2016-01-12 PA WGM Minutes

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Patient Administration Work Group Minutes - January 12, 2016

Tuesday Q1

HL7 Patient Administration Meeting Minutes

Location: Winter Park Room 49

Date: 2016-01-12
Time: Tuesday Q1
Facilitator Irma Jonganeel Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel VZVZ, The Netherlands
X Alex de Leon Kaiser Permanente, USA
X Line Saele HL7 Norway
X Brian Postlethwaite HealthConnex, Australia
X Iryna Roy Gevity, Canada
X Peter Bernhardt Relay Health, USA
X Alexander Henket Nictiz, The Netherlands
X Jim Whicker Cognosante, USA
X Lisa Doerr McKesson, USA
X Simone Heckmann HL7 Germany
X Colin Wright McKesson, USA
X Michael Donnelly EPIC, USA
X Oyvindaa Aassive eviCore Healthcare, USA
X Dennis Bassinger eviCore Healthcare, USA
X Nat Wong HL7 Australia
X Russell McDonell Telstra Health, USA
X Richard Kavanagh HCIC (NHS), UK
X Toril Reite HL7 Norway
X Tom Sutherland Ready Computing, USA
X Ewout Kramer Furore, The Netherlands
X Dennis Patterson Cerner, USA
X Chad Albenz Furore, The Netherlands
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

  • Welcome/introductions
  • Coordination with FHIR Core team

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions
The WG chairs gave a few minutes to report back on PA related steering division items.
Results of the steering division opinion of the name change of PA to PAS. Steering division agrees with the change and approved the inclusion of scheduling into the mission statement. The details around the specific changes to the PA web page for these changes along with navigation changes to/from the archived scheduling and personnel management pages will be referred to the electronic services group at HL7 Headquarters.

FHIR
Welcoming Ewout to the group with some information back to PA who reported on some key items below.
Deadline for new resource proposals Feb 9th.
Feedback on the new way of doing balloting with gForge. FHIR Infrastructure Group has been the first group to work through ballot resolutions of comments primarily through gForge and would like feedback on its use.
The WG discussed the usage within the development of the resources of which they are stewards. The tracker creation page was reviewed along with the dropdown options. It was noted that they do match ANSI standard designations and statuses. Overall, the PAWG is satisfied with the use of the gForge tracker to complete ballot resolution.
Build validations and timelines. The build tool does QA check. Right now, warnings are shown. However, starting Jan 31, some of these will actually be an error and will need to be fixed. Starting Feb 7, those showing errors will be demoted to FMM0. The QA page was reviewed for the criteria each FMM level.
After review of the various work groups, it appears that Patient Administration has 103 warnings but it is uncertain which of these are true errors or will remain warnings.
March 13 (v2.1) versus July 17 (v3.0) freeze. Ewout noted that the FHIR infrastructure group is discussing the options of v2.1 and v3.0 of the FHIR resources. Essentially, the HL7 community will be informally polled to determine the preference between two options. The first is to target a v2.1 version of FHIR resources for March 13, which would most likely push out the date for v3.0 out until sometime in 2017 due to the timelines needed for balloting, etc. The second option is to forego the v2.1 completely and target a 3.0 version for July 17. PA has most of their items handled but practitioner roles issue might not make the March 13. After considering whether there was anything that absolutely was needed for a v2.1 version, the general feeling was that PA could wait for v3.0 in July.
FMM targets - what FMMs do you plan to reach for which resources and how? The PA frozen resources Patient (FMM3), Organization, RelatedPerson. As noted above, PA will review and attempt to resolve some of the 103 warnings that appear more serious omissions of QA requirements. Meanwhile, the group feels that there is interest in the usage of other resources, such as encounter and appointment resources, within the next connectathon, which would raise their FMM.
In discussing the use of the resources within Connectathons, the Patient resource was discussed. It was noted that the primary open issue with this resource was link and unlink. How does searching behave in this scenario? Also use across scope was still outstanding as the Patient resources has not been used in a veterinary scenario. There are also Patient Master Index search issues.
Appointment, AppointmentRequest, AppointmentResponse, Schedule, Slot might be able to be upgraded
Encounter – there has been interest and work on this. PA might be able to raise the level of this one.

Connectathon – May 2016
Encounter, Appointment, AppointmentResponse, Schedule, Slot – Level 2
HealthcareService, Location, Practitioner, Organization– Level 2
Irma suggested that we introduce this in conference calls to solicit participation for target in May 2016, with a fallback in September.
Action: Solicit participation in Connectations using PA resources within the telecons. Ewout clarified that 2 weeks before a connectathon, the group will freeze the resources for use. So for the next WGM, this will put the status of the resources somewhere between v2.1 and v3.0.
The WG discussed the idea of skipping v2.1 and potentially going directly to v3.0. It seems that the leaning of the group is to forego a v2.1 release for PA resources and then move to v3.0 in Sept.
It appears that overall, there will probably be a v3.0 in September.
Irma asked about the result of the Workflow discussion.
The group started with trying to develop use cases and go through detail steps, but started with difficult ones such as pharmacy filler when all meds are not available but the patient cannot start treatment without meds.
So, the group was trying to define what “workflows” should cover. The discussion is covered at the following link:
http://wiki.hl7.org/index.php?title=FHIR_Workflow_Discussion
The goal is not to define all workflows but to create a Workflow resource that supports all scenarios.
At this point, the WG continued on with the resolution of the comments on gForge
6197 - Add date when the appointment was created. Important for tracking waitlist.
The WG agrees that this element should be added, but wants to be sure that there is some consistency in the naming.
Ewout noted that there is a Provenance resource to record the details of who recorded, when recorded, etc. but after discussion, this should be used if this information is a focus of the workflow.
Since this is important enough for these use cases mentioned here, the PA WG will add “creationDate” which records the date/time that the appointment was created.
Brian moves to add the creationDate property to the appointment resource and Nat seconds.
Discussion: None
Vote (for/against/abstain): 17/0/2

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action: Solicit participation in Connectations using PA resources within the telecons.
Next Meeting/Preliminary Agenda Items
  • .

Tuesday Q2

HL7 Patient Administration Meeting Minutes

Location: Winter Park, Room 49

Date: 2016-01-12
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 HealthConnex, Australia
X Line Saele HL7 Norway
X Kevin Shekleton Cerner, USA
X Iryna Roy HL7 Canada
X Rachel Davis American College of Cardiology, USA
X Simone Hechmann HL7 Germany
X Peter Bernhardt Relay Health, USA
X Jim Whicker Cognosante, USA
X Russell McDonell HL7 Australia
X Richard Kavanagh HSCIC (NHS), UK
X Toril Reite HL7 Norway
X Chad Albert Intor
Quorum Requirements Met (Chair +2 members): Yes

Agenda

Agenda Topics

  1. Ballot reconciliation FHIR DSTU2

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions
6262 - Appointment relationship to iCalendar - especially reoccurring
Although there are many examples of recurring appointments, the WG discussed that this is a very complex topic which has not been fully fleshed out in terms of needs. The feeling is that until there are implementers that can help define the needs, this item should be deferred, although the WG will answer that the creation date will be added as a result of another tracker item (6197, above).

7964 – Update Type of Priority - The priority of an appointment should be represented by a defined value set, rather than an integer "pointer" to the iCal standard for consistency and completeness
This has been discussed before in the WG with no clear preference to the value set being used. The WG looked at the priority list for v2, as found in chapter 10 (table 0485). It was noted that “priority” is a term that could potentially be interpreted differently, depending on perspective.
The values listed in table 0485 may be a more precise set of values for the user in appointment. What will be done in the next connectathon, is to extend the priority field to include this list of values.
The question came up as to whether these coded elements could be used in what today is an integer field. Brian explained that there would be two values for the priority field but the integer field will be ignored for use of these codes to see what the community thinks. It was clarified that, if used, these would be recommended values, able to be extended for individual implementation usages of values.
Brian will assure preparation is done to include the value set in v2 chapter 10, table 0485) for May connectathon and report back with results.
Action: Brian to report back on preparation for the May Connectathon after the use of the full set of appointment priority values in the May connectathon.

8411 - Appointment.type definition needs improvement
Definition: the type of appointment that is being booked
Comment: this is not an appropriate definition. Given the value domain - of specialties it would seem that this is actually the specialty to which a visit time and duration has been booked. Please clarify the definition and/or correct the value set
Brian showed he current set of preferred values.

The "type" property is mis-represented and can be confused between 2 contexts:
Service Type, and also booking appointment type.
This needs to be clarified, and split into 2 fields with appropriate definitions.
1. ServiceType: The healthare service that is to be performed during the appointment
e.g. Podiatry, Radiology - MRI
2. AppointmentType: The context in which the appointment
e.g. New Patient, follow-up, call-back
Additional followup is to further define this clarity in properties so that it can be used across contexts better lalter during the Orlando WGM

The appointment.type field is confusing 2 concepts: an administrative type, and a service type, these should be seperate properties.
Separate the Appointment.Type property into 2:
Appointment.AppointmentType (codeableconcept) 0..1
Appointment.ServiceType (codeableconent) 0..*

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action: Report back on the preparation for Connectathon. Responsible: Brian. Due: TBD
Next Meeting/Preliminary Agenda Items
  • .

Tuesday Q3

HL7 Patient Administration Meeting Minutes

Location: Room # 1367

Date: 2016-01-12
Time: Tuesday Q3
Facilitator Brian Postlethwaite Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Alex de Leon Kaiser Permanente
X Line Saele HL7 Norway
X Brian Postlethwaite HL7 Australia
X Toril Reite HL7 Norway
X Iryna Roy Gevity/HL7 Canada
X Christian Hay GS1, Switzerland
X Jim Whicker Congosante
X Simone Heckmann HL7 Germany
X Chad Albert Intor
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

  1. FHIR DSTU2 Account prep

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions.
FHIR Account resource
In preparation for discussions with the Financial Management (FM) work group, PA began with showing a model of an account resource that Alex d developed using the elements used in v2, merely as a prototype for the development of a more global resource that could be used internationally. Alex d. pointed out that most of the elements would be realm specific to the US, but this was intended as a springboard to constrain this for the 80/20 usage required for a true FHIR resource. Brian had already submitted a proposal for the Account resource which has been published, but the relationship with the currently developed FM resources was still a task to be completed from previous WG meetings The WG continued with discussion on the account resource and how the Coverage resource relates.
Both the Coverage and Contract resources were examined.
Use cases from HL7 Germany included self-pay, which was difficult to support using the current FHIR resources. After examining these resources, the following changes are suggested to the Coverage resource:
Add “patient” element to allow direct link to the patient
Add “priority” or “coordinationOfBenefits” for multiple coverages
Change reference of subscriber to “patient/relatedPerson/organization”
Change to “payor” and include references to organization/relatedPerson/patient
Consider “collapsing” all IDs into one identifier, move to the top of the elements.
The WG spent a good part of the quarter developing a diagram which showed the relationship between the FM and PA resources and how the account resource would support

Meeting Outcomes

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

Tuesday Q4

HL7 Patient Administration Meeting Minutes

Location: Winter Park Room 49

Date: 2016-01-12
Time: Tuesday Q4
Facilitator Brian Postlethwaite Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Brian Postlethwaite EPIC
X Simone Heckmann HL7 Germany
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

  1. Ballot reconciliation FHIR DSTU2

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions
Due to the smaller members within this quarter, the WG continued with the discussion on the resources involved in the coverage and how the Financial Management resources relate to the PA resources. The WG was still concerned about the relationships between account, coverage, account encounter, episodeOfCare, billable item and how this can and will be discussed with the Financial Management work group on Thursday, Q2 The WG continued with the associations between the resources for coverage, refining the diagram created within the last quarter in an attempt to cover the broad set of use cases and define what elements should be in extensions or profiles due to their realm specificity. Since there were representatives from Germany, Switzerland, The Netherlands, Australia and the United States, there was a lively discussion of needs and use cases. The model produced in the last quarter was used along with the model developed by Alex de Leon from a HL7 version 2, perspective to try to assure that elements pertaining to Patient Administration and Financial Management in the past, within the HL7 community were accounted for.

Meeting Outcomes

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

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