2011-09-14 PA WGM Minutes

Patient Administration Work Group Meeting - Wednesday September 14, 2011

Wednesday Q1

HL7 Patient Administration Meeting Minutes Location: Windsor East		Date: 2011-09-14 Time: Wednesday Q1
Facilitator	Jay Zimmerman	Note taker	Alex de Leon
Attendee	Name	Affiliation
X	Jay Zimmerman	Canada Infoway
X	Alex de Leon	Kaiser Permanente
X	Helen Drijfhout-Wisse	HL7 Netherlands
X	Barry Guinn	EPIC
X	Norman Doust	Doust Associates
Quorum Requirements Met (Chair + 4 members): Yes

Agenda

Agenda Topics

• Interdependent Registries
• V3 CMET Discussion

Supporting Documents

Minutes

Minutes/Conclusions Reached:

• v2.8 Proposals

The WG checked the v2 proposal database and found no new proposals to review.

• V3 Work - Scheduling Domain

The group then decided to address the V3 Work - Scheduling Domain agenda item. Discussion of the Patien Apointment Reminders proposal. This had to do with attempting to send appointment information via an SMS meessage (for mobile capabilities). The work group discussed the potential difficulties in sending a full appointment RMIM in an SMS message. The proposal has 2 different statements, one in which there is just a subset of information, the other refers to full appointment. The question came up as to what the minimum data set requirement is for appointment messages.There appears to be a disconnect on what the RMIM payload should be - either a subset or the full appointment RMIM The group reviewed the Hl7 v2.7 scheduling chapter (chapter 10), to find any references to SMS or mobile. The new S27 trigger event was reviewed as the lastest addition to the chapter which refers to "Broadcast Notification of Scheduled Appointments". This does not really seem to fit this use case. WG agrees that the proposal request for the ability to send an appointment reminder (notification) is a reasonable addition to the Scheduling Domain. However;

• there appears to be a need for a new application role other than 'Appointment Tracker' with less responsibilities
• appears to be a disconnect on what the RMIM payload should be - either a subset or the full appointment RMIM
• trigger event in V2.7 (S27) does not really fit this use case. It is a Broadcast Notification and time based trigger (not a point to point Notification and user based trigger as suggested.
• WG believes that should be "time-based" and not user based as suggested in the Proposed Changes

• Interdependent Registries

The WG addressed the interdependent registries need to fill roles to do the interim modelling and document creation for this efforts. Due to the retirement of Gregg Seppala and the limited availablility of the knowledgable resources (Ioana Singureanu), we would need a person resource who can make modifications to the artifacts using the particular necessary modeling tools. This may hinder work moving forward in this area.

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Meeting Outcomes

The WG requires clarification and feedback from the submitter on the noted points above. If the submitter wishes this content to be included in the January 2012 DSTU ballot, feedback will need to be received by Friday September 22, 2011. Conference calls will be scheduled to discuss the proposal.

Actions (Include Owner, Action Item, and due date) .

Next Meeting/Preliminary Agenda Items .

Wednesday Q2

HL7 Patient Administration Meeting Minutes Location: Suite Parlor # 1110, 1st Floor, Royal Palm Tower		Date: 2011-09-14 Time: Wednesday Q2
Facilitator	Jay Zimmerman	Note taker	Alex de Leon
Attendee	Name	Affiliation
X	Jay Zimmerman	Canada Infoway
X	Alex de Leon	Kaiser Permanente
X	Helen Drijfhout-Wisse	HL7 Netherlands
X	Barry Guinn	EPIC
X	Norman Doust	Doust Associates
X	Rene Spronk	HL7 Netherlands
X	Anita Lorck	HL7 Norway
X	Terje Halvorsen	HL7 Norway
X	Line A Saele	HL7 Norway
X	Corinne Gower	HL7 New Zealand
Quorum Requirements Met (Chair + 4 members): Yes

Agenda

Agenda Topics

• V3 Work - Scheduling Domain

Supporting Documents

• Patient Appointment Reminders Proposal

Minutes

Minutes/Conclusions Reached:

• Patient Appointment Reminders Proposal

Rene Spronk joined to address the scheduling domain proposal (Patient Appointment Reminders) from the WG:

• there appears to be a need for a new application role other than 'Appointment Tracker' with less responsibilities

Rene - A tracker has very little responsibilities, but this could be subject of discussion. Appilcation Roles are not normative so in order to solve the use case a new application role won't have an impact. After discussion it does seem that the sender and receiver need new application roles (informer and tracker) for this scenario. proposed: "appointment reminder informer" and "appointment reminder tracker". Currently in scheduling: "appointment informer" and "appointment tracker".

Motion made by: Rene to create 2 new application roles, namely, "appointment reminder informer" and "appointment reminder tracker" to support this proposal. Seconded by: Line Discussion: . none Vote (For/Against/Abstain): 9/0/0

• appears to be a disconnect on what the RMIM payload should be - either a subset or the full appointment RMIM

Rene confirmed that the payload would contain the full appointment RMIM. There was discussion on whether there might be constraints on the RMIM to allow not sending of cancelled appointments. This will be left to the publishing/modeling facilitator to decided whetther a new RMIM will need to be created, or whether the status code will be constrained in the current RMIM. Story boards will also show the status of always active to these messages.

• trigger event in V2.7 (S27) does not really fit this use case. It is a Broadcast Notification and time based trigger (not a point to point Notification and user based trigger as suggested. The WG discussed and decided that this particular use case (along with potential email reminder) should be added to the scheduling chapter for version 2. This will be an action item for the chapter 10 editor.

• WG believes that should be "time-based" and not user based as suggested in the Proposed Changes

Rene agrees that in practice this is time based, but this is incuded in the user-based trigger event.

• The WG requires clarification and feedback from the submitter on the noted points above. If the submitter wishes this content to be included in the January 2012 DSTU ballot, feedback will need to be received by Friday September 22, 2011.

It was confirmed that this is intended to be added to the January DSTU. In order to do this, the content should be sent and received by Alexander Henket as publishing facilitator by November 1st, 2011.

Motion made by: Rene to approve the proposal, and request that those that brought the proposal forward create publication ready artifacts, to be sent to PA before November 1st, with the intent to include it into the january DSTU.

Seconded by: Line Discussion: . Vote (For/Against/Abstain): 9/0/0

• Add Find Appointments Query

Rene presented this proposal that was approved in January 2010, to show that the response model did not includle a care provision element.

• Add CareProcision (EVN to scheduling domain

This proposal came as a result of the Find Appointments Query proposal with the intent of adding an element to the schduling D-MIM to show that the scheduling act is part of a care provision act. Specifically, Add A_CareEvent [identified] with a COMPonent of Act relationshiop to the ActAppointment cloass of the Scheduling D-MIM.

Motion made by: Rene to approve the proposal, and request that those that brought the proposal forward create publication ready artifacts, to be sent to PA before November 1st, with the intent to include it into the january DSTU.

Seconded by: Norman Discussion:

Vote (For/Against/Abstain): 9/0/0

Rene moved to adjourn as there is no further business planned this quarter.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Create 2 new application roles, namely, "appointment reminder informer" and "appointment reminder tracker" Add this use case to the v2.9 scheduling chapter 10 - Scheduling editor Publishing Editor (Alexander Henket) to check tracker # 1744 (Find Encounters Query Response changes-[[1]]) in features request to assure that the models have been updated with the changes.

Next Meeting/Preliminary Agenda Items .

Wednesday Q3

HL7 Patient Administration Meeting Minutes Location: Suite Parlor # 1110, 1st Floor, Royal Palm Tower		Date: 2011-09-14 Time: Wednesday Q3
Facilitator	Jay Zimmerman	Note taker	Alex de Leon
Attendee	Name	Affiliation
.	Jay Zimmerman	Canada Infoway
.	Alex de Leon	Kaiser Permanente
.	Helen Drijfhout-Wisse	HL7 Netherlands
.	Barry Guinn	EPIC
.	Norman Doust	Doust Associates
Quorum Requirements Met (Chair + 4 members): Yes

Agenda

Agenda Topics

• Approve Orlando minutes
• Plan next meeting
• V3 Work - Harmonization proposals

Supporting Documents

Minutes

Minutes/Conclusions Reached:

The WG moved on to address the "slot" portion of the scheduling content. Discovered that slot was removed from the ballot as of January 2010, due to not being balloted for more than one year, even though the appointment material has be retained. It is also not present in the normative edition

There are no changes in the current ballot. There is normative appiontment topic content. These have new proposals for the next ballot, including addition of a care provision association in the D-MIM. Does the WG want this included for existing R-MIMs (2 present in the normative content). After discussion, Rene brought forth that there are no use cases from the Norwegian proposals. The WG entertained the idea that the addition of the care provision association to the Appointment R-MIMs and walkthroughs for consistency sake.

Motion made by: Helen to approve add the care provision association to the Appointmebnt R-MIMs and walkthroughs to make make them consistent with the proposed and accepted query proposal by Rene.

Seconded by: Alex Discussion: The WG discussed the merits of this for consistency Vote (For/Against/Abstain): 4/0/1

Motion made by: Helen to change project 292 (Scheduling Release 2) ballot type from DSTU to Normative. Seconded by: Rene Discussion: Given the fact that the material is already normative and that all changes that are giong to be applied are backwards compatible, the WG feels that we might as well go normative, rather than DSTU. Otherwise, after the DSTU expires, we would have to go normative and go through the cycle again.

Vote (For/Against/Abstain): 5/0/0

Helen brought up that the WG should change the 3-year work plan.

This should complete the WG work for the Scheduling domain.

Motion made by: Rene to approve the orlando WGM 2011 Minutes.add the care provision association to the Appointmebnt R-MIMs and walkthroughs to make make them consistent with the proposed and accepted query proposal by Rene.

Seconded by: Helen Discussion: None. Vote (For/Against/Abstain): 4/0/1

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) .

Next Meeting/Preliminary Agenda Items .

Wednesday Q4

HL7 Patient Administration Meeting Minutes Location: Suite Parlor # 1110, 1st Floor, Royal Palm Tower		Date: 2011-09-14 Time: Wednesday Q4
Facilitator	Jay Zimmerman	Note taker	Alex de Leon
Attendee	Name	Affiliation
.	Jay Zimmerman	Canada Infoway
.	Alex de Leon	Kaiser Permanente
.	Helen Drijfhout-Wisse	HL7 Netherlands
.	Barry Guinn	EPIC
.	Norman Doust	Doust Associates
.	Corinne Gower	HL7 New Zealand
.	Gower	HL7 New Zealand
.	Corinne Gower	HL7 New Zealand
.	Corinne Gower	HL7 New Zealand
Quorum Requirements Met (Chair + 4 members): Yes

Agenda

Agenda Topics

• V3 CMET Discussion

Supporting Documents

Minutes

Minutes/Conclusions Reached:

• V3 CMET Discussion.

• R_Patient Identified CMET (COCT_RM050001UV07)

This CMET has a require link to the <providerOrganization". Since a sender will almost always know the provider organization, this means that it will have to send it along (even with a cardinality of 0..1) according to the current interpretation of "0..

Motion: From Helen to relax the conformance from required to optional. Second: Rene Discussion: Helen would like to know what status. If the motion carries, then what will occur? This will have to be coordinated with MnM. The updated model and walkthrough will be provided to MnM and they will include it into the next ballot using the same artifact identifier because this is backward compatible

Vote: 9/0/1

• E_person Identified (COCT_RM030201UV07)

This CMET has a<name> that is 0..1 *required*, even though the description reads: "This CMET supports the case of closely coupled systems where the receiver only needs the person's identifier". Yet, the sender will almost always KNOW the person name, so by the same interpretation of what 'required' means, it will HAVE to be sent in those cases.

Motion: From Helen to relax the conformance from required to optional on the person.name attribute for the E_person Identified CMET. Second: Rene Discussion: Vote: 9/0/1

• E_Person Universal (COCT_RM030200UV08)

Motion made by: Helen to relax the conformance from required to optional on the person.name attribute for the E_person Unversal CMET and to change the cardinality of person.name attribute from "1..*" to "0...*". Second: Rene Discussion: Vote: 9/0/1

• Linking and unlinking

Rene presented the Linking and Unlinking of Roles in Registries proposal Linking and Unlinking of Roles in Registries to get a feel of the group to see if the efforts in this implmentation is valid to be included in the broader standard.

Rene reviewed the current normative model, which allows for multiple identifiers (one main identifier and other identifiers), however stated that there is a need to place a stronger link between identifiers, for instance if there is a temporary patient identifier and a permanent identifier as in the Norwegian need. The generic strucutre used in the HL7 for Patient/Person registries.

The WG discussed the real-world use cases for this linking and unlinking patient roles (as opposed to linking/unlinking patient records). Rene explained that this would send a message to inform the receiver that these IDs were linked at some point (during an interval of time) and is known to have been done so in error. This does not resolve any issues of clinical data referring to an erroneous permanent ID, but allows for the history of having been linked at some point.

Rene is presenting this to the WG to get a feeling of the support for this direction from the group.

Norman asked for the source of these efforts. Line answered with use cases from Normway, in which the same patient identifiers have been assigned between the National Patient Registry, and regional registries. This resulted in a need to link patients and to unlink patienst due to errors.

Rene introduced the Norwegian wiki, whch describes identify management: www.hl7.no/hl7wiki/index.php?title=Identity_Management_in_Norwegian_Healthcare

Motion was made by: Norman move that the WG agrees with the direction of this proposal for linking and unlinking of roles in registries on the assumption that the outstanding questions are appropriately addressed. Second: Helen Discussion: Vote: 10/0/0

The WG decided to distribute to the PA listserve the intent to relax the conformance on the association to the scoping organization to identifiedPerson role from required to optional.

Meeting adjourned at 4:58

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Jay will distribute to the PA listserve the intent to relax the conformance on the association to the scoping organization to identifiedPerson role from required to optional.

Next Meeting/Preliminary Agenda Items .

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