2017-02-02 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=macd64a688fdc3410ab4178adab5820fb		Date: 2017-02-02 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)
	Evelyn Gallego	EMI Advisors LLC
X	Eric Haas	Haas Consulting
X	Rob Hausam	Hausam Consulting LLC
X	Laura Heermann-Langford	Intermountain Healthcare
X	Emma Jones	Allscripts
X	Russ Leftwich	InterSystems
	Tony Little	Optum 360
X	Jay Lyle	Ockham Information Services LLC, VA
	Russell McDonell	Telstra Health
	Lloyd McKenzie	Gevity (HL7 Canada)
	Larry McKnight	Cerner
X	Michelle M Miller	Cerner
X	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
X	Tracey Coleman	Allscripts
X	Hank Mayers
X	Pushpalatha Bhat
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2017-01-31_Patient_Care_FHIR_Call
   • Motion: Laura/Emma
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)

Block Vote (Thurs, Feb 2)

Non-ballot comments (all have been pre-applied) Motion: Stephen/Russ: 9-0-0

• 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

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

• AllergyIntolerance
  • RIM mappings (clinicalStatus and verificationStatus) -- use the same RIM mappings as Condition statuses
    • The ACT.statusCode is a workflow status element and cannot be used to represent clinical status. This will have to be mapped to an Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code=""clinicalStatus"", moodCode=EVN].value
    • The ACT.statusCode is a generic workflow status element and may not be adequate for representing clinical verification status. This will have to be mapped to an Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code=""verificationStatus"", moodCode=EVN].value
  • GF#12768 Motion: Rob/Eric: 12-0-0 -- Bind AllergyIntolerance.reaction.manifestation to http://build.fhir.org/valueset-clinical-findings.html (to remove the duplicate value sets)
    • 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
    • pc:ValueSetComparison Duplicate Valueset Names: manifestation-codes (SNOMED CT Clinical Findings) & adverse-event-type (SNOMED CT Clinical Findings) (name: [cts, findings, snomeds, clinicals] / [cts, findings, snomeds, clinicals]))
    • pc:ValueSetComparison Duplicate Valueset descriptions: manifestation-codes (SNOMED CT Clinical Findings) & adverse-event-type (SNOMED CT Clinical Findings) (description: [cts, findings, snomeds, alls, clinicals] / [cts, findings, snomeds, alls, clinicals]))

• Condition is clean on the QA report!

• Procedure is clean on the QA report!

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

• CareTeam - no QA warnings!

• CarePlan - no QA warnings!
  • MnM approved exemptions requested for element names should be singular (addresses and replaces)

• Goal
  • MnM approved exemption requested for element names should be singular (addresses)
  • GF#10623
    • MnM approved exemption requested for Goal.target.detail 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.
    • Update Goal.description's definition to read: Human-readable and/or coded description of a specific desired objective of care, such as "control blood pressure" or "negotiate an obstacle course" or "dance with child at wedding"
    • Bind Goal.description to http://build.fhir.org/valueset-clinical-findings.html

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

• Flag -- no QA warnings!

• FamilyMemberHistory -- no QA warnings!
  • Stephen Chu's recommendation is to use LOINC 75272-5 Age at onset for the FamilyMemberHistory.condition.onset
  • Motion: Stephen/Elaine: 11-0-1

• Communication & CommunicationRequest
  • Examples
    • Communication.definition Search Parameter 'Communication.definition' had no found values in any example. Consider reviewing the expression (Communication.definition) -- hyperkalemia protocol
    • Communication.part-of Search Parameter 'Communication.part-of' had no found values in any example. Consider reviewing the expression (Communication.partOf) -- part of observation measuring serum potassium
  • Bindings
    • Communication.notDoneReason An element of type CodeableConcept or Coding must have a binding GF#12766
    • Category Need to provide a binding - GF#8564 - Create FHIR value set with: alert, notification, reminder, instruction

• ReferralRequest
  • Bindings/Value Sets
    • pc:ValueSetComparison Duplicate Valueset Names: v2-0284 (v2 Referral Category) & referralcategory (ReferralCategory) (name: [referrals, categories] / [referrals, categories])) -- align with workflow, rename element to intent and use http://build.fhir.org/valueset-request-intent.html
    • pc:ValueSetComparison Duplicate Valueset Names: v2-0283 (v2 Referral Status) & referralstatus (ReferralStatus) (name: [referrals, statuses] / [referrals, statuses])) -- rename value set to Referral Request Status
  • ReferralRequest.description Element has a todo associated with it (This would be a good candidate for a 'markdown' data type.) -- delete TO DO

LOW Priority -- CareTeam, CarePlan, and Goal -- QA Information

• CareTeam
  • RIM Mapping
  • Example: CareTeam/note Path had no found values in any example. Consider reviewing the path

• 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/title Path had no found values in any example. Consider reviewing the path
    • 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)

Draft Resources with FMM = 0 -- ClinicalImpression and Linkage

• 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..*.)

Adjourn

Adjourned at 6:45pm Eastern.

Meeting Outcomes

Actions Michelle to email out workflow gap analysis

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

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