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2015-12-17 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: 2015-12-17
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
X Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
X Russ Leftwich InterSystems
X Jay Lyle Ockham Information Services LLC, VA
Sarah Maulden VA
Jim McClay Univ of Nebraska Medical Center
X Russell McDonell Telstra Health
X Lloyd McKenzie Gevity (HL7 Canada)
Larry McKnight Cerner
X Michelle M Miller Cerner
Lisa Nelson Life Over Time Solutions
Viet Nguyen Systems Made Simple
Craig Parker Intermountain Healthcare
Scott Robertson Kaiser Permanente
Simon Sum Academy of Nutrition and Dietetics
Iona Thraen Dept of Veterans Affairs
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2015-12-10_Patient_Care_FHIR_Call
    • Motion: Jay/Emma Abstain - 1, Negative - 0, Approve - 4
  3. Prior Action Item Follow-up
  4. 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 Item Follow-up

Russell thought a new resource, PatientCareNote or HealthCareNote, is needed.

Lloyd said clinical notes are a bunch of assertions that someone is making about something at a specific point in time, which is Observation. The Observation.value could be a valueString or valueAttachment (e.g. PDF). Observation.code.text could be used for title. Observations are rarely updated (unless prelim results --> final result; or, correcting error). Each new assertion is a new observation.

Notes about leaving against medical advice could be an annotation on the encounter, because only relevant in context of the encounter.

If there is no context, except the patient, then might consider episode of care (relationship between provider and patient)

Flag could have an extension that points to the detail (e.g. observation, allergyintolerance). Flag can have an intended audience. When anyone dealing with the patient today needs to be aware of the topic, then use flag.

Clinical notes as legal documentation -- contextual things that someone wants captured in the record to jog memory, justify actions, provide context (something written in chart). Not flagged in chart, just stuff being captured is more like an observation.

gForge Change Requests

gForge 6871
gForge 6872
gForge 7045
gForge 7185


Adjourned at 6:36pm Eastern.

Meeting Outcomes

  • Russell will log gForge change request for Appointment to reference ClinicalImpression
  • Russell, Michelle, and everyone else is welcome to compile a list of typical clinical notes to vet whether they fit the observation scope
  • Lloyd will talk to MnM about the possibility of renaming notes to annotation
  • Everyone is invited to contribute examples to the Representing_Negation
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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