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2017-03-02 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: 2017-03-02
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 Pushpalatha Bhat
X Stephen Chu The Australian Digital Health Agency (ADHA)
Evelyn Gallego EMI Advisors LLC
X Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
X Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Russ Leftwich InterSystems
X 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
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-02-23_Patient_Care_FHIR_Call
    • Motion: Stephen/Rob
  3. AllergyIntolerance.category
  4. Condition.stage
  5. 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



STU3 resolved trackers related to AllergyIntolerance.category

  • GF#11352 Some items may have multiple categories (Rob McClure) - The cardinality was increased to 0..* because there were some allergens/substances (e.g. bee pollen) that may fit into multiple categories AND a few implementers (Epic and Allscripts) said they support multiple categories.
  • GF#11351 AllergyIntoleranceCategory should be SNOMED (Rob McClure) - Kept the required binding to FHIR value set

Related QA checklist items

  • QA 4e: If constraining to the "code" data type, ensure that the set of available codes will be sufficient in all possible business scenarios (including "unknown" and possibly "other" situations), particularly if the element is minOccurs = 1. Also ensure all codes are mutually exclusive or are defined in a proper hierarchy where siblings are mutually exclusive
  • QA 4a: Coded values should draw from external code systems as much as possible. If defining a CodeableConcept, FHIR-specific codes must only be used when no external code systems apply (and should be verified for 80% if this occurs).

Questions raised by Grahame per - options to consider:

  • 0..1 code data type with required binding (like DSTU2)
  • 0..* CodeableConcept with preferred binding (relax binding)
  • 0..* code data type with required binding (assuming QA 4e is updated)


  • What do we think the purpose of category is? How will it be used?
    • Mutually exclusive - undesirable because it depends on perspective (e.g. bee pollen could be food or medicine)
    • Purpose is for decision support and/or searches
    • Not intended to be a set of tags with multiple axis of categorization
  • GF#12942


Ewout raised visibility that there are different kinds of cancer staging (e.g. pathological, clinical), but Condition.stage is only 0..1

Need to discuss short term recommendation. Some options might be:

  • consider Condition.stage the clinical stage and use extensions for other staging (e.g. pathological)
  • multiple Conditions
  • use Observations since Condition.stage.assessment is 0..*

Need to discuss whether Condition resource should support multiple stages (e.g. in 80%).

Cerner supports capture of both clinical and pathological oncology stages, but doing so as Observation. Our staging documentation (typically T, N, M, and Staging Group for both clinical and pathological) is conveyed via Observation because it is calculated based on an assessment/form

Condition.stage cardinality should be 0..* and add a new Condition.stage.type code with a FHIR defined binding to support clinical, pathological, post-therapy, or restaging


Consent Resource

Laura said that she would join CBCC this Friday and then update Patient Care on March 13.


Adjourned at 6:30pm 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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