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2016-04-28 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: https://www147.livemeeting.com/cc/_XML/cerner/join?id=8FNF2S&role=attend&pw=m9Kd%7Cx9

Date: 2016-04-28
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
Emma Jones Allscripts
Russ Leftwich InterSystems
Jay Lyle Ockham Information Services LLC, VA
Sarah Maulden VA
Jim McClay Univ of Nebraska Medical Center
X Russell McDonell Telstra Health
Lloyd McKenzie Gevity (HL7 Canada)
Larry McKnight Cerner
X Michelle M Miller Cerner
Lisa Nelson Life Over Time Solutions
Viet Nguyen Systems Made Simple
M'Lynda Owens Cognosante
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

Agenda Topics

  1. Agenda review
  2. AllergyIntolerance resource negation proposal from Terminfo
  3. Approve previous meeting minutes: 2016-04-14_Patient_Care_FHIR_Call and 2016-04-21_Patient_Care_FHIR_Call
    • Motion to approve both meeting minutes: Stephen/Rob Abstain - 0, Negative - 0, Approve - 4
  4. Prior Action Item Follow-up
  5. gForge change request
  6. QA Guidelines

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

Minutes

AllergyIntolerance resource negation proposal from Terminfo

  • Rename the existing AllergyIntolerance.substance element to AllergyIntolerance.code
    • Keep as CodeableConcept
    • Change the element cardinality to 0..1
    • Keep the current example value set binding to http://hl7.org/fhir/ValueSet/allergyintolerance-substance-code for the AllergyIntolerance.code element
      • Rename the value set to allergy-intolerance-code
      • Remove the individual negated codes for “No Known Allergies”, “No Known Food Allergies”, “No Known Drug Allergies” and “No Known Environmental Allergy” from the top level of the value set
      • Create a new value set (suggested name: allergy-intolerance-negated-code) to group all of the negated codes that are (or will be) included in the allergy-intolerance-code value set
        • Intensionally define the value set as “No known allergies (situation)” (160244002) and all of its descendants
          • This retains the current four codes and adds the codes for "No latex allergy" (409175002), "No known insect allergy" (428197003) and “No past history of animal allergy” (401189005)
          • It should also include new negated allergy/intolerance codes that may be added to the SNOMED CT “Situation with explicit context” hierarchy in the future
      • Change the definition of the allergy-intolerance-code value set to:
  • Create a standard extension to add a new AllergyIntolerance.excludedCode element
    • CodeableConcept (0..1)
    • Probably does not need to be a modifier extension
      • The meaning of AllergyIntolerance.code (and any other element in the resource) should not be changed by the presence of the excludedCode element and any value (code or text) that it may contain
    • Add an example value set binding to the http://hl7.org/fhir/ValueSet/allergyintolerance-substance-code value set (the same value set as above – to be renamed to allergy-intolerance-code as in 1.c.i)
    • Add an invariant with the extension to say that either AllergyIntolerance.code or AllergyIntolerance.excludedCode can be populated, but not both
      • Need to verify that this is possible
    • Add an explicit statement to the effect that double negation, if it occurs, is to be interpreted as additive or reinforcing of the negation, rather than as a "logically positive" statement of allergy or intolerance


Discussion about whether AllergyIntolerance.excludedCode is a modifier or not. Functionally, it isn't clinically unsafe to be unaware of the lack of an allergy. Technically, in order to write an allergy intolerance, the extension (or the narrative that includes the extension) would need to be persisted to make sense of the remaining allergy attributes.


Epic had shared the following feedback with Michelle:

  • We only support coded allergies, so we aren’t in need of identifying a positive vs. negative statements.
  • We actually don’t support negating allergies on a single allergy level. However, looking at what we would want to support, we’d certainly prefer having the negation live within the code itself, rather than as a top level element.

Prior Action Item Follow-up

Michelle flipped a couple gForge statuses back to Triaged where input was provided (specifically, those listed below under gForge Change Requests).


gForge Change Requests

Family Member History:

ClinicalImpression: http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=5696

QA Guidelines

Patient Care is discussing which of the following resources are candidates for FHIR maturity level 3 in the next release. In order to meet level 3, we are soliciting volunteers who are willing to evaluate any of the following resources against the DSTU_2_QA_guidelines. The QA spreadsheet tracks each QA checklist item (row) against each resource (column).

  • Condition
  • Procedure
  • CarePlan
  • Goal
  • FamilyMemberHistory
  • Referral Request -- might be best to wait until after workflow changes get applied

FYI….these resources already have volunteers identified for QA review.

  • Questionnaire -- Lloyd
  • Questionnaire Response -- Lloyd
  • AllergyIntolerance -- Rob


For resources without a volunteer assigned, dedicate time during our Thursday conference calls to do QA together as a work group. Would like to see the results of the FHIR survey (asking the community for input on the desired FMM levels per resource) to further prioritize the list.

Adjourn

Adjourned at 6:03PM Eastern.

Meeting Outcomes

Actions
  • Input from Viet, Russell, and Rob on Michelle's drafted ClinicalNote_FHIR_Resource_Proposal
  • Daniel Lanphear (submitter of gForge 8458) to draft new resource proposal for transfusion.
  • Rob to help fill in value sets for CareTeam status and type
  • Rob will share FHIR AllergyIntolerance resource negation proposal from Terminfo via Listserv
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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