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Pressure Ulcer Prevention 20110413

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HL7 project team meeting, 13 April, 2011, 3:00 PM ET


Meeting URL

Back to Pressure Ulcer Prevention


Patty Greim Jay Lyle y
Ioana Singureanu John Carter
Catherine Hoang Moon-Hee Lee
Mimi Haberfeld Donna DuLong
Charlie Selhorst y Sherri Simons
You-Ying Whipple Holly Miller y
Walter Suarez Susan Matney
Elaine Ayres Nancy Collins
Peter Hendler Andre Boudreau y
Ruth Gong y Deborah Francis y


  1. Agenda check
  2. Next steps
    1. Continue to refine model
      1. based on SME availability: identify convenient times
    2. Review of documents we think will define the document we want to create (MDS, etc.); identification of elements for target "pressure ulcer risk assessment"
    3. Review of SNOMED encodings
    4. Other options
      1. Continue to refine vocabularies based on LOINC subcommittee input
      2. Refine metamodel--especially approach to vocabulary representation
      3. Begin constraining model to the HL7 RIM in order to support document generation (understanding that there may be rework necessary after the ballot reconciliation)
      4. Work with Care Plan team to define mutual model boundaries
      5. Identify Detailed Clinical Model candidates (in collaboration with Patient Care)


Jay will conduct an orientation for people not familiar with the model

Jay will post the WebEx link on the wiki

2.1.1: we have two groups, nutritional and wound care. Whether the wound care group will meet as one large group or as a set of smaller teams will depend on people's availability.

2.2 specifications

  • Confirmed (for now): we aim to produce a pressure ulcer risk assessment document
  • The specifications mentioned as possible points of harmony or leverage won't do that
    • IHE Patient Plan of Care does not include all of the elements we need, and it requires some we don't: not a fit. Detail level of IHE specs limits usefulness as review.
    • IHE eNursing Summary does include all of the elements we need, but it, too, requires some we don't. Only a fit if we are happy being a subset of something else. Detail level of IHE specs limits usefulness as review.
    • CMS Minimum Data Set includes a lot of information we are not interested in, and it models some we are differently from the way we do. Useful as a review, but not a fit.
    • NQF Quality Measures include many of our elements, but they are not composed into a whole. Useful as a review, but not a fit.

2.3 SNOMED terms: Jay will annotate with term sources and bring to the LOINC Nursing Workgroup for review. Questions will include

  • whether siblings are or should be exclusive (disjoint) (see 'education')
  • whether post-coordinated terms will receive pre-coordinated synonyms (for the sake of implementers)
  • timeframe for new term submission

New topic: requirements management. Do we list requirements (and sources), or just build the model? So far, we have treated the model as the requirements document; there is no traceability to any person or statement of need.

Related topic: rules. test case: what if an intervention plan is changed; i.e., patient had been turned every 2 hours, but new development (e.g. respirator) requires that the frequency be changed. We need to be able to identify that the plan was changed (when, by whom, previous values).

  • We can model this, either by giving a planned interventions versions or by linking a revised intervention to its predecessor.
  • It is not clear that there is any business need for one approach over the other, and that this is not a modeling question rather than a clinical question.
  • Clinically, the requirement is that we be able to identify, for a modified planned intervention plan, its predecessor and the date and agent of change.
  • One more point: we are building interoperability specifications, not a system, so the force with which we should assert rules may not be all we wish.

Current approach (for review Monday)

  • For maximum flexibility, assume a need to change (rather than simply cancel and restart) a planned intervention
  • Annotate the intervention version property with a requirement

Action Items

ID Item Who Due Status Notes
14 Determine next steps Team 4/18 Closed Use SME review to confirm model; use HL7 ballot process.
10 Identify clinical experts we want to review the ballot Team 4/18 IP


ID Issue Recorded Status Notes
3 Requirements approach 4/25 IP Determine level of detail, traceability needs, approach.
2 No official HL7 project sponsor 1/10 Closed See action item 3, in process (1/12)

PC probably; needs meeting to confirm (1/19); approved 2/9

1 Model boundaries unclear 1/10 Closed See action item 2, to be confirmed (1/12)

Clarified in meeting (1/19)