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2017-03-09 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

Date: 2017-03-09
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
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 Chris Melo Philips Healthcare
x Nick Radov Optum
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-03-02_Patient_Care_FHIR_Call
    • Motion: Eric/Rob
  3. STU3 FMM Levels
  4. STU3 QA Work (checklist, warnings, and suggested changes/clarifications)
  5. STU3 Substantive Changes (post-freeze)
  6. gForge Change Request
  7. Zulip - ClinicalImpression for a cancer therapy decisions

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 = 4
  • Procedure = 3
  • CarePlan = 2
  • Goal = 2
  • CareTeam = 2
  • FamilyMemberHistory = 2
  • ReferralRequest = 1
  • Flag = 1
  • Communication = 1
  • CommunicationRequest =1
  • ClinicalImpression = 0
  • Linkage = 0

STU3 Action Items


STU3 FMM Levels

  • MOTION: CareTeam to FMM=1; Eric/Russ: 9-0-0
  • MOTION: Condition to FMM=4; Eric/Russ: 9-0-1
  • Note: Lloyd suggested FamilyMemberHistory move to FMM=2 due to past Clinical Genomics connectathon tracks

STU3 QA Work

  • New QA warnings! GF#12973 QA Warnings for Condition.onset search parameters
  • Update QA checklist for resources that we want to be FMM = 3
  • QA Topics
    • extension-procedure-causedby -- review beefed up description - "This procedure is because of the related item"
    • extension-condition-criticality -- no value set binding -- log tracker to address after STU3 (GF#13004)
    • flag -- questionable QA feedback
      • As “flag” has numerous usages in FHIR, this particular use should somehow be distinguished. Might it be a “clinical flag?” Reject QA feedback, some flags are non-clinical (e.g. financial)
      • A flag is typically presented as a label in a prominent location in "the a paper chart or visual rendering of an electronic" record to notify the clinician of the potential issues -- Reject QA feedback (too verbose)
      • given the volume of information frequently found in patients' records and the potentially serious consequences of losing sight of some facts, this redundancy is deemed appropriate -- Deemed by whom? HL7? We don’t make this kind of policy. Suggest “deemed important by the users of an information system.” - Reject QA feedback (too verbose)
      • Patient has large dog at home -- This doesn’t seem like a credible example of the semantics for a flag, even under the “other” category. -- Reject QA feedback since this is a legit flag example
      • The Flag resource is sometimes known as "patient notes" -- This is definitely beyond the scope of QA but there seems to be a serious conflict here between the notion of flags as a highly concise representation of information preselected for its urgency or relevance to workflow and a more general topic of patient notes, which could be wide ranging, couldn’t they?
        • Change The Flag resource is sometimes known as "patient notes" to be The Flag resource is sometimes used as "patient notes"
    • goal - HgbA1c level =<5.6% -- Is this a clinically credible example? Yes

STU3 Substantive Changes (post-freeze)

FMG Patch Approval

  • GF#12942 Change AllergyIntolerance.category data type to code -- patch sent to Grahame and Lloyd to apply

FMG Rejected / Deferred to R4

No Approval Needed

  • GF#12973 QA Warnings for Condition.onset search parameters

gForge Change Requests

  • GF#12988 Wrong mapping for Condition.clinicalStatus to HL7 V2 DG1-6 -- resolved
  • GF#12973 QA Warnings for Condition.onset search parameters -- resolved



Adjourned at 6:32pm Eastern.

Meeting Outcomes

  • Nick will log tracker to add a Condition note about using the new Encounter.diagnosis structure to capture admission/primary diagnosis in context of an encounter
  • Russ will create a few procedure examples to cover other dimensions of scope (e.g. education, counseling, exercise)
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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