2017-02-14 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://intermountainmeetings.webex.com/intermountainmeetings/j.php?MTID=m285042c1dfaad164ef45fcf2b7aa8619		Date: 2017-02-14 Time: 5-6pm 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
X	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
	Joe Quinn	Optum
	Simon Sum	Academy of Nutrition and Dietetics
	Iona Thraen	Dept of Veterans Affairs
	Serafina Versaggi	Dept of Veterans Affairs
	Pushpalatha Bhat
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2017-02-09_Patient_Care_FHIR_Call
   • Motion: Stephen/Emma
3. 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 workflow patterns)

Minutes

gForge Change Requests

GF#12828 - Update RIM mappings for Procedure.performer.role and CareTeam.participant.role

Event Workflow Pattern

Review workflow patterns GF#10293

ReferralRequest -- pre-applied

• add definition element
• add replaces element
• rename parent element to groupIdentifier; add aliases (grouperId and requisition)
• 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; binding strength of required
• rename fulfillmentTime element to be occurrence with choice of dateTime|Period
• align requester element with the agent and onBehalfOf elements (allowing agent to also be RelatedPerson|Device)
• rename reason element to be reasonCode, and increase cardinality 0..*
• add reasonReference element
• add relevantHistory element

ReferralRequest -- changes needed

• ReferralRequest.replaces Reference only ReferralRequest
• ReferralRequest.occurrence definition updated to "When the services requested in the referral should occur" with comment that when dateTime is populated, it is understood to be the same as if only Period.end (i.e. must happen before a specified date)
• rename patient element to be subject Reference(Patient|Group) and change to be required 1..1

Notes:

• Stephen is logging a tracker against the workflow pattern around intent/status
• Russ suggested that we consider where scheduled fits in
• exempt from renaming serviceRequested to code; keep 0..* as well
• exempt from performerType/performer pattern; prefer to keep recipient 0..* instead

ReferralRequest -- discuss / to be applied

• add definition search parameter / example
• add replaces search parameter / example
• add service requested search parameter / example
• add occurrence search parameter / example -- discuss whether to support Timing data type?
• add authoredOn search parameter / example

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

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 6:03pm 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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