from the “frozen” list of resources. Owner: Brian
Brian moves to accept the list as the frozen resources, with the exception of Encounter. Alexander H seconds.
Discussion: Epic stated a concern with Practitioner, as they have had issues with implementation internally. They have had to reduce scope twice because they cannot implement. Ewout and Alex d agreed that if there is work to be done and feedback of that implementation work can be received before 2.1, then that resource should not be frozen.
Therefore there was a suggestion to make a friendly amendment to include Practitioner. Discussion continued about this.
Vote: 17/1/0 (For/against/abstain)
Motion passes.
Sean EPIC moves to remove practitioner from the candidate list of resources to be frozen. Ewout seconded.
Discussion: Ewout asked if the feedback would be received, agreed upon and changed, would it be in time for use by EPIC or any other implementor. Brian
Timelines for 2.1… has to be ready for May 2016 ballot so the changes must be finalized by March of 2016. Epic (Sean) made a commitment to meet that timeline with that feedback. Ewout asked Keith if this timeline would work with IHE issues.
Vote: 15/0/2 (For/against/abstain)
Motion passes.
Brian moves to include Patient and Organization in the list of candidates to be frozen. Keith seconds.
Discussion: None.
Vote: 16/0/1 (For/against/abstain)
Motion passes.
The WG then discussed any additions and also any other things to be considered.
The discussion moved toward mappings beyond the element level but up to trigger events.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action: Send a message to the listerve and the fhir implementors group for people to participate in the next FHIR connectathon. Owner: Brian
  • Action: Ask FMG to remove the Encounter resource from the “frozen” list of resources. Owner: Brian
Next Meeting/Preliminary Agenda Items
  • .

Tuesday Q3

HL7 Patient Administration Meeting Minutes

Location: Room # 1367

Date: 2014-05-05
Time: Tuesday Q3
Facilitator Irma Jongeneel Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Alex de Leon Kaiser Permanente
X Christian Hay GS1
X Brian Postlethwaite HL7 Australia
X Prashant Trivedi EPIC
X Iryna Roy HL7 Canada
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
FHIR

Minutes

Minutes/Conclusions Reached:
Introductions. The WG began by reviewing the meeting around the workflows discussion that FHIR had yesterday in Q4. Although the discussion had started in Q3, the FHIR group continued on. The intent is to start 3 project teams.

To collect use cases for the request intent section to collect use cases which would build a good structure so that orders/results can follow consistent patterns to follow.
They established the need to have meetings 2 times a week. Still being discussed.
In these patterns the focus was on common elements and typical resources.
There is a list of deliverables to be discussed within these work groups.
PA got appointment to feed back into this process. This would be the deliverable from our team to this group. Someone has to be nominated from our team. It was suggested by Irma that Brian and Sam (EPIC) would work together to produce the workflow use cases for appointments to deliver to this team OnO. These products will be delivered to Lloyd who is coordinating this.
<< include the Workflow Issues.doc document from FHIR Workflow discussions document from Mon Q3/Q4 email>>

After this reporting back, the WG continued on with the review of the FHIR QA Report

Warning: “MnM must have confirmed this should not be an annotation. “
Action: MnM should be contacted to be told that we want this to be unstructured text and need not be an annotation data type for the following list of resources:
• Appointment.coment
• AppointmentResponse
• HealthcareService
• Schedule
• Slot
Motion was made by Brian to accept the seconded by Richard Kavanaugh
Vote: 5/0/0 (for/against/abstain)
Motion Passes
Resource must have an ‘entered in error’ status. For status in the related resource element
Action: An added status of “deleted” will be added to the value set. The definition with contain that delete should be used only when the appointment was entered in error. Brian will identify these so that these can be picked up by the QA process.
Brian moved to add the deleted status with the description above, to the value sent for appointment.status. Sam seconded.
Discussion: None
Vote: 6/0/0 (for/against/abstain)
An appointment response cannot be deleted.
If an appointment response is entered in error, then a status must be selected for the appointment.response.
Brian moved to accept the above as the entered in error status.
Vote: 6/0/0 (for/against/abstain)

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action: MnM should be contacted to be told that we want this to be unstructured text and need not be an annotation data type for the following list of resources:

• Appointment.coment • AppointmentResponse • HealthcareService • Schedule • Slot

  • Action: An added status of “deleted” will be added to the value set. The definition with contain that delete should be used only when the appointment was entered in error. Brian will identify these so that these can be picked up by the QA process.
Next Meeting/Preliminary Agenda Items
  • .

Tuesday Q4

HL7 Patient Administration Meeting Minutes

Location: Room # 1367

Date: 2014-05-05
Time: Tuesday Q4
Facilitator Irma Jongeneel Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Barry Guinn EPIC
X Nat Wong HL7 Australia
X Christian Hay GS1
X Alexander Henket E. Novation
X Alex de Leon Kaiser Permanente
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
FHIR Supporting Documents

Minutes

Minutes/Conclusions Reached:
The WG continued with the DSTU 2 quality work. The last quarter ended with “entered in error”.
The WG started with the “entered in error” scenario for Encounter. This is made up of multiple sub-components. Irma brought up that there may be implications if we focus only on the main resource.
However, Brian noted that this can be the case for other resources that are made up of multiple components overall.
Action: Brian will follow up with FMG for the entered in error warning to see if it has an effect on workflow and/or subcomponents.
The WG decided to move on to find other “entered in error” QA issues.
EpisodeOfCare.status
The current definition staths “planned, waitlist, active, onhold, finished, cancelled”. The WG considered the addition of “Deleted” to handle the enter in error status.
Brian moved to update this definition with the deleted status. Line seconded.
Vote: 6/0/0 (for/against/abstain)
HealthcareService
The WG looked at Organization and found that this was a Boolean active flag. This seemed to be enough to answer the entered in error situation. The WG decided that this would be done for HealthcareService as well. In addition,
the entered in error solution will be to set the Boolean flag to inactive.
Brian moved to update the HealthcareService with an active flag, Boolean, and indicate that setting this to inactive would be the “entered in error” solution. Alex seconded.
Discussion: None
Vote: 5/0/0 (for/against/abstain)
Location Resource
Warning: Short description doesn’t add any new content.
Brian moved to update thes short description loction, the the description of the location and add “description not otherwise captured.” Alex seconded.
Discussion:
Vote: 5/0/0
RelatedPerson Resource The WG noted that there was no status. Brian proposes adding an active boolean flag.
Brian moved to adding an active boolean flag. Alex seconded.
Discussion: Alex had doubts so it was discussed and clarified.
Vote: 5/0/0 (For/against/abstain)
Schedule Resource
For entered in error, Brian suggests that in his case, he would delete the schedule. Irma noted that there might be slots related to this schedule. The response from Brian is that he would take the slots along with the deletion.
After talking through some use cases, this seemed not a viable option. After working through the workflow implications.
Brian introduced the idea that we may have to create a specific section that addresses what should be done if a schedule resource needs to be deleted and what must be done afterward (e.g. replace, merely delete, etc.). For
instance, resolving appointments once a schedule is deleted and the appointments are disassociated with the slots.
For earlier resources, wherein a flag or process was put into place this will refer or be included into this section. This will resolve the entered in error QA warnings.
Slot Resource
The solution for the “entered in error” warning should be resolved by the schedule solution.
Brian moved to change the Slot.freeBusyType to “Slot.Status” and the name of the search parameter from “FB-Type” to “Status”. Alex seconded.
Discussion: None
Vote: 5/0/0 (for/against/abstain)
The WG then moved back to encounter to see if resolutions of the warnings could be find.
The WG the moved to Encounter.hospitalization.reAdmission which showed Element has a todo associated with it (Need a harmonization proposal for this.).
Action: Brian to find out who entered the “Todo” to find out what needs to be harmonized or if this is because there is no value set established, or… ?
The WG continued with considering what else could be handled with the time we had left. In looking at the Patient resource, we found INFORMATION:Patient Search Parameter name 'deathdate' does not follow the style guide.
This led to the continuation of the birth time/date that was started by Dale during the co-chair dinner. He had an issue with needing the birth date in some situations (neonatal) but not in others within the same system.
He did not think it a good design to have to look at the core for one situation, when the time is not needed (since core only has birth date and not time elements) and look in another
(within the extension for this element which defines birth date-time). After looking at the extension within the specification, the WG discovered that there could be more explanatory text to help with such situations of use.
Action: Update the description of the Extension time or day of birth to help with usage. Brian.
Action: If an extension has an overlap with a core element, what happens especially when the values differ? Brian.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action: Brian will follow up with FMG for the entered in error warning to see if it has an effect on workflow and/or subcomponents.
  • Action: Brian to find out who entered the “Todo” to find out what needs to be harmonized or if this is because there is no value set established, or… ?
  • Action: Update the description of the Extension time or day of birth to help with usage. Brian.
  • Action: If an extension has an overlap with a core element, what happens especially when the values differ? Brian.
Next Meeting/Preliminary Agenda Items
  • .

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