2017-05 09 PA WGM Minutes

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Patient Administration Work Group Minutes - May 09, 2017

Tuesday Q1

HL7 Patient Administration Meeting Minutes

Location: Marriott Madrid Auditorium, Potsdam Conference Room

Date: 2017-05-09
Time: Tuesday Q1
Facilitator Brian Postlethwaite Scribe Iryna Roy
Attendee Name Affiliation
X Helen Drijfhout HL7 Netherlands
X Iryna Roy Gevity Consulting Inc, Canada
X Line Saele HL7 Norway
X Brian Postlethwaite Telstra Health, Australia
X Simone Heckmann Gefyra
X Christian Hay GS1
X Marten Smits Furore
X Jeff Danford Allscripts
X Michael Donnelly Epic
X Andrew Torres Cerner
X Dennis Patterson Cerner
X Guillaume Rossignol Almerys
X Fahmi Boussetta Almerys
X Vadim Peretokin Furore
X Eric Haas Health eData Inc
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
Welcome/introductions
• FHIR-I updates
• Tracker Items

Supporting Documents
PA gforge Tracker list

Minutes

Minutes/Conclusions Reached:
Introductions

The WG began by reviewing the email sent out by Lloyd McKenzie regarding FHIR deliverable dates and timelines.

Ewout representing the FMG reviewed where we are today. Timelines for R4 reviewed.
QA Rules:
- Feedback on existing rules due by the end of May 2017.
- Candidate Rules will be published by FMG by the end of June 2017
- Work group should plan to align by the end of November
- Encourage to start sooner than later
Brian: QA rules question. RIM Mapping mandatory – will this go away?
Planned ballot timeline discussed.
Brian’s updates on PA activities:
Examples’ help is needed for PA group for the Encounter resource.
New Resource needs are discussed for joining Organizations. Brian: many organizations are associated through a business partnership. It will allow expressing various relations. A proposal will be submitted.
ChargeItem – linkage between Account and what was charged. A proposal is already submitted.
Other PSSs – Occupational Health Data (H7 V2) and impacting the FHIR data as well. What resources are impacted is unknown at this moment but it will be reflected in a new standard. PA group is considering the Occupational Health Data belong to a Patient and this is our scope.
Provider Directory PSS is going through FMG – Practitioner.Certification? may be impacted.
The group discussed the Normative ballot process. There will be more than one package: terminology and conformance package; patient resource package, etc. If one package fails to make a normative, the other one can still be accepted.
The group discussed the FMM rules for determining the maturity of resources.
Resources reviewed for possible Normative candidates:
- Organization possible Level 3 or 4?
- Patient 5 (definitely)
- Practitioner
- PractitionerRole
- RelatedPerson
- Location
- Endpoint
- HealthcareService (needs some additional work and implementation)
James identified that the Patient resource is used for veterinary use case. It made the resource to be approved to be Normative.
The group discussed that all of the resources that are used for Provider Directory can be Normative.
Encounter is lacking an implementation.
Appointment and Scheduling : Argonaut and another project PA & SOA – looking at clinical scheduling in details. The group reviewed the new $find operation in details yesterday.
Ewout: Martin, what was the issue with the Practitioner resource?
Martin expressed an interest to use a reference to PracticionerRole instead of Practitioner in other resources. This is related to a Workflow pattern implementation.
Brian: Wednesday Q2 this is where those questions will be discussed.
The group discussed how the packaging for a Normative ballot will look like? Is it by the subject? Such as all related to Patient resources? Brian: No, it will be decided what is mature enough to be packaged together. Ewout: the number of packages should be reasonable. Too many packages may create confusion in tracking ballot comments.
Any other concerns?
Brian: Human resource availability. It is not just Brian working on resources in PA.
Tooling issues are discussed. Excel worksheets may no longer be enough, a replacement should be considered.
Brian: trackers report. 48 items to go through.
Question: should the extension change the resource maturity? This question wasn’t raised before.

  1. 13075 – Patient Notes refer to Patient Match operation.

Reference needs to be fixed.
Moved By Michael Donnely/Andrew Torres
Discussion: None
Vote: 13/0/2

  1. 10042 – Add an example for an infant.

Action: An example will be created. Already moved and approved.

  1. 12299 – Mapping to Breed/Strain

A change is coming from Hans Buitendijk.
Eric Haas will investigate an issue. PID -35 may convey both breed and strain. The mapping may be changed and explanation will be added. No voting yet needed.

  1. 12594 - Patient match shouldn't require match-grade

The wording will be update to relax the requirement for the match grade extension always needed.
Moved By Michael Donnely/Line Saele
Discussion: None
Vote: 13/0/2

  1. 12454 – Patient.photo should be Media vs. Attachment.

Not persuasive. The group does not believe the change is necessary. A patient photo is a quick identification mechanism, no need for additional information.
Moved By Eric Haas/Andrew Torres
Discussion: None
Vote: 12/0/2


Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action:


Next Meeting/Preliminary Agenda Items
  • .

Tuesday Q2

HL7 Patient Administration Meeting Minutes

Location: Marriott Madrid Auditorium, Potsdam Conference Room

Date: 2017-05-09
Time: Tuesday Q2
Facilitator Brian Postlethwaite Scribe Iryna Roy
Attendee Name Affiliation
X Brian Postlethwaite Telstra Health, Australia
X Helen Drijfhout HL7 Netherlands
X Iryna Roy Gevity Consulting Inc
X Line Saele HL7 Norway
X Christian Hay GS1, Switzerland
X Simone Heckmann Gefyra
X Ashley Duncan Furore
X Andrew Torres Cerner
X Guillaume Rossignol Almerys
X Fahmi Boussetta Almerys
Quorum Requirements Met (Chair +2 members): Yes

Agenda

Agenda Topics
Welcome/introductions
• ChargeItem resource overview
• Tracker Items

Supporting Documents
PA gforge Tracker list

Minutes

Minutes/Conclusions Reached:
Introductions Simone presented the ChargeItem resource business scope. The discussion is about what is the difference between ChargeItem and Service? Christian Hay is asking how the service and charge item are related. The discussion is about the relationship between those two concepts and ClaimItem. A ChargeItem will always be related to Account. There is a general model in FHIR that is called CatalogueItem? What is currently missing in a ChargeItem is a reference to a definition of that particular charge item. At some point we would want to create a ChargeItemDefition resource that would connect to CatalogueRecord and describe the definition of a particular ChargeItem resource. ChargeItem only has one field for manual price overwrite. All other prices should be described in a catalogue record. Business rules may be attached to a catalogue item to clarify how and when it should be billed. Simone collected business requirements from one of the vendors in Germany. Other vendors are welcome to submit requirements as well. The group discusses various use cases for a definition of ChargeItem and where to link it: EpisodeOfCare or Encounter (Visit). Element review: occurenceTiming – a field that indicates how many hours (time unit)need to be charged. Participant – Ok The proposal is to review the resource with Patient Care and get their agreement on certain elements. priceOverride - ok. Allows manual change of a record without impacting the catalogue, if needed. Account – account to place a charge. Can be multiple accounts. Simone proposed to keep the cardinality of 0..* to keep the possibility of restricting it using national profiles vs the constratined cardinality can’t be extended. Helen asked to consider relaxing the context of a ChargeItem to be able to refer to both EpisodeOfCare and Encounter. Brian asked to create tracking number The presentation of ChargeItem resource is completed.

  1. 13216 – Default filter for active patients.

The group continues discussing the Patient Search options. The issue is related to identification of an active patient, proper retrieval of records where a patient does not have a status. Brian and Andrew are discussing the status option. Patient has a flag = active. The flag is optional. The search should use not active = false statement to get nulls and actives. Appointment search option – the status has a set of values assigned for a status option. MedicationRequest status is a set of codes as well. Resolution: the group believes the issue is not scoped to a patient only and needs to be resolved on a higher level. The group would like to review requirements for the “default” filter. This is impacting all terminology systems where the value set exclude items “outside of the range”. The group agrees that the outcomes of the discussion should be updated in patient resource notes. The tracker is updated to “waiting for input” and awaiting a response from Lloyd with additional requirements.

  1. 12441 - Clinical Trial extension should be defined without reference to specific US registries.

The group discussed that the NCT element is US-specific and should not be included in the standard extension. Brian: question – would the doctor be interested to know if the patient is participating in a clinical study. Should this information be on a patient profile? Line asks a question, if a patient is part of a clinical trial and dr is querying information, the dr should know to query for ResearchSubject resource as well. The group decided: if the ResearchSubject will become a normalized status, then this extension will no longer be required. A suggestion is to consider including this resource into $everything response for Encounter and Patient resources. Tracker status: Waiting for Input.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • • Action:
Next Meeting/Preliminary Agenda Items
  • .

Tuesday Q3

HL7 Patient Administration Meeting Minutes

Location: Marriott Madrid Auditorium, Potsdam Conference Room

Date: 2017-05-09
Time: Tuesday Q3
Facilitator Brian Postlethwaite Scribe Iryna Roy
Attendee Name Affiliation
X Helen Drijfhout HL7 Netherlands
X Line Saele HL7 Norway
X Brian Postlethwaite Telstra Health, Australia
X Iryna Roy Gevity Consulting Inc.
X Simone Heckmann Gefyra
X Christian Hay GS1
X Andrew Torres Cerner, USA
X Guillaume Rossignol Almerys
X Ashley Duncan Furore
X Fahmi Boussetta Almerys
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
Welcome/introductions
• Joined session with SOA
• Review of Scheduling Service
• Tracker Items

Supporting Documents

Minutes

Minutes/Conclusions Reached:
PA met with SOA in San Antonio. Exchanged information about what was done and what are the plans. The Scheduling Service work is primarily driven by Cooper (Epic), Argonaut is also involved. PA has an operation definition for finding the available appointments. Service Functional model?
The operation within a FHIR methodology
Document template that SOA was working on was presented. We will be reviewing it and will be using it as a template for the Implementation Guide. Service Functional model is a template purpose. SOA is a sponsor.
SOA reporting the work on Ordering Service (IHE, OMG), Care Coordination Service (IHE/HL7). SOA concerned that the overall monitoring is required to ensure that the work is compatible and it is not three different outcomes.
Brian presented the new operation template. The complete set of operations is not yet defined. What operation, what parameters, guidance for what is going inside the operation, expected outcomes. It is purely expressed as an operation definition. Another concept: define Terminology Service through the Capability Statement.
Scheduling Service operation definition is on Simplifier. Brian presents the operation definition document: https://simplifier.net/Scheduling/Appointment-find Capability Statement: http://hl7.org/fhir/capabilitystatement.html
Brian covers elements of the newly defined operation for finding appointments.
Question: why to pass Patient at all to the finding service. Brian: for additional checking such as consent, preferences.
HP expressed an interest to contribute to the Scheduling service. Open source system to do national scheduling, HP produced a demo version to meet the tender requirements. The project never started, the HP has detailed requirements for the scheduling service.
Another use case: Scheduling of Medications. Brian: not at this point. But according to the scope administration of chemo as appointment is wihin the scope.
Other PA activity (interest for SOA): Provider Directory. Base resources are completed. (eHPD profile). The next step is waking beyond resources into the service space. How we can do change notifications? Filtering of notifications. Cross reference locations, practitioners. Single Provider list downloaded (like all providers, all locations, etc.) so there is no need to pull one by one.

Timeframe for Provider Directory service? STU4 timelines.
Action: Vincent will follow up with HP on documentation (requirements) for scheduling.
Brian: do we need a joined session in September?
SOA: Yes. Next time more detailed review.
Action: Schedule Q3 on Tuesday for the September meeting.

Tracker items:

  1. 12299 Eric Haas provided updates in comments. Both species and breed are mapped to HL7 V2 PID-35.

Note: a breed is commonly specified in smaller species, this is why it is included in FHIR resource.
Moved by Eric Haas/Second Andrew Torres
Discussion: None
Vote: 9-0-2

  1. 9711 – Vocabulary work is required to complete the tracker.

  2. 12319 - Broadening Value Set Encounter Reason Codes.

The group discussed the Event and Situation with explicit context branches applicability for appointment reasoning and extension of a current value set with these branches. The decision is to support the change. Persuasive.
Moved by Eric Haas/Second Ardon Toonstra
Discussion: None
Vote: 10-0-2

  1. 12884 – Appointment.appointmentType to Appointment.type

The discussion is to enhance the description of an element? The group is not convinced that this is an issue. The name and description of an element will stay the same. Not Persuasive. Additional details are in the tracker. Moved by Andrew Torres/Michael Donnelly
Discussion: None
Vote: 9-0-3

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • • Brian/Line: Schedule Q3 on Tuesday for joined with SOA meeting
Next Meeting/Preliminary Agenda Items
  • .

Tuesday Q4

HL7 Patient Administration Meeting Minutes

Location: Marriott Madrid Auditorium, Potsdam Conference Room

Date: 2017-05-09
Time: Tuesday Q4
Facilitator Line Saele Scribe Iryna Roy
Attendee Name Affiliation
X Helen Drijfhout HL7 Netherlands
X Line Saele HL7 Norway
X Brian Postlethwaite Telstra Health, Australia
X Iryna Roy Gevity Consulting Inc.
X Christian Hay GS1
X Andrew Torres Cerner, USA
X Guillaume Rossignol Almerys
X Melissa Mendivil US Realm
X Fahmi Boussetta Almerys
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
Welcome/introductions
1. Review Meeting Minutes
2. Updates from Steering Division
3. Harmonization proposals - no proposals
4. HL7 V2 work
5. Tracker

Supporting Documents

Minutes

Minutes/Conclusions Reached:
San Antonio Meeting Minutes are reviewed. Action items are collected and recorded to the Google sheet. Minutes approval: Moved by Helen/Second by Brian Discussion: None Vote:7/0/0

The WG continued with the draft agenda for September WGM 2017. From the last quarter, we understand that we still will want a joint session with SOA and PA will host. Action: Line to request rooms for next meeting.

Draft agenda is created and reviewed Minutes approval: Moved by Brian/Second by Helen Discussion: None Vote: 8/0/0

Updates from Steering Division from Line: Line is working on a new group Structure and Semantic design. The New name is Domain Foundation. DAM is updated with small details. O&O PSS that was approved. Patient Administration name is challenged as well. The group is thinking about a new name. No harmonization proposals yet. HL7 V2 work: Melissa requested an update for the AL1.6. The AL1.6 – Allergy date. Suggested to move the date to the IAM segment and verify that IAM segment is included into ADT message type.

Tracker Items
  1. 12974 – birthPlace does not follow the standard naming convention and does not include prefix.

The group supports the suggestion. The name will be updated. Moved by Brian/Second by Andrew Torres Discussion: None Vote: 8/0/0

  1. 12441 – Research Subject.

Lloyd has provided additional information. The group has agreed to remove an extension with the US specific element. The group has agreed to add a reference to the ResearchSubject resource. Moved by Brian/Second by Helen Discussion: None Vote: 8/0/0

  1. 9993 – Patient LinkType Negation

PA group discussed the negation of potential association between 2 records to indicate that they are not the same patient (even though they look the same).seems reasonable. But would like further input on this, and potentially investigate if that would make more sense in the Linkage resource. For an unmerge operation, the system would remove patient.link entries and create negated linkage resource to reduce a change of re-merging records. Additional details are in the tracker. Input expected from Lloyd.

  1. 13146 – Relationship type contains both roles and relationships. Request is to separate concepts if possible.

The group has discussed a change of cardinality of the relationship type, as well as separating codes. The change options and implications will be further discussed. Action item: Andrew Torres to check implication of changing the relationship from 0..1 to 0..*


Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • • • Line to book a room for PA and PA joined meetings

• Action item: Andrew Torres to check implication of changing the relationship from 0..1 to 0..* (13146)

Next Meeting/Preliminary Agenda Items
  • .

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