Negation Requirements Project Minutes 12 September 2018

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Meeting Information

HL7 PC-CIMI-POC Meeting Minutes

Location: PC call line

Date: 2018-09-05
Time: 4:00-5:00 PM ET
Facilitator Jay Lyle Note taker(s) Jay Lyle
Attendee Name Affiliation

Jay Lyle JP Systems
Yanyan Hu Joint Commission
Senthil Nachimuthu 3M
Ken Lord VA
Rob Hausam IMO
Ben Hamlin NCQA
Lisa Nelson
Emma Jones Allscripts
George Dixon Allscripts
Michelle Miller Cerner
Michael Padula Cerner
Stephen Chu


Agenda Topics

  1. WGM agenda
  2. Confirming transformations with steward organizations
  3. Cognitive Impairment
  4. Problem
    1. Cases
      1. Refute a rule-out, suspected, or previously asserted condition
        1. use verification status
      2. Resolve a problem
        1. use clinical status
      3. Assert absence for protocol: not pregnant, no night sweats.
        1. Use Observation, not condition. We don't find evidence of a need for specific negation of conditions.
      4. Translate CDA asserting "diabetes" negated
        1. How often does this happen?
        2. Translation engine needs to specify assumptions, e.g.,
          1. if it's a negated condition, it's not a condition; drop it, or
          2. only transmit negated conditions with histories that tell us whether to tag it as Resolved or Refuted, or
          3. transmit negated conditions as observations: code = condition; answer = absent
    2. status matrix


  1. WGM
    1. Get confirmation from SD, FHIR
      1. Invite Sarah, Rick, Jean, Lisa
    2. propose connectathon
  2. Cognitive Impairment
    1. CDA Section deprecated: use mental status
    2. Mental status is just like Problem: a code (classifier as cognitive status value) and value (finding)
    3. Also CDA Framework for Questionnaire Assessments
      1. Lays out design patterns for questions & assertions
  3. Question: does C-CDA problem pattern define "observation" templates in addition to the problems?
  4. Review of Problem cases in agenda, above
    1. Agreement: 1-3 should cover it.
    2. How to confirm #4 does not happen?
      1. Get a bunch of documents and look. Not feasible.
      2. Ask SD listserv, call.
      3. Deprecated Problem Status can say Inactive, Resolved; not Refuted.

Meeting Outcomes

  • request FHIR example of negated family history
  • stakeholders interested in completion, secure resources
  • review posted document draft, examples

Next Meeting/Preliminary Agenda Items

Agenda for 9/19:

  • tbd

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