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2015-10-22 Patient Care FHIR Call

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Meeting Information

Patient Care FHIR Resources Conference Call

Location: Conference Call
Phone Number: +1 770-657-9270
Participant Passcode: 943377
Live Meeting:

Date: 2015-10-22
Time: 5-6:30pm ET
Facilitator Michelle M Miller Note taker(s) Michelle M Miller
Attendee Name Affiliation

Elaine Ayres NIH/Department of Clinical Research Informatics
X Stephen Chu Queensland Health
Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
Emma Jones Allscripts
X Russ Leftwich InterSystems
X Russell McDonell Telstra Health
X Lloyd McKenzie Gevity (HL7 Canada)
X Larry McKnight Cerner
X Michelle M Miller Cerner
Lisa Nelson Life Over Time Solutions
Viet Nguyen Systems Made Simple
Craig Parker Intermountain Healthcare
X Iona Thraen Dept of Veterans Affairs
X Jay Lyle VA
X Simon Sum Academy of Nutrition and Dietetics
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2015-10-15_Patient_Care_FHIR_Call
    • Motion: Russ/Lloyd Abstain - 1, Negative - 0, Approve - 8
  3. Follow-up on Prior Action Items
    • Lloyd is logging a change request for condition/observation boundary clarification
    • Collaborate on definitions of note, annotation, and comment to provide feedback to MnM
  4. Negation
  5. OpenEHR collaboration
  6. DSTU 2.1 prioritization
  7. gForge change request

Supporting Information

DSTU 2.1 Timeline
FHIR Resources owned by Patient Care

  • AllergyIntolerance (1) -- frozen
  • Procedure (1) -- frozen
  • Questionnaire (1)-- potential normative candidate
  • Questionnaire Answer (1)-- potential normative candidate
  • Condition (1) -- possible normative only if it doesn't have substantive changes after working through health concern, negation, and alignment with OpenEHR
  • CarePlan (1) -- probably not enough wide spread implementation to be considered normative, but Lloyd will check with community to see if there are any planned implementations coming up in the next 18 months
  • Goal (1) -- probably not enough wide spread implementation to be considered normative
  • Referral Request (1)-- probably not enough wide spread implementation to be considered normative
  • FamilyMemberHistory (2) genomics / Jonathan Holt – Vanderbilt - interested in contributing to this resource -- possible normative, but may not have wide spread implementation to be considered normative
  • Procedure Request (2)
  • Flag (2)
  • ClinicalImpression (3)
  • Communication (3)
  • CommunicationRequest (3)

Note: Contraindication and Risk Assessment are owned by CDS, not Patient Care
Note: Substantive changes to frozen resources in DSTU2.1 are prohibited unless FMG explicitly approves the substantive change


Prior Action Items

Condition/observation boundary

Lloyd logged a change request for condition/observation boundary clarification

MnM feedback on notes/annotation/comments


  • Notes are....
    • also known as clinical note or document; could be unstructured or structured; could require review and authentication; likely has a subject or type of note assigned to enable retrieval of note; could follow the SOAP format
  • Comments are....
    • unstructured, free form text that applies to the entire entity (e.g. condition, allergy, medication order, etc.). A comment is typically comprised of an author, date/time, and text only. Typically, comments don't have a status or title. Comments don't standalone, so there is typically no title of the comment or need for additional workflow to review or authenticate the comment independent from the overall entity's status.
    • comments could be independent
  • Annotations are....
    • unstructured, free form text that is context specific with a given entity (e.g. annotated condition code display or annotation within a flowsheet or wave form for a specific point in time or time frame)
    • could be a comment, but distinguished from comments by being "attached" to document or image
    • annotate a point of interest in document or wave form, or "topic of interest" (e.g. medication dose/frequency/brand matters)
    • an annotation is a comment on something else
    • annotation is "part of" something else

Both comments and annotations are impacting something else versus a note is standalone

Lloyd said that there is no note resource today (and even if a clinical note was added, it would be named clinical note)
Lloyd said that there is no expectation that data types and element names match, ContactPoint / telecom is an example
As related to, is it worth it to change the recommended name from note (0..*) to annotation (0..*)?

Larry feels that having procedure.note could be ambiguous (annotation vs clinical note).

Stephen shared Observation,_Clinical_Assessment_and_Clinical_Annotation


Representing_Negation -- Rob and Stephen will further build out the wiki and then come back to the Patient Care WG meeting next week.

OpenEHR collaboration

Previously, allergy intolerance was harmonized with OpenEHR
Do we want to do this again?
Russ said it was worthwhile; It did result in harmonization (success), but wasn't necessarily efficient. Carefully consider which resource would be most valuable to harmonize. It should be based on what resource really aligns with openEHR archetype.
Stephen suggested conditions and procedures. OpenEHR didn't have concept of condition, but rather it has diagnosis and problems. Lloyd suggested we could have 2 profiles on condition to represent diagnosis and problems. Lloyd would prefer working through concern vs condition first before we tackle alignment with OpenEHR. Russell mentioned Care Plan, but does that pull in condition (possible dependency the care plan may reference version specific condition at a point in time)? Lloyd feels like the Care Plan just points to a reference to a Condition, so it shouldn't pull in Condition if we focus on aligning the care plan goals, status etc.

Consensus around picking FamilyMemberHistory is another possibility because it is as robust as we can make them without going through harmonization. Interest across many different workgroups. Vote: Russ/Stephen 0-0-9

DSTU 2.1 Prioritization

  1. Normative candidates
  2. For resources that are frozen, doing non-substantive changes to get them ready for quality criteria and moving up maturity levels.
  3. For draft or new resources, then be informed by what implementers are saying they need/want. Ping implementer community for feedback to help us prioritize -- Lloyd volunteered to solicit feedback from implementer community

Notes are above in the supporting information section, but Lloyd will solicit feedback to see if there are implementer plans around care plan to bump it back up to the normative candidate list.

gForge Change Requests


Adjourned at 06:35 pm Eastern

Meeting Outcomes

  • Elaine looking at the equivalent ISO 27953 standard for Adverse Event inspiration
  • Lloyd will solicit feedback from implementer community on which resources should be prioritized and who has plans to implement care plan
  • Lloyd will talk to MnM about the possibility of renaming notes to annotation
  • Stephen and Rob will build out the negation proposal/wiki
  • Michelle will log change request to fix typo in AllergyIntolerance.recorder
Next Meeting/Preliminary Agenda Items
  1. Agenda review
  2. Approve previous meeting minutes
    • Motion: <moved>/<seconded> Abstain - <#>, Negative - <#>, Approve - <#>
  3. gForge change request

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