2017-01-05 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=mfc8969c4f77244480beee61d31385e79		Date: 2017-01-05 Time: 5-6:30pm ET
Facilitator	Michelle M Miller	Note taker(s)	Michelle M Miller
Attendee	Name	Affiliation
X	Elaine Ayres	NIH/Department of Clinical Research Informatics
X	Stephen Chu
	Danielle Friend	Epic
X	Eric Haas	Haas Consulting
X	Rob Hausam	Hausam Consulting LLC
	Laura Heermann-Langford	Intermountain Healthcare
X	Emma Jones	Allscripts
X	Russ Leftwich	InterSystems
X	Tony Little	Optum 360
	Jay Lyle	Ockham Information Services LLC, VA
	Sarah Maulden	VA
	Hank Mayers	ReliaTech Consulting
	Jim McClay	Univ of Nebraska Medical Center
	Russell McDonell	Telstra Health
	Lloyd McKenzie	Gevity (HL7 Canada)
	Larry McKnight	Cerner
X	Michelle M Miller	Cerner
X	Lisa Nelson	Life Over Time Solutions
	Viet Nguyen	Lockheed Martin, Systems Made Simple
	M'Lynda Owens	Cognosante
	Craig Parker	Intermountain Healthcare
	Scott Robertson	Kaiser Permanente
	Simon Sum	Academy of Nutrition and Dietetics
	Iona Thraen	Dept of Veterans Affairs
X	Joe Quinn	Optum
X	Serafina Versaggi	Dept of Veterans Affairs
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2016-12-15_Patient_Care_FHIR_Call
   • Motion: Stephen/Rob
3. Prior Action Item Follow-up
4. gForge change request

Supporting Information

STU 3 Timeline

From FHIR_Ballot_Prep

• Sun. Nov. 27 Ballot substantive resource freeze (prioritize resources that IGs will be based on)
• Sun. Dec. 4 Ballot total freeze
• Sun. Dec. 9 (or a day or two earlier) Freeze released - all changes allowed
• Sun. Feb. 5 Ballot reconciliation deadline - All ballot comments must be reconciled, tracker issue report must be clean
• 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

[1] 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

Resource	Current FMM Level	Goal FMM Level	QA Status	QA Reviewer	Implementation	Comments
AllergyIntolerance	1	3		Michelle	Argonaut
Condition	2	3		Michelle	Argonaut
Procedure	1	3		Michelle	Argonaut
CarePlan	1	3		Michelle	Argonaut
Goal	1	3		Michelle
QuestionnaireResponse	2	2		Lloyd		Lloyd will QA to get to level 3
Questionnaire	0	2		Lloyd		Lloyd will QA to get to level 3
CareTeam	0	2	NA	Michelle		Aggressive goal (e.g. whether we'll get the implementations needed)
FamilyMemberHistory	1	2	NA	NA		Aggressive goal (e.g. whether we'll get the implementations needed)
ClinicalImpression	0	1	NA	NA
ReferralRequest	1	1	NA	NA
ProcedureRequest	1	1	NA	NA
Linkage	0	1	NA	NA
Flag	1	1	NA	NA
Communication	1	1	NA	NA
CommunicationRequest	1	1	NA	NA

Note: Bold denotes top 20 resource based on survey
Note: Contraindication and Risk Assessment are owned by CDS, not Patient Care

Minutes

Prior Action Item Follow-up

WGM agenda: http://wiki.hl7.org/index.php?title=January_2017_WGM_San_Antonio,_Jan_14_to_Jan_20

• Tues Q4 is on the PC agenda as Negation (chaired by Jay) - Russ wouldn't be able to join; Elaine, Rob H. can attend;
• Thurs Q1 is on the PC agenda as a CarePlan (chaired by Laura) -- Russ & Rob H. can attend
• Wed Q1 is on the PC agenda as FHIR topics (chaired by me) -- Rob H and Russ can't attend

As a follow-up to our discussion on Dec 15 about finding a WGM quarter when Lloyd can join us to discuss pulling AdverseReaction back out into its own resource (http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11021), Lloyd said:

“I'll be with you Thurs Q1 and Tue Q4. I might be able to pop by briefly at the start of Wed Q1”

Check with Lloyd to see if he can attend Thurs, Jan 12 conference call (5-5:30pm Central Time)

gForge Change Requests

Questionnaire / QuestionnaireResponse Ownership

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12512 - Transfer ownership of Questionnaire to FHIR-I from PC (Grahame) - questionnaires are really an infrastructure thing that are cropping up all over the place, and the discussions around them are mostly driven by infrastructure concerns - types, metadata, processing requirements, form vs function, questionnaires vs profiles. Obviously PC will continue to have an interest in patient focused questionnaires, but I think that this is just one valid usage

• Russ/Stephen would prefer to retain ownership of the Questionnaire. Data that comes from the questionnaire is an important part of the clinical workflow; would like to figure out a joint ownership process
• Rob H. thinks most of the SDC discussion is more like infrastructure
• Serafina & Lisa - feels more infrastructure-related, though needs more clinical input during infrastructure discussions
• Lisa - Questionnaires are used by vital records, public health, patient administration - structure is independent of the content of the questionnaire

FHIR Publication / Backlog Status

• 43 unresolved tracker items (34 ballot + 9 high maturity resource non-ballot comments)
  • 16 requested input from vocab (value set related ballot comments) -- 5 of which require input from Patient Care first
  • 3 waiting for input
  • 2 waiting to be scheduled (joint with OO)
  • 14 ready for discussion during our weekly conference call
  • 8 Block Vote 1

• 21 Resolved - Change Request tracker items
  • 19 ballot or high maturity resource (+ 2 non-ballot, non-priority resource)
  • 9 are substantive (+ 12 are non-substantive)
    • 4 related to new extensions/profiles
    • 1 workflow pattern
    • 3 ready to be applied
    • 1 new resources (AdverseEvent/Reaction)

Waiting for Input

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11346 suggest adding 'modified' element to indicate when the careTeam was last updated (Emma)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=7185 ClinicalImpression is poorly thought out (ClemMcDonald@mail.nih.gov)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10090 Condition Introduction (Michelle)

In Person (Pending Schedule)

Joint with OO -- in the process of being scheduled -- hopefully at WGM

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11026 Relationship between Condition and Observation - 2016-09 core #45 (Jay Lyle)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11119 Differentiate ProcedureRequest and DiagnosticRequest and align their elements - 2016-09 core #273 (Danielle Friend)

Discussed Today

AllergyIntolerance

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11155 Unclear how the negation value set will work - 2016-09 core #309 (Stephen Chu) -- resolved!
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12177 Review/expand the AllergyIntolerance.criticality valueset (Mohannad Hammadeh) -- resolved!

Questionnaire

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10998 Questionnaire.concept -> Questionnaire.code and update definitions - 2016-09 sdc #64 (Stephen Chu) - resolved!

Backlog - Ready to Discuss in Subsequent Calls

Resources with higher maturity - target FMM Level 3

Workflow

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10293 revisit workflow patterns; review gap analysis attached to the gForge

CarePlan / Goal / CareTeam

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11116 Better define the careplan.activity.outcome field - on-going discussions taking place on Patient Care CarePlan conference calls
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12090 Rename goal attribute
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11344 Allow CarePlan.activity.detail.performer to be CareTeam

Care Team

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11342 - Add CareTeam.relatedTeam or other composition relationship - 2016-09 core #500

Value Set topics:

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10620 - QA 7a: CarePlan.activity.outcome needs a binding to a value set
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10623 - QA: Goal CodeableConcept elements are missing a binding to a value set
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10725 - QA 4: CareTeam CodeableConcepts need a binding to a value set
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11334 - Constrain CareTeam participant role value set - 2016-09 core #492

Condition

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10635 QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller)

Procedure

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11162 Suggest include reference to remedial treatment(s) - 2016-09 core #316 (Stephen Chu)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10626 - QA: Procedure.usedCode needs a binding to a value set (Vocab/PC)

Questionnaire / QuestionnaireResponse

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12186 Proposed Changes to Questionnaire / Questionnaire Response from Tuesday evening discussion (Grahame Grieve)

ClinicalImpression

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11209 Feedback on ClinicalImpression - 2016-09 core #363

Communication/CommunicationRequest

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10391 - Communication.reason needs to be searchable (John Moehrke)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10390 - CommunicationRequest query on reason (John Moehrke)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10387 - CommunicationRequest needs ability to describe the location that the communication is about (John Moehrke)

Block Vote 1 (scheduled for Jan 12)

• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=9044 - Need extension to track FHIR data type
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12400 - Add Goal search parameter for startDate
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12418 - add status search parameter to CarePlan
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12442 - QA: Questionnaire.item.enableWhen.answer and Questionnaire.item.initial bindings missing
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12434 - Remove answerInstant from Questionnaire(Response)
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12517 - add diagnosticrequest to context of procedure-targetbodysite
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12511 - Questionnaire.item.type optional problem
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12430 Make clear that QuestionnaireResponse must align with corresponding Questionnaire

Adjourn

Adjourned at 6:36PM Eastern.

Meeting Outcomes

Actions Ask Lloyd to join us next Thurs, Jan 12 to discuss AllergyIntolerance Follow up with Eric about OO/PC WGM quarters

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

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