Negation Requirements Project Minutes 15 August 2018

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Meeting Information

HL7 PC-CIMI-POC Meeting Minutes

Location: PC call line

Date: 2018-08-15
Time: 4:00-5:00 PM ET
Facilitator Jay Lyle Note taker(s) Jay Lyle
Attendee Name Affiliation

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


Agenda Topics

  1. review
    1. family history generic, including no history of x: George


  1. family history updated (George)
    1. typically family history straightforward member and condition; no negations
      1. CCDA: example is fine, but it's pretty rare to negate family history
      2. breast cancer example of a condition where you might need a negation
      3. even breast cancer negation would tend to be in a progress note
      4. Issue of boundary between capture of data for human use and for automated processing
    2. no issues with CCDA example
    3. Issue: FHIR has two ways to go
      1. precoordinated code or List with empty reason
      2. no example to instruct us which way to go
      3. ask for one
    4. clinical need: to negate a specific condition for a specific relation; not, typically "no known problems"
      1. [track down fhir extension - allergyintolerance-substanceExposureRisk]
    5. List solution only addresses generic statement, not specific negation
      1. Also, Mappings that have already been done in CCDA on FHIR IG
        1. CCDA set of conditions -> fhir conditions, not a List
        2. Implementer community seems to prefer not to use list
    6. if precoordinated code exists 'no history of cancer'
      1. but none for a second disorder; use an expression?
      2. burden on terminology
    7. option: like Procedure, have a concrete tightly scoped property for presence/absence
      1. note: keep distinct from absence of data
    8. proposition: CDA negation and FHIR 'no known' mean the same thing for all practical purposes.
      1. no dissent
    9. Potential Rationale for when to use a list: to represent RIM Organizer

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 8/22:

  • tbd

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