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2017-08-03 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: 2017-08-03
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
Dave Carlson VA
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
Russ Leftwich InterSystems
X Tony Little Optum 360
Jay Lyle Ockham Information Services LLC, VA
Russell McDonell Telstra Health
Lloyd McKenzie Gevity (HL7 Canada)
Larry McKnight Cerner
X Michelle M Miller Cerner
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 Mary Ann Slack FDA
X Mitra Rocca FDA
X Floyd Eisenberg
X Scott Gordon
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-07-27_Patient_Care_FHIR_Call
    • Motion: Stephen/Elaine
  3. AdverseEvent transition from BR&R to Patient Care
  4. gForge change request

Supporting Information


AdverseEvent Transition

  • Elaine's presentation
  • BR&R has v3 message for adverse event - focus on regulatory reporting
  • Majority of the real contribution was from Patient Care (e.g. Elaine)
  • Elaine asked how will AdverseEvent interact with ResearchSubject and ResearchStudy?
  • 201709_Clinical_Research Connectathon planned
  • Mary Ann asked if we can represent reporter? The resource has a recorder, but may need to discuss reporter further.
  • Stephen asked to confirm scope. The scope of the AdverseEvent resource *is* intentionally broader than clinical research to cover any event reporting
  • Elaine compiled all past documentation, meeting minutes, etc: FHIR_Adverse_Event_Resource
  • Recapped GF#13308 and GF#13309, which have been applied
  • Rob H has been assigned GF#13312 regarding the AdverseEvent.event value set
  • Michelle will reach out to Rik to see if he can attend Thurs Q3 meeting with BR&R and PC to discuss AdverseEvent

gForge Change Requests Discussed

Prioritization of backlog was discussed on July 20, 2017

Joint discussion with BRR (AdverseEvent)

  • GF#11021 AdverseEvent - need patient medical history for cases in which subject is not patient
    • Stephen wants more time to remember his intent (and may end up withdrawing it)
  • GF#13302 Vocabulary issues with AdverseEvent
    • actuality - value set no longer contains abbreviations
    • category - Elaine to look at MeDRA and SNOMED CT for value sets
    • seriousness - Elaine will log a tracker to sort out severity vs seriousness
    • severity - make codes lower case and/or think about whether to use v3 - some inconsistency across resources whether required binding to FHIR-defined value set versus preferred binding to SNOMED CT value set (e.g. Condition.severity)
  • GF#13698 AdverseEvent.suspectedEntity.instance should allow CodeableConcept
    • AdverseEvent.suspectEntity.instance should support a choice of types CodeableConcept | Reference, but need to decide on the value set
  • GF#11021 Increase cardinality of substance and make certainty relation to substance not reaction - 2016-09 core #40 (Jay Lyle)

gForge Change Requests Backlog

Aug 10 + WGM: Joint discussion with Pharmacy, OO

Backlog Rady to Discuss

  • GF#12163 Update payload URL to lead to a real file (Guillaume Rossignol)

Medium Backlog

  • GF#12509 CareTeam participant (Michelle Miller)
    • Feedback from LHS, and LHS continues to meet and discuss
    • CareTeam.participant.role (existing) 0..* - need to update definition of role (since it mentions responsibility) Example: PCP - close to finalizing the value set
    • CareTeam.participant.function 0..* (new) - Example: PT, Wound Care - close to finalizing the value set
    • CareTeam.participant.specialty is no longer needed -- instead, get from Practitioner
  • GF#12633 Split Procedure into Procedure and ProcedureStatement (Lloyd McKenzie)
  • GF#10028 Careplan: Provide ability to specify patient and/or provider preferences (Emma Jones)
    • meet need with a profile for preference on the observation resource. Requirements are a preference category (nutrition, medication, care), the preference priority (high/medium/delayed from C-CDA) and with elements of expressor and recorder.
    • This profile would not be developed for this release cycle
  • GF#13140 logical definition of care-plan-category value set may require realignment with SCT changes (Matthew Cordell)

Low Backlog

  • GF#10635 QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller)
    • ClinicalImpression is not mature enough to resolve this issue. Ask MnM for an exemption on the QA checklist (re: Condition having a circular reference with ClinicalImpression)
    • Add note: "A known issue exists with circular references between Condition and ClinicalImpression, which is due to the low maturity level of ClinicalImpression. The Patient Care work group intends to address this issue when ClinicalImpression is considered substantially complete and ready for implementation"
  • GF#11173 CarePlan needs support for reviews - 2016-09 core #327 (Stephen Chu)
    • Tracking of reviews and plans for reviews is something that applies to many resources, not just CarePlan (e.g. protocols, standing orders, long term care admissions, etc.). This is something probably best handled by "Task" but will require a fair bit of analysis and discussion with other work groups to agree on approach. Defer to R4. Consider transfer to OO who owns Task


Adjourned at 6:35PM Eastern

Meeting Outcomes

  • Rob H has been assigned GF#13312 regarding the AdverseEvent.event value set
  • Michelle will reach out to Rik to see if he can attend Thurs Q3 meeting with BR&R and PC to discuss AdverseEvent
Next Meeting/Preliminary Agenda Items
  1. Agenda review
  2. Approve previous meeting minutes
    • Motion: <moved>/<seconded> Abstain - <#>, Negative - <#>, Approve - <#>
  3. Aug 10 + WGM: Joint discussion with Pharmacy, OO (transfusion)
  4. Aug 17 + WGM: Joint discussion with CQI (regarding harmonization of condition/problem status value set)
  5. gForge change request

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