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2016-06-09 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=9DMFKM&role=attend&pw=w9%7D6;Sc

Date: 2016-06-09
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
X Stephen Chu
Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Russ Leftwich InterSystems
Jay Lyle Ockham Information Services LLC, VA
Sarah Maulden VA
Jim McClay Univ of Nebraska Medical Center
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 Lockheed Martin, 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. Approve previous meeting minutes 2016-06-02_Patient_Care_FHIR_Call
    • Motion: Elaine/Stephen Abstain - 0, Negative - 0, Approve - 3
  3. Negation Update
  4. Prior Action Item Follow-up
  5. gForge change request

Supporting Information

STU 3 Timeline

  • Wed, June 1
    • All resource and IG proposals for STU3 have been completed, reviewed by WG and submitted
    • Connectathon tracks for Sept have been proposed
    • Feedback on gForge submitted to FMG
  • Sun, July 17 - Substantive content freeze for ballot -- core resources
  • Sun, July 24 - Total content freeze, start of QA
  • Wed, Aug 10 (midnight) - All QA changes applied
  • Fri, Aug 12 - FHIR ballot opens
  • Fri, Sept 12 - FHIR ballot closes
  • Fri, Sept 16 - FHIR triage complete and ballot content loaded to gForge (or alternate)
  • Sept 17-23 - Baltimore WGM
  • Sun, Dec 11
    • Reconciliation complete/substantive changes applied
    • Just over 10 weeks
    • Will re-evaluate at Baltimore based on volume of ballot comments
  • Dec 31 - Publish

FHIR Maturity Levels

[1]

  • Level 3 requires the artifact has been verified by the work group as meeting the DSTU_2_QA_guidelines and has been subject to a round of formal balloting; has at least 10 implementer comments recorded in the tracker drawn from at least 3 organizations resulting in at least one substantive change
    • Substantive changes (element names, sort order, vocabulary bindings, etc.) need to be applied by ballot freeze (Aug 10).
    • Unapplied QA checklist changes can be logged as ballot issues to be applied Sept-Dec. Substantive changes after ballot should be driven by ballot.
    • Non-substantive changes are fine
  • Level 2 requires artifact has been tested and successfully exchanged between at least three independently developed systems leveraging at least 80% of the core data elements using semi-realistic data and scenarios based on at least one of the declared scopes of the resource (e.g. at a connectathon). These interoperability results must have been reported to and accepted by the FMG.
Resource
Current FMM Level Goal FMM Level QA Status QA Reviewer Implementation Comments
AllergyIntolerance 1 3 Rob Argonaut
Condition 2 3 PCWG Argonaut
Procedure 1 3 Argonaut
CarePlan 1 3 Argonaut
Goal 1 3
QuestionnaireResponse 2 2 Lloyd Lloyd will QA to get to level 3
Questionnaire 0 2 Lloyd Lloyd will QA to get to level 3
CareTeam 0 2 NA NA Aggressive goal (e.g. whether we'll get the implementations needed)
FamilyMemberHistory 1 2 NA NA Aggressive goal (e.g. whether we'll get the implementations needed)
ClinicalImpression 0 1 NA NA
ReferralRequest 1 1 NA NA
ProcedureRequest 1 1 NA NA
Linkage 0 1 NA NA
Flag 1 1 NA NA
Communication 1 1 NA NA
CommunicationRequest 1 1 NA NA

Note: Bold denotes top 20 resource based on survey
Note: Contraindication and Risk Assessment are owned by CDS, not Patient Care

Minutes

Prior Action Item Follow-up

  • http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10067 -- Russ' comments about harmonization are denoted in the gForge, but he will be in Amsterdam on 6/9, so let's wait to resume discussion until 6/16 when he can attend.
    • Will defer the discussion until next week, but Rob thinks there may still be some changes needed (possibly a hierarchy where active includes both confirmed and unconfirmed) to differentiate between record status (entered in error) and clinical status (confirmed, unconfirmed).
    • Elaine suggested that we consider whether each status is "actionable" or not.
    • Michelle suggested that we consider how systems have it implemented; allergies don't always get confirmed whereas conditions more often go through a verification/confirmation lifecycle.

gForge Change Requests

FamilyMemberHistory: http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10008
Goal: http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10023
CarePlan: http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10026

Negation Update

  • Zulip chat: https://chat.fhir.org/#narrow/stream/implementers/topic/negation.2Fexclusion.20in.20AllergyIntolerance.20resource
  • via Zulip, Erich suggested code (allergen/substance/category) + relationship (refuted/no known/confirmed)
  • relationship mixes assertions (no known) and verification status (refuted)
  • via Zulip, Grahame suggested seeking "a solution that enables what should be but allows a graceful path forward for those constrained by what already is in place"
  • Would like to see how current use cases would be handled:
    • No Known Allergies
    • No Known Drug Allergies (category)
    • No Known Latex Allergy (substance)
    • Latex Allergy (confirmed)
    • Latex Allergy (refuted)


  • Terminology relies on information model to provide context, i.e. SNOMED would consider AllergyIntolerance.code = substance a causative agent.
  • Do we need to declare context model for each type of SNOMED concept?

Adjourn

Adjourned at 06:34PM 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
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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