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2017-03-17 Learning Health Systems Call

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Facilitator Russell Leftwich Note taker(s) Emma Jones
Attendee Name Affiliation

X Russell Leftwich InterSystems
John Roberts Tennessee Department of Health
X Stephen Chu Individual
X Evelyn Gallego ONC
X Kathy Walsh LabCorp
Asim Muhammad Philips Research Europe
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
X Jeff Brown Cancerlinq
Lisa Nelson Individual
Dave Carlson VA
X Chris Melo Phillips Healthcare
X Michele Miller Cerner
Benjamin Kummer Columbia University
Matt Rhan
X Michael Padula
X Serafina Versaggi VA


  • Chair: Russell Leftwich
  • Scribe: Emma Jones
  • Approved Previous call Minutes: Stephen Chu Moved/Jeff Brown Second
  • PSS for Care Team DAM has been approved by TSC. Link to approved version is on LHS wiki
  • ONC Jira site documents have been downloaded. Russ will welcome guidance on if to post all artifact on LHS wiki or post the latest. Stephen has uploaded the most recent slide deck and the care team walkthrough of the care team types - condition, encounter, episode and longitudinal care focused care team types.
  • Stephen presented care team use cases walkthrough - orthopedic use case. Goal is to see how it fits within the FHIR care team elements.

Points discussed:

  • The use case walkthrough
    • identified the individual practitioners - part of the NUCC code sets
    • CareTeam.category -e.g. condition focused
    • careTeam.participant.role - using HL7 v2.x and V3 provider role type. Specialization of these roles come from the Medicare taxonomy cross walk
  • careTeam.participant.member --> Practitioner resource backbone element had a role that has been removed. Does the role.speciality element get used here?
  • Definition of practitioner qualification.specialty - more of licensure. Follows the practitioner, i.e. specific to the practitioner
  • Qualification.role- based on role of the practitioner at a particular location or organization.
  • Specialty can also be location specific - FHIR has taken away the specialty from the practitioner resource
  • Noted that systems in the US that are integrated with reimbursement - practitioner can have multiple specialty and get credential from multiple organizations
  • Qualification infers your specialty - e.g Hand Surgeon -which is the specialty
  • Practitioner.role is site specific
  • Credentialling is a facility or organization designation. Board certification is part of credentialing
  • Specialty is missing from the practitioner resource
  • For a specific Care team that is associated with an individual patient - the provider can have a single role in association with the patient.
  • Question 1. Regarding specialty - does the practitioner resource should have 0..* specialty (as well as the qualifications)? - Examples valueset for qualification - MD, RN, etc
  • Care team members need specialty and special skills represented. Sometimes people have different roles at which they can be wearing a different hat for a given patient. If this is a requirement it need to be modeled and not try to add practitioner role because that is not in reference to a patient.
  • Suggest adding specialty to care team - if in context of the patient yes, if no, have to add it to the practitioner. Agree to go thru the care team route because in HL7 care provision supports this. Add as sibling to careTeam.participant.role as a codable concept with cardinality 0..* - for example practitioner be a pulmonologist and an ICU specialist. Will be a member of the participant backbone element. Suggest using "skill set" instead of "specialty". Suggest calling it "type". Need to be mindful of when the participant is a caregiver. Will need good definition and examples. This is meant to convey the relationship to the patient. Cerner is adding family member relationship in roles.
  • Debating what to name the one new element.
    • Patient resource has financial planner as an attribute. Would this be a duplicate? This addition is context centric. There will always be the patient centric part that can overlap and vary. Patient Admin named their element "relationship" but not meaning family member relationship.
    • Homework - Stephen will start email discussion about this topic
      • Have agreed to add a new element - need to think about the purpose of this element and from there decide what to call it. What will this element do in the scheme of careTeam participant?
      • In the email, include role as well so we have the clear distinction between the two.
  • Emma will use the initial use case scenario to build on to include nursing related teams (including caregiver team).