2017-09-14 PA WGM Minutes

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Patient Administration Work Group Minutes - Thursday September 14, 2017

Thursday Q1

HL7 Patient Administration Meeting Minutes Location: Hyatt Regency, San Diego, USA, Room: President		Date: 2017-09-14 Time: Thursday Q1
Facilitator	Line Saele	Note taker	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	Helse Vest IKT Norway
X	<< update attendee list >>
Quorum Requirements Met (Chair + 2 members): No/Yes

Agenda

Agenda Topics

1. <<update agenda topics>>

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions

The WG discussed the existence of the PRT and the role (ROL) segment. The participation segment (PRT) and the ROL segments were Public health needs this clarified for their messages, specifically the VXU message. The WG discussed the inclusion of this and looked across many of the other chapters. It seems that the general trend is to include the PRT segment and text to deprecate the ROL segment. After much discussion, it seems that since this is the trend and meets the need, chapter 3 should follow this through. This would probably be done in v2.91. The work would include the Occupational Data for Health (ODH) and ROL deprecation process and inclusion of the PRT segment. Irma move Add PRT segment to ADT messages to replace the ROL segment and deprecate the ROL segment. Alex second. Discussion: Cooper asked if it was present in Scheduling and Master file
Vote: 8/0/3

Irma noted that there might be additional v2 work. The WG looked at proposal 716. This is about adding the PRT segment within the messages within chapter 3 wherever AUT and REF appear and an call them Authorization and Referral segment groupings respectively. This should also be considered for inclusion in the next editing cycle.

After looking at chapter 11, it seems that that had a different segment grouping structure authorization and referral. There was discussion on the consistency of the chapters where these concepts are concerned

Action: Hans will check I the proposed structure in proposal (716) will be consistently changed in all chapters specifically chapter12. Hans will be the results back to the committee and the WG will vote then on the proposal.

The WG moved on to discuss the FHIR Encounter resource. Simone asked to have some time to discuss some aspect of the Encounter. She proposed introducing a backbone element to include history information especially for class, location and status.

The WG continued with how to handle the history on the encounter, whether as a backbone element, a separate resource, etc.

The WG seemed inclined to accept the proposal to create the backbone element and put the “movement” elements within this backbone element. However Brian wondered if there was more refinement of the rest of the element structure of the Encounter resource.

The WG then noted that there were minutes left in the quarter. This was spent trying to determine who will be sent to patient care for representation in Care Team resource topic.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) <<Consolidate action items>>

Next Meeting/Preliminary Agenda Items .

Thursday Q2

HL7 Patient Administration Meeting Minutes Location: Hyatt Regency, San Diego, USA, Room:President		Date: 2017-09-14 Time: Thursday Q2
Facilitator	Line Saele	Note taker	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	Helse Vest IKT Norway
X	<<update attendee list>>	Kaiser Permanente
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. << update agenda topics >>

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Joint with FM.
Introductions

The workgroup began discussing the joint resources. Healthcare provider plan ONC effort.
https://basecamp.com/2847230/projects/13100335/messages/70027901

The WG discussed some of the financial management needs having to do with PA resources. Brian brought in the new resources Network, Organization Role, Insurance Plan.

The WGs discussed the Network resource, whether it should be an FM or PA resource and the contents.
The WGs discussed the OrganizationRole and it’s need. After discussing the difference that it is a contract between two organizations. The WGs also looked at the definition for Network. Looking at the
The WG reviewed the 20-June2017 PA telecon minutes where OrganizationAffiliation was discussed and brainstormed as sort of draft resource.

After discussing the structure and usage, it seemed that for this Healthcare Directory effort “Network” could potentially be off of the “HealthcareService” and eliminate the OrganizationRole concept.

Although the WGs agreed that OrganizationRole is not needed, there still needs some finalization of the modeling based on this. Brian has committed to doing this.

The target is to get this into the next ballot.

The WG discussed making this for a telecon. Our Tuesday was considered. Tuesday 9/26 will be the call to discuss this topic.

The WG continued with attempting to cover the tracker items. 12685 – Linking of accounts. Seems to have been handled by adding a property to link a part of an account.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) <<consolidate action items>>

Next Meeting/Preliminary Agenda Items .

Thursday Q3

HL7 Patient Administration Meeting Minutes Location: Hyatt, San Diego, USA, Room:President		Date: 2017-09-14 Time: Thursday Q3
Facilitator	Line Saele	Note taker	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	HL7 Netherlands
X	<< update attendee list >>
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. <<update agenda topics>>

Minutes/Conclusions Reached:
Introductions.
Atendees: Brian Drew Torres Irma Alex de leon Motion: To approve the modified 3-year work plan Brian sent to the updated 3 year plan Motion passes Irma/Drew 2-0-0

1. 13601 - Summary: Common "patient" searchparam has non-patient target
   
2. 13216 - Summary: Improve documentation of importance of Patient.active when querying and in safety list
   

See https://chat.fhir.org/#narrow/stream/implementers/subject/Patient.20search.20-.20active

1. 13603 - Summary: Add support for Sex at Birth
   

Add an attribute to support sex at birth. Currently there is a US Core extension, but recommend that this be included as core attribute. See further discussion here.
http://community.fhir.org/t/sex-at-birth-and-current-gender-identity/496
Valid values would be: Male, Female, and Not Assigned Male or Female (note: in consultation with stakeholders, the term Undifferentiated is deemed offensive).

The WG discussed this and considering how the definition of “Sex at Birth” could change across realms. Therefore the WG deemed it should stay as a US Core extension.

Drew moves to disposition this non persuasive with the text explaining the above. Irma seconds.
Discussion: None Vote (for/against/abstain): 3/0/0

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) <<consolidate action items>>

Next Meeting/Preliminary Agenda Items .

Thursday Q4

Meeting cancelled due to other duties of the core members}

Agenda

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Minutes

Introduction

Tracker Item resolution 13682 - Summary: Add Organization info back to Practitioner or perform more outreach to let WGs know to update their resources
Most workgroups are not aware that the relationship between a Practitioner and their Organization(s) was removed from Practitioner and put into PractitionerRole. Therefore, most resources no longer have the ability to record the Organization that is related to the Practitioner, since they only have a link to the Practitioner itself. This is a huge loss of valuable information, and should not have been done without more outreach. Either add the Organization information back to Practitioner, or perform extensive outreach to all WGs that own resources that currently just point to Practitioner and have them add PractitionerRole as an option.

The work group considered this and determined that there was not enough information about the usage to suggest resolutions. Therefore the WG will update the tracker requesting more information on the need.

Action: Advise the HL7 FHIR community (OnO, Patient Care, Security, FHIRi, Financial Management, Pharmacy), on the recommendation of referencing PractitionerRole, wherever Practitioner is referenced. Assigned: Brian

1. 9249 - Summary: Manage the Provenance of Practitioner (and Other Resources) using an Extension
   

Within the context of a discussion about the Practitioner resource during a PA meeting in Orlando, we debated how to declare the curation of data, or a subset of data, within a particular resource. The particular use case was to define a curating organization (such as an HIE or RLS service) of Role, specialty, contact information, etc, of a particular practitioner, as distinct from thr organization(s) to which the practitioner is associated. We debated several options but came to the conclusion that an extension within the specification would: - Allow us to assign a curating entity to a subset of a resource or to different content contained within the same resource. - Apply to additional resources. Remove the implementer burden on non-provider directory use cases to support and/or understand this field and concept. We propose: - An extension which defines the curating entity, which references an Organization.

Motion made by Line, to disposition this Non Persuasive, Drew seconds. The provenance is the appropriate solution for this. Discussion: None Vote (for/against/abstain): 6/0/0

1. 8513 – Summary: Practitioner.qualification needs work

1. Practitioner.qualification needs a type code, e.g. Degree, License, certification, Prodessional society membership 2. The current value set for Occupations is not a good fit. The fact that a person is currently employed as a proctologist does not mean they are qualified to be one.
Action Item: Re-check all our workgroups pss's that are active for the end dates or create a new PSS. Assigned: Line

The WG reviewed the current practitioner resource. It seems many of the needs are covered by the current element structure As this tracker was before PractitionerRole

Name Flags Card. Type Description & Constraints

  Practitioner

DomainResource A person with a formal responsibility in the provisioning of healthcare or related services Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension

   identifier

Σ 0..* Identifier A identifier for the person as this agent

   active

Σ 0..1 boolean Whether this practitioner's record is in active use

   name

Σ 0..* HumanName The name(s) associated with the practitioner

   telecom

Σ 0..* ContactPoint A contact detail for the practitioner (that apply to all roles)

   address

Σ 0..* Address Address(es) of the practitioner that are not role specific (typically home address)

   gender

Σ 0..1 code male | female | other | unknown AdministrativeGender (Required)

   birthDate

Σ 0..1 date The date on which the practitioner was born

   photo

0..* Attachment Image of the person

   qualification

0..* BackboneElement Qualifications obtained by training and certification

    identifier

0..* Identifier An identifier for this qualification for the practitioner

    code

1..1 CodeableConcept Coded representation of the qualification v2 table 0360, Version 2.7 (Example)

    period

0..1 Period Period during which the qualification is valid

    issuer

0..1 Reference(Organization) Organization that regulates and issues the qualification

   communication

0..* CodeableConcept A language the practitioner is able to use in patient communication Common Languages (Extensible but limited to All Languages)

 Documentation for this format

The disposition was set to “Considered no action required” since the needs for this tracker have been met by current build.
No vote needed

1. 13264 - Summary: Organization, Location, and Practitioner need support for Merge/Link/Unmerge
   

The WG noted that a request for submitters avilalability was for a Thursday as it is awaiting input from submitter. Therefore a note was made to see if the submitter is available for a telecon in the future.
Much like the Patient resource needs merge/link/unmerge; the Resources of Location, Organization, and Practitioner also need this ability. IHE working on a Provider Directory (mCSD Profile) have uncovered the need when practicle operational deployment of distributed (aka National) directories. That is one custodian of directory entries learns of a merge/link/unmerge of an object that it has let others know about. There is a need to inform any future queries or bulk communications of the change.

1. 13604 - Summary: Add 'nursepractitioner' to the PractitionerRole value set.
   

We have the need to identify a Nurse Practitioner as one of the Practitioner Roles. Code: nursepractitioner Display: Nurse Practitioner Definition: A nurse who is qualified to treat certain medical conditions without the direct supervision of a doctor.

I recognize that the definition uses the terms 'nurse' and 'doctor', but I believe that provides the full explanation of the term. Details We have the need to identify a Nurse Practitioner as one of the Practitioner Roles. Code: nursepractitioner Display: Nurse Practitioner Definition: A nurse who is qualified to treat certain medical conditions without the direct supervision of a doctor.

I recognize that the definition uses the terms 'nurse' and 'doctor', but I believe that provides the full explanation of the term.

The WG considered this but it is still awaiting input.

1. 13710 - Summary: Organization/1 is a part of itself
   

Organization/1 is a part of itself. Found it by accident when a tool entered a recursive loop... it's not sensible and should be fixed.
Drew moves to disposition this as persuasive and fix one of the organization examples in the FHIR specification for Organaziatino. Samantha seconds.
Discussion: None
Vote (for/against/abstain): 6/0/0

1. 13419 - Summary: Organization example for an HIE entity
   

Need an example Organization that describes a Health Information Exchange. The Consent Resource often are recorded for an HIE, and we need an example to put in our examples. Might be useful to have a Organization-type for HIE too. <Organization xmlns="http://hl7.org/fhir">

 <id value="HIE_001"/> 
 <text> 
   <status value="generated"/> 

ACME HIE - Covering the whole state of ACME

 </text> 
 <identifier> 
   <system value="http://www.acme.org/"/> 
   <value value="ACME_HIE"/> 
 </identifier> 
 <type text="HIE"/>
 <name value="ACME HIE"/> 
 <telecom> 
   <system value="phone"/> 
   <value value="+1 555 234 1234"/> 
   <use value="work"/> 
 </telecom> 
 <telecom> 
   <system value="email"/> 
   <value value="contact@hie.acme.org"/> 
   <use value="work"/> 
 </telecom> 

< /Organization> Details Need an example Organization that describes a Health Information Exchange. The Consent Resource often are recorded for an HIE, and we need an example to put in our examples. Might be useful to have a Organization-type for HIE too. <Organization xmlns="http://hl7.org/fhir">

 <id value="HIE_001"/> 
 <text> 
   <status value="generated"/> 

ACME HIE - Covering the whole state of ACME

 </text> 
 <identifier> 
   <system value="http://www.acme.org/"/> 
   <value value="ACME_HIE"/> 
 </identifier> 
 <type text="HIE"/>
 <name value="ACME HIE"/> 
 <telecom> 
   <system value="phone"/> 
   <value value="+1 555 234 1234"/> 
   <use value="work"/> 
 </telecom> 
 <telecom> 
   <system value="email"/> 
   <value value="contact@hie.acme.org"/> 
   <use value="work"/> 
 </telecom> 

</Organization>

Drew moves to disposition this non persuasive. This could end up being quite a lot of work to create examples to cover even common usages. Samantha seconded
Discussion: Cooper noted that there is a tooling effort within the AID work group that may help with examples
Vote (for/against/abstain): 6/0/0

10304 - Summary: Organization Affiliation 

Add an Organization.Affiliation to manage Organization relationships. This ticket is a result of an Argonaut Provider Directory Discussion This is similar to Practitioner.PractitionerRole.

The WG considered this but decided to leave it as there is a Healthcare Directory project that will address this.

13607 - Summary: Timings (Working Hours) for a location or organization
Hi, In our world we have data of the operating hours of the clinic like M,W,F between 9:30 AM to 6:30 PM and TU, TH,S between 10:00 AM and 2:30 PM. The Location/Organization resource does not have the fields to capture this information. We have checked on healthcare service resoource which has this capability but these timings do not necessarily communicate the location timings accurately. So we see a need to include this in location/organization whichever the group thinks is apt. Thanks Ravi Kuchi Fresenius Medical Care

Drew moves to disposition this as persuasive and add the “Hours of operation” conceptual element structure including day/hour on location. Alex seconds.

After looking at the HealthcareService resource and the element groups that express these concepts, (availableTime, notAvailable, availabilityExceptions) the WG decided to add onto location: daysOfWeek 0…* code allDay 0…1 openingTime closingTime Outside of the hoursOfOperation backbone element. We will have an additional property “availability Exception” These properties were modeld after the healthcareService with some name pupdates to make them appropriate for location. Discussion: None
Vote (for/against/abstain): 6/0/0
Line moves to adjourn.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) <<consolidate action items>>

Next Meeting/Preliminary Agenda Items .

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