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Negation Requirements Project Minutes 30 March 2016

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Meeting Information

HL7 PC-CIMI-POC Meeting Minutes

Location: PC call line

Date: 2016-03-30
Time: 11:00-12:00 ET
Facilitator Jay Lyle Note taker(s) Jay Lyle
Attendee Name Affiliation

Jay Lyle JP Systems
Floyd Eisenberg NQF
Serafina Versaggi
Michelle Miller Cerner
Susan Barber
Lisa Nelson
Juliette Rabini


Agenda Topics

  1. Review of prior minutes
    1. Provenance
    2. Quality use case
    3. New examples
    4. Cases other than observation


Minutes/Conclusions Reached:

  1. Add link to PSS: it's on project wiki. Perhaps this referred to the TermInfo wiki.
    1. PSS status: still pending Vocab approval
  2. Provenance
    1. Provenance may affect interpretation of a negated fact, e.g., patient asserts no allergies. If there is a record of an reaction, this is reason to doubt such an assertion. However, positive assertions are also subject to trust and validation. Provenance is important, and may be a requirement for displaying allergy negation, but it's not specific to negation. This topic remains out of scope for this project.
  3. Use cases introduced by quality measure use case: need to identify actions not taken for cause.
    1. This information should not be specifically created for the measure calculation: if it's important enough for the measure, it should be in the record. Persistence is necessary to support cases such as "discontinued medication," which would presumably influence future opportunities for administration.
    2. QDM models a property, "negation rationale," for recording such causes.
    3. Whether such a note automatically excludes a patient from the denominator depends on the design of the rule -- for some rules, there are value sets of valid exclusion kinds.
    4. These reasons are not limited to contraindications; they may include patient refusal.
    5. Note that the reason is distinct from the assertion that the act was not performed.
    6. There was some discussion of identifying whether an act is not done# "intentionally." The "reason" property seems to at least offer the ability to identify intentionally omitted acts, and possibly some unintentional. All unintentionally omitted acts would be an infinite set, so we are not concerned with modeling it.
    7. Current systems handle this case in a variety of ways.
      1. Reason may annotate the order.
      2. It may not be saved in a predictable place.
      3. CDA template design: _act.negation, entryRel.reason: observation reason.
    8. VA is considering ways to handle this issue.
    9. CQL logical design under discussion.
  4. New examples: see items 73 - 86 in spreadsheet.
  5. Examples other than observations
    1. Procedures & substance administrations pretty well covered above
    2. Encounter: follow-up not needed; patient did not show up
    3. Supply: did not provide electric wheelchair; did not use antithrombotic device on legs (as a supply item within a larger order or without order)

Meeting Outcomes

  • review examples for completeness, classification for accuracy (all)
  • secure Vocabulary co-sponsorship (Rob H)
  • request involvement from SD & FHIR (Jay)
  • consolidate wiki pages (Jay)
Next Meeting/Preliminary Agenda Items
  • none identified

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