2017-01-30 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=m87be2b4c4fb1cbf375343ca17831c187		Date: 2017-01-30 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	The Australian Digital Health Agency (ADHA)
X	Dave Carlson
	Evelyn Gallego	EMI Advisors LLC
	Eric Haas	Haas Consulting
X	Rob Hausam	Hausam Consulting LLC
	Laura Heermann-Langford	Intermountain Healthcare
X	Emma Jones	Allscripts
	Russ Leftwich	InterSystems
	Tony Little	Optum 360
	Jay Lyle	Ockham Information Services LLC, VA
	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
	Joe Quinn	Optum
	Simon Sum	Academy of Nutrition and Dietetics
	Iona Thraen	Dept of Veterans Affairs
	Serafina Versaggi	Dept of Veterans Affairs
	Tracey Coleman	Allscripts
	Amit Popat	Epic
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2017-01-26_Patient_Care_FHIR_Call
   • Motion: Emma/Rob H
3. Prior Action Item Follow-up
4. gForge change request

Supporting Information

STU 3 Timeline

From FHIR_Ballot_Prep

• 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!

Minutes

STU3 Action Items

• Review Tracker Issues - https://docs.google.com/a/lmckenzie.com/uc?id=0B285oCHDUr09Mzh3b09rMFhEV1E
• Resolve QA Warnings to have resource FMM > 0
• Resolve QA Information messages to achieve FMM = 3
• Update QA checklist for resources that we want to be FMM = 3
• Review workflow gap analysis per GF#10293
• Block Vote (see below) scheduled for Feb 2, 2017 for low hanging fruit, i.e. non-ballot comments
• Apply changes (all "substantive" changes have been applied, except allergy, care team invariant, and workflow patterns)

16 Deferred Ballot Comments

• GF#7185 2015May core #244 - ClinicalImpression is poorly thought out (Clem McDonald) Waiting for Input
• GF#10387 CommunicationRequest needs ability to describe the location that the communication is about (John Moehrke)
• GF#10621 QA 4a: Consider whether CarePlan.activity.detail.category should be bound to an external code system (Michelle Miller)
• GF#10622 QA 4a: Consider whether Goal.category should be bound to codes from an external code system (Michelle Miller)
• GF#10635 QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller) -- deferred, but asking for MnM exemption
• GF#11026 Relationship between Condition and Observation - 2016-09 core #45 (Jay Lyle)
• GF#11209 Feedback on ClinicalImpression - 2016-09 core #363 (Riki Merrick)
• GF#11355 CarePlan category value set is out of date or wrong - 2016-09 core #513 (Robert McClure)
• GF#11357 Re-use the procedure value set instead of wrapping it - 2016-09 core #515 (Robert McClure)
• GF#11358 Should not make a new value set ehre - use the Problem value set that also includes Events and SWEC concepts. - 2016-09 core #516 (Robert McClure)
• GF#11359 Why only one medication in an activity? And the value set is problematic (but example) - 2016-09 core #517 (Robert McClure)
• GF#11354 Substance identified in both AllergyIntolerance.code and reaction.substance is problematic - 2016-09 core #512 (Robert McClure)
• GF#11021 Increase cardinality of substance and make certainty relation to substance not reaction - 2016-09 core #40 (Jay Lyle)
• GF#11023 Why isn't AllergyIntolerance.reaction an Observation? - 2016-09 core #42 (Jay Lyle)
• GF#11173 CarePlan needs support for reviews - 2016-09 core #327 (Stephen Chu)
• GF#11332 Acknowledge Advance Directives as type of Care Plan - 2016-09 core #490 (David Tao)

Vote to defer non-ballot comments

Motion to defer the list below: Rob/Dave: 3-0-0
Non-ballot comments related to non-priority resources (e.g. Communication, ReferralRequest, FamilyMemberHistory, ClinicalImpression, Flag)

• GF#8782 NoKnown[X] for FamilyMemberHistory (Danielle Friend)
• GF#10352 CHange Encounter or annd element to remove referencial limitation to on Encounters (Paul Knapp)
• GF#10508 FamilyMemberHistory ignores events (Richard Townley-O'Neill)
• GF#12163 Update payload URL to lead to a real file (Guillaume Rossignol)
• GF#12167 Communication Resource need valueset for communication.category (Laura Heermann) -- QA WARNING too
• GF#12212 Include HealthcareServce in the recipient reference types (Brian Postlethwate)
• GF#5979 Would prefer the name for this resource to be ClinicalNote (Brian Postlethwate) Waiting for Input
• GF#8458 Is a blood transfusion closer to a medication administration or a procedure or something else? (Daniel Lanphear) Waiting for Input
• GF#8647 Missing codes from Flag.category valueset (Jason Mathews) Waiting for Input
• GF#8781 FamilyMemberHistory Should be Patient not Relative Centric (Danielle Friend) Waiting for Input
• GF#8784 Proposed History Resource (Danielle Friend) Waiting for Input
• GF#9028 Use SCT values rather than V3 for family history relationship (Jay Lyle) Waiting for Input

TOP Priority -- AllergyIntolerance, Condition, and Procedure -- QA Warnings/Information (desire FMM = 3)

• AllergyIntolerance
  • Rob Hausam is helping with RIM mappings (clinicalStatus and verificationStatus)
  • Rob Hausam is using data Elaine sent to see if we can curate the SNOMED CT Clinical Findings to a smaller subset. If not, then we'll update the binding for AllergyIntolerance.reaction.manifestation to use the same valueset-clinical-findings
    • Duplicate Valueset Names: manifestation-codes (SNOMED CT Clinical Findings) & clinical-findings (SNOMED CT Clinical Findings)
    • AllergyIntolerance.reaction.manifestation -- http://build.fhir.org/valueset-manifestation-codes.html
    • DiagnosticReport.codedDiagnosis (and profiles) -- http://build.fhir.org/valueset-clinical-findings.html

• Condition is clean on the QA report!
  • QA Checklist: GF#10635 QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller) -- deferred and asking for MnM exemption

• Procedure is clean on the QA report!

HIGH Priority -- CareTeam, CarePlan, and Goal -- QA Warnings (desire FMM > 0 means we address all warnings)

• CarePlan
  • MnM exemptions requested for element names should be singular (addresses and replaces)

• Goal
  • MnM exemption requested for element names should be singular (addresses)
  • PCWG needs to address GF#10623
    • Rob was going to help with Goal.description - example binding to a new value set
    • Goal.target.detail - ask MnM for exemption because target detail is a choice of data types (i.e. Quantity and CodeableConcept could have different value sets) - Observation.value[x] does not show this same QA warning.

MEDIUM Priority -- All other resources -- QA Warnings (desire FMM > 0 means we address all warnings)

• FamilyMemberHistory
  • PCWG: FamilyMemberHistory.condition.onset[x] Element has a todo associated with it (Define/find appropriate observation code.) -- remove TO DO

• Communication & CommunicationRequest
  • Started to review workflow alignment
  • PCWG: category Need to provide a binding
    • GF#12167 marked as a duplicate of GF#8564
    • Rob will check to see if v3 has existing codes. If so, use v3. If not, then add v3 codes: alert, notification, reminder, instruction
  • PCWG: workflow could resolve GF#10293
    • A resource must have an 'entered in error' status
    • CommunicationRequest.subject Elements with name 'subject' cannot be a reference to just a patient

• ReferralRequest
  • PCWG: Bindings/Value Sets
    • ReferralRequest.type Need to provide a binding
    • ReferralRequest.reason Need to provide a binding
    • pc:ValueSetComparison Duplicate Valueset Names: v2-0284 (v2 Referral Category) & referralcategory (ReferralCategory) (name: [referrals, categories] / [referrals, categories]))
    • pc:ValueSetComparison Duplicate Valueset Names: v2-0283 (v2 Referral Status) & referralstatus (ReferralStatus) (name: [referrals, statuses] / [referrals, statuses]))
  • PCWG: ReferralRequest.description Element has a todo associated with it (This would be a good candidate for a 'markdown' data type.)
  • Examples
    • ReferralRequest.context Search Parameter 'ReferralRequest.context' had no found values in any example. Consider reviewing the expression (ReferralRequest.context)
    • ReferralRequest.group-identifier Search Parameter 'ReferralRequest.group-identifier' had no found values in any example. Consider reviewing the expression (ReferralRequest.groupIdentifier)

• ClinicalImpression -- keep as FMM = 0
  • Stephen Chu will work on examples to cover all elements
    • ClinicalImpression.action Search Parameter 'ClinicalImpression.action' had no found values in any example. Consider reviewing the expression (ClinicalImpression.action)
    • ClinicalImpression.previous Search Parameter 'ClinicalImpression.previous' had no found values in any example. Consider reviewing the expression (ClinicalImpression.previous)
  • PCWG: ClinicalImpression.code Need to provide a binding

• Linkage -- keep as FMM = 0
  • PCWG: Linkage A resource must have an 'entered in error' status
  • PCWG: Linkage All resources should have an identifier
  • PCWG: Linkage.item Element has a todo associated with it (Make this 2..*.)

LOW Priority -- CareTeam, CarePlan, and Goal -- QA Information (desire FMM = 3 means we address all information)

• CareTeam
  • RIM Mapping

• Goal
  • RIM Mapping
  • QA Checklist: GF#10622 QA 4a: Consider whether Goal.category should be bound to codes from an external code system (Michelle Miller)

• CarePlan
  • RIM Mapping
  • Examples
    • CarePlan/activity/detail/definition Path had no found values in any example. Consider reviewing the path
    • CarePlan/activity/detail/quantity Path had no found values in any example. Consider reviewing the path
    • CarePlan/activity/detail/reasonCode Path had no found values in any example. Consider reviewing the path
    • CarePlan/activity/detail/reasonReference Path had no found values in any example. Consider reviewing the path
    • CarePlan/supportingInfo Path had no found values in any example. Consider reviewing the path
  • QA Checklist: GF#10621 QA 4a: Consider whether CarePlan.activity.detail.category should be bound to an external code system (Michelle Miller)

Block Vote (Thurs, Feb 2)

Non-ballot comments

• GF#12585 Add Goal.target.measure invariant (Michelle Miller) Persuasive
• GF#12645 CarePlan.activity.reference includes ProcessRequest (Dave Carlson) Persuasive
• GF#12646 Add "careplan-title" extension (Dave Carlson) Persuasive with Mod
• GF#12668 ClinFHIR: extension-condition-partof - add support for referencing Condition (Michelle Miller) Persuasive
• GF#12669 Please add note element to careTeam (Emma Jones) Persuasive

Adjourn

Adjourned at 6:35pm 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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