2016-05-10 PA WGM Minutes

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Patient Administration Work Group Minutes - May 10, 2016

Tuesday Q1

HL7 Patient Administration Meeting Minutes Location: Salon Musset		Date: 2016-05-10 Time: Tuesday Q1
Facilitator	Irma Jonganeel	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	VZVZ, The Netherlands
X	Alex de Leon	Kaiser Permanente, USA
X	Line Saele	HL7 Norway
X	Brian Postlethwaite	HealthConnex, Australia
X	Andrew Torres	Cerner, USA
X	Dennis Patterson	Cerner, USA
X	Alexander Henket	Nictiz, The Netherlands
X	Ewout Kramer	HL7 The Netherlands
X	Emmanuel Helm	HL7 Austria
X	Egger Olive	HL7 Switzerland
X	Christian Hay	GS1 Switzerland
X	Michael Donnelly	EPIC, USA
X	Genny Luensman	CDC/NIOSH, USA
X	Cooper Thompson	EPIC, USA
X	Christof Gessner	HL7 Germany
X	Elliot Silver	McKesson, USA
X	Mark Kramer	MITRE, USA
X	Toril Reite	HL7 Norway
X	Brad Genereaux	AGFA Healthcare, USA
X	Paul Lumayesva	Intersystems, HL7 , The Netherlands
X	Matthew Spielman	Intersystems, HL7 , The Netherlands
X	Tara Oskam	iDeaWorks, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

• Welcome/introductions
  
• Coordination with FHIR Core team

Supporting Documents

• FHIR QA Criteria
• FHIR Resources
• FHIR Workflow Discussion

Minutes

Minutes/Conclusions Reached:
Introductions
PA hosting FHIR Managemnt Group

Irma passed the floor to Ewout for updates from the FMG
Preparation for the new publication STU 3 which would like to publish in December, 2016. This means the process for ballot has to start in September. If there is anything that PA wants to get in to the ballot it has to be in by 24 of July (total content freeze). Resource proposals should be in by June 1st. Irma commented that this means that this means the expectation is that there will only be one ballot cycle. Ewout responded that it depends of course of how much comments come back.

The FMG would like to have a sense of what FMM PA would like to achieve for the resources which we steward.

The group reviewed the current resources and their FMM levels. PA resources are at level 1 except for Patient which is at 3. To get to level 2 there has to be exchange between 3 organizations for example at a connectathon.

Lloyd would like our resources to be at level 3.

Organization, Practitioner, Location have had the balloting done… the discussion focused on the ability to get these to level 3. There is an Argonaut project that might test this through a provider directory project.

Norway is expecting to test Encounter but probably not within this timeline. So, Encounter will most likely remain at level 1.

The list of priority resources were shown

<<insert priority list>> Person was discussed as potentially not being a priority, especially for the PAWG.
The group discussed the Appointment resource and how it has been used. There will be a Norway implementation this fall.

On the priority list from our WG are:

• Patient
• Practitioner
• Organization
• Encounter
• Person

The challenge with Patient is exercising Patient with veterinary organizations. Discussion about ownership of patients (e.g. service dogs, etc.). Within the discussion were the situations where a child might be a ward of the state as an example where a human patient is under the auspices of an organization.

The WG then presented the idea of event level mapping and how this can be done. This has yet to be presented to the FMG. This can be presented on Thursday.

When asked if we had any new resources the WG presented:

• Endpoint – new resource
• PractitionerRole – new resource taken from a subcomponent of the Practitioner resources

Action: Create formal proposals for each of the above resources. Owner: Brian. Due: Prior to 30-May
The group then reviewed the Endpoint resource which is a brand new resource.
https://hl7-fhir.github.io/endpoint.html

Some discussion occurred around the name (Endpoint). Brian reviewed the elements within this resource, clarifying that this is more of a type of address book and should stay at that level of abstraction.

The group then discussed whether PA should be the steward of this. It was developed as part of the provider directory, but since it is leaning more toward infrastructure should it be in the FMG. Some in the group considered that this should indeed be under the FHIR infrastructure group since it crosses all systems beyond PAWG scope. However, this could be said around Patient resource as well. Even if this stays within PA, it does have to be developed in conjunction with FHIR infrastructure group as well as methodology.

Ewout noted that if this remains in PA, when it will be discussed, it should be announced on the listserve. Brian noted that there is much discussion already happening on Zulip. John Merke should be included as well as infrastructure folk.

Ewout then brought the subject of gForge as the tracker tool. Due to feedback, there was enough interested that the FMG is exploring other tooling options. There is work to look at an alternative option (e.g. Jira) throughout this summer.

The group then addressed the WG health in terms of FHIR. The main concern was about tracker items and addressing them. Currently, there are 57, which is manageable. The PAWG seems to be in good FHIR health.

There were some items that PA had as concerns having to do with Entered in error, MPI, link/unlink and merge/unmerge. These might affect or have impacts/changes on the resources we steward, most importantly for the Patient resources.
Brian brought up the discussion about MPI search and posting to the server to find a patient. The results of which can be a perfect match or a list of matches. This may conceptually may have infrastructure components for searching. Are there operations that can be generalized. Perhaps there should be generalized operations that can support provider, organization searching.

Examples
$match
$search

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Action:

Next Meeting/Preliminary Agenda Items .

Tuesday Q2

HL7 Patient Administration Meeting Minutes Location: Salon Musset		Date: 2016-05-10 Time: Tuesday Q2
Facilitator	Irma Jongeneel	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	HL7 Norway
X	Irma Jongeneel	HL7 Netherlands
X	Alex de Leon	Kaiser Permanente, USA
X	Brian Postlethwaite	HealthConnex, Australia
X	Toril Reite	HL7 Norway
X	Cooper Thompson	EPIC, USA
X	Christian Hay	GS1, Switzerland
X	Michael Donnelly	EPIC, USA
X	Kevin Chekletom	Cerner, USA
Quorum Requirements Met (Chair +2 members): Yes

Agenda

Agenda Topics

1. Ballot reconciliation FHIR DSTU2

Supporting Documents

• gForge Open Resource Tracker Items

Minutes

Minutes/Conclusions Reached:
Introductions
The WG covered the Steering Division updates. There was only one PSS for mobile health. They will be producing a white paper and see if anyone is using any standard for mobile health.
FHIR Reconciliation

1. 8436 – Add location to the Patient resource.
   
   

I would like to propose adding a "location" attribute to the "Patient" resource. The specific use-case would be for long-term care facilities where patients are assigned to a room.
Right now, the current alternatives are (without using extensions):
- recording room assignments through an Encounter. (The standard seems to keep changing, but at one point there was a "hospitalization" aspect that included a room number. I'm not sure if it's totally clear how to do this with the latest version.) The issue with this is figuring out a Patient's current room assignment may require searching through years of Encounters to find the most recent one with a room assignment.
- parsing through the Patient.address hoping to find a room number. (As most patients at a long-term care facility are full-time residents, there address is usually the facility. However, it'd be very difficult to reliably extract a room assignment from the address.)

The group discussed that we have done a lot of work regarding location, making it discrete and allowing for a structure like room, however for FHIR it seems less discreet and allows for textual entry of address.
Long term care location is the use case in this tracker.
The WG considered this request and determined that the address in the patient resource is intended for administrative purposes, not necessarily tied to a clinical even. The encounter related to the person should contain the current location. So, in a long-term care facility, there should be an active encounter that can be searched upon for the location (including the room assignment).

The WG then looked at the query. The group noted that the location element had a status on it that includes “planned”, “active”, “reserved”, and “completed”.
Brian moved to non-persuasive and respond to the submitter with the following text:
I would like to propose adding a "location" attribute to the "Patient" resource. The specific use-case would be for long-term care facilities where patients are assigned to a room.
Right now, the current alternatives are (without using extensions):
- recording room assignments through an Encounter. (The standard seems to keep changing, but at one point there was a "hospitalization" aspect that included a room number. I'm not sure if it's totally clear how to do this with the latest version.) The issue with this is figuring out a Patient's current room assignment may require searching through years of Encounters to find the most recent one with a room assignment.
- parsing through the Patient.address hoping to find a room number. (As most patients at a long-term care facility are full-time residents, there address is usually the facility. However, it'd be very difficult to reliably extract a room assignment from the address.)
Cooper seconded
Discussion: None.
Vote: 8/0/0

1. 9337 Summary: marital-status#U should be replaced with v3-MaritalStatus#U
   

The code "U" is defined in http://hl7.org/fhir/ValueSet/marital-status with the commend "work around for missing code in v3 code system - should be temporary, until added in v3". U is now present in http://hl7.org/fhir/v3/MaritalStatus. http://hl7.org/fhir/ValueSet/marital-status can therefore be deleted entirely. Additionally, the display for "U" in http://hl7.org/fhir/v3/MaritalStatus using capitalization that is not consistent with the rest of the concepts, and should be changed from "unmarried" to "Unmarried".

Brian moved to make this persuasive replace the binding on patient.maritalStatus with the v3 marital status code system code set and remove the FHIR specific workaround value set. Insure that the U valueis in the FHIR v3 list. Michael seconded
Discussion: None
Vote: 8/0/0

1. 9236 Summary: Add highest level of education in Patient
   

The WG considered this and determined that this is not part of the 80%
Brian moves this as non persuasive and including the following text in the response:
This is not likely to be in the 80% of systems, and hence should be defined in the extension space on Patient. If you believe this should be a standard extension we would request that you provide additional descriptions and guidance for correct usage of the property, and include a recommended (or example) valueset binding if proposing a coded value.
Kevin Shekleton seconds.

1. 8859 Summary: change example valuesets for animal.species and .breed to SNOMED CT
   

change example valuesets for animal.species and .breed to SNOMED CT. Rationale is HL7 policy to use external code system when and where they exist. Although not widely adopted, SCT codes are used in veterinary medicine for example NAHLN. https://www.nahln.org Suggested example value sets for large animal practice or food animal surveillance are provided in the attached file. The Breed codes are taken directly from NALHN. The species code I enumerated based upon the breed codes to represent the commonly named species. (The concept of species in vet med does not neatly divide into distinct taxons)
Brian moved to have this be persuasive with mod with the following text:
These valuesets seem to be reasonable to bind as examples replacing the fabricated FHIR valuesets, and will be applied to the patient resource as proposed, and also to the practitioner standard extension (used for service animals).
Irma seconded.
Discussion: None
Vote: 5/0/3
Motion Passes

1. 5899 - Summary: Change Patient Search Parameter "Name" to include HumanName.text
   

Currently the SearchParameter in Patient called "Name" searches patient resources based on given or family name and does not include the HumanName.text attribute. Sometimes systems may just capture the name as part of text and not distinguish given or family name and it would be better if the searchParameter "Name" includes the HumanName.text as part of the search space.
Brian moves to note this as persuasive with mod and will include the folllwing text:

For all "name" based search parameters on Patient, Practitioner, RelatedPerson and Person the description of the search will be clarified to reflect the intent of this style of search. Enabling the server to intelligently process the provided text to search any of the name based properties ("Google search style"). This could also cover aliases not otherwise visible in the resource structure.
Seconded by Michael
Disussion: None
Vote: 7/0/1

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Action:

Next Meeting/Preliminary Agenda Items .

Tuesday Q3

HL7 Patient Administration Meeting Minutes Location: Salon Musset		Date: 2016-05-10 Time: Tuesday Q3
Facilitator	Brian Postlethwaite	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Brian Postlethwaite	HL7 Australia
X	Irma Jongeneel	HL7 Netherlands
X	Alex de Leon	Kaiser Permanente
X	Simone Heckmann	HL7 Germany
X	Christian Hay	GS1, Switzerland
X	Cooper Thompson	EPIC, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. FHIR DSTU2 Account prep

Supporting Documents

• Account Resource

Minutes

Minutes/Conclusions Reached:
Introductions.

The WG started the discussion regarding coverage and the model for coverage along with the model.

interaction model Issuer to Payor

The WG discussed the coverage, account, insurance and how they are related across different use cases. Different use cases around the world have different uses for account and coverage.
On the Coverage resource, there is beneficiary. This is obviously the patient and can really only be the patient. Therefore it should be changed to that.
It was clear that some of the decisions made with Financial Management in previous meetings were not applied to the account or coverage resource.

Therein followed a lengthy discussion around the concept of Guarantor and whether this was a global or US realm concept.
The unofficial conclusion was that there are similar concepts around the world but they’re not exact nor as critical a health care scope concern as in the US.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) .

Next Meeting/Preliminary Agenda Items .

Tuesday Q4

HL7 Patient Administration Meeting Minutes Location: Salon Musset		Date: 2016-05-10 Time: Tuesday Q4
Facilitator	Line Saele	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	HL7 Netherlands
X	Alex de Leon	Kaiser Permanente
X	Nancy Orvis	DOD Military CS Health, USA
X	Cooper Thompson	EPIC, USA
X	Christian Hay	GS1, Switzerland
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. Ballot reconciliation FHIR DSTU2

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions
The WG started with action items from last WGM.
As soon as Nancy showed up, the WGM switched the topic to explaining our need for an interim facilitator. We explained the need and that Wendy, our regular vocabulary facilitator was out for about one year. Our need is a general one in which v2, v3 and FHIR are subjects for vocabulary. Nancy, who has done vocabulary In the past, has agreed to act in this capacity.
Motion made by Irma, seconded by Alex, to accept Nancy as our current vocabulary facilitator.
Discussion: None
Vote: 5/0/0

The WG continued with the action items.
Motion made by Irma to approve the minutes. Seconded by Christian Hay.
Discussion: 4/0/0

Harmonization proposals
Table 203
Alex moves to suggests to the Publishing work group, and Vocabulary for the tables project, that the database reflects current table of 203 (Identifier Type) in v2.3.2 with values contained therein. Irma seconds.
Discussion: None.
Vote: 4/0/0
End of quarter

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) .

Next Meeting/Preliminary Agenda Items .

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