2016-09-20 PA WGM Minutes

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Patient Administration Work Group Meeting - Tuesday September 20, 2016

Tuesday Q1

HL7 Patient Administration Meeting Minutes

Location: Hyatt Regency, Baltimore, MD, Room #603

Date: 2016-09-20
Time: Tuesday Q1
Facilitator Line Saele Scribe Alexander de Leon
Attendee Name Affiliation
X Line Saele Helse Vest IKT Norway
X Brian Postlethwaite HealthConnex, Australia
X Alex de Leon Kaiser Permanente, USA
X
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions
Ewout reviewed the deadlines and the fact that most people are using the GFORGE tracker for more items November 27th substantive changes cut off for FHIR resource trackers. Dec 4 Final content deadline with the idea to publish by end of December or thereabouts. The deadlines do not seem to be a problem for the PAWG. There are 21 total tracker items that we must have to get done for the ballot and 14 major negatives.
The next topic was regarding the maturity levels for the FHIR resources. Alexander has tried to map the PHIR resources to the v2, v3 elements. The only things left were Slot and Schedule, but they do not have mappings to v2 or v3 elements. Ewout noted that last time Practitioner was going to be “redone”. Brian noted that the only thing that needs to be done is the work on PractitionerRole.
Brian brought up that the PAWG has some issues with bringing up the resources up. For instance, Patient has an issue that veterinary has not exercised the resource enough to raise the maturity level. The two areas that should be exercised were Patient link/merge and Patient Master Index query. There are also some address use tracker items that might hold back the maturity level but this might be datatype issues.

The WG discussed the Organization and Location. These had questions about returning childe elements to these structures when querying.
Appointment – Appointment type Schedule and Slot
Patient we might be able to get to level 4 with the exemptions.
Parattiiotner might move uponce practitioner role is resolved

RelatedPerson needs connectathon as well as person
Organization should move to level 3
HealthcareService no experience
Endpoint can move forward to 3
Location might have an issue with searching holding it back from getting to level 4. All need examples The WG continued beyond maturity levels/QA to talk about the messaging and FHIR. Brian noted that Simone had an issue with location. Business logic versus data mapping. This is the work that the WG will be moving forward with. Having completed the update of where the WG is with FHIR resources, it moved on to the Tracker items:

  1. 9191 - Summary: Add reasonReference element to Appointment

Appointment has an 'reason' element, but no way of linking supporting information. Such linkage is available in DiagnosticOrder, ReferalRequest, ProcedureRequest, MedicationOrder and SupplyReqeust which help viewers of those orders/requests understand the evidence behind those orders/requests. Appointments are no different; viewers of appointments should have ready access to the supporting evidence for the appointment. The linkage from ClinicalImpression to Appointment in ClinicalImpression.action is wrong. ClinicalImpressions are created and stored. Subsequently an Appointment may be created as a direct result of the impression. So linkage between the ClinicalImpression and Appointment is required. However, it should be from Appointment to ClinicalImpression. The addition of a reasonReference element, being a reference to ClinicalImpression, is required to facilitate this. The Patient Care Work Group wishes to remove the 'action' element from ClinicalImpression, because the linkage is the wrong way around. However that would require a mechanism for linking from an Appointment to a ClinicalImpress (linkage to the other resources is already possible with just a minor addtion of ClinicalImpression, to the list of referencable resources).

The WG sees the need for this and considers Indication as is expressed in the encounter as a potential answer for this linkage. After looking at the elements, the WG considered copying not only the Indication element but also the ReferralRequest. The WG considered the use of the Indication and ReferralRequest. This actually might be a good topic for the joint session with PC, since the ClinicalImpression The WG will also update the indication on encounter (and ppointment aboeo to include ClinicalImpression. These actions will be followed up with PC to assure that it meets their needs. Action: Include this item on the joint session with Patient Care on Wed Q2.


Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action Item:

Owner: , Due:

Next Meeting/Preliminary Agenda Items
  • .

Tuesday Q2

HL7 Patient Administration Meeting Minutes

Location: Hyatt Regency, Baltimore, MD, Room #603

Date: 2016-09-20
Time: Tuesday Q2
Facilitator Line Saele Scribe Alex de Leon
Attendee Name Affiliation
X Line Saele Helse Vest IKT Norway
X Brian Postlethwaite HealthConnex, Australia
X Alex de Leon Kaiser Permanente, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Update from the steering division. The Co-chairs noted that we did present and alert the ster

  1. 9539 Summary: Make patient-mpi-match StructureDefinition more generic/available for multiple resources

Brian noted that there are 4 options

  1. Basic search using parameters as they are
  2. Using the MPI query which is effectively an operation
  3. Generalize this approach to “all” resources, but this might be problematic
  4. Consider a search by example approach where you send what you have in a partial resource (or complete) and the server does an MPI on that. Using whatever algorithm, you like.

Mandatory fields might be an issue. However after discussing, this might not be an issue since the content is not being stored and server would return “no match”. The WG considered conditional create issues that could come up with this match.
This search by example solution would answer the MPI needs however, the WG discussed the various requirements for the MPI query. For example, how will a client know to search for specific elements defined by the server.
Internal business rules cover what the intelligence is that determines the matching, and weightings, etc.
The operation definition was discussed as a place to define what is needed. However, the WG discussed where the required fields for the search would be expressed for the client use.

Profile referenced StructureDefinition could describe which fields could be considered as part of the search.

The proposal is to create a new generalized operation “$match” that performs complex match processing. This will be configured to have a single inbound parameter of type resource that is the type of he resource being queried for. This may also include the profile on the resource to indicate which properties may be considered in the matching., including any mandatory items.

The output will be a bundle of the type of resource being queried and should have a bundle type of “search”. Where additional information on the search is provided, this will be through an operation outcome. For example indicating that there were not results, but they were ok, or where were too many results. The total count will not include the optional operationoutcome resource.
AN operation outcome will be returned instead of a bundle in cases where a search was not able to be performed due to inadequate properties, permissions, etc.
The extension http://hl7-fhir.github.io/extension-match-grade.html should be used to provide feedback on the confidence level of the match.

The note on the patient resource regarding the addition of userid to the call seems redundant, as this should come from the context of the call (e.g. smart on fhir) and not as parameters. The _count parameters should also be considered and paging may be supported also.
Question: Should this operation ever return more than 1 patient?
The WG continued discussing the various aspects of query using the above proposal including phonetic, multiple returns on matches, etc. Brian moves to disposition this as persuasive with mod, including the consideration above, seconded by Simone. Discussion: None. Vote: 8/0/0

Meeting Outcomes

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

Tuesday Q3

HL7 Patient Administration Meeting Minutes

Location: Hyatt Regency, Baltimore, MD, Guest Room# 603

Date: 2016-09-20
Time: Tuesday Q3
Facilitator Line Saele Scribe Alex de Leon
Attendee Name Affiliation
X Line Saele Helse Vest IKT Norway
X Brian Postlethwaite HealthConnex, Australia
X Alex de Leon Kaiser Permanente, USA
Quorum Requirements Met (Chair + 2 members): Yes/No

Agenda

Agenda Topics

Supporting Documents

Minutes

Minutes/Conclusions Reached: The WG decided to look at Coverage resource. In looking at some elements, it appears that none of the suggestions worked on by PA last WGM (Montreal) were implemented. One has to do with network which seems as the is in the 80%, therefore, be in the core specification, however when looking more closely, there is disagreement on whether it should be a string, coded concept, etc. Therefore PA suggests that this be national extensions with appropriate datatype assigned..

After discussing the lack of updates to the financial management resources, for those that PA has a stake in, Brian suggested that we contact FM and present the changes, have them vote and approve them, then Brian can actually implement and publish the changes.

  1. 9200 will include the changes to the coverage resource as decided upon in the last WGM.
  1. 9115 – BIN Number. Removed as this is really a card identifier.. Should be moved to the identifier coleection or an extension. There are also a lot of ther properties (i.e. plan, subPlan, group, subgroup) that are described as identifiers, but don’t seem to be.

A new tracker (#12066 ) was created - Summary: The Network property in Coverage should be an extension. As discussed at the Montreal WGM in May 2016, the Network property has different meanings in differnet jurisdictions, and different datatypes to represent the concept, so should be moved into an extension. This property could be a string, codeableconcept or organization depending on the usage, hence sharing as a core property doesn't work.

A new tracker (# 12067) was created – The PlanBenificiary property on the coverage is actually the patient that is being treated in this context and therefore should be changed accordingly to Patient to be consistent with FHIR resources. 7863 - Coordination of benefits- Coverage Primary and secondary sequencing for coordination of benefits. Existing Wording: Coverage.sequence = An optional counter for a particular instance of the identified coverage which increments upon each renewal. --- Comment: Can sequence be used to communicate primary coverage vs secondary coverage? The examples are named "General Person Primary Coverage Example" with sequence = 1 and "General Person Secondary Coverage Example", but the sequence definition doesn't sound like that was its intention. I would like a way to convey primary vs secondary coverage

Reference from Encounter to Coverage is missing.


Meeting Outcomes

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

Tuesday Q4

HL7 Patient Administration Meeting Minutes

Location: Hyatt Regency, Baltimore, MD, Guest Room #603

Date: 2016-09-20
Time: Tuesday Q4
Facilitator Line Saele Scribe Alex de Leon
Attendee Name Affiliation
X Line Saele Helse Vest IKT Norway
X Brian Postlethwaite HealthConnex, Australia
X Alex de Leon Kaiser Permanente, USA
Quorum Requirements Met (Chair + 3 members): Yes

Agenda

Agenda Topics

  1. 3 Year Work Plan – FHIR

Supporting Documents

Minutes

Minutes/Conclusions Reached: Line addressed the Harmonization schedule and how the co-chairs should be sure to attend and or let the harmonization team know if there are items to be done.
V2.9 Ballot Recon
Action: Resolve the last item which is the Organization Table that seems to be duplicated. Owner: Alex.
The WG then reviewed the last WGM minutes, specifically noting the action items.
Dave Hamill from HL7 HQ visited the group, so the WG used the opportunity to ask about project information since the Reafirmation of v3 Registires has passed ballot and
The WG continued with the review of the minutes. Action: Wording on CareTeam.subject (group) to indicate that this refers to a group of patients. Michelle (Cerner).
Action: Brian to craft a proposal relating CarePlan, EpisodeOfCare, Encounter and Care Team to be discussed in joint session with Patient Care.
Action: Create PSS for STU3 for FHIR resources. Endpoint, BillableItem and PractitionerRole, delivery dates. Alex Action: Brian to create resource proposal for BillableItem. Brian moves to accept the minutes from Montreal. Iryna seconds. Discussion: None. Vote (For/Against/Abstain): 6/0/0 The WG then continued on with the draft agenda for the next WGM (San Antonio). Action: Contact Patient Care to see if they want to have a 3-way joint session along with SOA on Q4 on Monday at the next WGM . Owner: Brian The WG then decided to continue with the tracker items. Before that the WG reviewed the FHIR maturity levels. Brian noted that the levels have changed slightly. This was to try to apply these to elements outside of just resources, such as profiles, etc. The WG then went into the maturity levels for PAWG’s resources. In doing so, the WG reviewed he QA Guidelines to assure where the resources are in terms of their maturity levels. Reference: | QA Guidelines

Meeting Outcomes

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

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