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2016-09-15 Patient Care FHIR Call
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Contents
Meeting Information
| Patient Care FHIR Resources Conference Call Location: Conference Call |
Date: 2016-09-15 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 | ||
| X | Tony Little | Optum 360 | |
| Jay Lyle | Ockham Information Services LLC, VA | ||
| Sarah Maulden | VA | ||
| Hank Mayers | ReliaTech Consulting | ||
| 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
- Agenda review
- Approve previous meeting minutes 2016-09-08_Patient_Care_FHIR_Call
- Motion: Stephen/Rob
- Prior Action Item Follow-up
- WGM Agenda
- FHIR QA / Ballot Feedback Summary
- gForge change request
Supporting Information
STU 3 Timeline
- Mon, 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
- 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
WGM Agenda
PC Agenda: http://wiki.hl7.org/index.php?title=September_2016_WGM_Baltimore:_Sep_18_to_Sep_23
FHIR Agenda: http://wiki.hl7.org/index.php?title=FHIR_Agenda_201609_WGM
| Quarter | PC Agenda | FHIR Agenda | Comments |
| Mon Q3 | FHIR Workflow | Workflow (FHIR-I, CDS, FM, II, MnM, OO, PC - LM, GG, EK) -- and -- FHIR-I, PC - JM |
|
| Mon Q4 | FHIR Workflow | Workflow (FHIR-I, CDS, FM, II, MnM, OO, PC - LM, GG) | OK |
| Tues Q1 | FHIR/PCWG/ECWG and CIMI | ||
| Tues Q2 | condition/concern/linkage | PC, EC, FHIR-I - JM | |
| Tues Q3 | CQI and CDS - Condition Status, Allergy Intolerance and Care Plan QDM RCRIM - Adverse event | RCRIM - LM? | OK |
| Tues Q4 | negation * GF#9335 (http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=9335) Orders to not do things - to gather implementer feedback since we haven't heard anything via https://chat.fhir.org/#narrow/stream/implementers/topic/Orders.20NOT.20to.20do.20something yet |
Negation modelling & vocab discussions (PC, CIMI, EC, Vocab, FHIR-I, OO, Pharm - LM) | OK |
| Wed Q1 | Joint meeting with Child Health, ED, CBCC , SDWG, Learning Health Systems (LHS), Care Team, Agenda: children with special needs, consumer generated contingency/emergency directive Personal Advance Care Plan - Lisa Nelson |
||
| Wed Q2 | PA/PC * GF#10544 (http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10544) Add condition extension(s) to represent a role in context of Condition.encounter (e.g. Primary/Sequence Admit Discharge etc.) * Care Team |
TO DO: update FHIR agenda wiki | |
| Wed Q3 | FHIR/PCWG Joint meeting (PCWG Hosting FHIR reps) Family CDS-CQI-RCRIM-OO-FHIR - * Order sets/PlanDefinition - how does it coordinate with various work groups that own request resources, such as CarePlan |
PC, OO, RCRIM, FHIR-I- LM | OK |
| Wed Q4 | PCWG-FHIR clinical resources ballot reconciliation | PC - FHIR clinical resources ballot reconciliation | OK |
| Thurs Q1 | Care Plan -invite FHIR, Structured Docs, Pharmacy Pharmacy Care Plan - PSS (Shelly Spiro) C-CDA on FHIR: care plan template (Rick Geimer) C-CDA - clinical oncology treatment plan (Jeff Brown) HL7 Care Plan model - FHIR - C-CDA harmonization (Laura, Emma, Lisa Nelson) CCS update (Emma) Care team members definition update (Laura, Emma) |
PC, FHIR-I - LM | |
| Thurs Q2 | Joint with SD Structured Doc, CDA update (SDWG co-chairs) Clinical status vs Act |
PC, SD, Templates, FHIR-I - EK | |
| Thurs Q3 | PCWG - Ballot reconciliation * Assessment scale *FHIR - AllergyIntolerance resource |
FHIR-I, PC - EK | |
| Thurs Q4 | Dynamic Care Planning FHIR Implementation Laura to invite HSI to join this meeting |
TO DO: Add to FHIR agenda |
FHIR QA / Ballot Summary
91 FHIR ballot comments to be loaded into gForge (additional ballot comments tied to existing gForge items)
- AllergyIntolerance 15
- CarePlan 15
- Condition 14
- CareTeam 8
- ClinicalImpression 7
- ProcedureRequest 6
- Goal 5
- Flag 3
- Procedure 2
- Questionnaire 2
- (blank) 2
- FamilyMemberHistory 2
- Communication 2
- Questionnaire, QuestionnaireResponse 1
- CommunicationRequest 1
- QuestionnaireResponse 1
- AllergyIntolerance,Condition 1
- ReferralRequest 1
- Procedure, Medication 1
- Condition, Observation 1
- Procedure,ProcedureRequest 1
Michelle started QA on AllergyIntolerance, CarePlan, Condition, Goal, Procedure (resources targeted for FMM level 3) focusing on anything that might be a substantial change, which warranted a ballot comment. Below is a summary of the findings (with gForge ballot comments logged if changes are needed).
| QA Checklist | AllergyIntolerance | CarePlan | Condition | Goal | Procedure | CareTeam |
| 1a. Contexts identified | Y | 10601 | Y | Y | Y | |
| 1b. Resource differentiated from peers | Y | 10601 | 10090 | 10606 | Y | |
| 1c. Non-examples provided | Y | Y | 10090 | Y | Y | |
| 1d. Definition for 'entered in error' | Y | 10602 | 10603 | 10604 | Y | 10725 |
| 2a. Examples cover all contexts & elements | Y | 10090 | 10607 | |||
| 2b. Examples ok for clinical/business w/ comments | Y | Y | Y | |||
| 2c. Extensions have valid/example URLs | N/A | 10608 | N/A | Y | N/A | |
| 3a. RIM mappings ok | ||||||
| 3b. External mappings provided | Y | |||||
| 4a. Valuesets draw from right code systems | Y | 10615, 10621, 10620 | 10091 | 10615, 10622, 10624 | 10627 | 10725 |
| 4b. Value sets "representative" where possible | example, not preferred | example, not preferred | example, not preferred | example, not preferred | example, not preferred | |
| 4c. FHIR codes have good definitions | Y | Y | Y | Y | Y | |
| 4d. Code used for structural or FMG-cleared | many codes! | what are structural elements? | Y | Y | Y | |
| 4e. Code types cover all scenarios, don't collide | 10369, 10642 | 10617 | 10618 | 10613 | 10625 | |
| 5a. References point right way | Y | 10634 | 10635 | Y | 10636 | Y |
| 5b. Inline content only where appropriate | Y | Y | Y | Y | Y | Y |
| 5c. isModifier appropriately declared | 10642, 10645 | 10643 | 10641 | Y | Y | Y |
| 5d. Summary appropriately declared | 10646 | Y | 10546 | Y | Y | |
| 5e. W5 column filled in and verified | 10628 | 10630 | Y | 10631 | 10629 | Y |
| 6a. Names appropriately consistent | Y | Y | Y | Y | Y | Y |
| 6b. Elements sorted appropriately | 10628 | 10630 | y | 10631 | 10629 | |
| 7a. Todos resolved | Y | 10615, 10622 | LOG GFORGE | 10623 | LOG GFORGE | 10725 |
| 7b. Definitions follow best practices | ||||||
| 7c. Rationale provided where needed | ||||||
| 7d. Committee notes filled in | ||||||
| 8a. Constraints allow narrative-only | Y | Y | Y | Y | Y | y |
| 8b. Constraints not over-restrictive | Y | Y | Y | Y | Y | Y |
| 9a. Search criteria meet 80% | ||||||
| 9b. Search descriptions complete |
gForge Change Requests
AllergyIntolerance:
- 10646 (http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10646) QA 5d: Too many AllergyIntolerance summary elements
- Resolution: slimmed down the list of summary elements
- 10645 (http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10645) QA 5c: Consider whether AllergyIntolerance.reaction.certainty should be is-modifier element
- Resolution: AllergyIntolerance.reaction.certainty is-modifier = false (no change). Reason: part of the definition of AllergyIntolerance.reaction.substance says it must be clinically safe to only process the 'code' and ignore the 'reaction.substance'
Condition
- 10641 (http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10641) QA 5c: Condition.abatement should be an is-modifier = true element
- Resolution: Condition.abatement doesn't need to be is-modifier as long as Condition.clinicalStatus is populated. Create an invar where clinicalStatus is required if verificationStatus is NOT entered in error.
Adjourn
Adjourned at 6:35PM Eastern.
Meeting Outcomes
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