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Difference between revisions of "2017-08-17 Patient Care FHIR Call"

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|colspan="2"| VA
 
|colspan="2"| VA
 
|-
 
|-
−
| || Stephen Chu
+
| X || Stephen Chu
−
|colspan="2"| The Australian Digital Health Agency (ADHA)
+
|colspan="2"| Brisbane South Primary Health Network (BSPHN)
 
|-
 
|-
 
| || Evelyn Gallego
 
| || Evelyn Gallego
 
|colspan="2"| EMI Advisors LLC
 
|colspan="2"| EMI Advisors LLC
 
|-
 
|-
−
| || Eric Haas
+
| X|| Eric Haas
−
|colspan="2"| Haas Consulting
+
|colspan="2"| Health eData Inc
 
|-
 
|-
−
| || Rob Hausam
+
|X || Rob Hausam
 
|colspan="2"| Hausam Consulting LLC
 
|colspan="2"| Hausam Consulting LLC
 
|-
 
|-
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|colspan="2"| Intermountain Healthcare
 
|colspan="2"| Intermountain Healthcare
 
|-
 
|-
−
| || Emma Jones
+
|X || Emma Jones
 
|colspan="2"| Allscripts
 
|colspan="2"| Allscripts
 
|-
 
|-
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|colspan="2"| InterSystems
 
|colspan="2"| InterSystems
 
|-
 
|-
−
| || Tony Little
+
| X || Tony Little
 
|colspan="2"| Optum 360
 
|colspan="2"| Optum 360
 
|-
 
|-
−
| || Jay Lyle
+
| X|| Jay Lyle
 
|colspan="2"| Ockham Information Services LLC, VA
 
|colspan="2"| Ockham Information Services LLC, VA
 
|-
 
|-
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|colspan="2"| Cerner
 
|colspan="2"| Cerner
 
|-
 
|-
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| || Michelle M Miller  
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| X || Michelle M Miller  
 
|colspan="2"| Cerner
 
|colspan="2"| Cerner
 
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|colspan="2"| Intermountain Healthcare
 
|colspan="2"| Intermountain Healthcare
 
|-
 
|-
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| || Joe Quinn
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|X || Joe Quinn
 
|colspan="2"| Optum
 
|colspan="2"| Optum
 
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|colspan="2"| Dept of Veterans Affairs
 
|colspan="2"| Dept of Veterans Affairs
 
|-
 
|-
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| || Floyd Eisenberg
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|X || Floyd Eisenberg
 
|colspan="2"|  
 
|colspan="2"|  
 
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#Agenda review
 
#Agenda review
 
#Approve previous meeting minutes [[2017-08-10_Patient_Care_FHIR_Call]]
 
#Approve previous meeting minutes [[2017-08-10_Patient_Care_FHIR_Call]]
−
#*'''Motion:''' <moved>/<seconded>
+
#*'''Motion:''' Stephen/Rob
−
#Prior Action Item Follow-up 
 
 
# Problem Status Value Set
 
# Problem Status Value Set
 
# gForge change request
 
# gForge change request
Line 174: Line 173:
 
<!-- **** Delete instructions  and fill in minutes ON NEXT LINES  ******-->
 
<!-- **** Delete instructions  and fill in minutes ON NEXT LINES  ******-->
  
−
=== Prior Action Item Follow-up ===
 
  
 
=== Problem Status Value Set ===
 
=== Problem Status Value Set ===
 +
Floyd's question is whether the codes are mutually exclusive (e.g. inactive and remission;  active and relapse)? 
 +
<br>
 +
Stephen mentioned that FHIR has a hierarchy as follows:
 +
* '''Active''' The subject is currently experiencing the symptoms of the condition or there is evidence of the condition.
 +
** '''Recurrence''' The subject is experiencing a re-occurence or repeating of a previously resolved condition, e.g. urinary tract infection, pancreatitis, cholangitis, conjunctivitis.
 +
** '''Relapse''' The subject is experiencing a return of a condition, or signs and symptoms after a period of improvement or remission, e.g. relapse of cancer, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, bipolar disorder, [psychotic relapse of] schizophrenia, etc.
 +
** '''Well-Controlled''' The subject's condition is adequately or well managed such that the recommended evidence-based clinical outcome targets are met.
 +
** '''Poorly-Controlled''' The subject's condition is inadequately/poorly managed such that the recommended evidence-based clinical outcome targets are not met.
 +
* '''Inactive''' The subject is no longer experiencing the symptoms of the condition or there is no longer evidence of the condition.
 +
** '''Remission''' The subject is no longer experiencing the symptoms of the condition, but there is a risk of the symptoms returning.
 +
** '''Resolved''' The subject is no longer experiencing the symptoms of the condition and there is a negligible perceived risk of the symptoms returning.
 +
<br>
 +
Floyd said the harmonization didn't reflect the hierarchy.  Emma said that the coding system reflects that (not the value set).
 +
<br>
 +
Harmonization proposal is about CDA value set and it uses SNOMED, not FHIR.  SNOMED codes have a hierarchy, so Rob agrees with Emma that the hierarchy lives in the SNOMED coding system.
 +
<br>
 +
SNOMED hierarchy differs from FHIR's code system hierarchy.  For example:  recurrent episode is not a child of active in SNOMED.
 +
<br>
 +
Measure developers want this level of detail, but Floyd questions whether systems captures this level of detail.
 +
<br>
 +
Tues Q4 WGM - follow-up on the SNOMED hierarchy during joint quarter with PC/Vocab
 +
<br>
 +
Eric said there is [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=13162 GF#13162] for FHIR Publishing to make the hierarchy more clear.  Patient Care added our recommendation to add guidance as well.
  
−
=== gForge Change Requests ===
+
=== gForge Change Requests Discussed ===
 +
Resolved
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12163 GF#12163] Update payload URL to lead to a real file (Guillaume Rossignol)
 +
 
 +
Discussed
 +
* [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=13743 GF13743] Add AllergyIntolerance, Observation, RiskAssessment, and List to CarePlan.addresses
 +
 
 +
=== gForge Change Requests Backlog (did not discuss) ===
 +
Aug 10 + WGM:  Joint discussion with Pharmacy, OO
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12673 GF#12673] How to handle HCT/TP
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12993 GF#12993] Please Create a NonMedicationAdministration object or an Administration object
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=13047 GF#13047] Add DosageInstructions to Procedure
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12676 GF#12676] Guidance request for GP SOAP in FHIR (Alexander Henket) -
 +
** https://chat.fhir.org/#narrow/stream/implementers/topic/ClinicalImpression
 +
** PC, SD - possibly Thurs Q2
 +
* Patient Care WGM agenda: [[PC_Sept_2017_WGM]]
 +
 
 +
Medium Backlog
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12509 GF#12509] CareTeam participant (Michelle Miller)
 +
** Feedback from LHS, and LHS continues to meet and discuss
 +
** CareTeam.participant.role (existing) 0..* - need to update definition of role (since it mentions responsibility) Example: PCP - close to finalizing the value set
 +
** CareTeam.participant.function 0..* (new) - Example: PT, Wound Care - close to finalizing the value set
 +
** CareTeam.participant.specialty is no longer needed -- instead, get from Practitioner
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12633 GF#12633] Split Procedure into Procedure and ProcedureStatement (Lloyd McKenzie)
 +
** Zulip chat asking for implementer feedback:  https://chat.fhir.org/#narrow/stream/implementers/topic/Procedure.20vs.20ProcedureStatement
 +
** Dave commented that there is relevance for ProcedureStatement in context of CarePlan activities (Activity Statements where the activity is a procedure)
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10028 GF#10028] Careplan: Provide ability to specify patient and/or provider preferences (Emma Jones)
 +
** meet need with a profile for preference on the observation resource.  Requirements are a preference category (nutrition, medication, care), the preference priority (high/medium/delayed from C-CDA) and with elements of expressor and recorder. 
 +
** This profile would not be developed for this release cycle
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=13140 GF#13140] logical definition of care-plan-category value set may require realignment with SCT changes (Matthew Cordell)
 +
** pending SNOMED proposal: https://confluence.ihtsdotools.org/display/cmag/Care+plans
 +
** Rob said he would follow up on the status of the SNOMED proposal
 +
 
 +
Low Backlog
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10635 GF#10635] QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller)
 +
** ClinicalImpression is not mature enough to resolve this issue.  Ask MnM for an exemption on the QA checklist (re: Condition having a circular reference with ClinicalImpression)
 +
** Add note: "A known issue exists with circular references between Condition and ClinicalImpression, which is due to the low maturity level of ClinicalImpression. The Patient Care work group intends to address this issue when ClinicalImpression is considered substantially complete and ready for implementation"
 +
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11173 GF#11173] CarePlan needs support for reviews - 2016-09 core #327 (Stephen Chu)
 +
** Tracking of reviews and plans for reviews is something that applies to many resources, not just CarePlan (e.g. protocols, standing orders, long term care admissions, etc.).  This is something probably best handled by "Task" but will require a fair bit of analysis and discussion with other work groups to agree on approach.  Defer to R4. Consider transfer to OO who owns Task
  
 
=== Adjourn ===
 
=== Adjourn ===
−
Adjourned at <hh:mm am/pm> <timezone>.
+
Adjourned at 6:31pm Eastern
  
 
==Meeting Outcomes==
 
==Meeting Outcomes==

Latest revision as of 22:45, 17 August 2017



Meeting Information

Patient Care FHIR Resources Conference Call

Location: Conference Call
Phone Number: +1 770-657-9270
Participant Passcode: 943377
WebEx: https://cernermeeting.webex.com/join/michelle.m.miller

Date: 2017-08-17
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
Dave Carlson VA
X Stephen Chu Brisbane South Primary Health Network (BSPHN)
Evelyn Gallego EMI Advisors LLC
X Eric Haas Health eData Inc
X Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Russ Leftwich InterSystems
X 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
Lisa Nelson Life Over Time Solutions
Viet Nguyen Lockheed Martin, Systems Made Simple
M'Lynda Owens Cognosante
Mike Padula The Children's Hospital of Philadelphia
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 Floyd Eisenberg
Quorum Requirements Met: yes

Agenda

Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-08-10_Patient_Care_FHIR_Call
    • Motion: Stephen/Rob
  3. Problem Status Value Set
  4. gForge change request

Supporting Information

Minutes

Problem Status Value Set

Floyd's question is whether the codes are mutually exclusive (e.g. inactive and remission; active and relapse)?
Stephen mentioned that FHIR has a hierarchy as follows:

  • Active The subject is currently experiencing the symptoms of the condition or there is evidence of the condition.
    • Recurrence The subject is experiencing a re-occurence or repeating of a previously resolved condition, e.g. urinary tract infection, pancreatitis, cholangitis, conjunctivitis.
    • Relapse The subject is experiencing a return of a condition, or signs and symptoms after a period of improvement or remission, e.g. relapse of cancer, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, bipolar disorder, [psychotic relapse of] schizophrenia, etc.
    • Well-Controlled The subject's condition is adequately or well managed such that the recommended evidence-based clinical outcome targets are met.
    • Poorly-Controlled The subject's condition is inadequately/poorly managed such that the recommended evidence-based clinical outcome targets are not met.
  • Inactive The subject is no longer experiencing the symptoms of the condition or there is no longer evidence of the condition.
    • Remission The subject is no longer experiencing the symptoms of the condition, but there is a risk of the symptoms returning.
    • Resolved The subject is no longer experiencing the symptoms of the condition and there is a negligible perceived risk of the symptoms returning.


Floyd said the harmonization didn't reflect the hierarchy. Emma said that the coding system reflects that (not the value set).
Harmonization proposal is about CDA value set and it uses SNOMED, not FHIR. SNOMED codes have a hierarchy, so Rob agrees with Emma that the hierarchy lives in the SNOMED coding system.
SNOMED hierarchy differs from FHIR's code system hierarchy. For example: recurrent episode is not a child of active in SNOMED.
Measure developers want this level of detail, but Floyd questions whether systems captures this level of detail.
Tues Q4 WGM - follow-up on the SNOMED hierarchy during joint quarter with PC/Vocab
Eric said there is GF#13162 for FHIR Publishing to make the hierarchy more clear. Patient Care added our recommendation to add guidance as well.

gForge Change Requests Discussed

Resolved

  • GF#12163 Update payload URL to lead to a real file (Guillaume Rossignol)

Discussed

  • GF13743 Add AllergyIntolerance, Observation, RiskAssessment, and List to CarePlan.addresses

gForge Change Requests Backlog (did not discuss)

Aug 10 + WGM: Joint discussion with Pharmacy, OO

Medium Backlog

  • GF#12509 CareTeam participant (Michelle Miller)
    • Feedback from LHS, and LHS continues to meet and discuss
    • CareTeam.participant.role (existing) 0..* - need to update definition of role (since it mentions responsibility) Example: PCP - close to finalizing the value set
    • CareTeam.participant.function 0..* (new) - Example: PT, Wound Care - close to finalizing the value set
    • CareTeam.participant.specialty is no longer needed -- instead, get from Practitioner
  • GF#12633 Split Procedure into Procedure and ProcedureStatement (Lloyd McKenzie)
  • GF#10028 Careplan: Provide ability to specify patient and/or provider preferences (Emma Jones)
    • meet need with a profile for preference on the observation resource. Requirements are a preference category (nutrition, medication, care), the preference priority (high/medium/delayed from C-CDA) and with elements of expressor and recorder.
    • This profile would not be developed for this release cycle
  • GF#13140 logical definition of care-plan-category value set may require realignment with SCT changes (Matthew Cordell)

Low Backlog

  • GF#10635 QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller)
    • ClinicalImpression is not mature enough to resolve this issue. Ask MnM for an exemption on the QA checklist (re: Condition having a circular reference with ClinicalImpression)
    • Add note: "A known issue exists with circular references between Condition and ClinicalImpression, which is due to the low maturity level of ClinicalImpression. The Patient Care work group intends to address this issue when ClinicalImpression is considered substantially complete and ready for implementation"
  • GF#11173 CarePlan needs support for reviews - 2016-09 core #327 (Stephen Chu)
    • Tracking of reviews and plans for reviews is something that applies to many resources, not just CarePlan (e.g. protocols, standing orders, long term care admissions, etc.). This is something probably best handled by "Task" but will require a fair bit of analysis and discussion with other work groups to agree on approach. Defer to R4. Consider transfer to OO who owns Task

Adjourn

Adjourned at 6:31pm Eastern

Meeting Outcomes

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

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