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2017-02-14 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

Date: 2017-02-14
Time: 5-6pm 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
X 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
Joe Quinn Optum
Simon Sum Academy of Nutrition and Dietetics
Iona Thraen Dept of Veterans Affairs
Serafina Versaggi Dept of Veterans Affairs
Pushpalatha Bhat
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-02-09_Patient_Care_FHIR_Call
    • Motion: Stephen/Emma
  3. 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


gForge Change Requests

GF#12828 - Update RIM mappings for Procedure.performer.role and CareTeam.participant.role

Event Workflow Pattern

Review workflow patterns GF#10293

ReferralRequest -- pre-applied

  • add definition element
  • add replaces element
  • rename parent element to groupIdentifier; add aliases (grouperId and requisition)
  • bind status element to (effectively adding suspended and unknown)
  • rename category element to intent and bind to (pre-applied)
  • change priority from CodeableConcept to code; binding strength of required
  • rename fulfillmentTime element to be occurrence with choice of dateTime|Period
  • align requester element with the agent and onBehalfOf elements (allowing agent to also be RelatedPerson|Device)
  • rename reason element to be reasonCode, and increase cardinality 0..*
  • add reasonReference element
  • add relevantHistory element

ReferralRequest -- changes needed

  • ReferralRequest.replaces Reference only ReferralRequest
  • ReferralRequest.occurrence definition updated to "When the services requested in the referral should occur" with comment that when dateTime is populated, it is understood to be the same as if only Period.end (i.e. must happen before a specified date)
  • rename patient element to be subject Reference(Patient|Group) and change to be required 1..1


  • Stephen is logging a tracker against the workflow pattern around intent/status
  • Russ suggested that we consider where scheduled fits in
  • exempt from renaming serviceRequested to code; keep 0..* as well
  • exempt from performerType/performer pattern; prefer to keep recipient 0..* instead

ReferralRequest -- discuss / to be applied

  • add definition search parameter / example
  • add replaces search parameter / example
  • add service requested search parameter / example
  • add occurrence search parameter / example -- discuss whether to support Timing data type?
  • add authoredOn search parameter / example


  • 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
  • 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 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!
    • MnM approved exemptions requested for element names should be singular (replaces)
  • ReferralRequest -- no QA warnings!
    • MnM approved exemptions requested for element names should be singular (replaces)

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..*.)


Adjourned at 6:03pm Eastern

Meeting Outcomes

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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