2018-07-25 PA Call Minutes

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Patient Administration Call

Meeting Information

PA Work Group Conference Call

Minutes
GoToMeeting
Local numbers sent to list

Meeting Information

PA Work Group Conference Call

Minutes
Gotomeeting - see pafm@lists.hl7.org
HL7 Conference Call phone number

Date: Wednesday, July 25, 2018


Time: 12:00 PM (US Pacific Time, GMT -7)
Quorum Met (Chair+2, Yes/No)? Yes

Facilitator Brian Postlethwaite Scribe Brian Postlethwaite
Attendee Name Affiliation
X Brian Postlethwaite Telstra Health, AU
X Claude Nanjo University of UTAH
X Cooper Thompson Epic, US
X Daniel Chaput ONC, US
X Alex Kontur ONC, US
X Andrew Torres Cerner, US
X Michelle Miller Cerner, US
X Joe Quinn Optum, US

Agenda

Agenda Topics
Agenda

  1. Ballot update – review key dates, focus on work remaining to be done
  2. Tracker Issues – Ballot(s)
  3. Other trackers outside ballot (noted below)
  4. Decide what to do with the trackers from the January Core Comment 2018 Ballot

There are a 9 that are marked for a potential block vote, and 6 others.
Should we mark them as considered for future use?

  1. 69 trackers are in status resolved, change required – help please?
  2. Jan VHD Ballot trackers for block Vote.
  3. Grahame’s zulip comments


Supporting Documents


Minutes

Ballot process key dates:
http://wiki.hl7.org/index.php?title=FHIR_Ballot_Prep#Sept_2018_Cycle
2018-08-05: Reconciliation packages must be posted by this date at the absolute latest
2018-08-10: All substantive reconciliation applied. FHIR Core is frozen, limited QA process for content subject to ballot only
2018-08-17: Pre-ballot (and connectathon) content freeze. Publication process begins, including ensuring that content is appropriately flagged for ballot status and there are no last minute QA issues
2018-08-24: Ballot opens
2018-09-24: Ballot closes and initial triage occurs. Note: No substantive changes allowed for normative candidates unless they drop to STU.

https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemBrowse&tracker_id=677

Ballot Trackers:
May Core:
16148 Encounter.reason and Encounter.diagnosis (Waiting for input)
No Persuasive deferred Michelle Miller/Claude Nanjo:7-0-0

May Patient:
16129 Patient.active (disposition documented – have reached out to Claude if he wants to attend)
Persuasive with mod Dan Chaput/Andrew Torres:7-0-0

Jan Core:
Block vote 1 (9 items) – all recommended non-persuasive
(note 14727 Use compositional approach for Person/Patient/Composition - is marked as in person by Claude)
ID Summary Resolution Real Submitter

14803 Instead of adding patient in participant list, it should be added as additional field in appointment. - 2018-Jan Core #143

The Patient(s) need to have their required and participation status set too, so would have another backbone element for patient that looks the same as participation. So it was collapsed in the same structure.

There is a specific search parameter for patient which enables simple searching for the patient explicitly.

Group appointments need the multiple patients, so has multiple cardinality.

Divya Ahuja 14836 Job title and Specialty field (Ex: Orthopedic, Pediatrician etc) can be introduced. - 2018-Jan Core #176

The Specialty field is already available on the Practitioner Role resource, as this is only relevant to where the practitioner works.

The Job Title could be a local extension on PractitionerRole to capture this data, and introduce as a standard extension if sufficient implementer feedback requests it.

Dileep Ravindranath 14837 Billing Provider concept (Ex. Specialty license, State license, UPIN etc) field can be introduced. - 2018-Jan Core #177

The Practitioner.Qualification backbone element is there to capture this information.

The US Core & VhDir Implementation guides definine specifically how some of these are represented in the US.

Dileep Ravindranath 14845 Add active flag for Slot - 2018-Jan Core #185

If a slot is not available, just delete it, you don't need to set it as inactive.

These are only created as they are needed (based on the schedule planningHorizon) and can be deleted when not needed.

Divya Ahuja 14393 Patient.animal needs a meaning when absent

As the Animal component has been moved to a standard extension, there is no meaning when missing required.

Lloyd McKenzie 14727 Use compositional approach for Person/Patient/Composition - 2018-Jan Core #49

The person resource is optionally used as a registry of potential patients, or a linkage resource between systems (and is usually external to the clinical systems).

Where used internally, typically the patient.link resource is used.

(It does also permit linking Practitioners that are also patients)

We did not model separately as you described to keep the usage simple in most cases, and managing the differences between the systems can be co-ordinated more easily by administration systems.

Claude Nanjo 14680 Can a pending appointment timeout or have a default? - 2018-Jan Core #3

This is a behaviour of the systems behind the scheduling.

If timeouts were to be included, these would be local extensions. (and likely defined by the receiving system, not the creator of the appointment request)

Brian Pech 14839 Search by Specialty (Ex: Orthopedic, Pediatrician etc) can be introduced - 2018-Jan Core #179

This is available through chained searching and the PractitionerRole.specialty search field.

Dileep Ravindranath 14808 A flag to indicate if new time is proposed by participant - 2018-Jan Core #148

consider for future use

Status: To be deferred Divya Ahuja (block vote all of the above) Not Persuasive Cooper Thompson/Andrew Torres: 6-0-0

Grahame’s Zulip Question in order to interoperate with systems that use a single generic property, the basic Patient.gender property attempts to represent an administrative gender: the gender that the patient is considered to have for administration and record keeping purposes. Grahame Grieve: 1. can we remove the word 'attempt' please 2. does PA have a view on whether FamilyMemberHistory should use administrative gender?" PA doesn’t have a strong opinion on this, and with Michelle Miller on the call, she will bring it up at Patient Care (who owns the resource)


VhDir Tracker Items Block Vote:

ID Summary Resolution Disposition Real Submitter

15174 How will event be able to be used at a national level if it is specific to the location? - 2018-Jan VHD #7

The code in question indicates that a care team exists to address an event, and may be relevant at any jurisdictional level. Therefore, it is appropriate to include this code for care teams in a national directory.

Considered - Question Answered Manisha Khatta 15182 Could there be a descrepancy in current and past? If an org had both.. - 2018-Jan VHD #10

The alias contributes to facilitating the search capabilities, simplifying discovery of the network.

Searching on an alias or the current name would return the resource.

The organization profile includes a period and type which could be used on this profile also.

Considered - Question Answered Manisha Khatta 14486 vhdir Location extensions

Having discussed this further we would like to try this as a start point and try it out in connectathons.

We can re-consider things once the Guide is complete in the Sept Ballot.

Not Persuasive Michelle Miller 15166 2018-Jan VHD #3

The accessibility extension can be used on Location, Practitioner and has a cardinality of 0..*.

Please provide additional feedback in the Sept Ballot if this does not address your concern.

Not Persuasive Manisha Khatta 15187 Putting cart before the horse. At this point can only be a logical model or a Basic profile - 2018-Jan VHD #12

The InsuranceProduct is almost through the FMG process, and will be renamed InsuranceProduct.

Now has a complete definition, and examples to include in the specification.

Not Persuasive Eric Haas 15189 Putting cart before the horse. At this point can only be a logical model or a Basic profile - 2018-Jan VHD #13

The OrganizationRole resource has already been through the the FMG as OrganizationAffiliation, and will be renamed back to this for the R4 release

Not Persuasive Eric Haas 15195 Putting cart before the horse. At this point can only be a logical model or a Basic profile - 2018-Jan VHD #15

The resource content and proposal is very detailed, and is the difference with Provenance that is being worked through.

This resource is going through the resource proposals process over the last few months, and has been circulated quite widely and is well understood.

Additional design work is still going on with this, but expect it to be complete and approved prior to R4 being completed.

Not Persuasive Eric Haas 14467 ONC Techlab Healthcare Directory Project hyperlink

This will be addressed in the latest version of the IG

Persuasive Michelle Miller 14489 Typo in vhdir-location mandatory data elements section

This will be addressed in the latest version of the IG

Persuasive Michelle Miller 14507 vhdir: No value set bindings for nearly all codes/CodeableConcepts in Location extensions

This will be addressed in the latest version of the IG

Persuasive Michelle Miller 14510 vhdir: Missing value set bindings for codes/CodeableConcepts in Organization extensions

This will be addressed in the latest version of the IG

Persuasive Michelle Miller 14511 vhdir: Practitioner required fields

This was also reported in tracker #15164 and the cardinality will be relaxed.

Persuasive Michelle Miller 14530 vhdir: OrganizationRole.network references Organization instead of vhdir-network

This has been addressed in the latest version of the IG

Persuasive Michelle Miller 14531 vhdir General Guidance doesn't match the ProductPlan resource definition

The text will be updated to desribe the correct resource.

Persuasive Michelle Miller 15164 request change of cardinality constraints on practitioner telecom, gender and birthdate to be optional elements - 2018-Jan VHD #1

These properties have been set to not be mandatory as there are multiple use cases at play here, and many of them will require these fields to be optional for privacy reasons.

They may be required when submitting to the directory, but may be not required when exposing them from the directory to local environments.

Persuasive Brian Postlethwaite 15167 For each profile, requirements and guidance are given in a simple narrative summary. - 2018-Jan VHD #4

Each profile will have a narrative and guidance included

Persuasive Manisha Khatta 15171 File not found - 2018-Jan VHD #6

Bad links will be fixed

Persuasive Manisha Khatta 15180 Because network may be of interest within HcDir, providing some examples on content page would be helpful. - 2018-Jan VHD #9

Additional Examples will be added for the network profile.

(in addition to the existing Patriot preferred provider network)

Persuasive Manisha Khatta 15203 Profile introduction does not match formal contents - 2018-Jan VHD #18

The incomplete content will be completed

Persuasive Eric Haas 15206 Profile introduction does not match formal contents - 2018-Jan VHD #19

The incomplete introduction will be updated

Persuasive Eric Haas 15211 Need interaction diagrams in order to understand use cases. - 2018-Jan VHD #21

Additional use case/narrative information is to be provided, please check that this addresses your concerns in the Sept Ballot.

Persuasive Eric Haas 15214 The IG as a whole is not complete - 2018-Jan VHD #22

The IG as presented for the Comment ballot was a work in progress, and will be completed for the STU ballot

Persuasive Eric Haas 15217 Add more description - 2018-Jan VHD #23

Additional text will be added for each of the Use cases as requested.

Persuasive Galen Mulrooney 15241 This page is mostly TBDs. - 2018-Jan VHD #32

This page will be completed for the Sept Ballot.

Persuasive Galen Mulrooney 15264 Insufficient detail in Guide - 2018-Jan VHD #41

This page will be completed for the Sept Ballot.

Persuasive Galen Mulrooney 14487 US Core and Validated Healthcare Directory IG profiles for Location

Mismatch between FHIR versions of US Core (STU3) and this IG (R4). Once an R4 version of US Core is available, we will adopt US Core as appropriate for US Realm requirements and produce a new version of the Validated Healthcare Directory IG

Persuasive with Mod Michelle Miller 14491 US Core and Validated Healthcare Directory IG profiles for Organization

Mismatch between FHIR versions of US Core (STU3) and this IG (R4). Once an R4 version of US Core is available, we will adopt US Core as appropriate for US Realm requirements and produce a new version of the Validated Healthcare Directory IG

Persuasive with Mod Michelle Miller 14496 US Core and Validated Healthcare Directory IG profiles for Practitioner

Mismatch between FHIR versions of US Core (STU3) and this IG (R4). Once an R4 version of US Core is available, we will adopt US Core as appropriate for US Realm requirements and produce a new version of the Validated Healthcare Directory IG.

Persuasive with Mod Michelle Miller 14533 vhdir HealthcareService extensions?

Healthcare data is messy and therefore we expect there may be inconsistencies. For example, an organization may no longer accept patients at a location, but a provider at that location may accept a new patient at a referral. Exceptions to stated availability can be described through the newPatientProfile element.

Persuasive with Mod Michelle Miller 15165 request changed to org-alias-type extenstion value as Coding - 2018-Jan VHD #2

The Alias Type will be updated to be of type CodableConcept to support multiple bindings, and also contain the system/display values for the codes provided.

Persuasive with Mod Brian Postlethwaite

Michelle noted that some of the items that were marked as already updated, weren’t. This was clarified that some of them are still to be applied, but will be before the IG is balloted in Sept. (block vote) Michelle Miller/Andrew Torres: 5-0-1

Removed from the block (to be discussed later):

14512 vhdir-network

All comments have been addressed in the latest version of the IG, please review the updated guide to ensure you're issues are all addressed.

Persuasive with Mod Michelle Miller


Next Meeting/Preliminary Agenda Items
  • Next telecom meeting: Wednesday 01. August 2018

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