Negation Requirements Project Minutes 27 April 2016

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Meeting Information

HL7 PC-CIMI-POC Meeting Minutes

Location: PC call line

Date: 2016-04-27
Time: 11:00-12:00 ET
Facilitator Jay Lyle Note taker(s) Jay Lyle
Attendee Name Affiliation

Jay Lyle JP Systems
Serafina Versaggi
Rob McClure
Rob Hausam
Gerard Freriks
Juliet Rubini
M'Lynda Owens
Ron Van Duyne
Michael S


Agenda Topics

  1. Prior minutes
  2. Action items
  3. Classify requirements


Minutes/Conclusions Reached:

  1. Minutes: no comments; approved
  2. Action items:
    1. wiki updated
    2. PSS to go to DESD
  3. Classification of items in list
    1. Using term "symptom" in addition to "finding" needlessly complex; introduces different assumptions about definition
    2. Most current examples are "finding absent"
      1. SCT distinction between finding & observable tabled to design phase
      2. "No drug allergy" is also a "finding absent" but so common as to merit separate treatment
    3. example 11: "Begin light exercise (walking on a level surface for 5 minutes, 3 times a day). Add 1 minute to each session, each day until able to complete 10-15 minutes in each session without cardiac symptoms"
      1. We recommend recording explicitly "no cardiac symptoms" (or "cardiac symptoms absent") when executing the rule (rather than discontinuing treatment without comment)
      2. How the rule might represent the condition: potentially the same way (absence of finding), but within some kind of "goal" or subjunctive mood class.
    4. # 14 "No change": this is a positive assertion of stability, not a negation of another assertion.
    5. # 15 "If the patient does not produce 250ml urine in first 30 minutes, furosemide 40mg IV x1 should be administered": this is a threshold, not a negation.
    6. # 18 "Nothing to eat or drink until respiratory distress dissipates" -- a conditional prohibition
    7. # 25 "Provider notices that the patient did not tolerate Prazosin in the past (which was started to address difficulty sleeping)": this is the observation of a contraindication
    8. # 26 "and was discontinued due to irregular heartbeats and hyperventilation" -- this is two statements: one of discontinuing an order and one of a reason. State seems sufficient here.
    9. # 28 "Patient still refuses cessation treatment despite motivational interventions"
      1. If there is an order, it could have a state and reason, as above.
      2. Can we rely on that, or do we need a separate "act not done" kind of assertion?
      3. Compare # 99 "hearing screening not done - needed for quality measure": if there is a protocol for the measure that excludes valid reasons documented otherwise (on ventilator, e.g.), we don't. But is that assumption sufficient?

Meeting Outcomes

  • review examples for completeness, classification for accuracy (all)

Next Meeting/Preliminary Agenda Items
  • Continue review of requirements

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