2017-05-10 PA WGM Minutes

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Patient Administration Work Group Minutes - May 10, 2017

Wednesday Q1

HL7 Patient Administration Meeting Minutes

Location: Marriott Madrid Auditorium, Potsdam Conference Room

Date: 2017-05-09
Time: Wednesday Q1
Facilitator Brian Postlethwaite Scribe Helen Drijfhout
Attendee Name Affiliation
X Helen Drijfhout HL7 Netherlands
X Richard Kavanagh NHS Digital
X Line Saele HL7 Norway
X Brian Postlethwaite Telstra Health, Australia
X Isabelle Gibaud HL7 France
X Christian Hay GS1
X Michael Donnelly Epic
X Andrew Torres Cerner
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
Welcome/introductions

  1. FHIR R4 resource work

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions
Line: We have a problem with Q4 today, we want to do tracker items but Brian is not present.
Drew Torres will be there, so we will keep the quarter as planned.

Tracker Items

#13146 Resource joins via RelatedPerson.
Discussion yesterday: Person is very limited in scope. Patient is used everywhere.
There is a desire to have a more general Resource for the relationship.
Brian would love to have a resource proposal for the general resource to resource relationship. It will have a 0..* relation to Any resource, with a relationship Type.
There already is a Linkage resource, maybe this one could be used when the scope is extended.
Brian: we need a relationship for things that are not the same thing, Linkage is just for linking records for the “same” item.
Attributes on the proposed Relationship resource:
• Type (e.g. Familial relationship)
• Source
• Target
• RelationshipType (e.g. Father)
• Period
Yesterday we talked about the RelatedPerson, who has a relationship item with cardinality 0..1.
Brain wanted to make that 0..*, but that would open the issue of choosing the relationship that applies in a specific context.
Brian: Back to reality, look at the current tracker item (13146).
Suggestion is to add another item next to relationship: role 0..*.
This can be used for e.g. “Billing person”, “Legal guardian”.
Brian drafts some examples.
He shows a software application in which there is a relationship coding system, which includes all family relations and also codes for e.g. “Formal guardian”, “Carer”.
We now look at the resource definition of Patient.Contact.
This also has an Organization item, 0..1.
There is a fundamental problem in FHIR that doesn’t let you model your relationships well.
If this tracker item will be fixed by adding a .role item, there will still be a fundamental issue.
Procedure request and diagnostic order are merged back again, also Medication request and …
Lloyd suggests in the tracker item to use the CareTeam resource for expressing the role.
The RoleCode table on Personal Relationship roleType has some more codes in it that do not directly belong in a CareTeam, e.g. “State Agency”, “Insurance Company”.
Drew and Michael wouldn’t use the CareTeam resource for that.
Concluding this for now, this needs more discussion. Brian updates the tracker item.
PA thinks we should be considering a new general relationship resource in FHIR. It would be similar to the Linkage resource, except not for the relationship with itself.
This is not voted on, action is waiting for further input.

Other issues
Michael brings on a wish to be able to use a hierarchy in the use of the Practitioner resource:
System one wants to use Practitioner in a more simple way, no PractitionerRole resource is needed.
A second system wants to use this instance in a general regional directory system which has more information. Their resource would relate to the general Practitioner instance with an inheritance reference.
Third: a local system would inherit the regional practitioner set, and add some other things like specialty, fax number.
The question is if there can be an inheritance tree for the same resource.
You would only publish the practitioner information for which you are the truth of source.
Local content would override the information from the general directory system.
Brian: this would demonstrate the PractitionerRole concept.
Question: where do we change the Practitioner reference to a PractitionerRole reference?
Concerns which Brian had before: there will be changes in PractitionerRole, and that impacts the historical references to this resource. E.g. when a practitioner has no longer a specialty role like Neurosurgeon, what would the reference from CareTeam to Practitioner (Role) do?
Drew: there are temporary Care Teams, e.g. for an Encounter, and lifetime Care Teams like PCP. Sometimes they associate to a Practitioner, sometimes to the PractitionerRole.
A new approach would be using a contained PractitionerRole, which not suffers from changes to the actual resource.
This makes it hard to search for with a parameter.
There are more places in which contained resources are actually used.
We do not come to a conclusion on this at the moment, just need to have further input and discussion.

  1. 9226 Provide a way to rank procedures in the context of an encounter

To designate the most significant procedure. This should also be applied to conditions.
There is a proposal, but there are circular references in that:
Collapse all in diagnosis.role.
Procedures are not referenced on the encounter, the reference is the other way.
In the proposal there is a new item: rank 0..1 (int).
This will do the ranking, within the role (billing, admitting, etc.).
Question if there should be more clarification about the ranking, saying it is the ranking within the role.
Question is if this covers the original change request.
Related tracker for Condition: 10544. This one is fixed and closed, by adding the new diagnosis item with role, procedure/condition and rank. This is in STU3.
Conclusion is that the 9226 item also is solved by this resolution.
Resolution: question answered, resolved.



Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • None


Next Meeting/Preliminary Agenda Items
  • .

Wednesday Q2

HL7 Patient Administration Meeting Minutes

Location: Marriott Madrid Auditorium, Potsdam Conference Room

Date: 2017-05-10
Time: Wednesday Q2
Facilitator Brian Postlethwaite Scribe Helen Drijfhout
Attendee Name Affiliation
X Brian Postlethwaite Telstra Health, Australia
X Helen Drijfhout HL7 Netherlands
X Vadim Peretokin Furore
X Line Saele HL7 Norway
X Christian Hay GS1, Switzerland
X Simone Heckmann Gefyra, Germany
X Isabelle Gibaud HL7 France
X Andrew Torres Epic, USA
X Emma Jones Allscripts
X Michelle Miller Cerner
X May Terry Flatiron Health
X Russ Leftwich Intersystems
X Stefan Lang HL7 Germany
X Michael Donnelly Epic
X Michael Tan Nictiz
X Chris Melo Philips
Quorum Requirements Met (Chair +2 members): Yes

Agenda

Agenda Topics
Welcome/introductions
Joint Meeting with Patient Care. Focus on joint resources • Tracker Items

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions

Tracker items

  1. 12509 CareTeam participant

Michelle Miller explains: there is a lot of discussion about the role of a participant, how do you describe what the participant is responsible for. The current opinion is to extend the cardinality for role from 0..1 to 0..*. Also ideas are to add Responsibility and Specialty.

There will have to be good clarification about what is a role, and what is a responsibility.
PC is focusing now on the value sets for these elements.
Brian asks if it impacts CareTeam on e.g. Encounter.
You can reference a PractitionerRole, which is a particular Person.
There is some discussion about what is a CareTeam: are those actors? Or are the individual Persons the actors? If a role can be played by a CareTeam, it has to be an actor.

See also #13338, PC resolved this today: there is some clarification about CareTeam. It may be for a single patient, a group or an organization, e.g. an emergency response team.
There can be transfers of team members over time, and of responsibilities.

PA was talking about RelatedPerson, who could be the billing contact. Some people in there are there for professional reasons, like “Billing person”. Lloyd suggested they should be part of the CareTeam resource, and not add a role to RelatedPerson. PC thinks this is not a CareTeam role, but a RelatedPerson role.

Michael: it feels weird to have the person to which the bill is send in the CareTeam.
Example: I have 2 siblings, one of them is living in the same street and part of the Care team. This one should be in the CareTeam. The other one is just a RelatedPerson.
Michelle: the RelatedPerson should carry the familiar relationship, the CareTeam should carry the care relationship.
Brian shows #13146, the request to add role to RelatedPerson.
Michelle: There are roles that are not persistent in time and could be context specific, they should be on CareTeam rather than RelatedPerson.
Michael Donnelly: there was also a request to extend the cardinality for relationship on RelatedPerson.
Drew: prefers to create another resource instance for each relationship of the same person to a patient.
Michelle thinks that a person could as well be the grandmother, as the legal guardian. In all contexts this RelatedPerson would have both roles.
Drew agrees, and suggests to relax the cardinality on relationship and NOT add another item role. Role should be put in the CareTeam. Brian puts this resolution in item #13146.
Michelle: the role could also be in other resources, that would not only be in CareTeam.
Brian goes back to the text we got today in Q1 about linkage of resources.
There we talked about an OrganizationAffiliation resource.
Question to PC is whether they also have a need for a generic linkage resource.
Michelle: this would also be useful for Practitioner linkage, as long as you are able to distinguish different network organization types.
In STU3 there is a Linkage resource, but this has a restricted scope: “Identifies two or more records (resource instances) that are referring to the same real-world "occurrence".
This resource is still a draft version (level 0).
The discussion on this doesn’t affect the resolution of #13146.
The motion to relax the cardinality on relationship and to not add role is moved by Michelle, seconded by Michael Donnelly. Votes: 13-0-2.

ChargeItem
Simone presents the draft proposal for ChargeItem. This is the result of an activity which can be send to the billing system.
The ChargeItem would not contain the unit price, but could override the list price e.g. when there is a discount for a particular reason.
Comments from Patient Care:
Michelle: is there a relationship between charges?
Simone: yes, ChargeItem can be a part of another ChargeItem. ChargeItems can be grouped. This is done with the partOf relationship.
May: has not seen this hierarchy relationship before. How does this relate to Claim?
The Claim resource does not include ChargeItem at the moment, it has an “item”.
Brian: the context is modelled in a reference to the “context”, which can be an Encounter of an EpisodeOfCare.
Specific information about the services is in “service”, this references to 0..* different services.
Drew: Encounter should be in the list of services, it is not there at the moment.
Simone: the rules for the billing code should not be in this resource, but in a Definition resource. We do not have that yet.
Discussion about negative amounts. What do you do when the charge has been entered in error?
Simone: the ChargeItem has a status, which can be “Entered in error”.
There is a quantity item on the ChargeItem, which may be different from the quantity in the service depending on regulation for the charge codes.
May: that is fine. We would use HIPAA codes.
LHS Care Team DAM
Russ Leftwich presents the Care Team DAM. This is about a Learning Health System, it is continuously improving process. The approach for the DAM was to reverse engineer the care team for a specific patient and look at all the care team participants. Participants could retire, or may have limited time engagements, or be there for only a specific period of time. So the care team for a patient will be dynamic over time. There also could be sub-teams.
Many attributes still need to be defined, e.g. consent. Who has consent and how is that transferred, how is the communication.
We are keeping this joint quarter in the next WGM.
Russ: you might also invite the Learning Health System group.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • • None
Next Meeting/Preliminary Agenda Items
  • .

Wednesday Q3

HL7 Patient Administration Meeting Minutes

Location: Marriott Madrid Auditorium, Potsdam Conference Room

Date: 2017-05-10
Time: Wednesday Q3
Facilitator Line Saele Scribe Helen Drijfhout
Attendee Name Affiliation
X Helen Drijfhout HL7 Netherlands
X Brian Postlethwaite Telstra Health, Australia
X Peter Jordan Gevity Consulting Inc.
X Christian Hay GS1, Switzerland
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

  1. FHIR R4 work

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Brian spoke with Lloyd about the Patient Active stuff. He is supporting it.
So this would need some clarification and then this can be voted on.

  1. 11368 coveragePeriod -> period - 2016-09 core #526

The requested change on the Account resource has already been applied in STU3, it is even published.
There is a wording issue in the active period, it still refers to “coveragePeriod”.
Action for Brian to file a new tracker item to change the text.

  1. 11367 Change description of Coverage - 2016-09 core #525

Brian: This will be put on the joint session with FM, Q2 on Thursday.

  1. 13345 Organization, Location include alias elements and extensions

The Organization resource has received an alias item in STU3, before that there was a standard alias extension on Organization and Location. This can be removed.
The datatype is string, 0..* cardinality, same as the extension.
Motion to remove the extensions made by Brian, seconded by Helen, accepted with 4-0-0.

  1. 13264 Organization, Location, and Practitioner need support for Merge/Link/Unmerge

Needs more discussion.

  1. 13235 add endpoint to group

Brian thinks we need more information on this. Practitioner already has an e-mail address, also Care Team will get an Contact Point. Is it then still needed in Group?

  1. 10762 Wrong system used in practitioner example file

This is part of QA changes. The examples will be updated.

  1. 13074 QA: Valueset warnings cleanup for Encounter and ChargeItem (draft)

The QA warning is about update casing.
This seems to be already applied as part of QA.
Motion to accept the change made by Brian, seconded by Helen, accepted with 4-0-0.

  1. 13020 Encounter Length is Quantity search, not Number

Length of the Encounter has been changed from positive integer to duration, so the Search example doesn’t fit anymore.
Motion made by Brian to update the search parameter for length from number to quantity. This datatype is compatible to duration. Seconded by Helen, accepted 4-0-0.

  1. 12888 Add "Alternate Home" to EncounterDischargeDisposition value set

In Canada there is a need for a concept like “discharged to home, but not the patients own home”.
This sounds reasonable.
Helen remarks that the proposed code is “ALTDISHM”, why the “DIS” in this code? Brian agrees there is no need for this. All the codes are for Discharge Disposition.
Suggestion to make this “alt-home”.

Motion to accept the change made by Brian, seconded by Peter, accepted with 4-0-0.

  1. 12722 Replace organization type Insurance Company with Payer

Discussion about deprecating Insurance Company: there are several countries, like The Netherlands and Norway, in which still insurance companies are paying for the hospital services.
We are quite happy with adding Payer, but not with dropping “Ins”.
The valueset is an Example, so this will likely will be overruled locally.
Motion to add the concept Payer as indicated made by Brian, seconded by Helen, accepted with 4-0-0.

  1. 12854 Remove/anonymize ical mappings from Appointment resource definition

The present examples have Brains name and e-mail in it. Suggestion to remove that.
Brian moves to anonymize the examples. Peter seconds. Accepted with 4-0-0.

  1. 13066 QA: Location.mode should not be an modifier

Location.mode has a modifier on it, which according to Grahame is not appropriate.
Brian moves to remove the modifier as requested. Peter seconds. Accepted 4-0-0.




Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • None
Next Meeting/Preliminary Agenda Items
  • .

Wednesday Q4

HL7 Patient Administration Meeting Minutes

Location: Marriott Madrid Auditorium, Potsdam Conference Room

Date: 2017-01-09
Time: Wednesday Q4
Facilitator Line Saele Scribe Helen Drijfhout
Attendee Name Affiliation
X Helen Drijfhout HL7 Netherlands
X Line Saele HL7 Norway
X Andrew Torres Cerner
X Michael Donnelly Epic
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

  1. Tracker items

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Tracker items

  1. 12270 Add DICOM mappings for Organization

This item has no extra information provided. Line changes this to “wait for input” from Brad Generaux.

  1. 10304 Organization Affiliation

Will be discussed later.

  1. 13264 Organization, Location, and Practitioner need support for Merge/Link/Unmerge

We ask John Moehrke if he will be available tomorrow to discuss this.

  1. 12920 Person definition/description needs work

Lloyd suggests a change of the definition text:
The resource needs to state in the first line of its definition that "Person is a linking resource used to convey shared demographics for one or more other Patient, Practitioner and/or RelatedPerson resources". A later sentence needs to say "Person instances are never directly referenced as actors (authors, subjects, performers, etc.) Individual actors are identified as either Patient, Practitioner or RelatedPerson, depending on the role of the individual when undertaking the action"
This looks reasonable.
Moved to accept the proposed change by Michael: the text will be updated as requested. Seconded by Drew, accepted 3-0-0.

  1. 13033 8.3.3 De-normalized Data

Suggestion to change the text of the Person resource:
The second sentence in the first paragraph states:

    This is intentional and highlights that the "disconnectedness" of the resources.

Since the word "disconnectedness" portrays a negative connotation, you might consider using the words "loose coupling" instead. For instance:

    This is intentional and highlights the loose coupling of the resources.


Moved to accept the proposed change by Drew: the text will be updated as requested. Seconded by Michael, accepted 3-0-0.

  1. 12726 Appointment needs a property for the actual arrival time.

Drew: finds this not persuasive, because the Appointment is in the future. Arrival time can already be put in the Encounter with the Status history.
Drew moves to make this non-persuasive, Michael seconds, accepted 3-0-0.

  1. 12739 Need a per-participant period for Appointment

Cooper Thompson asks to add the period on the participant backbone item in the Appointment resource, because participants may be involved with the appointment for different periods in time.
After having some discussion of the options the motion is made by Michael to add period 0..1 to the participant. Drew seconds, accepted 3-0-0.

  1. 12304 Add IHE PCD MEMLS data items to FHIR DSTU2 Location resource

Monroe Pattillo asks to align the Location resource with MEMLS profile from IHE.
Drew remarks that some of the extra attributes, like accuracy and speed, are attributes of the device which has been used, not of the Location itself. The Location is fixed and has GPS coordinates.
Drew moves to make this not-persuasive. Michael seconds. Accepted 3-0-0.

  1. 9249 Manage the Provenance of Practitioner (and Other Resources) using an Extension

The suggestion is to use the Provenance resource.
There has been voted on this in January 2016, to refer this for future use. It would be tested in a connectathon by Brian, but there has not been a follow-up. We ask Brian for more information.

  1. 12365 How should we represent an Endpoint.address for a v2 mllp connection?

There is an example in the tracker item.
We need an IP address and a port number. Michael types the example in the resolution.
Michael moves to add the example, Drew seconds, accepted 3-0-0.

  1. 11367 Change description of Coverage - 2016-09 core #525

The Coverage resource is owned by FM, so we will not vote on this today.

  1. 12364 Added 'Direct-project' to valueset-endpoint-connection-type

Michael: This is about direct messages, not about the project “direct-project”, that doesn’t exist anymore. But looking at the wiki page for the Direct project (http://wiki.directproject.org/), he changes his mind and finds this persuasive. Drew seconds the motion. Accepted 3-0-0.

Line has just heard that Alex deLeon has been re-elected as a co-chair of PA!


Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action item: Andrew Torres to check implication of changing the relationship from 0..1 to 0..*
Next Meeting/Preliminary Agenda Items
  • .

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