2017-02-09 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: 2017-02-09 Time: 5-6:30pm ET
Facilitator	Michelle M Miller	Note taker(s)	Michelle M Miller
Attendee	Name	Affiliation
	Elaine Ayres	NIH/Department of Clinical Research Informatics
X	Stephen Chu	The Australian Digital Health Agency (ADHA)
	Evelyn Gallego	EMI Advisors LLC
	Eric Haas	Haas Consulting
X	Rob Hausam	Hausam Consulting LLC
	Laura Heermann-Langford	Intermountain Healthcare
X	Emma Jones	Allscripts
X	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
X	Joe Quinn	Optum
	Simon Sum	Academy of Nutrition and Dietetics
	Iona Thraen	Dept of Veterans Affairs
	Serafina Versaggi	Dept of Veterans Affairs
X	Pushpalatha Bhat
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2017-02-02_Patient_Care_FHIR_Call
   • Motion: Russ/Stephen
3. Prior Action Item Follow-up
4. gForge change request

Supporting Information

STU 3 Timeline

From FHIR_Ballot_Prep

• 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

Maturity Levels 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

Target FMM levels for STU3 publication

• AllergyIntolerance = 3
• Condition = 3
• Procedure = 3
• CarePlan = 1
• Goal = 1
• CareTeam = 1
• FamilyMemberHistory = 1
• ReferralRequest = 1
• Flag = 1
• Communication = 1
• CommunicationRequest =1
• ClinicalImpression = 0
• Linkage = 0

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
• Apply changes (all "substantive" changes have been applied, except care team invariant and workflow patterns)

Minutes

gForge Change Requests

GF12776 Goal.subject should be 1..1 -- Deferred

Event Workflow Pattern

Review workflow patterns GF#10293

FamilyMemberHistory - Ask FHIR-I to exempt FMH from workflow

• make identifier a summary element
• add definition element Reference(Questionnaire | PlanDefinition) -- search parameter / example
• don't add basedOn element
• don't add partOf element
• don't bind status to http://hl7.org/fhir/ValueSet/event-status
• add notDone element
• add notDoneReason element (example binding; similar to FHIR value set to http://build.fhir.org/valueset-list-empty-reason.html)
  • Patient does not know subject
  • Patient refused to provide information about subject
  • Unable to obtain
  • Deferred (e.g. don't know why family member died)
• don't add code element
• don't rename patient element to subject -- keep the Reference(Patient)
• don't add context element -- Reference(Encounter|EpisodeOfCare)
• exempt from occurrence pattern (i.e. don't rename date, keep dateTime data type)
• don't add performer structure (i.e. role, actor, onBehalfOf)
• add reasonCodeableConcept (example value set binding to http://build.fhir.org/valueset-clinical-findings.html)
• add reasonReference element Reference (Condition | Observation | AllergyIntolerance |QuestionnaireResponse)

Communication

• exempt from occurrence pattern (i.e. keep sent/received dateTime)
• exempt performer structure (i.e. role, actor, onBehalfOf) and keep sender/recipient elements as is
• add reasonCodeableConcept (example value set binding to http://build.fhir.org/valueset-clinical-findings.html)
• add reasonReference element Reference(Observation | Condition)

Request Workflow Pattern

CommunicationRequest

• add supportingInfo as extension (GF#10293)
• add relevantHistory as extension (GF#10293)
• add definition as extension Reference(ActivityDefinition|PlanDefinition)
• add basedOn element -- Reference(CommunicationRequest + all other request)
• add replaces element -- Reference(CommunicationRequest)
• add groupIdentifier element -- search parameter / example
• don't add intent element (order doesn't apply)
• change priority from CodeableConcept to code (and add w5 mapping to grade)
• exempt from having code element added
• exempt from making subject 1..1 -- keep 0..1
• rename scheduled element to occurrence and don't add choice of Timing
• rename requestedOn element to authoredOn, add w5 mapping to when.recorded, add aliases (createdOn, signedOn) -- update search param
• align requester element with the agent and onBehalfOf elements (allowing agent to also be Organization|Device)
• exempt from performerType/performer pattern; prefer to keep sender/recipient instead
• rename reason element to be reasonCode
• add reasonReference element - Reference(Condition | Observation)
• add note element

Next Week

ReferralRequest

• add definition element -- search parameter / example
• add replaces element -- search parameter / example
• add aliases (grouperId and requisition) to groupIdentifier element
• bind status element to http://hl7.org/fhir/ValueSet/request-status (effectively adding suspended and unknown)
• rename category element to intent and bind to http://hl7.org/fhir/ValueSet/request-intent (pre-applied)
• change priority from CodeableConcept to code
• exempt from having code element added OR rename serviceRequested element to code? (request pattern has 0..1 cardinality, but keep 0..*)
• rename patient element to be subject Reference(Patient|Group) and change to be required 1..1
• rename fulfillmentTime element to be occurrence with choice of dateTime|Period|Timing?
• align requester element with the agent and onBehalfOf elements (allowing agent to also be RelatedPerson|Device)
• exempt from performerType/performer pattern; prefer to keep recipient 0..* instead
• rename reason element to be reasonCode, and increase cardinality 0..*
• add reasonReference element
• add relevantHistory element

ClinicalImpression

• add definition element -- search parameter / example
• add basedOn as extension (GF#10293) -- search parameter? / example
• add partOf as extension (GF#10293) -- search parameter? / example
• bind status to http://hl7.org/fhir/ValueSet/event-status
• add notDone element
• add notDoneReason element (need to determine value set binding)
• add alias (of patient) to subject element
• exempt from occurrence pattern (i.e. don't rename effective, don't add Timing)
• align assessor with the performer structure (i.e. role, actor, onBehalfOf) - can actor Reference(Practitioner|Organization|Patient|Device|RelatedPerson)? or just Practitioner?
• add reasonCodeableConcept (need to determine value set binding)
• add reasonReference element

Resource QA Summary

TOP Priority

• AllergyIntolerance is clean on the QA report!
• Condition is clean on the QA report!
• Procedure is clean on the QA report!

HIGH Priority

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

MEDIUM Priority

• 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 -- no QA warnings!
• CommunicationRequest -- no QA warnings!
• ReferralRequest -- no QA warnings!

LOW Priority

• 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 6:36pm Eastern.

Meeting Outcomes

Actions Michelle to ask FHIR-I/workflow to exempt FamilyMemberHistory from workflow event pattern

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

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