Negation Requirements Project Minutes 27 June 2018

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Meeting Information

HL7 PC-CIMI-POC Meeting Minutes

Location: PC call line

Date: 2018-06-27
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
Gay Dolin IMO
Rob Hausam Optum
George Dixon Allscripts
Lisa Nelson
Emma Jones Allscripts


Agenda Topics

  1. Review schedule draft
  2. Review sample examples


  1. Schedule: Things are getting tight; those interested in seeing the work go forward please recruit resources.
    1. 23-May choose meeting times
    2. 30-May agree on objectives; dispose ballot
    3. 6-Jun agree on outline & schedule
    4. 13-Jun assign parts; review sample part for common look and feel
    5. 20-Jun review drafts; agree on format -- not achieved. need samples for next week.
    6. 27-Jun review of chunk 1 -- Note: schedule is yellow
    7. 4-Jul review of chunk 2
    8. 11-Jul review of chunk 3
    9. 18-Jul review of chunk 4
    10. 25-Jul review of chunk 5
    11. 1-Aug review of chunk 6
    12. 8-Aug final comments to editor
    13. 15-Aug finalize submission; due 8/19
    14. 19-Aug Final content submission due
  2. Examples:
    1. George: family history. CCDA uses normal observation negation, with related subject in organizer.
      1. FHIR uses terminology, like allergy. Only specified value is 'No current problems or disability' (though binding is example)
      2. [is there an allergy extension?]
    2. Jay: allergy
      1. *include verification status example - refuted. Only for phase 2, FHIR to CDA.
      2. *include refutation of specific allergy. (done)
      3. can we assert a pattern: no double negatives?
        1. If a FHIR resource contains a negated code: both statuses should be null.
        2. would we ever need to refute a negative? edge case.
        3. what is case for refutation?
          1. only previously asserted, or include differential, suspected, or even not previously suspected?
          2. UI: just uncheck the box
          3. 'we'd never extract an allergy that wasn't active'
            1. is this an axiom?
            2. or might we need to support intra-system operations that do include refuted or inactive items?
          4. case: pt reports allergy, records it. Provider determines it's an intolerance, may give anyway.
          5. question of use of refuted: open.
            1. one option: if it's FHIR refuted, it doesn't go in CCDA. Or entered-in-error.
              1. and it likely won't be sent in FHIR.
      4. current scope: CCDA to FHIR only, to start?
        1. Lisa moves, Ken seconds: we're starting with CCDA to FHIR in this iteration and we'll return to address FHIR-to-C-CDA (5-0-0)

Meeting Outcomes

  • stakeholders interested in completion, secure resources
  • review posted document draft, examples

Next Meeting/Preliminary Agenda Items
  • Continue example discussion
  • Settle on format

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