2016-11-17 Patient Care FHIR Call

Meeting Information

Patient Care FHIR Resources Conference Call Location: Conference Call Phone Number: +1 770-657-9270 Participant Passcode: 943377 WebEx: https://cerner.webex.com/cerner/j.php?MTID=mfc8969c4f77244480beee61d31385e79		Date: 2016-MM-DD Time: 5-6:30pm ET
Facilitator	Michelle M Miller	Note taker(s)	Michelle M Miller
Attendee	Name	Affiliation
X	Elaine Ayres	NIH/Department of Clinical Research Informatics
X	Stephen Chu
	Danielle Friend	Epic
X	Eric Haas	Haas Consulting
	Rob Hausam	Hausam Consulting LLC
	Laura Heermann-Langford	Intermountain Healthcare
	Emma Jones	Allscripts
X	Russ Leftwich	InterSystems
	Tony Little	Optum 360
	Jay Lyle	Ockham Information Services LLC, VA
	Sarah Maulden	VA
	Hank Mayers	ReliaTech Consulting
	Jim McClay	Univ of Nebraska Medical Center
	Russell McDonell	Telstra Health
	Lloyd McKenzie	Gevity (HL7 Canada)
	Larry McKnight	Cerner
X	Michelle M Miller	Cerner
	Lisa Nelson	Life Over Time Solutions
	Viet Nguyen	Lockheed Martin, Systems Made Simple
	M'Lynda Owens	Cognosante
	Craig Parker	Intermountain Healthcare
	Scott Robertson	Kaiser Permanente
	Simon Sum	Academy of Nutrition and Dietetics
	Iona Thraen	Dept of Veterans Affairs
X	Clem McDonald	National Library of Medicine
X	Joe Quinn	Optum
X	Ian Bull	Optum
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2016-11-10_Patient_Care_FHIR_Call
   • Motion: Stephen/Joe
3. gForge change request
   • Updated timelines and backlog review
   • Discuss/vote on pre-applied changes (including a few proposed revised resolutions)
   • Discuss Clem's in person tracker items
   • Decide whether to spend remaining time on allergy or care plan (both will be used by IGs balloting in the January ballot, so today is the *last* day to resolve changes for the Jan ballot)

Supporting Information

STU 3 Timeline

From FHIR_Ballot_Prep

• Sun. Nov. 27 Ballot substantive resource freeze (prioritize resources that IGs will be based on)
• Sun. Dec. 4 Ballot total freeze
• Sun. Dec. 9 (or a day or two earlier) Freeze released - all changes allowed
• Sun. Feb. 5 Ballot reconciliation deadline - All ballot comments must be reconciled, tracker issue report must be clean
• Sun. Feb. 19 Publication substantive resource freeze
• Sun. Feb 26 Publication total freeze
• Mon. Feb 27 QA period opens
• Tue. Feb 28 FMM QA spreadsheet updated for all WG resources
• Sun. Mar. 13 QA period closes
• Sun. Mar. 20 All QA applied

The "following week" STU 3 is published!

FHIR Maturity Levels

[1] Level 3 requires the artifact has been verified by the work group as meeting the DSTU_2_QA_guidelines and has been subject to a round of formal balloting; has at least 10 implementer comments recorded in the tracker drawn from at least 3 organizations resulting in at least one substantive change

Resource	Current FMM Level	Goal FMM Level	QA Status	QA Reviewer	Implementation	Comments
AllergyIntolerance	1	3		Michelle	Argonaut
Condition	2	3		Michelle	Argonaut
Procedure	1	3		Michelle	Argonaut
CarePlan	1	3		Michelle	Argonaut
Goal	1	3		Michelle
QuestionnaireResponse	2	2		Lloyd		Lloyd will QA to get to level 3
Questionnaire	0	2		Lloyd		Lloyd will QA to get to level 3
CareTeam	0	2	NA	Michelle		Aggressive goal (e.g. whether we'll get the implementations needed)
FamilyMemberHistory	1	2	NA	NA		Aggressive goal (e.g. whether we'll get the implementations needed)
ClinicalImpression	0	1	NA	NA
ReferralRequest	1	1	NA	NA
ProcedureRequest	1	1	NA	NA
Linkage	0	1	NA	NA
Flag	1	1	NA	NA
Communication	1	1	NA	NA
CommunicationRequest	1	1	NA	NA

Note: Bold denotes top 20 resource based on survey
Note: Contraindication and Risk Assessment are owned by CDS, not Patient Care

Minutes

gForge Change Requests

FHIR Publication / Backlog Status

• 44 unresolved tracker items (39 ballot + 5 high maturity resource non-ballot comments)
  • 18 requested input from vocab (value set related ballot comments)
  • 7 waiting for input
  • 5 waiting to be scheduled (joint with OO or in person requests)
  • 14 ready for discussion during our weekly conference call

• 24 Resolved - Change Request tracker items
  • 20 ballot or high maturity resource (+ 4 non-ballot, non-priority resource)
  • 9 are substantive (+ 15 are non-substantive)
    • 5 related to new extensions/profiles
    • 2 workflow patterns
    • 1 is pre-applied pending revised resolution
    • 1 populate structure

In Person (Pending Schedule)

In Person Requests -- in the process of being scheduled

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12090 Rename goal attribute

Joint with OO -- in the process of being scheduled

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11026 Relationship between Condition and Observation - 2016-09 core #45 (Jay Lyle)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11119 Differentiate ProcedureRequest and DiagnosticRequest and align their elements - 2016-09 core #273 (Danielle Friend)

Feedback on prior resolutions - may need to revisit when Rob McClure can attend.

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11354 - add extension for condition findings
  • Resolution is inconsistent -- a terminology service would still need to extract out the substance from the product codes
  • In some jurisdictions, like the UK, the use of the condition codes is very much in the 80% (closer to 100%)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11352 - category cardinality
  • Do 80% of systems support multiple categories?
  • Our resolution conflicts with the FHIR GA guidelines 4e that say when constraining to the "code" data type, “ensure all codes are mutually exclusive or are defined in a proper hierarchy where siblings are mutually exclusive” – since the value set binding is required and cardinality is 0..*, the value set is neither mutually exclusive, nor defined in a proper hierarchy

Discussed

Condition

• PREAPPLIED (proposed revised resolution): http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10554 - invariant updated with clarification added for abatementString - resolved

Questionnaire/QuestionnaireResponse

• PREAPPLIED (proposed revised resolution): http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10429 - revert back QuestionnaireResponse.questionnaire to be a reference (not uri) per https://chat.fhir.org/#narrow/stream/implementers/topic/QuestionnaireResponse - resolved
  • Per Grahame, you can put a canonical URL on a contained resource, but now you have to make it unique. And also, you can't make it contained anymore, because there's no reference to it
  • Per Lloyd, There's no need for URI. (URI is needed on value set because you want to be able to point to web pages for things like language codes and mime types, but it makes no sense to support that for Questionnaire.)
• PREAPPLIED (proposed revised resolution): http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11003 - update resolution per Zulip chat with Brian Postlethwaite to include Questionnaire.item.initial clarification in comments: "The user is allowed to change the value and override the default (unless marked as read-only). If the user doesn't change the value, then this initial value will be persisted when the QuestionnaireResponse is initially created" - resolved
  • Per Brian, rendered to me implies view only, not storage

CarePlan

• PREAPPLIED: http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12341 Make careplan.subject 1..1 - resolved

Clem McDonald In Person

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11281 Overall Condition.clinicalStatus and Condition.verificationStatus Condition body site - Clem McDonald - resolved
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11290 clinical impression and condition - Clem McDonald withdrew
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11288 reporting impressions as observations - Clem McDonald - PC added comments that OO/Eric will address via Observation boundaries

AllergyIntolerance

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11021 Increase cardinality of substance and make certainty relation to substance not reaction - 2016-09 core #40 (Jay Lyle) -- Discussed - no resolution yet

Backlog - Ready to Discuss in Subsequent Calls

Resources with higher maturity - target FMM Level 3

AllergyIntolerance

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11021 Increase cardinality of substance and make certainty relation to substance not reaction - 2016-09 core #40 (Jay Lyle) -- Deferred
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11155 Unclear how the negation value set will work - 2016-09 core #309 (Stephen Chu)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12177 Review/expand the AllergyIntolerance.criticality valueset (Mohannad Hammadeh)

CarePlan / Goal

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11116 Better define the careplan.activity.outcome field - discussion occurred during the CarePlan (Wed, Oct 26) conference call. PCWG agreed that outcome is needed on both the activity and goal. For example, a goal of losing 20 pounds might include activities to 1) reduce caloric intake via diet and 2)exercise 30 minutes per day. The outcome associated with the weight loss goal might be an observation with the updated body weight whereas the outcome on the activity side might be the number of calories burned via exercise or calories consumed via diet. Next steps:
  • expand/clarify the outcome definitions on both the activity and goal.
  • harmonize the outcome structure to allow the activity to reference an observation (like the goal outcome allows)
  • bind the outcome codeableconcepts to value sets
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12090 Rename goal attribute (in person?)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11344 Allow CarePlan.activity.detail.performer to be CareTeam - 2016-09 core #502 (Emma Jones) -- pulled from block vote

Condition

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10635 QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller)

Procedure

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11162 Suggest include reference to remedial treatment(s) - 2016-09 core #316 (Stephen Chu)

Questionnaire / QuestionnaireResponse

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12315 Additional Status Code for QuestionnaireResponse 'Not Complete'
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10998 Questionnaire.concept -> Questionnaire.code and update definitions - 2016-09 sdc #64 (Stephen Chu)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12186 Proposed Changes to Questionnaire / Questionnaire Response from Tuesday evening discussion (Grahame Grieve)

Care Team

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11342 - Add CareTeam.relatedTeam or other composition relationship - 2016-09 core #500
• DAF - http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10715 Add entered in error to valueset-daf-careteam-status (Michelle Miller) - related to http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10725, which is part of the Vocab set to review

ProcedureRequest

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=9335 Orders to not do things (Emma Jones)

FamilyMemberHistory List

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11139 - Genetic Pedigree profile - 2016-09 core #293

Adjourn

Adjourned at 6:45pm Eastern.

Meeting Outcomes

Actions

Next Meeting/Preliminary Agenda Items Agenda review Approve previous meeting minutes Motion: <moved>/<seconded> Abstain - <#>, Negative - <#>, Approve - <#> gForge change request

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