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2017-06-29 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: 2017-06-29
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
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
X Jay Lyle Ockham Information Services LLC, VA
Russell McDonell Telstra Health
Lloyd McKenzie Gevity (HL7 Canada)
Larry McKnight Cerner
X Michelle M Miller Cerner
X Lisa Nelson Life Over Time Solutions
Viet Nguyen Lockheed Martin, Systems Made Simple
M'Lynda Owens Cognosante
Mike Padula The Children's Hospital of Philadelphia
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 Bob Thompson
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-06-22_Patient_Care_FHIR_Call
    • Motion: Russ/Stephen
  3. Prior Action Item Follow-up
  4. gForge change request

Supporting Information




  • FMG approved the transition of ownership of AdverseEvent to Patient Care
  • Elaine will re-assign the open trackers
  • There might be a few unapplied trackers as well
  • Russ suggested a dedicated call to facilitate the knowledge transfer as part of the transition of ownership
  • Terminology work is still needed
  • Elaine will coordinate with BRR to identify a Thursday in the next few weeks when we can collectively discuss

Advance Directives / Consent / Care Plan

  • GF#11332 has resolution:
    • 1-Update CarePlan scope to say: Self-maintained patient or care-giver authored plans identifying their goals and an integrated understanding of actions to be taken. This does not include the legal Advance Directives, which should be represented with the Consent resource with Consent.category = Advance Directive. Informal advance directives could be represented as a Goal, such as "I want to die at home."
    • 2-Add element to CarePlan as follows: CarePlan.consent, 0..*, Reference(Consent) One or more Advance Directives or Medical Treatment Consent Directives
    • 3-Update Goal boundaries to say: Goal does not include the legal Advance Directives, which should be represented with the Consent resource with Consent.category = Advance Directive. Legal Advance Directives may specify clinical goals that can be represented as a Goal resource as well. Informally, advance directives could be represented as a Goal resource regardless of whether it was included in the legal Consent, such as "I want to die at home."
    • Do not apply changes until we hear back from FMG/CBCC
  • Lisa Nelson update on discussion with Lloyd and Grahame around CarePlan/Goal/Consent - Personal Advance Care Plan Notes from Lisa
    • MyDirectives (UI) --> document (CDA L3 Personal Advance Care Plan) --> FHIR Resources
    • "Submission Set" (DocumentManifest)
    • DocumentReference
    • Composition (many other resources....Goal, PlanDefintion, RequestGroup, Questionnaire, Consent, Contract, List etc)
    • CommunicationRequest
    • Communication
    • These are not orders or proposals -- a person's directives are just preferences (e.g. no decision is made) expressed for the health care power of attorney -- the person doesn't make decision ahead of time, appoint a health care agent, who will make decision in the future and sign the consent.
    • Composition includes:
      • Healthcare Agents will sign official consents
      • Certain Health Conditions (or upon death) -- PlanDefinition -- if terminally ill, how do you feel about XYZ; if brain injury, which activities should be done or not; which would then instantiate a RequestGroup -- activities in RequestGroup (tightly aligned with PlanDefinition)
      • Once you have died, what activities should be done
      • CareExperience --> QuestionnaireResponse
      • Admin -- contract -- who signed and witnessed
    • FHIR Connectathon Opportunities
      • CCDA on FHIR - establish industry norm
      • CarePlan - Demonstrate inclusion of patient generated health data
      • CDS Hooks

Mapping CCDA Document Section/Entry to FHIR Resources

Reviewed Lisa's spreadsheet:

gForge Change Requests


  • GF#8647 Missing codes from Flag.category valueset
  • GF#10621 QA 4a: Consider whether CarePlan.activity.detail.category should be bound to an external code system
  • GF#11209 Feedback on ClinicalImpression
  • GF#13389 Clarify Communication Scope and Usage


Adjourned at 6:34pm 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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