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May 2017 WGM Madrid, Spain: May 6 to May 12

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Madrid, Spain, WGM - May 2017 Patient Care WG Meeting Draft/Approved agenda:

Agenda

Day Time Qtr Room # Event Host Joining Chair Scribe
Sunday
May 7		 AM Q1 ?
Q2 ?
PM Q3 ?
Q4 ? FHIR co-chair updates
Day Time   Room # Event Host Joining Chair Scribe
Monday
May 8		 AM Q1 TBD 15 Plenary Room Requested
Q2 Oxford Mega joint session EHR Accepted N/A Laura
PM Q3 Estraburgo 20 Admin recap; FHIR Change requests Accepted: FHIR-I Michelle Michael
Q4a Burdeos Joint Session with FHIR & OO on FHIR workflow FHIR Accepted N/A Emma
Q4b Estraburgo 20 FHIR Change requests Declined: FHIR-I Michelle
Q4c Marsella Learning Health Systems Hosted Joint meeting LHS Accepted N/A Laura
Day Time   Room # Event Host Joining Chair Scribe
Tuesday
May 9		 AM Q1 Munich 50 FHIR/PCWG - CIMI - Skin Care model meeting. Stefan Hufnagle project CLIM Declined: FHIR-I

Accepted: ECWG, CIMI		 Laura Emma
Q2a Esquivias 20 FHIR Change requests Accepted: FHIR-I Michelle Michael
Q2b La Puebla SOA Hosted Joint Quarter: Care Coordination SOA Accepted invite from SOA N/A Emma
PM lunch ?
Q3a Marsella 20 FHIR Change requests Accepted: FHIR-I Michelle Michelle
Q3b Estrasburgo SD Hosted Joint Quarter: CDA Product Family -This meeting is to provide an update to all interested work groups regarding the formation of a CDA Product Family. There will be many work groups invited to participate, so send representatives only SD Accepted invite from SD N/A Emma
Q4 Estrasburgo 40 Negation + other topics;
GF#12633 Split Procedure into Procedure and ProcedureStatement 		Invited: Clin Genomics, SD, ED

Accepted: OO, Vocab, CIMI, FHIR-I 		Jay Emma
Day Time   Room # Event Host Joining Chair Scribe
Wednesday
May 10		 AM Q1 Burdeos 20 FHIR Change requests Accepted: FHIR-I Michelle Emma
Q2a Potsdam PA hosted joint meeting -- Episode of Care; Care Team PA Accepted invite from PA N/A Michelle/Michael
Q2b Burdeos Learning Health Systems Hosted Joint meeting LHS Accepted N/A Laura
PM lunch Santa Olalla
 15 Clinician-On-FHIR Preperation meeting Room Requested
Q3a TDB PC/RCRIM/CIC Joint meeting - Topic: Adverse Event (RCRIM) RCRIM (confirm) CIC, RCRIM, PC Elaine
Q3b Estrasburgo 40 FHIR/PCWG Joint meeting (PCWG Hosting FHIR reps)
GF#12966 ProcedureRequest - add DosageInstructions or Quantity
ReferralRequest / ProcedureRequest boundaries		 Accepted PC Invite: CDS, CQI, OO, FHIR-I Michelle
Q4 Estrasburgo 20 Allergy/Intolerance topic meeting. Drug list approach & Issues.

Christian Hay to present on IDMP.

Allergy resource maturity		 Invited: Pharmacy

Accepted: Vocab 		Elaine / Jay
Day Time   Room # Event Host Joining Chair Scribe
Thursday
May 10		 AM Q1a Munich 25 Care Plan -invite FHIR, Structured Docs, Pharmacy

HL7 C-CDA 2.1 Care Plan Document Template - Lisa Nelson HL7 Care Plan Domain Analysis Model/FHIR Harmonization - Laura Heermann/EMma Jones HL7 Care Coordination Services (CCS) functional model - LH/EJ HL7 CDA R2 Personal Advanced Care Plan Document - Lisa Nelson HL7 FHIR Care Plan Resource - LH/EJ IHE PCC Dynamic Care Planning Profile- EJ IHE QRPH Early Hearing Detection and Intervention (EHDI) Plan of Care- Lisa Nelson HL7 Clinical Oncology Treatment Plan and Summary - Jeff Brown NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro Care team members definition update (Laura/Emma) Child special needs Care Plan/Care Team Implementations

Check the minutes ....		 Invited: SD, CH

Accepted: Pharmacy, LHS, FHIR-I		 Laura Emma
Q1b Stuttgart OO hosted joint meeting with CDS, PC, Templates - Per Hans, topic is anything that has a joint interest, such as FHIR ProcedureRequest, other tracker items of mutual interest OO Tentatively Accepted N/A Michelle
Q2 TDB Joint meeting with SDWG

Topic: Care plan, Allergy Intolerance (criticality), Clinical status, International Patient Summary

PC hosting; room reserved by Sd		 SDWG N/A Emma
PM lunch Esquivias
 10 Co-Chair Admin Meeting Requested Room
Q3a Esquivias 5 Assessment scales - ballot reconciliation; SDC update; Room Requested Michael Michael
Q3b Munich 20 FHIR Change requests Accepted: FHIR-I Michelle Michelle
Q3c Stuttgart Clinical Statement hosted joint meeting with OO and PC. Per Hans, typically this one is very short (as it is in maintenance mode). Rest of the quarter is strictly OO CS Tentatively Accepted N/A ??
Q4
Day Time   Room Event Host Joining Chair Scribe
Friday
May 11		 AM Q1 ClinFHIR  
Q2   ClinFHIR        
PM Q3   ClinFHIR        
Q4   No meeting        





Madrid, Spain, WGM - May 2017. Patient Care WG Meeting Meeting Minutes

Sunday, May 7

International Council Meeting
- No PCWG meeting


Patient Care WGM, Monday, May 8, 2017


Patient Care Monday Q1

Minutes

General Plenary session No meeting from Patient Care



Patient Care Monday Q2

Chair: EHR Hosting other WG



Minutes

  • EHR: many functional profiles, completed & in process
  • CQI: consolidation of measure and decision support tactics
  • PC presented slides




Patient Care Monday Q3

Chair: Michelle Miller
Scribe: Michael Tan


Attendees

  • Ewout Kramer
  • Marten Smits
  • Russ Leftwich
  • Stefan Lang
  • Masaaki Hirai
  • Yukimori Konishi
  • Sadama Takaraba
  • Jay Lyle
  • Beau Bannerman
  • Emma Jones



Minutes

  • Review agenda of WGM agenda
    • Wednesday RCRIM no invitation received. Is this still on?
    • No one from PC on Thursday Q3
    • Wednesday Q3 is a joint with O&O. Negation will be discussed on Tuesday Q4..
    • Wednesday lunch session for Clinicians on FHIR will be in Santa Ollalla.
    • Patient Care Tuesday Q1 will need to discuss a PSS dietary. This will be discussed during the CIMI session.
    • No further comments on the agenda.
  • Meeting notes of HL7 WGM January
    • Laura moved to approve the notes WGM January 2017. Emma seconds
    • 13 in favour, 0 against, 0 abstentions.
  • FHIR
    • E-mail from Lloyd to all co-chairs. Which resources are candidates for the next normative publication? Deadline is April 2018. Allergies, Conditions and procedures have reached maturity level 3 and are the candidates to be promoted. The maturity level defines which resources are tested and proven that are mature enough to go to level 4. The gut feeling is that we are not ready for December.
    • Allergy and intolerances still have issues with adverse events.
    • The issue with Condition are about Health Concerns. Clinical Status still raises discussions on the value set. ( active, recurrence. Relapse, well controlled, poorly controlled, inactive, remission, resolved).
    • Procedure and Procedure statements could be split, similar to medication and medication statement, for example a patient saying he has had an operation when he was a kid.
    • Discussion arises how maturity is decided. We should have a general approach for accepting normative. For example a QA spreadsheet or looking at Zulip. Should be measurable and formalized by FMG.
    • This concludes that we have no resources fit for promotion to normative status.
    • Are there specific preferences for PC resources to be put on the short lists for the normative?
    • Are there any new resources to be developed? Adverse event, procedure statements,( not PC).
    • Maturity levels changed? Care Plan , Goal and Care team are now level 2. Family member history also 2. Has there been any experience in a Connectathon? Ewout is looking at technical connectathons. But the result is usually a self-report. It is more a sense of how stable a resource is.
    • There is some feeling about which resources are being referenced in Zulip. Nobody has a firm finding which resources are mature.
    • Should we make distinction between technical maturity and clinical maturity? Issue for the FMG? Laura has worries, especially if patient safety is concerned.
    • Emma brings in the vendors point of view, that IT vendors want to roll out FHIR structures without the risk of redeveloping the software on a new release. You will also need to convince users to start using the resources.


Patient Care Monday Q4a

Chair: OO
Scribe: Emma


Attendees

  • taken by OO


Minutes

  • Please see Lloyd's workflow notes
  • Of interest to PC:
    • there is a new pattern for workflow that applies to patient, practitioner. Purpose if to provide a notion for who is responsible, what role they were acting in, what organization etc. The current way to do this is ugly. The pattern will provide a way of just pointing to practitioner role (new resource). However, per Lloyd, this will not apply to care team ...
  • Relevant timelines
    • Feedback on existing rules and patterns by end of May 2017 (issues with existing ones, proposals for change)
    • Candidate set of rules for R4 (including tooling support) will be published by FMG by end of June 2017
    • FMG will accept feedback in early July (1st two weeks) and will publish final rules and tool updates by end of July
    • workflow calls mon and wed at 2pm eastern or send Lloyd email



Patient Care Monday Q4b

Chair: Michelle Miller
Scribe: Michael Tan


Attendees
Michelle Miller
Michael Tan
Dennis Patterson
Danielle Friend
Marten Smits
Ardon Toonstra
Jay Lyle


Minutes
Flag

  • GF#12798 Flag resource should allow for a Condition reference as subject (Ardon Toonstra) -- withdrawn

FamilyMemberHistory

  • GF#8782 NoKnown[X] for FamilyMemberHistory (Danielle Friend) -- non-substantive
  • GF#8781 FamilyMemberHistory Should be Patient, not Relative Centric (Danielle Friend) -- non-substantive
  • GF#9028 Use SCT values rather than V3 for family history relationship (Jay Lyle) -- Deferred

List

  • GF#8784 Proposed History Resource (Danielle Friend) -- Withdrawn

Condition/Observation

  • GF#11026 Relationship between Condition and Observation - 2016-09 core #45 (Jay Lyle) -- Waiting For Input

FHIR tracker items

  • 9028 Mapping of SNOMED codes to V3 codes for family relations. ( example binding);
    • Found SNOMED codes for most of them, but some were not found.
    • VA desires to use SNOMED, but it is not a hard requirement. Michelle remarks that it is an example binding and if the VA wants to use the SNOMED, then they could use it. SNOMED could add the V3 values to SNOMED. Clinical genomics require certain values on the relationships such as natural father of fetus.
    • Motion to defer the request until SNOMED has harmonized their value set. Request at SNOMED will be placed by Jay.
    • Move Jay second Danielle: Vote 6 in favor, 0 abstentions, 0 against
  • 8782 Danielle ( EPIC) Often “no known history” of patients. How do I express this?
    • This is resolved when the value set was updated with an extra SNOMED code: “no current problems or disability”. Similarity with conditions. Have to add a note on the conditions, because the value set is shared.
    • Move Danielle, second Marten: Vote 6 in favor, 0 abstentions, 0 against
  • 8781 “no known problems” On the patient level.
    • Lloyd suggests to use list. List empty reason
    • Move Danielle, second Marten: Vote 6 in favor, 0 abstentions, 0 against
  • 10508 Gap in the entry . It mentions events and conditions, but it does not cover this topic anymore and only mentions conditions. Comment is deferred.
  • 8784 Requirement to have a broader usage of family history.
    • Discussion postponed.
  • 12798 flag resource should allow a Condition reference as subject on a non-patient condition. It is related to the “Alerts” in NL. But the issue is withdrawn because the use case is not completely clear.
  • 13201 Discussion on outcome of clinical status ( inactive, resolved or remission. ) and Abated. Why do we need abatement? This discussion is postponed until we have clinicians to explain the use case of abatement.
  • 11026. Distinction between conditions and observations. The boundary is rather subjective, but there is explanation in the wiki. These resources will not be merged. They should however be of similar construction. This is a broad topic and Jay should provide more explanation. Waiting for input from Jay.



Patient Care Monday Q4c

Chair:
Scribe:


Attendees



Minutes




Patient Care Monday Q5: Placeholder for extra meeting if necessary

Present:



Minutes:



Patient Care WGM, Tuesday, May 9, 2017


Patient Care Tuesday Q1

Chair: Laura Heerman-Langford
Scribe: Emma Jones


Attendees

Agenda

  • Podiatry EHR SFM PSS
  • Skin model update
  • CLIM project

Minutes

  • Dr. Brody presented Podiatry EHR SFM PSS
    • Brought forward by practicing podiatrist - American Podiatry Association and Vendors in the podiatry space. Many of the people new to the standards development process
    • Gaps have been identified in EHR functional model as it relates to this domain. For example, physician dispense samples - no good workflow to handle this; no tool in the EHR for devices implanted

or wound treatment

    • Best route when CIMI is co-sponsoring a model - the requesting group will be the owner

Not just patient care

    • PC will consider offline
    • CIMI is documenting the process
      • Patient is a strong advocate of CIMI. Need for CIMI to teach us how we can get other groups engaged
    • Resulting discussion of SFM/DAM/DCM process. Draft:
      • 1. Clinical use cases
      • 2. DAM
      • 3. EHR System Functional Model profiling (decomposition/elaboration of DAM cases)
      • 4. DCM
      • 5. implementable specification
    • Further discussion in CIMI/CIC meeting Wednesday
  • Skin model
    • SOLOR modeling of skin assessment concepts
      • Further discussions on CIMI Skin project, probably Friday mornings ET.
    • Semantics of CIMI assertion & evaluation patterns (a.k.a. Condition & Observation)
      • To the extent this discussion informs FHIR, it goes through PC (and loop in OO)
    • Fall ballot:Vitals & labs
    • Project ownership; transition to CIMI
      • To do: confirm current PSS closure criteria. Close and re-start to address broader scope, possible change of sponsor.
  • Stefan Hufnagle project CLIM making progress


Patient Care Tuesday Q2a

Chair: Michelle Miller
Scribe: Michael Tan


Attendees

[1]


Minutes

  • GF#11021 Increase cardinality of substance and make certainty relation to substance not reaction - 2016-09 core #40 (Jay Lyle) - need to discuss jointly with BR&R (formally known as RCRIM)
  • GF11021 Allergy : Certainty can change overtime. The substance is preferably stored in code, because this is where Clinical Decision Support would be looking at. Resolution to remove reaction and instead replace with a reference to adverse reaction. Options^:
    • Keep reaction embedded in Allergy
    • Slim down the reaction ( move substance out of the resource).
    • Reference to observation
    • Make adverse reaction a separate resource
    • Make adverse event a separate resource.
  • Difference between adverse reaction and event is that an adverse reaction is strongly related to the patient ( disposition for a medicine). An event is more related to a context, such as falling out of bed. Possibly an event is an overarching event, where adverse reaction to a drug is a component of the adverse event. The event is also meant for reporting purposes. The event is the action of giving medication to a patient, while a reaction is the outcome.
  • Consider that when the event occurs you might not know whether it really is an allergy. You may suspect that it is an allergy, but it could be caused by other reasons such as empty stomach.
  • Jay withdraws his request to refer to observation. (gf 11023).
  • GF#11023 Why isn't AllergyIntolerance.reaction an Observation? - 2016-09 core #42 (Jay Lyle) - withdrew
  • Can you have reference to a backbone element? And query it?
  • Current EHR systems usually record the adverse events in a separate system.
  • For creating a new resource ( adverse reaction) you have to prove why adverse event is inadequate. Adverse event is owned by BRR ( formerly RCRIM).
  • Need to test this out in Clinicians for FHIR.
  • Allergy & Intolerance is usually used for patient safety reasons. In that case you should keep the resource simple.
  • GF 12623 care plan activity status.
    • Value set: not started, scheduled, in progress, on hold…..
    • Missing abandoned. There is cancelled. What are the characteristics? Who abandoned, after start of before start? There is an element called statusreason where you can express a reason why it is cancelled. Do we need a hierarchy ( ended, with abandoned and cancelled. Discussion will be continued.

Patient Care Tuesday Q2b

Chair: SOA
Scribe: Emma Jones


Attendees Attendance taken by SOA


Minutes

  • Ken Rubin not present.
  • Update given that CCS has been published on HL7 products page.
  • No new information on OMG use of care plan
  • SOA has a report out on Mondays - would prefer to have this meeting then instead of on Tuesday - next WGM

Patient Care Tuesday Q3a

Chair: Michelle Miller
Scribe:


Attendees

[2]


Minutes
CarePlan/Goal

  • GF#11359 Why only one medication in an activity? And the value set is problematic (but example) - 2016-09 core #517 (Robert McClure) -- Not Persuasive / No Change
  • GF#11355 CarePlan category value set is out of date or wrong - 2016-09 core #513 (Robert McClure) -- Not Persuasive / No Change
  • GF#10622 QA 4a: Consider whether Goal.category should be bound to codes from an external code system (Michelle Miller) -- Not Persuasive / No Change, but need to revisit

Communication

  • GF#13306 Communication Extension: reasonNotPerformed is redundant (Eric Haas) -- Persuasive

Patient Care Tuesday Q3b

Chair: SDWG
Scribe: Emma Jones


Attendees

  • See SDWG meeting notes


Minutes

  • The agenda was changed to answer C-CDA-on-FHIR questions



Patient Care Tuesday Q4

Chair: Jay Lyle
Scribe: Michael Tan


Attendees [3]

Agenda

  • Negation ballot comments
  • Negation analysis; possible tactics for policy
  • GF#12633 Split Procedure into Procedure and ProcedureStatement (Lloyd McKenzie) -- agreement for PC to do the analysis
  • GF#13201 Condition Xpath constraint con-4 is not correct (Ardon Toonstra) -- Persuasive with Mod


Minutes

  • Nr, ? Comment ballot: Should use CDA examples. Disposition: Persuasive.
    • Richard Move; Rob Second. Vote : 21 in favor, 1 abstain, 0 against
  • Organize better table or remove it. Disposition to include definitions of columns in the text and explain and in the key.
    • Richard Move; Rob Second. Vote : 22 in favor, 1 abstain, 0 against
  • Commenter does not know what the table means
    • Susan Move; Rob Second. Vote : 21 in favor, 1 abstain, 0 against
  • Nr. 26, 27, 69 numbers and headings
    • Susan Move; Rob Second. Vote : 23 in favor, 1 abstain, 0 against
  • Nr 30, and 70 definitions all seem persuasive. Motion to make the definition:
    • Galen move Second Susan: Vote : 23 in favor, 1 abstain, 0 against
  • Nr. 36 will provide explanation:
    • Galen move Second Claude: Vote : 24 in favor, 0 abstain, 0 against
  • Nr. 32, 33 and 37 and 39 will be rewritten:
    • Additional editors volunteering to provide text.
  • Galen move Second Susan: Vote : 25 in favor, 0 abstain, 0 against
    • Nr.46 there are no standard formats: will be refrased. There are formats, but none are standard.
    • Galen move Second Claude: Vote : 25 in favor, 0 abstain, 0 against
  • Nr. 47 question answered. Need to talk to Lisa.
  • Nr. 51 the classes in the appendices will be aligned. Persuasive
    • Rob move Second Galen: Vote : 25 in favor, 0 abstain, 0 against
  • Nr. 60 the document is not a DAM. No requirements: There are requirements; Not persuasive. It does contain requirements.
    • Galen move Second Claude: Vote : 25 in favor, 0 abstain, 0 against
  • Nr. 63 needs an better example. The given example is also not valid. Susan provides a better example.
    • Richard move, second Susan; Vote : 21 in favor, 0 abstain, 0 against
  • Nr. 71 will include principles:
    • Galen move, second Susan; Vote : 21 in favor, 0 abstain, 0 against
  • Nr. 83 Prohibition: Don’t do something: Not persuasive but will add more clarification.
    • Galen move, second Richard; Vote : 20 in favor, 1 abstain, 0 against

FHIR Procedure resource

  • Up till now procedure capture procedures information as history, but there is also a need to capture data for management purposes. These are 2 different needs and scenario;s.
    • Options:
      • 2 different resources
      • 1 resource with an extra flag.
    • These would be similar to medication administration and medication statement. I.e. procedure versus procedure statement.
    • The should be alignment with other resources. PC would apply the same policy towards procedure and procedure statements.
    • Also need to analyse how the different resources would look like before a decision is made. Need to look which attributes goes into which resource.
    • Also need to look into GF issues that have comments related to the split.
    • Vendors ( Cerner, EPIC) need to check
    • Lloyd: Motion PC need to make a initiative to make an analysis to make 2 separate resources, Michelle Second: Vote 20 in favor, 0 abstain, 0 against.
  • GF 13201: Condition : status: should we have a rule that abatement ( Boolean= false) and status not contradicting the Boolean. What is the use case for abatement? This can be reflected by status. Motion to remove the Boolean. But the remaining fields of abatement are still there. They should be in line with status. Stan Huff has not seen any system capturing abatement. Michelle moves a motion, second Galen.
    • Vote 20 in favor, 0 abstain, 0 against


Patient Care WGM, Wednesday, May 10, 2017


Patient Care Wednesday Q1

Chair: Michelle Miller
Scribe: Emma Jones


Attendees


Minutes

CarePlan

  • GF#11332 Acknowledge Advance Directives as type of Care Plan - 2016-09 core #490 (David Tao) -- need representation from Community Based Collaborative Care (CBCC), who is working on Consent -- Resolved

CareTeam

  • GF#13233 add careteam to endpoint (Eric Haas) -- Resolved
  • GF#13293 XPath in CareTeam invariant is too restrictive (James Agnew) -- Resolved
  • GF#13338 careteam into and scope to be clearer about group (Brian Postlethwaite) -- Resolved


Patient Care Wednesday Q2a

Chair: Brian P. (Patient Admin hosted quarter) Scribe: Michelle Miller

Minutes
PC/LHS gave PA a brief update on CareTeam related work

  • GF#12509 CareTeam participant
  • GF#13338 careteam into and scope to be clearer about group (Brian Postlethwaite)

Resolved PA tracker:

  • GF#13146 Separate .relation and .role on RelatedPerson -- agreed that CareTeam.participant can be used for Power of Attorney (i.e. don't add role to RelatedPerson), but it is ok to support multiple RelatedPerson.relationship to meet requirements around grandmother AND legal guardian

CareTeam DAM update given by Russ Leftwich

Patient Care Wednesday Q2b

Meeting combined with Q2a



Patient Care Wednesday Q3a

Chair:
Scribe:


Attendees



Minutes
a

Patient Care Wednesday Q3b

Chair: Michelle Miller
Scribe: Riki Merrick


Attendees

[4]


Minutes

  • GF#13196 Clarify the boundary between ProcedureRequest and ReferralRequest or merge them (Eric Haas) -- Resolved (OO will own)
  • GF#13047 Add DosageInstructions to Procedure (Jamie Hignite) - GF#12966 ProcedureRequest - add DosageInstructions or Quantity -- Joint with OO/PC/Pharmacy
  • GF#10028 Careplan: Provide ability to specify patient and/or provider preferences (Emma Jones)
  • GF#12633 Split Procedure into Procedure and ProcedureStatement (Lloyd McKenzie) -- agreement for PC to do the analysis

Podiatry Functional Model PSS

  • Implantations of artificial joints – writing conformance criteria for capturing device IDs
  • OO owns UDI project – ties nicely in there, simple motion for OO to support Hans, Lorraine, no further discussion, abstain: 2, against: 0, in favor: 32


GF#13196: procedureRequest vs referralRequest – boundaries or merge

  • The outcome is what is different, but the boundary is fluid depending on the organizational relationships
  • procedureRequest is NOT always precise as to what exact procedure is going to be done – so is that using procedureRequest or referralRequest
  • when you merge and you cannot establish how much care was transferred vs just for the specific procedure
  • if we can describe that using this kind of resource, when care is being handed off, vs when you are just asking for a specific procedure
  • perhaps merge and add element (who decides it is a transfer of care – initiator and receiver) to indicate if transfer of care (Boolean / more vocab needed as may be, for sure etc)
  • how would we track who is owner of care provision – choice is patient vs sender vs receiver – put this somewhere else not in this resources
  • Epic stores referrals separately from orders, but from a data model no difference – if merge – what name?
  • Difference is not in data elements, but in business flow / trigger events
  • Collaborate on the problem rather than transfer care – depends on the individual situation
  • Referral: take over care for a problem / consultation = just input on specific issue
  • Since we are STU add comment to implementers to submit comments on issue and if we get no answer there is no problem = merge both resources and add the extra element (NOT Boolean) – this would require more analysis of the two reources
  • Capture the intent of care transfer rather than the actual act of transfer of care
  • procedureRequest (FMM3) does has more elements than referralRequest (FMM1) – what happens to those elements, when you want a referral?
  • If there are differences, then do we need a main resource that each of these would be profiles? – If that is the case, keep them separate.
  • Currently only have leaf resources besides the requestPattern
  • Motion to merge and request implementer feedback (merge ok, how dealing with care transferring) category element and how transfer of care is managed), do the analysis and name change if needed and add the additional element about intent of transfer of care and evaluate the FMM level, have OO be the sponsoring WG of that merged – similar to merge of diagnosticRequest with ProcedureRequest Eric Haas, Floyd Eisenberg, further discussion: first do the analysis before the make decision about merge; note of FMM level – and will merging change the FMM? – after merge will have to re-analyse FMM level; what do we do with the elements that don’t stay in the final resource – where do they go? – that is part of the analysis; abstain: 8, against: 2, in favor: 21


GF#13047 Add DosageInstructions to Procedure (Jamie Hignite) - GF#12966 ProcedureRequest - add DosageInstructions or Quantity -- Joint with OO/PC/Pharmacy

  • also has been discussion about how to handle blood products / biological derived project – to create a resource proposal for that – do we need more instructions in general procedures / procedureRequests in
  • Should we not have a resource or pattern that abstract class for products – for biological product vs medication vs vaccine vs supply that can have the same approach for all “things” – table that discussion
  • What does dosage mean here- that is for medication vs how fast to give the blood product? What are chemotherapy – procedure or medication? Need to talk to Rx
  • The problem here is managing the transfusion process – so we need Rx in the room
  • Need Rx, OO, PC for the next discussion – also may be use v2 Chapter 4 on Blood product handling – add note to both trackers


GF#10028 Careplan: Provide ability to specify patient and/or provider preferences (Emma Jones)

  • How to represent patient preferences: PC suggest to do a profile on observation – example prefer apple juice – could this also apply to procedure kind that drives care / decision support, so that is sometimes the reason we did something
  • How do vendors represent these preferences in current systems? Isn’t this just a note on the procedure or order etc
  • Would like it to be reusable and easy to find for the patient – as new improvement to systems
  • Proposed as profile, not base
  • Experience: in imaging system has notes that relate to the patient – similar stuff here; but not experience with exchange of that data
  • In NL have patient portal that collects patient preferences on specific things, like diet, birth type etc.
  • Need to ay be differentiate between observation and statement?


GF#12633 Split Procedure into Procedure and ProcedureStatement (Lloyd McKenzie) -- agreement for PC to do the analysis

  • proposal voted on by PC – involves procedure is written that you can document history about procedures in the past and actual procedures executed during encounter (more detail); analysis what elements needed for procedure statement (history) vs procedure instance in the record – so level of detail as part of who the informant is here rather than it is statement overall (may be evaluate what is relevant over time vs the current active handling of the procedure)


Patient Care Wednesday Q4

Chair: Jay Lyle
Scribe: Michael Tan


Attendees

Agenda

  1. Drug substance list
    1. approach
    2. preliminary results
    3. Key issues
      1. Defining cross-reactive classes
      2. Routes, salts, and other details; e.g., salycilates
      3. Vaccines & biologics
      4. Identifier selection
  2. IDMP: model & possible impact on identifier selection

Minutes

PC wants to create a concise list of substances as value set of allergies and intolerances. The presentation from Jay is available on the wiki. There is a top 20 registered allergies. Currently this is a US realm project ( RXNorm, UNII are US realm specific). You need a license for SNOMED. IDMP. Presentation

  1. Are salts relevant? Salts are relevant for intolerances. You would put retromycin on the list of substances.
  2. what to do about classes that have been attributed to the wrong product. Does not really fall into classes.
  3. Cross reactivity in modern penicillin’s is rather small. The technical components should support the need for the doctors to register their allergies. IT cannot decide for the doctors what they are allowed to register. This project is on the border of domain knowledge. The concern is valid.

IDMP
Presentation of IDMP by Christian Hay and Panagiotis Telonis. See the presentation ( with the wedding cake) . IDMP is a joint project from HL7 and ISO TC215. Without substance ID you don’t have IDMP. ISO 14872 is the implementation guide for the governance of IDMP. Substances are complex, but the substances implementation guide is in the third iteration and is being reviewed. The substances are registered in GSRS. The GSRS is free available and contains all information required for the registration of Allergies and Intolerances. It describes all types of medication ranging from herbal products, bloodproducts chemical products.

ISO_IDMP

What is the impact of IDMP on the value set of allergies and intolerances? The allergies team needs to get familiar with IDMP. We should make GSRS work for this purpose. Christian suggests a tutorial of 90 minutes to understand IDMP. Questions from Rob McLure:

  • What domains have been researched.
  • How to deal with cross reactivity.



Patient Care WGM, Thursday, May 11, 2017


Patient Care Thursday Q1a

Chair: Laura Heerman
Scribe: Emma Jones


Attendees



Minutes

Care Plan Status Update


  • HL7 C-CDA 2.1 Care Plan Document Template - Lisa Nelson
    • Additional sections added to the care plan document that are already represented
    • Motion made by Russ to work with HL7 Example task force to provide an example for the care plan document; Thom Kuhn second Vote: 0 abstain, 0 against, 16 approve
  • Care plan as being only prospective
    • From the beginning it has been prospective but also need to provide retrospective data to provide context
    • Action Item: May be time to start revising the DAM
    • Suggestion to call it a Care Summary was not agreeable
    • Action Item: Care Plan group need to think about this and provide an update to the DAM
  • IAT Care Plan implementationathon
    • Nesting templates - fits with reconciliation
      • Will include reconciliation as part of the DAM work
  • Representing care team in CDA documents - Keith boone
    • Care team template from SDWG - new and coming. Email from Keith Boone about this
    • Action Item: Need to discuss care team members and their relationship to Care Plan - how they relate and how represent them
    • HIMSS Health Story Project working on explanation of the different document types and their intended use. Need to shed insight on the difference between care summary documents and care plan documents.
    • This is redundant for some of our actions items. Need to see how to engage with this effort.
    • Action Item: Pat - HL7 need to promote what HL7 develop
  • HL7 CDA R2 Personal Advanced Care Plan Document - Lisa Nelson
    • Uptake by ADVault
    • Reference the PACP from the clinical summary
    • Action Item - need some dedicated time taking about this and how implementers are dealing with this.
    • Mapping FHIR composition resource and CDA documents
      • Participation from PC in their calls is needed
  • IHE QRPH Early Hearing Detection and Intervention (EHDI) Plan of Care- Lisa Nelson
  • IHE DCP - in trial implementation
  • DCTM - going to public comment
  • CP DAM - will be going back to it. Addressing things that have not been addressed before. Presentation to ONC.
  • CCS - Nothing new
  • FHIR care plan resource - Keep wanting to map the care plan DAM to the care plan resource. Most progress has been the clin-on-FHIR with a run-thru every WGM and Care plan is addressed on thurs calls
    • Trackers 12623 - carePlan activity detail status value set discussion (need more discussion and input)
  • HL7 Clinical Oncology Treatment Plan and Summary - Jeff Brown
    • C-CDA work
    • CDA- R2 implementation in Jan 2016
      • Suggestion to see how this work align with Cancer report. Project facilitator Jeff Brown - ASKO has taken it over.
  • NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro - Not present.
  • Child special needs Care Plan/Care Team Implementations - not present

Patient Care Thursday Q1b

Chair:
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Patient Care Thursday Q2

Joint with SDWG and Template WG

Chair: SDWG
Scribe: Emma Jones


Attendees

  1. need to follow HL7 Harmonization process for harmonizing vocabulary - have less than a month to do this
  2. C-CDA Revision - need to get on C-CDA DSTU comment page as a future update. The plan is for reviewing and developing as updated content(this is not an errata because it's not a technical change)
  3. Will be added as an STU update to Volume 3. Volume 3 is currently going thru a comment only ballot. Will be back in Sept ballot which will need to go thru reconciliation. Expectation is that clinical status will go in the Jan 2018 ballot. Vote called to make the status a RIM harmonization - Pat moved/Rob second 21 Approved - 0 abstain- 0 against.


Minutes



Patient Care Thursday Lunch: Co-Chairs Meeting

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Patient Care Thursday Q3a

Chair: Michael Tan
Scribe: Michael Tan


Attendees William Goossen Michael Tan


Minutes
This quarter was intended to perform ballot reconciliation on the HL7 Assessment Scales ballot. There were 32 affirmative votes and 24 was the minimum required. This means that the ballot is concluded with a positive result. There was one ballot spreadsheet with comments and the quarter was spent to discuss the comments. The dispositions were written directly in the ballot spreadsheet which you can find here.

Media:Total_Ballot_reconciliation.xls

We did not have enough quorum to vote on the dispositions and this will be dealt during a Monday co-chair call.

Patient Care Thursday Q3b

Chair: Michelle Miller
Scribe: Michelle Miller


Attendees

[5]


Minutes

  • GF#10387 CommunicationRequest needs ability to describe the location that the communication is about (John Moehrke)
  • GF#12599 Consider adding Communication.priority to match CommunicationRequest.priority (Grahame Grieve)
  • GF#13113 CommunicationRequest extensions need review (Elliot Silver)
  • GF#13130 Clarify use of Communiation for failed communications (Elliot Silver)
  • GF#13167 Should be able to refer to earlier Communications (Elliot Silver)
  • GF#13346 Communication includes notDone element and extension (Elliot Silver)

Patient Care Thursday Q3c

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Patient Care Thursday Q4

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Patient Care WGM, Friday, May 12, 2017

Clinician-on-FHIR


Patient Care Friday Q1

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Patient Care Friday Q2

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Patient Care Friday Q3

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Patient Care Friday Q4

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