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Clinician on FHIR - May 2017 Madrid, Spain

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Introduction

The May 2017 Clinician-on-FHIR event will be hosted on Friday May 12, 2017.


Weekly preparatory conference calls are being hosted on Tuesdays at 5:00 - 6:00 pm US Eastern.

First Clinician-on-FHIR call starts: Tuesday January 24, 2017

Conference call details: please see HL7 email broadcast


Planning/Preparation

Master Plan for Baltimore Clinicians on FHIR - May 2017 - placeholder


Tracks to be addressed and leadership

- Details to be included


Planning Notes

  • See the conference call notes in the "Planning Calendar and Meeting Minutes" subsection below for details
  • Also see the "Clinician-on-FHIR Tracks" section below for details


  • Goal = create at least one (or more if possible) meaningful example(s) (actual JSON resource instance) for each FHIR resource otherwise the limitation of the FHIR resource is identified.


clinFHIR Scenario Builder walkthrough/demo video

  • Video on a demo/walk-through by David Hay on the clinFHIR tool (focus on Scenario Builder functionality) is available through the following link:
- https://drive.google.com/file/d/0B4plV0sP9KyCNFU2VlpZaDZHZms/view?usp=sharing
- The video has been tested on the web browser - Chrome
- Before viewing the video through Chrome, install a Video viewer add on apps to Chrome. The app can be found by a google search
- Once the video viewer apps is install, the video can be launched by clicking on the "play" button on the video image



Planning Calendar and Meeting Minutes


Tooling and Supporting Information

  • Tool
- Participants registered for the Clinician-on-FHIR event are strongly recommended to familiarise themselves with the clinFHIR tool
- A new user interface has been created to support creation of clinical story built from a set of FHIR resources based on the clinical scenario described in the Tracks section below
- Logon to the clinFHIR site:
- [clinFHIR.com/]
- Connect to the FHIR servers by selecting the appropriate Data Server (e.g. Public HAPI DSTU3), Conformance Server and Terminology Server
- click on the "Tool" icon on the top right hand corner of the clinFHIR page and select "simple builder" option
(Note - "simple builder" will soon be changed to "scenario builder")


  • Supporting Information
- To be included



Clinician-on-FHIR Tracks


Track 1 Diagnostic Ordering and Reporting

  • Track Lead: Rob Hausam
  • Clinical Scenario
    • Follow the DM Patient Care Scenario from Care Plan
      • Order HgA1C
      • Order baseline renal function test
      • Order lipid panel (cholesterol)
      • Order fasting glucose
      • Order doppler flow studies in feet for vascular study
      • Order urinalysis and microalbumin
      • Order culture swab of a foot ulcer
  • enter values for each of the above...... (include reference values for the results, with flags of High and low etc?)
- HgA1C = 7.8%
- Baseline renal test - metabolic panel (urea = , creatine = , BUN = , electrolytes (Na = , K= , CO2/Bicarb= , Cl= ) and eGFR=
- fasting glucose = 163
- Comprehensive Metabolic Panel Reference Ranges
(does synthea have this type of data?)
- lipid panel (cholesterol = , total = , LDL = , HDL = , triglyceride= )
- Lipid Profile Reference Ranges
- UA results (urine microalbumin = 32 mg/mmol)
- Urinalysis Reference Ranges
- Urine results
- doppler results =
- Culture results from foot swab =


  • Look for diagnostic report for the blood exams (FBS, HgA1C, lipid, renal)
  • Look for diagnostic report for the urine studies (UA/microalbumin)
  • Look for the diagnostic report for the doppler study
  • Look for the microbiology report for the foot culture



Track 2 Care Plan and Care Team

Leads: Emma Jones, Laura Heermann


  • Care Plan - inclusion of the components. These are the components of the care plan, how are they included into the FHIR Care Plan resource?
  • Care Team - MD, RN, dietician, PT, referral to skin/wound nurse,
    • Refer to the technical connectathon use case spread sheet - how do you assign the common functionality of the team members to them - who is the team lead, coverage for others, who is reviewing only, who can edit, accept, review, decline, delete, reconcile, history of team members? (new PCP), etc.
    • Spreadsheet prepared by Stephen for the ONC call. Touches on care team type.
  • Instructions - Discharge, wound care, medication, diet
  • Medications - insulin...
  • Procedures - dressing change, foot care,
  • XX
  • XX
  • Select Patient
  • Select Care Plan
  • Select Care Team (multiple care team members)
    • Add MD
    • Add RN
    • Add Nutritionist
    • Add Consulting podiatrist
    • Add Pharmacist
    • Add RN Educator
    • Patient in the team
    • Caregiver (lay) on the team

For each of these:

  • Name
  • Role(s) - multiple needed per person (PCP, Covering MD, Wound RN, Team Lead) (need a Gforge item for Role to be 0...*
  • Specialty
  • Status on the team (active, past...)
  • Participation privileges - create, accept, decline, update, review...

Additional: instructions, need the goals for instruction?


CarePlan - Use Case Spreadsheet

  • This is the spreadsheet containing a Type 2 Diabetes use case for Care Plan and Care Team. The contents were used in the January 2017 San Antonio Technical Connectathon and Clinician-on-FHIR Care Plan track.
Type 2 DM - Use case and test data for Care Plan and Care Team


Goal for November: to have one cohesive storyboard - look at the one from the last technical connectathon. It needs to have a nursing spin put on it. With a nursing focus of content included. Such as nurse reinforcing diabetic teaching, injection instruction, etc.



Track 3 Medications

Track leads: Melva Peters/ John Hatum

  • Two potential option for consideration
- Test medication reconciliation workflow and related resources
- Contribute to testing of medication resources in other tracks, e.g. Care Plan, Adverse Event tracks
Melva will discuss with John Hatum on which option to take


Track 4 Adverse Event Resource

Track Lead: Russ Leftwich with help on use cases from Elaine, Margaret and Lindsey

  • specifically test the ability of the resource to fully represent an allergic reaction.
  • Specifically test a range of use cases that would fall under this and see if it works or not..
    • such as:
      • Drug drug interaction
      • non immunologic reaction that is undiagnosed at the onset (a physiologic change that is sudden and unexpected - an intolernance... such as severe abdominal pain an vomiting)
      • Medication error
      • procedure error
      • patient fall
      • Needle stick


  • Conference call notes (11 April):
- see wiki page:
April 11 - Adverse Event


Report Out...

Adverse Event

new comer (software engineer) - would like to see wizards that walk you through the software that help you create use cases.... how do I know if I have the sufficient condition vs the required(?) condition

There is not a lot of descriptive information on this resource - but the resource was added just for some basic testing to the build. It is not really fully formed yet.

Discussion at the table. looking at the AE logical model -

  • There are 3 important dimension.
  • what is the resource intended for? something that happens (Fall? med AE?), something that led to the adverse finding? (med given with allergy, rails down)
  • What is a sentinel event? - the event raising the concern
  • And assessment has been performed - to eval the event?
  • What has lead to the AE?

don't want to mix the meanings of these things.

Looking closely at how it is modeled and ....


Comment: our company uses Bamboo - This is what I think a use case looks like.... these 5 resources.

Look at Bamboo HR - borrow their human engineering.... Ask Jackie Mulroony about this.... demo?


the resource was created around clinical trials. that is an element in it. There are still questions if adverse event of a clinical trial is the same as adverse event in clinical care. In clinical trial - it really is the resulting condition....

Russ identified some issues around the Oncology use case that has conditions associated with it - such as give this med until wbc returns to XXX

Pharmacy is participating in the implementation guide for Oncology.

Care Plan

Learned to not try to connect the different table work as with CinFHIR we will run into race conditions - so unless well orchiestrated we will overwrite each others work. We decided it would not be a good use of David Hays time right now.

The other half of the table had a technical/clinical discussion with the several technical folks at the table. Learned about the the "Apply" function.

Pharmacy

Played with the import function quite bit. Have tried by hand to try to recreate them. - but started to see how the examples could be dropped into the tool.

everybody is required to create examples for our resources. If we all created our examples to support one clinical scenario - then we could almost by default have an example of different disciplines and could perhaps get to a full detailed use case.

David hay- working with Grahame to pull the current examples in automatically. -

Get a scenario or two that ties it all together would be very helpful. It may help us to make more clinically relevant examples.

Need to get more clarity on how medications and care plan relate. There are medications request, etc in care plan, but there are also care plan in Medication (based on) - mechanism to refer to a care plan.

Would be good to have use cases that describe these relationships.

Diagnostic Ordering and reporting

Started by looking at connecting their work into the Care plan work on the same patient. Currently we would run into race conditions on ClinFHIR unless we were more carefully orchestrated.

Rather then going further on that - they worked independently on building out resources. The were able to do ordering through report with HgA1C and Glucose results, wound culture and susceptibility tests etc. . new attendees were a big help. Found a couple of bugs for David - they will log those into the zulip chat


New Attendee: using the tool helped me to understand FHIR better. Was frustrating in the beginning as I didn't understand what I was doing. I was happy when I could do more.

Common Theme - getting used to FHIR is like getting a little burned.... burnt....

Next Steps

Look into Synthea - data





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