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2017-06-30 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
Evelyn Gallego ONC
Kathy Walsh LabCorp
Asim Muhammad Philips Research Europe
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Jeff Brown Cancerlinq
X Lisa Nelson Individual
Dave Carlson VA
Chris Melo Phillips Healthcare
Michelle Miller Cerner
Benjamin Kummer Columbia University
Matt Rhan
Michael Padula
X Julia Skapik ONC
X Bob Thompson
Serafina Versaggi VA


  • Chair: Russell Leftwich
  • Scribe: Emma Jones
  • Motion to approve previous call minutes, [June 16. 2017]: <Lisa - moved>/<Stephen - second>
  • Julia offered to connect this group with clinicians involved in the State SIM grants
    • Involves a number of care coordination efforts. Willing to help distribute some care team content and compare what exists today with what we have. Goal is to identify gaps.
    • Will help to put something out to them - we can ask targeted questions or ask for open ended responses.
    • Russ - Agreement it would be great to get their feed back.
    • Will work with Julia to distribute some of our valuesets and set up a plan to establish a feedback loop
  • Lisa - Care Team Value Sets discussion
    • goal is to improve the way care teams are documented in C-CDA
    • Under pressure with what we have today - SDWG is about to release an update for C-CDA. Would like to provide a tangible step forward now so we can easily align with FHIR in the future
    • Pariticption functionCode
      • Where to look to see if the provider is PCP - limited value set
      • Roles have a code - place where the concepts comes from NUCC for clinicians. When not a clinician use personal and legal relationship role types
    • these are the things attemping to lay down for C-CDA
    • other classifications - for use in the future to use entryRelationships in the body of the document. Can use this for when more valuesets are establish
    • See Lisa's presentation Media:Care_Team_Value_Sets_20170630.pptx
    • use of entries - things in the header will be put in at the entry level. Currently the functionCode is not in CDA when in the entry. Working with Calvin to add this in CDA 2.1 as an extension
    • FunctionCode (Group A)- Took the concepts from the existing valueset used for function code. Added in concepts received today and flattened it to care careTeam.participant.responsibility values. Have a total of 110 concepts. This provides a richer set of function codes to draw from.
    • For the roleCode (group B)- big enough for the NUCC codes and the personal and legal relationship roleType valueset
    • If the admitting physician is a cardiologist will have cardiologist from group B and the attending is from group A)
    • Stephen - Looks like group A mixes group A and B together. we don't have a place for specialty nor a place for responsibility. In FHIR the role is 0..1. Question if this can be relaxed to 0..*
    • This will combine the role and the responsibility - we need to make a decision.
    • concepts like care manager will be the functionCode (group A)- in CDA this is 0..1. Role code (group B) is 0..1 in CDA and cannot be changed. FHIR may be able to have a broader cardinailty for roleCode.
    • Will not apply the specialty. Instead may make responsibility (functionCode - valueset A) 0..* This need to be added to the resource. Need to consider if we need to change the name to match CCDA to function
    • roleCode for FHIR is valuset B - this is 0..1 in FHIR. this will allow ability to say if the person is a father or a cardiologist (NUCC list).
    • Stephen first Motion is to put back to patient care FHIR team to revise the previous resolution to drop the addition of part.specialty and rename part.responsibility to participant.function element: Lisa second. No discussion/friendly admendment. Vote 0 oppose; 0 abstain; 5 for
    • Lisa suggests when patient care FHIR team take this up can decide on the cardinality
    • Stephen suggests that the finalization of the valueset will wash out the need for the cardinality changes. We have 2 valuesets to work on as a step forward. During the vetting of the valueset will decide on the cardinality. Can see that a cardiologist can also be the care-coordinator of chronic disease. Stephen have a few example use cases.
    • Lisa will share spreadsheet with group.