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2017-02-09 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
WebEx: https://cerner.webex.com/cerner/j.php?MTID=macd64a688fdc3410ab4178adab5820fb

Date: 2017-02-09
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 The Australian Digital Health Agency (ADHA)
Evelyn Gallego EMI Advisors LLC
Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
X Russ Leftwich InterSystems
Tony Little Optum 360
Jay Lyle Ockham Information Services LLC, VA
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
X Joe Quinn Optum
Simon Sum Academy of Nutrition and Dietetics
Iona Thraen Dept of Veterans Affairs
Serafina Versaggi Dept of Veterans Affairs
X Pushpalatha Bhat
Quorum Requirements Met: yes

Agenda

Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-02-02_Patient_Care_FHIR_Call
    • Motion: Russ/Stephen
  3. Prior Action Item Follow-up
  4. gForge change request

Supporting Information

STU 3 Timeline

From FHIR_Ballot_Prep

  • Sun. Feb. 19 Publication substantive resource freeze
  • Sun. Feb 26 Publication total freeze
  • Mon. Feb 27 QA period opens
  • Tue. Feb 28 FMM QA spreadsheet updated for all WG resources
  • Sun. Mar. 13 QA period closes
  • Sun. Mar. 20 All QA applied

The "following week" STU 3 is published!

FHIR Maturity Levels

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

Target FMM levels for STU3 publication

  • AllergyIntolerance = 3
  • Condition = 3
  • Procedure = 3
  • CarePlan = 1
  • Goal = 1
  • CareTeam = 1
  • FamilyMemberHistory = 1
  • ReferralRequest = 1
  • Flag = 1
  • Communication = 1
  • CommunicationRequest =1
  • ClinicalImpression = 0
  • Linkage = 0

STU3 Action Items

Minutes

gForge Change Requests

GF12776 Goal.subject should be 1..1 -- Deferred


Event Workflow Pattern

Review workflow patterns GF#10293

FamilyMemberHistory - Ask FHIR-I to exempt FMH from workflow

  • make identifier a summary element
  • add definition element Reference(Questionnaire | PlanDefinition) -- search parameter / example
  • don't add basedOn element
  • don't add partOf element
  • don't bind status to http://hl7.org/fhir/ValueSet/event-status
  • add notDone element
  • add notDoneReason element (example binding; similar to FHIR value set to http://build.fhir.org/valueset-list-empty-reason.html)
    • Patient does not know subject
    • Patient refused to provide information about subject
    • Unable to obtain
    • Deferred (e.g. don't know why family member died)
  • don't add code element
  • don't rename patient element to subject -- keep the Reference(Patient)
  • don't add context element -- Reference(Encounter|EpisodeOfCare)
  • exempt from occurrence pattern (i.e. don't rename date, keep dateTime data type)
  • don't add performer structure (i.e. role, actor, onBehalfOf)
  • add reasonCodeableConcept (example value set binding to http://build.fhir.org/valueset-clinical-findings.html)
  • add reasonReference element Reference (Condition | Observation | AllergyIntolerance |QuestionnaireResponse)

Communication

  • exempt from occurrence pattern (i.e. keep sent/received dateTime)
  • exempt performer structure (i.e. role, actor, onBehalfOf) and keep sender/recipient elements as is
  • add reasonCodeableConcept (example value set binding to http://build.fhir.org/valueset-clinical-findings.html)
  • add reasonReference element Reference(Observation | Condition)

Request Workflow Pattern

CommunicationRequest

  • add supportingInfo as extension (GF#10293)
  • add relevantHistory as extension (GF#10293)
  • add definition as extension Reference(ActivityDefinition|PlanDefinition)
  • add basedOn element -- Reference(CommunicationRequest + all other request)
  • add replaces element -- Reference(CommunicationRequest)
  • add groupIdentifier element -- search parameter / example
  • don't add intent element (order doesn't apply)
  • change priority from CodeableConcept to code (and add w5 mapping to grade)
  • exempt from having code element added
  • exempt from making subject 1..1 -- keep 0..1
  • rename scheduled element to occurrence and don't add choice of Timing
  • rename requestedOn element to authoredOn, add w5 mapping to when.recorded, add aliases (createdOn, signedOn) -- update search param
  • align requester element with the agent and onBehalfOf elements (allowing agent to also be Organization|Device)
  • exempt from performerType/performer pattern; prefer to keep sender/recipient instead
  • rename reason element to be reasonCode
  • add reasonReference element - Reference(Condition | Observation)
  • add note element

Next Week

ReferralRequest

  • add definition element -- search parameter / example
  • add replaces element -- search parameter / example
  • add aliases (grouperId and requisition) to groupIdentifier element
  • bind status element to http://hl7.org/fhir/ValueSet/request-status (effectively adding suspended and unknown)
  • rename category element to intent and bind to http://hl7.org/fhir/ValueSet/request-intent (pre-applied)
  • change priority from CodeableConcept to code
  • exempt from having code element added OR rename serviceRequested element to code? (request pattern has 0..1 cardinality, but keep 0..*)
  • rename patient element to be subject Reference(Patient|Group) and change to be required 1..1
  • rename fulfillmentTime element to be occurrence with choice of dateTime|Period|Timing?
  • align requester element with the agent and onBehalfOf elements (allowing agent to also be RelatedPerson|Device)
  • exempt from performerType/performer pattern; prefer to keep recipient 0..* instead
  • rename reason element to be reasonCode, and increase cardinality 0..*
  • add reasonReference element
  • add relevantHistory element

ClinicalImpression

  • add definition element -- search parameter / example
  • add basedOn as extension (GF#10293) -- search parameter? / example
  • add partOf as extension (GF#10293) -- search parameter? / example
  • bind status to http://hl7.org/fhir/ValueSet/event-status
  • add notDone element
  • add notDoneReason element (need to determine value set binding)
  • add alias (of patient) to subject element
  • exempt from occurrence pattern (i.e. don't rename effective, don't add Timing)
  • align assessor with the performer structure (i.e. role, actor, onBehalfOf) - can actor Reference(Practitioner|Organization|Patient|Device|RelatedPerson)? or just Practitioner?
  • add reasonCodeableConcept (need to determine value set binding)
  • add reasonReference element

Resource QA Summary

TOP Priority

  • AllergyIntolerance is clean on the QA report!
  • Condition is clean on the QA report!
  • Procedure is clean on the QA report!

HIGH Priority

  • CareTeam - no QA warnings!
  • CarePlan - no QA warnings!
    • MnM approved exemptions requested for element names should be singular (addresses and replaces)
  • Goal - no QA warnings!
    • MnM approved exemption requested for element names should be singular (addresses)
    • MnM approved exemption requested for Goal.target.detail because target detail is a choice of data types (i.e. Quantity and CodeableConcept could have different value sets) - Observation.value[x] does not show this same QA warning.

MEDIUM Priority

  • Flag -- no QA warnings!
  • FamilyMemberHistory -- no QA warnings!
    • Stephen Chu's recommendation is to use LOINC 75272-5 Age at onset for the FamilyMemberHistory.condition.onset
    • Motion: Stephen/Elaine: 11-0-1
  • Communication -- no QA warnings!
  • CommunicationRequest -- no QA warnings!
  • ReferralRequest -- no QA warnings!

LOW Priority

  • ClinicalImpression -- keep as FMM = 0
    • Stephen Chu will work on examples to cover all elements
      • ClinicalImpression.action Search Parameter 'ClinicalImpression.action' had no found values in any example. Consider reviewing the expression (ClinicalImpression.action)
      • ClinicalImpression.previous Search Parameter 'ClinicalImpression.previous' had no found values in any example. Consider reviewing the expression (ClinicalImpression.previous)
    • PCWG: ClinicalImpression.code Need to provide a binding
  • Linkage -- keep as FMM = 0
    • PCWG: Linkage A resource must have an 'entered in error' status
    • PCWG: Linkage All resources should have an identifier
    • PCWG: Linkage.item Element has a todo associated with it (Make this 2..*.)

Adjourn

Adjourned at 6:36pm Eastern.

Meeting Outcomes

Actions
  • Michelle to ask FHIR-I/workflow to exempt FamilyMemberHistory from workflow event pattern
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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