2018-01-04 Patient Care FHIR Call

Meeting Information

Patient Care FHIR Resources Conference Call Location: Conference Call Phone Number: +1 563-999-2090 Participant Passcode: 792564 WebEx: https://join.freeconferencecall.com/patientcare		Date: 2018-01-04 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	The Australian Digital Health Agency (ADHA)
	Evelyn Gallego	EMI Advisors LLC
	Eric Haas	Health eData Inc
X	Rob Hausam	Hausam Consulting LLC
X	Laura Heermann-Langford	Intermountain Healthcare
X	Emma Jones	Allscripts
X	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	Piper Ranallo
X	Katie Wheatley	UK NHS Digital
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2017-12-07_Patient_Care_FHIR_Call
   • Motion: Jay/Emma
3. Prior Action Item Follow-up
4. gForge change request

Supporting Information

• FHIR_Ballot_Prep
  • 2018-01-22 - Ballot closes
• FHIR_Conformance_QA_Criteria - remember to check updated workflow patterns, too
• FHIR QA Conformance Tracker
• 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

Minutes

Condition Q&A

Piper asked a couple questions, such as:

• Confirm understanding of the "code" data type
  • QA guidelines around code vs CodeableConcept - typically, we don't have required bindings to SNOMED since not all countries have SNOMED licenses
  • code means that the code system is defined as part of the resource
  • CodeableConcept can support text only and/or one to many codings (to allow for translations)
• Condition.severity
  • the binding strength is preferred, which means that other codes (beyond of the value set provided) can be used.
  • Sometimes, DSM severity is precoordinated with the condition code; Other times, it is a qualifier.
• How do you convey abatement/remission context of whether it is in a controlled setting (e.g. jail)? Any of the below options could be considered:
  • Extension if 80% of systems don't support it
  • Base resource change request if 80% of systems support it
  • Use Condition.note (Annotation) if it doesn't need to be discretely documented and can be documented as part of an annotated note

Prior Action Item Follow-up

Condition

• QA 4a. Condition.category is CodeableConcept with FHIR-defined value set - related to past GF#11091 -- Rob H. provided an update -- this is still an open question with next step to talk to Grahame and Ted.
• revisit GF#13026 Condition.clinicalStatus -- Rob will consult with SNOMED and Stephen's PPT is attached to the tracker -- discuss with co-chairs on Monday

High Priority Resources (AlleryIntolerance, Condition, Procedure)

• FHIR Admin FHIR_Ballot_Prep
  • QA guidelines have changed: FHIR_Conformance_QA_Criteria
  • No PC resources are currently targeted for normative, but we can still evaluate
    • AllergyIntolerance - questions about reaction/AdverseEvent - is this just writing down boundaries?
    • Condition - questions about health concern/linking - need Connectathon planned around concern management, need use cases (from domain analysis) and scenarios to test and recruit implementers to participate
    • Procedure - questions about splitting Procedure (performed) vs ProcedureStatement (history/ patient stated) - need to draft resources as a starting point and sync with Russ on whether we need a more generic patient activity statement resource
      • Procedure statement is a good idea. Need to broaden the concepts to other activities. Idea is to have activity statement and then profile it specific to procedure. A patient statement about their exercise or nutritional intake or their ADLs, these are different
      • Who are the actors that would use this - patient statement and carer statement but can be an activity statement that a provider can use as secondary information. Scope includes provider use as well.
      • PMH - where it should be possible do distinguish surgical or diagnostic procedure from when the patient reported the procedure. Post surgery, the surgeon will make an interventional procedure report. This is different. FHIR has a procedure report. OO part would be the diagnostic report (report of findings) and the report that is interventional - these are two different reports. How does FHIR separate the two. And how does FHIR handle the real world where these are combined? Ultrasound guided biopsy would be a diagnostic report with findings (description of the procedure and description of findings).
      • There is an extension that adds the types of terms that you would see on the procedure.
      • Might be a more general solution but it's not settled.
      • Standard operative report has a description of the procedure and a section that deals with findings.

gForge Change Requests (Backlog)

Communication/CommunicationRequest

• GF#13936 CommunicationRequest - intent value set (Ravi Kuchi)
• GF#13979 QA 4a: Communication.topic needs binding to a value set (Michelle Miller)

CarePlan/Goal backlog

• GF#13903 CarePlan should allow tracking of past activities (i.e. past interventions) (Rick Geimer)

AdverseEvent / BR&R:

• GF#13302 Vocabulary issues with AdverseEvent
• GF#13698 AdverseEvent.suspectedEntity.instance should allow CodeableConcept
• GF#11021 Increase cardinality of substance and make certainty relation to substance, not reaction - 2016-09 core #40
• GF#13892 Need guidance on overlap of AdverseEvent.event.text and AdverseEvent.description (Lloyd McKenzie)
• GF#13893 Correction to AdverseEvent.subject definition (Lloyd McKenzie)
• GF#13894 AdverseEvent.eventParticipant needs work (Lloyd McKenzie)
• GF#14238 AdverseEvent.suspectEntity.instance should be expanded to include the Immunization resource (Craig Newman) - also related to GF#14152
• GF#14151 Add Media to subjectMedicalHhistory (Elliot Silver)

CareTeam / LHS:

• GF#14334 allow careteam.participant,member to reference a Practitioner role (David Hay) -- started discussion, but didn't resolve today
• GF#12509 CareTeam participant (Michelle Miller)

OO:

• GF#12673 How to handle HCT/TP
• GF#12993 Please Create a NonMedicationAdministration object or an Administration object
• GF#13047 Add DosageInstructions to Procedure

SD:

• GF#12676 Guidance request for GP SOAP in FHIR (Alexander Henket) -
  • https://chat.fhir.org/#narrow/stream/implementers/topic/ClinicalImpression
  • Dec 14 SD Minutes

Medium Backlog

• 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)
• 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)
  • 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

• 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
• GF#14150 Add Media to investigation, finding (Elliot Silver)

Adjourn

Adjourned at 6:35pm 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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