2016-10-20 Patient Care FHIR Call

Meeting Information

Patient Care FHIR Resources Conference Call Location: Conference Call Phone Number: +1 770-657-9270 Participant Passcode: 943377 WebEx: https://cerner.webex.com/cerner/j.php?MTID=mfc8969c4f77244480beee61d31385e79		Date: 2016-10-20 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
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
X	Lisa Nelson	Life Over Time Solutions
X	Viet Nguyen
	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
X	Joe Quinn	Optum
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2016-10-13_Patient_Care_FHIR_Call
   • Motion: Stephen/Elaine
3. Prior Action Item Follow-up
4. gForge change request

Supporting Information

STU 3 Timeline

From FHIR_Ballot_Prep

• Sun Oct. 9
  • Last date for change requests (subsequent change requests are auto-punted to release 4)
• Sun Oct. 30
  • NIBs due for any IGs balloting in the Jan. cycle
• Sun Nov. 20
  • All ballot reconciliation complete
• Sun Nov. 27
  • All substantive changes applied to Core
• Sun Dec. 4
  • Content freeze for ballot & connectathon & publication QA review
• Sun Dec. 24
  • QA review complete, Qa changes begin being applied
• Dec 29 - Jan 3ish
  • 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

Resource	Current FMM Level	Goal FMM Level	QA Status	QA Reviewer	Implementation	Comments
AllergyIntolerance	1	3		Michelle	Argonaut
Condition	2	3		Michelle	Argonaut
Procedure	1	3		Michelle	Argonaut
CarePlan	1	3		Michelle	Argonaut
Goal	1	3		Michelle
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	Michelle		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

gForge Change Requests

Block Vote 1

Vote on Block Vote 1: Tony/Stephen - 3 approve / 0 negative / 3 abstain

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10310 ClinicalImpression.investigations should be singular(Lloyd McKenzie) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10601 QA1: Update CarePlan scope and usage(Michelle Miller) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10602 QA 1d: Add entered in error to valueset-care-plan-status(Michelle Miller) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10604 QA 1d: Add entered in error to valueset-goal-status.html(Michelle Miller) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10606 QA1: Update Goal scope and usage(Michelle Miller) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10608 QA 2c: CarePlan examples with extensions should use example prefix(Michelle Miller) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10628 QA 5e & 6b: AllergyIntolerance.onset should be mapped to w5 when.init and appear before attestedDate(Michelle Miller) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10629 QA 5e & 6b: Add Procedure w5 mappings and fix order of elements(Michelle Miller) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10630 QA 5e & 6b: Add CarePlan w5 mappings and fix order of elements(Michelle Miller) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10631 QA 5e & 6b: Add Goal w5 mappings and fix order of elements(Michelle Miller) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10698 CarePlan note is no longer applicable as CareTeam is now its own resource(Michelle Miller) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11118 Goal.description should stay textual. - 2016-09 core #272 (Danielle Friend) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11161 Include Person in the Procedure.subject reference list - 2016-09 core #315 (Stephen Chu) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11172 CarePlan.status needs suspended - 2016-09 core #326 (Stephen Chu) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11174 Will accept the implementation of Goal.milestone as extension - 2016-09 core #328 (Stephen Chu) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11175 Allow other resources to point to Goal - 2016-09 core #329 (Stephen Chu) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11178 ReferralRequest.status missing resume - 2016-09 core #332 (Stephen Chu) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11180 ProducedureRequest.status missing resume - 2016-09 core #334 (Stephen Chu) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11206 entered-in-error is not "inactive" align with Condition - 2016-09 core #360 (Stephen Chu) Persuasive with Mod
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11207 entered-in-error does not implay inactive - 2016-09 core #361 (Stephen Chu) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11231 Expansion for the QuestionaireResponse.status - is there a need for entered-in-error as a status? - 2016-09 core #385 (Riki Merrick) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11333 Clarify what context means - 2016-09 core #491 (David Tao) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11336 Fix care team example - 2016-09 core #494 (David Tao) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11338 Clarify goal outcome - 2016-09 core #496 (David Tao) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11349 Card is 1..1. (required). Suggest making 0..1 - 2016-09 core #507 (Emma Jones) Persuasive

Block Vote 2

Not enough attendees had reviewed, so request to defer Block Vote 2 until Oct 27.

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11171 Clarify CarePlan.context and CarePlan.duration - 2016-09 core #325 (Stephen Chu) Not Persuasive with Mod
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11177 Change CareTeam definition - 2016-09 core #331 (Stephen Chu) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11337 Clarify order set - 2016-09 core #495 (David Tao) Persuasive with Mod
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11345 Add CarePlan.activity.detail.prohibited.reason - 2016-09 core #503 (Emma Jones) Not Persuasive with Mod

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=7045 2015May core #110 - Allow the protocol data element to be multi-typed as either text or uri. (Andy Bond) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10403 add condition.onsetDateTime (Marten Smits) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10429 QuestionnaireResponse.questionnaire should be URI (Lloyd McKenzie) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10634 QA 5a: Resource references exist in both directions for CarePlan and ReferralRequest (Michelle Miller) Not Persuasive with Mod
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10723 Add a search parameter for status for the ProcedureRequest resource (Emmanuel Helm) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10755 Questionnaire item required when enabled (Sean McIlvenna) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11001 enableWhen.hasAnswer -> enableWhen.answerEnabled - 2016-09 sdc #67 (Stephen Chu) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11002 item.maxLength -> item.answerMaxLength - 2016-09 sdc #68 (Stephen Chu) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11003 item.initial -> item.prePopInfo - 2016-09 sdc #69 (Stephen Chu) Not Persuasive with Mod
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11004 What's the difference between Questionnaire.subjectType and QuestionnaireResponse.subject? - 2016-09 sdc #70 (Stephen Chu) Persuasive with Mod
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11005 Questionnaire.useContext sounds too much like QuestionnaireResponse.context - 2016-09 sdc #71 (Stephen Chu) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11165 Reword short description for ClinicalImpression.code - 2016-09 core #319 (Stephen Chu) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11166 The goal to use as short as possible concept name should not be at the expense of semantic accuracy - 2016-09 core #320 (Stephen Chu) Not Persuasive with Mod
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11167 ClinicalImpression shouldn't include plan - 2016-09 core #321 (Stephen Chu) Persuasive with Mod
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11202 Flag information should support machine processing and human readability - 2016-09 core #356 (Stephen Chu) Persuasive with Mod
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11203 Add invariant to ensure Flag.duration and Flag.encounter align - 2016-09 core #357 (Stephen Chu) Not Persuasive with Mod
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11204 Suggest rename to "Alert and Warming" - 2016-09 core #358 (Stephen Chu) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11380 Communication basedOn(any) seems too broad - shouldn't it be limited to CommunicationRequest? - 2016-09 core #538 (Paul Knapp) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11923 Required value set is missing "entered-in-error" concept - 2016-09 daf #7 (Calvin Beebe) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12071 Need to differentiate when to use each nesting approach for item (Lloyd McKenzie) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12168 Future observations need to be included in goals (Floyd Eisenberg) Not Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12169 Expand the scope of the entryFormat Questionnaire extension (Michele Mottini) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12171 careplan.activity.detail.prohibited description "Do NOT do" is misleading and confusing (Emma Jones) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12172 The spec use Questionnaire in many places where they should use QuestionnaireResponse (Michele Mottini) Persuasive
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12188 Add search parameters to ProcedureRequest (Elliot Silver) Persuasive

In Person

In Person Requests:

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11354 Substance identified in both AllergyIntolerance.code and reaction.substance is problematic - 2016-09 core #512 - Robert McClure - reschedule since he wasn't on the call today (Oct 20)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12136 Searching on optional attribute is dangerous (e.g., allergyintolerance.category)- Mark Kramer - TBD
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11281 Overall Condition.clinicalStatus and Condition.verificationStatus Condition body site - 2016-09 core #435 - Clem McDonald - TBD
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11290 clinical impression and condition - 2016-09 core #444 - Clem McDonald - TBD

Discussion

AllergyIntolerance

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11020 - Need use-case for reaction.certainty - Michelle to solicit feedback from other implementers
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11024 - Handling spurious allergy records - Not Persuasive

Adjourn

Adjourned at 6:35pm Eastern

Meeting Outcomes

Actions http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11020 - Need use-case for reaction.certainty - Michelle to solicit feedback from other implementers http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10662 Clarify how medical history should be handled - schedule joint discussion with SD http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11116 Better define the careplan.activity.outcome field - discussion will be continued during Patient Care CarePlan (Wed) conference call http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10642 - sent email to workflow listserv (http://lists.hl7.org/read/messages?id=302719) to highlight why PC doesn't believe the status recommendation applies to Condition (and AllergyIntolerance) Daniel Lanphear (submitter of gForge 8458) to draft new resource proposal for transfusion.

Next Meeting/Preliminary Agenda Items Agenda review Approve previous meeting minutes Motion: <moved>/<seconded> Abstain - <#>, Negative - <#>, Approve - <#> gForge change request

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