2018-01-18 Patient Care FHIR Call

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Meeting Information

Patient Care FHIR Resources Conference Call

Location: Conference Call
Phone Number: +1 563-999-2090
Participant Passcode: 792564
WebEx: https://join.freeconferencecall.com/patientcare

Date: 2018-01-18
Time: 5-6:30pm ET
Facilitator Michelle M Miller Note taker(s) Michelle M Miller
Attendee Name Affiliation


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 Health eData Inc
X Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Russ Leftwich InterSystems
Tony Little Optum 360
X 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
X Mike Padula The Children's Hospital of Philadelphia
Craig Parker Intermountain Healthcare
X Joe Quinn Optum
X Katie Wheatley UK NHS Digital
X Genny Luensman CDC
X Angela Crovetti
Quorum Requirements Met: yes

Agenda

Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2018-01-11_Patient_Care_FHIR_Call
    • Motion: Mike/Stephen
  3. Review WGM agenda
  4. Review new resources
  5. gForge change request

Supporting Information

Minutes

Review WGM Agenda

January_2018_WGM_New_Orleans;_Jan_27_to_Feb_8

Review new FHIR Resources

  • http://build.fhir.org/occupationaldata.html
    • Genny and Rob gave a brief overview of OccupationalData. Public Health WG decided that this warrants a resource proposal because it is different from a collection of Observations. Rob helped draft the resource. This is closer to v2 model than CDA model. CDA model is going through SD. CDA is part of Connectathon, but not implemented yet (Emma mentioned, though, that the cancer report, which is part of Meaningful Use, uses a couple elements)
    • Boundaries between Observation vs OccupationalData: What if more than one job? Or, both job/student? Demographics seemed more focused on billing workflows. In order to support clinical decision support, then use SHx. OccupationalData isn't static enough to put it in demographics. If not a resource, could this end up as an IG of profile(s) on Observation?
    • Is student in scope of OccupationalData? Took high school out of scope because not a job. Graduate/work practicum-related work is in scope. Volunteer / unpaid jobs are in scope.
    • EmploymentStatus is at the patient level (not job level); OccupationalData.pastOrPresentJob.workClassification is at the job level
    • usualWork is the type of work a person has held for the longest amount of time during his or her life, regardless of the occupation currently held and regardless of whether or not it has been held for a continuous time. For example, cancers show up 10 years later and may not correlate to the current job. In a perfect world, if we had detailed history, then we wouldn't need usualWork. Job is employer-specific vs occupation could span multiple jobs. Welder for 30 years, for 3 different companies, but now bagging groceries. usualWork is longest held occupation. Consider renaming it usualOccupation
    • Is this on the schedule for Public Health WGM agenda? Agenda will be finalized next week, but no quarter is identified (yet) WGM discussions won't bump up maturity level yet. It is FMM=0 (draft).
  • http://build.fhir.org/biologicallyderivedproduct.html
    • Eric doesn't recommend looking at the content too closely (it was largely copied from Specimen). The scope and boundaries need to be beefed up significantly.
    • Bob will present use cases on Wed Q3 in New Orleans
  • http://build.fhir.org/organizationrole.html
  • http://build.fhir.org/medicinalproduct.html, http://build.fhir.org/medicinalproductclinicals.html, http://build.fhir.org/medicinalproductauthorization.html, http://build.fhir.org/medicinalproductpharmaceutical.html, http://build.fhir.org/medicinalproductpackaged.html, http://build.fhir.org/medicinalproductingredient.html, http://build.fhir.org/medicinalproductdevicespec.html

High Priority Resources (AlleryIntolerance, Condition, Procedure)

  • FHIR Admin FHIR_Ballot_Prep
    • QA guidelines have changed: FHIR_Conformance_QA_Criteria
    • No PC resources are currently targeted for normative, but we can still evaluate
      • AllergyIntolerance - questions about reaction/AdverseEvent - is this just writing down boundaries?
      • Condition - questions about health concern/linking - need Connectathon planned around concern management, need use cases (from domain analysis) and scenarios to test and recruit implementers to participate
      • Procedure - questions about splitting Procedure (performed) vs ProcedureStatement (history/ patient stated) - need to draft resources as a starting point and sync with Russ on whether we need a more generic patient activity statement resource
        • Procedure statement is a good idea. Need to broaden the concepts to other activities. Idea is to have activity statement and then profile it specific to procedure. A patient statement about their exercise or nutritional intake or their ADLs, these are different
        • Who are the actors that would use this - patient statement and carer statement but can be an activity statement that a provider can use as secondary information. Scope includes provider use as well.
        • PMH - where it should be possible do distinguish surgical or diagnostic procedure from when the patient reported the procedure. Post surgery, the surgeon will make an interventional procedure report. This is different. FHIR has a procedure report. OO part would be the diagnostic report (report of findings) and the report that is interventional - these are two different reports. How does FHIR separate the two. And how does FHIR handle the real world where these are combined? Ultrasound guided biopsy would be a diagnostic report with findings (description of the procedure and description of findings).
        • There is an extension that adds the types of terms that you would see on the procedure.
        • Might be a more general solution but it's not settled.
        • Standard operative report has a description of the procedure and a section that deals with findings.

gForge Change Requests (Backlog)

Workflow

  • GF#14446 PatientCare resources do not have a clean Workflow report

CarePlan

  • GF#13903 CarePlan should allow tracking of past activities (i.e. past interventions) (Rick Geimer)
  • 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)
  • 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

AdverseEvent / BR&R -- Thurs Q3

  • GF#13302 Vocabulary issues with AdverseEvent
  • GF#13698 AdverseEvent.suspectedEntity.instance should allow CodeableConcept
  • GF#11021 Increase cardinality of substance and make certainty relation to substance, not reaction - 2016-09 core #40
  • GF#13892 Need guidance on overlap of AdverseEvent.event.text and AdverseEvent.description (Lloyd McKenzie)
  • GF#13893 Correction to AdverseEvent.subject definition (Lloyd McKenzie)
  • GF#13894 AdverseEvent.eventParticipant needs work (Lloyd McKenzie)
  • GF#14238 AdverseEvent.suspectEntity.instance should be expanded to include the Immunization resource (Craig Newman) - also related to GF#14152
  • GF#14458 AdverseEvent should have a context reference

CareTeam / LHS -- Thurs Q4

  • GF#14334 allow careteam.participant,member to reference a Practitioner role (David Hay) -- discuss at WGM after we get implementer feedback
  • GF#12509 CareTeam participant (Michelle Miller)

OO -- Wed Q3

  • GF#12673 How to handle HCT/TP
  • GF#12993 Please Create a NonMedicationAdministration object or an Administration object
  • GF#13047 Add DosageInstructions to Procedure

SD -- Mon Q2

Procedure -- Wed Q1

ClinicalImpression

  • 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"

Adjourn

Adjourned at 6:27pm Eastern

Meeting Outcomes

Actions
Next Meeting/Preliminary Agenda Items
  1. Agenda review
  2. Approve previous meeting minutes
    • Motion: <moved>/<seconded> Abstain - <#>, Negative - <#>, Approve - <#>
  3. gForge change request

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