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2016-02-11 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: 2016-02-11
Time: 5-6:30pm ET
Facilitator Michelle M Miller Note taker(s) Michelle M Miller
Attendee Name Affiliation

X Elaine Ayres NIH/Department of Clinical Research Informatics
Stephen Chu
Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
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)
X 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
X Simon Sum Academy of Nutrition and Dietetics
Iona Thraen Dept of Veterans Affairs
X M'Lynda Owens
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes: 2016-02-04_Patient_Care_FHIR_Call
    • Motion: Russell/Jay Abstain - 0, Negative - 0, Approve - 4
  3. Prior Action Item Follow-up
  4. gForge change request

Supporting Information

FHIR Resources owned by Patient Care
Maturity levels [1]

  • Questionnaire (2) -- Lloyd will QA to get to 3
  • Questionnaire Response (2) -- Lloyd will QA to get to 3
  • Condition (2)
  • AllergyIntolerance (1) -- Rob
  • Procedure (1)

Connectathon candidates

  • CarePlan (1)
  • Goal (1)
  • Referral Request (1)
  • FamilyMemberHistory (1)

Lower priority resources

  • Procedure Request (1)
  • Flag (1)
  • ClinicalImpression (0) -- goal to move to level 1 by next release
  • Communication (1)
  • CommunicationRequest (1)

Note: Contraindication and Risk Assessment are owned by CDS, not Patient Care


Prior Action Item Follow-up

Note vs ClinicalImpression Boundaries

A ‘Note’ is about a subject (typically a patient)
A ‘Note’ may have one or more ‘Clinical Impressions’ which are typically part of a section (named "Assessment/Plan") OR sometimes this is part of a dictation (where the entire document is stored as a PDF or single block of text)
Notes, on the other hand, may contain many things that are NOT clinical Impressions. Notes may contain many things that are NOT clinical impressions at all.
Can any content be included in the note (e.g. allergies, family history)? Anything is possible in a note.

If the H&P is signed, then an annotation could be added.

If capture allergy, diagnosis, procedure, family history, then one possibility in system to capture narrative only (still lives in same place, such that you could retrieve it with other structured allergies, etc). More common to capture raw text into a single bucket with a mixture of allergies, diagnoses, procedures, family history etc.

Different ways to capture data in FHIR:

  1. Domain resource (e.g. allergy, condition, procedure, etc) -- discrete form or narrative form or combination of both
  2. Questionnaire contains structured data

Are notes another way to capture undifferentiated data? Narrative, tied to subject, context/encounter, author, time

Introduce new resource for capturing raw form text
When we know what the content is, then use specific domain resource narrative

Documents in FHIR require content to live in other resources, which get packaged into a Bundle and Composition (who created, when, for what purpose). Collection of stuff gets passed around with rules about how to render. Narrative associated to Composition (who wrote it, title, date, type of document). In some circumstances, use Composition to wrap PDF or equivalent (whole text of document). The narrative ends up being the PDF. Most of the time, though, the content of the document comes from the various resources that each section points to (e.g. list) and narrative of that will be the blob for that section. When query the Bundle, can use parameters of Composition.

  • What element is used for text body when the text is all in one big blob? Composition narrative (text or HTML -- or reference to contained binary)
  • Why not have a single section with section.text? The text is the entire document....and might represent more than a single section, so don't use section to represent the entire note.
  • Still use Bundle that contains Patient and Composition.

H&P is more document-like because discrete resources do exist.

Nursing notes at end of shift (e.g. patient had nausea, gave meds) -- is not a document.


  1. Look into a new clinical note resource, which represents a big undifferentiated textual blob with narrative, tied to subject, context/encounter, author, time (maybe it is Basic, but will evaluate) -- often from dictation or a text editor
  2. Need a way to represent processes, like H&P or SOAP, without needing to invoke Document paradigm (to make it possible to share SOAP without having to define sections) -- next step: if we didn't do documents, but wanted discrete information, what does that resource look like? Larry and Rob; might have references to existing resources and/or might have content specific to the new resource
  3. If a Document exists, then can continue with Document instead of parsing into discrete data

gForge Change Requests

N/A - ran out of time


Adjourned at 06:57 PM Eastern.

Meeting Outcomes

  • Russell is withdrawing his prior gForge requesting a new Clinical Note resource
  • Larry, Rob, and Michelle will draft elements of a new resource to represent structured notes (such as H&P, SOAP notes, etc)
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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