January 2018 WGM New Orleans; Jan 27 to Feb 8

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• Back to Patient Care Work Group meeting Agenda and Draft Minutes

• Back to 2018 PCWG WGM Agenda and Minutes

New Orleans WGM - Jan 2018 Patient Care WG Meeting Draft/Approved agenda:
NOTE- to view WGM meeting minutes: follow the link for each quarter in Event column of the agenda below

Attendee List http://bit.ly/HL7PC_Attendees

Agenda

Day	Time	Qtr	Room	#	Event	Host	Joining	Chair	Scribe
Sunday Jan 28	AM	Q1
		Q2
	PM	Q3
		Q4
Day	Time		Room	#	Event	Host	Joining	Chair	Scribe
Monday Jan 29	AM	Q1	Windsor - 3rd Floor	20	* Agenda: PCWG Admin Approve PC_Sept_2017_WGM Review Jan 2018 WGM Agenda DMP review Default DMP DMP Addendum Template chat.hl7.org	Patient Care		Michelle	Michael Tan
		Q2	Jefferson Ballroom - 3rd Floor	20	GF#14720 Add Guidance for Exchanging Notes - 2018-Jan Core #42 GF#12676 Guidance request for GP SOAP in FHIR (Alexander Henket) - https://chat.fhir.org/#narrow/stream/implementers/topic/ClinicalImpression Dec 14 SD Minutes 2017-11-30_Patient_Care_FHIR_Call#Clinical_Note ClinicalNote_FHIR_Resource_Proposal Past tracker, GF#8780, A Home for Unstructured Clinical Content Health Concern - tracking/linking heterogeneous resources Clinical Impression FHIR resource maturity	Patient Care	Accepted: SD, FHIR-I,EC	Michael	Jay
		Q2b	TBD	NA	Podiatry Functional Profile Head	EHR		NA	TBD
	PM	Q3	Jefferson Ballroom - 3rd Floor	NA	* Agenda: Mega Report Out * Meeting notes - refer to EHRWG meeting minutes and Mega Report Out Slides * PCWG presentation slide deck: insert here	EHR	Accepted: Patient Care	NA	Jay/Laura - Present; Emma - Scribe
		Q4	Commerce - 3rd Floor	NA	* Agenda: Joint Session with FHIR & OO on FHIR workflow *Meeting Notes	FHIR-I	Accepted: PC	NA	Emma
Day	Time		Room	#	Event	Host	Joining	Chair	Scribe
Tuesday Jan 30	AM	Q1	Jefferson Ballroom - 3rd Floor	40	* Agenda: FHIR/PCWG - CIMI - Skin Care model meeting * Meeting notes	Patient Care	Accepted: CIMI, EC	Jay	Laura
		Q2	Magazine - 3rd Floor	20	* Agenda: FHIR Change requests * PHER will join PC to discuss the new OccupationalData resource CarePlan / Goal / CareTeam trackers GF#14870 Goal.outcome should support Quantity - 2018-Jan Core #210 GF#14818 detail.reasonCode redundant with Goal.description - 2018-Jan Core #158 GF#14817 detail.kind is redundant with reference - 2018-Jan Core #157 GF#14760 Why can care teams omit subject have group? - 2018-Jan Core #99 Gay Dolin-InPerson GF#14483 Use of reference for planDefinition in carePlan need to be added back. Jeffrey Danford-InPerson GF#13903 CarePlan should allow tracking of past activities (i.e. past interventions) (Rick Geimer) GF#14819 No submission - 2018-Jan Core #159 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 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	Patient Care	Declined: FHIR-I	Michelle	Michelle/Emma
	PM	lunch	?
		Q3a	Magazine - 3rd Floor	20	* Agenda: FHIR Admin and Change requests * Nutrition Transitions of Care IG Procedure GF#14869 Procedure.statusReason has the wrong value set - 2018-Jan Core #209 AllergyIntolerance GF#14801 Add a field for Approximate onset date - 2018-Jan Core #141 GF#14800 AllergyIntolerance.code should be 1..1 - 2018-Jan Core #140 Family Member History GF#14825 Clarify FamilyMemberHistory.date meaning - 2018-Jan Core #165 Condition GF#14820 Recorder card should be marked as 1..1 - 2018-Jan Core #160 Workflow Alignment GF#14446 PatientCare resources do not have a clean Workflow report	Patient Care	Accepted: FHIR-I	Michelle	Michelle
		Q3b	TBD	NA	* Agenda: SD Hosted Joint Quarter: C-CDA Score Card; Advance Directive Templates * Meeting notes:	SD		NA	Emma
		Q4	Jefferson Ballroom - 3rd Floor	40	* Agenda: * Negation * harmonization across specification families * other vocab topics * Michael T to Pharmacy/BRR re medication knowledge * Meeting notes:	Patient Care	Accepted: CIMI, Vocab, Clin Genomics, SD, OO	Jay	Emma
Day	Time		Room	#	Event	Host	Joining	Chair	Scribe
Wednesday Jan 31	AM	Q1	Magazine - 3rd Floor	20	* Agenda: FHIR Change requests - with OO representatives GF#14732 How are dependent relationships represented? - 2018-Jan Core #54 Claude Nanjo-InPerson 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) ServiceRequest - trackers and open issues Procedure/Diagnostic Report - picking up this stream: http://lists.hl7.org/read/messages?id=319935 Seems to imply using DR to create a ProcedureReport ( e.g. a SX Report, Dental Report, etc) Need to clarify the intent in order to update Proc and DR's scope and boundaries Update on ClinicalNotes from Mon Q2 discussion with SD, FHIR-I, and PC. Other areas of common interest Meeting notes	Patient Care	Accepted: OO	Michelle	Emma
		Q2	Durham - 3rd Floor	NA	* Agenda: PA hosted joint meeting -- Episode of Care; Care Team * Should OrganizationRole be added to CareTeam? * onBehalfof / reminder about Friday Meeting notes:	PA	Accepted: PC	NA	Michelle / Michael
	PM	lunch	TBD	20	* Agenda: Clinician-On-FHIR Preperation meeting * Meeting notes	Patient Care		Russ	Emma
		Q3	Jefferson Ballroom - 3rd Floor	NA	* Agenda: Focus on BiologicallyDerivedProduct GF#12673 How to handle HCT/TP GF#12993 Please Create a NonMedicationAdministration object or an Administration object GF#13047 Add DosageInstructions to Procedure Meeting notes:	OO	Accepted: PC Invited: CQI, CDS, Pharmacy, OO, PA, FHIR-I	NA	Michelle
		Q3b	TBD	NA	* Agenda: Common Clinical Registry Framework * Meeting notes:	CIC	Accepted: PC Invited: CQI	NA	Laura
		Q4	Magazine - 3rd Floor	30	* Agenda: Allergy/Intolerance topic meeting. Drug list approach & Issues. Allergy resource maturity * Meeting notes:	Patient Care	Accepted: Pharmacy, Vocab	Jay	Michael T
Day	Time		Room	#	Event	Host	Joining	Chair	Scribe
Thursday Feb 1	AM	Q1a	St James - 3rd Floor	35	Care Plan -invite FHIR, Structured Docs, Pharmacy Evelyn Gallego Care Plan Survey - Implementations, pilots, proposals CDA HL7 C-CDA 2.1 Care Plan Document Template - Lisa Nelson HL7 CDA R2 Personal Advanced Care Plan Document - Lisa Nelson IHE QRPH Early Hearing Detection and Intervention (EHDI) Plan of Care- Lisa Nelson Patient Care Care Plan Project HL7 Care Plan Domain Analysis Model/FHIR Harmonization - Laura Heermann/Emma Jones HL7 Care Coordination Services (CCS) functional model - LH/EJ Essential Information for Children with Special Healthcare Needs (Mike Padula) HL7 FHIR Care Plan Resource - LH/EJ IHE PCC Dynamic Care Planning Profile- EJ Update: PlanDefinition/ActivityDefinition Care Team Managment Profile - EJ New: CDA Care Plan Summary Section - EJ HL7 Clinical Oncology Treatment Plan and Summary - Jeff Brown/Gay Dolin NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro Learning Health Systems Care team project update (Russ/Laura/Emma) Bidirectional Social Services Referrals Others Check the minutes ....	Patient Care	Accepted: Pharmacy, LHS, SD	Laura	Emma
		Q1b	TDB	NA	Joint meeting with OO, CDS, PC, Templates (Note: editorial resp for V2 - Chapters 11 & 12)	OO	Accepted: Patient Care	NA	Rob H
		Q2	Jackson - 3rd Floor	25	Joint meeting with SD and Templates Proposed agenda: Template update (Template co-chair/rep) Template versioning; Structured Doc/CDA update (SDWG co-chairs) Patient Care update: Allergy/Intolerance harmonization Care Team (PC with LHS) Clinical Status Value-set - C-CDA and FHIR	Patient Care	Accepted: SD Invited: Templates	Laura/Rob H/Jay	Emma
	PM	lunch	Magazine - 3rd floor	10	Co-Chair Admin Meeting	Patient Care		Michelle	Michelle
		Q3	St James - 3rd Floor	20	*Agenda: FHIR Change Requests related to AdverseEvent GF#14238 AdverseEvent.suspectEntity.instance should be expanded to include the Immunization resource (Craig Newman) - also related to GF#14152 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#14759 Why can adverse events omit subject have group? - 2018-Jan Core #98 Gay Dolin-InPerson Meeting notes: - Need to invite CIMI	Patient Care	Accepted: BRR, FHIR-I	Michelle	Michelle
		Q3b	TBD	NA	Joint meeting with CS, OO, and PC. * Meeting notes - PC Not Needed anymore	CS	Accepted: Patient Care	NA	NA
		Q4	Norwich - 3rd Floor	NA	* Agenda: LHS - CareTeam DAM ONC/CMS eLTSS Project GF#14334 allow careteam.participant,member to reference a Practitioner role GF#12509 CareTeam participant * Meeting notes	LHS	Patient Care	NA	Emma
		Q5	Ascot - 3rd Floor	NA	L-Forms demo; Simplifier demo		Patient Care	NA	NA
Day	Time		Room		Event	Host	Joining	Chair	Scribe
Friday Feb 2	AM	Q1	St Charles Ballroom - 3rd Floor		ClinFHIR
		Q2	St Charles Ballroom - 3rd Floor		ClinFHIR
	PM	Q3	St Charles Ballroom - 3rd Floor		ClinFHIR
		Q4			No meeting

Meetings

Attendee List http://bit.ly/HL7PC_Attendees

Monday Q1

• Chair: Michelle Miller.
• Scribe: Michael Tan

• Approve minutes HL7 WGM September 2017:
  • Motion: Laura Heermann Langford
  • Second: Jay Lyle
• Approving the agenda of the current WGM. No additions and no corrections applied to the agenda.
  • Demo from Michel Rutten about the FHIR registry. Combine with L-froms on Thursday Q5. See HL7 wiki agenda.

• DMP review: do we need to adjust the DMP?
  • Quorum: Our current DMP requires 3 persons. We still tend to keep this quorum to have enough diversity of standpoints.
  • Electronic voting: Our current DMP is identical to the standard DMP, but the section on the quorum does not seem viable, because it is difficult to calculate the 90% of a previous call or WGM.
  • 3 options:

1. Stick to the default DMP (90% of last meeting)
2. Stick to the standard quorum. (co-chair +3, organizing person + 3))
3. Equal to the amount of co-chair ( 7 people).

• Vote:
  • 2 persons for option 1
  • 4 persons for option 2
  • 2 persons for option 3.
• Option 2 prevails. This means that PCWG will divert for the default DMP and use the same calculation the standard quorum calculation.
• Action Item for Michael Tan to add the adjustments to DMP.

• Chat.HL7.org.
  • Wayne Kubrick has e-mailed a proposal to use Zulip as a chat platform.
  • A chat fills a need for fast moving discussions. The FHIR folks usually Zulip for this purpose. The speed of the chat is too high for normal discussion.
  • A list server discussion requires more structure and is more appropriate for a working group.
  • Most attendants prefer to stick to e-mails thru the list server. Zulip can still be used occasionally for certain events such as the Clinicians on FHIR.

• Discussion on CIMI and the relationship with CDA.
  • The CIMI should be responsible for the content.
  • The CDA is more about infrastructure.
  • There should be a CIMI management board. CIMI would guard that a CIMI product would be consistent in CDA, FHIR or V2. This CIMI management group would resemble the FHIR management group.
  • There is a call for volunteers to join the CIMI chair. Jay is considering.
  • Amit Popat reminds the attendees of a request from Austin about the future of HL7v2. This is planned for Monday Q3. **Amit is assigned as the official representative of Patient Care WG.

Monday Q2

• Chair: Michael Tan
• Scribe: Jay Lyle

Brett Marquard presented an approach for modeling Notes in FHIR. After grappling with some of the content questions, the team decided that the key differentiator is structure, and that a Note is likely a chunk of text, a document, a reference to a resource, or a mixture of these. This approach defers the definition of note content, supporting a richer variety of use cases, while supporting the ability to identify notes via some classification such as the LOINC document ontology.

• Most attendees felt this is a reasonable approach.
• MM: also address state changes, e.g., signature
• LM: docRef is for locating documents on servers. That could be changed.
• KB: But it shouldn’t, because you’ll break things that already work.
• Brett will arrange for this to be tested in the Cologne connectathon.

Alexander Henket presented an approach for recording SOAP notes as Compositions

• There is a draft profile on Simplifier
• Discussion ensued on whether Composition should contain text not derived from referenced resources.
• Decision on table: allow new content in Composition or create another resource.

Concern

• Do Condition & Linkage support requirements for Concern? Suggested it does, if Linkage supports heterogeneous resources. Others dissent.
• Clinical Impression maturity
• Maturity is low. PC priorities are currently focused on advancing most mature resources.

Monday Q3

• Meeting notes - refer to EHRWG meeting minutes and Mega Report Out Slides
• Scribe: Emma Jones

Monday Q4

• See here for Attendees list
• Chair: Lloyd
• Scribe (PC): Emma Jones
• FHIR workflow - project run by FHIR-I
  • Objective 1 - consistency in recording what need to be done with what was done
  • Objective 2 - to define and make clear to folks the different ways to ask for something to be done and not rely only on the request resource but to follow-up on whether it was done.
• Workflow was to increase the consistency.
• Focus for this session
  • Workflow reports that identified request or event patterns that need to be fully aligned or intentional not. Allows override. Some workgroups have done this. Impoertant to do this if hte resource is moving to normative (# or above)

Once that is done, the workflow project will review. Want to encourage consistency where they can get.

• • Look at the patterns - some changes have occurred since STU 3
  • exampleScenario resource - hope to have it publishable as part of STU4. A mechanism for seeing the different flows related to the original request.
  • Provide review of what exists in the workflow space

Review workflow space

• Patterns - Request, Event
  • Workgroups should have received an xml file
  • for things that should not have the pattern applied paste into the suppressedIssues to make if clear this is a conscious decision to not apply the workflow pattern
  • Patterns should not drive decisions. Implementations should drive decisions.
    • For care plan - PC has a change request against carePlan.instantiates to have a reference + uri.

exampleScenario

• new resource - ExampleScenario
  • Overview of what this resource does
  • May be in the May ballot
  • when working on scenarios will be able to see this
  • Allows an out if a resource is not used as part of the scenario
  • Is available to start playing with the resource.
  • Hope to have this built into the build project
  • Explore introducing this into CoF on Friday
    • See here for an example - Jose Example
  • May want to start with a smaller set and maintain the deltas between them
  • May tie into the vision of where we want parts of the connecthathon to go into cross track scenarios
  • Indepth discussion about the degree of the examples that is also needed for clinical examples.

Change requests

• Describe relationship between FHIR workflow and Healthcare Business Process happening in OMG
• Consider applying the SOA work to workflow
• Workflow calls are mondays and wednesdays at 2 pm EST
• This quarter continues at next WGM - FHIR-I will host.

Tuesday Q1

Attendees: see the online log

• Skin and wound CIMI model
  • slide deck update provided by Susan Matney. Susan Matney CIMI Update Slides
    • See the slide deck to see how this work aligns with previous DAM work.
    • The slide deck also discusses the different Terminology work occurring in this area.
  • Link to the CIMI browser http://www.clinicalelement.com/cimi-browser/#/
  • Link to Open CEM Browser http://www.opencem.org/#/
  • Governance question re: when are CIMI models approved? Ans = acceptance by the CIMI group, but also to ballot through HL7. The question is the level that gets balloted. Balloting works ok for the major patterns - but balloting each individual model will not work too well. It may need to be a crowdsourcing approach of reporting on successful use for those.
  • How do CIMI compliant claims get validated? - it is up to CIMI, validating models is not up to implementers - but there is not any type of process or people set up to approve these yet. That process needs to be determined and put in place. Will also need to look at how to validate equivalence.
• Adverse Event update provided by Claude - work has started but it will be continuing, Please contact Claude Nanjo if you are interested to join future calls.

Tuesday Q2

Chair: Michelle Miller
Scribe: Emma Jones

Occupational data for health

• Goal is to align with other resources
• Has population health use
• CDS alignment with these data elements.
• FHIR resource in the ballot modeled around what was done in CDA.
• Content
  • employment status
  • retirement status
  • combat zone
  • usual occupation
  • PastOrPresent Jobs
  • etc
• New information trying to get into the clinical health record
• Currently systems are collecting usual occupation for cancer reporting
• Working with a couple of clinical settings about collecting the data - 3 engagements have been using work around
• Billing collects some information but not for social history purposes
• also have a functional profile htat is balloted
• Valuesets harmonization is needed.
• expectation is this data will be collected by EHRs
  • Case reporting - if there is an opportunity to collect the data there should be a means of getting the data collected
  • CDS - if patient has refractory diabetes, ask about their work - this is not the use case for this
  • Need to recognize there is a challenge for capturing the data in a clinical setting. Should Public Health be collecting this data directly?
    • Public Health does collect this data during an investigation. Illegal for collecting the data in advance
    • Working on a FHIR app so the patient can provide the data.
    • Also want to assist the care provider in facilitating awareness of certain predisposing situations
    • May not be collected by the care provider but can be collected by academia and schools
• Is academia and school related work in scope for this resource?
  • Students was in the occupation scope but was removed because not within the boundary because it did not meet the definition of work (census does not record homemaker and student as occupations)
    • Do we need to expand the boundary for common practice? Could include based on local use. Need to define where the boundaries are.
  • Agreement on being transparent about scope
• Suggest scope and boundaries around observation - as it relates to social history. The resource does not reference observation
  • Questionaire can contain social history
  • Observation can contain social history
  • could live in observation as an option (profile observation)
  • can use a profile to make the observation more specific to occupation data.
• Next steps - either invite PC to PHER call if assistance needed or come to PC Thursday FHIR calls

Trackers Resolved

• GF#14870 Goal.outcome should support Quantity - 2018-Jan Core #210
• GF#14818 detail.reasonCode redundant with Goal.description - 2018-Jan Core #158
• GF#14817 detail.kind is redundant with reference - 2018-Jan Core #157

Started discussion

• GF#14483 Use of reference for planDefinition in carePlan need to be added back.

Tuesday Q3

Chair: Michelle Miller
Scribe: Michelle Miller

Nutrition Transitions of Care IG

• 67 comments on ballot
• 20 of which were negative
• 2 more outstanding (the rest were resolved earlier in the WGM)
• more specific value sets needed

Trackers Resolved:

• GF#14869 Procedure.statusReason has the wrong value set - 2018-Jan Core #209
• GF#14801 Add a field for Approximate onset date - 2018-Jan Core #141
• GF#14800 AllergyIntolerance.code should be 1..1 - 2018-Jan Core #140
• GF#14825 Clarify FamilyMemberHistory.date meaning - 2018-Jan Core #165
• GF#14820 Recorder card should be marked as 1..1 - 2018-Jan Core #160

Started discussion

• GF#14446 PatientCare resources do not have a clean Workflow report

Tuesday Q4

Agenda

1. Negation
   1. capture cases well-represented
   2. usage cases needed
2. Harmonization
   1. Does PC specify value sets, or only semantics of value sets?
   2. Is PC responsible for maintenance and harmonization of value sets?
   3. Can PC suggest FHIR use SD values, or vice versa?
   4. Should FHIR data type policy trump interoperability?
   5. Does legacy momentum count? I.e., should C-CDA have more weight than FHIR?
   6. Or realm? I.e., should FHIR have more weight than C-CDA?
   7. Should PC simply specify values in the DAM and expect SD & FHIR to conform?
   8. Or maintain concept maps for divergent value sets?
   9. Who should be in the discussion

Attendees

• See here
• Chair: Jay
• Scribe: Emma

Negation

• Goal: align requirements so divergent syntactical specifications can be translated
• Capture of representation cases: B
• Identification of desiderata:C
• Capture of usage cases (query):F
  • CQL May 1

harmonization across specification families

• Allergy Criticality
  • C-CDA
    • • CRITL: low criticality
      • CRITH: high criticality
      • CRITU: Unable to assess criticality

• • FHIR
    • low: Low Risk
    • high: High Risk
    • Unable-to-assess
• Current
  • Identical clinical requirements
  • Similar model elements & term semantics
• To do
  • Design global approach (governance, evaluation, solutions)
  • Criteria (clinical, technical, practical)
  • Solution (Pick one, Merge, Map, other?)

Discussion

• FHIR has this as a code element so can only do FHIR defined terminology. Will never use the mapping if mapped to another code.
• Question of risk vs criticality
• Intended to mean the same
• How big of a problem is this?
  • What happens if CDS needs a SNOMED code? Will need to map to the needed code
  • The issue is the strict FHIR methodology
• Issue with the use of strings
• Where FHIR has bounds to code- the workgroup encourage mappings to V2, V3 so automated translation can occur.
• PC workgroup looked at SNOMED and did not find adequate codes

other vocab topics

• Allergy Type conceptially maps but there are gaps
  • CCDA has it pre-coordinated (food allergy; drug allergy)
  • FHIR is not (food; drug)
  • FHIR has a structured transformation instead of a structure translation. If you have something that does not fit, can do it as extension
  • Harder to map
• From a process perspective, what are next setps
  • Vocab UTT project to get all HL7 code systems and value sets in the same place.
    • Few efforts to get there - observation interpretation. There are others that are similar but not there yet.
• Please forward any further use cases

Tracker Items

• gForge 11026 Relationship between condition and observation
• Condition.clinicalStatus should not be a limited to a code from the condition-code value set - 2018-Jan Core #215
• Indepth discussion related to clinical status and concern status

Tuesday Q4 BR&R

• Rik Smithies has been working on FHIR resources for IDMP.
• The current model of Medication in STU3 is only meant for the primary purpose such as prescribing, dispensing and administration. There is a need to extend the model for other intentions.
• In O&O Jose Costa Teixeira has suggested a pattern, but that is not the FHIR method.
• Up till now there are 3 basic models:
  • Skinny resource for primary purpose.
  • Knowledge base medication such as contra-indications.
  • Regulatory resource including IDMP.
• These models should be assembled from smaller building blocks, for example “package”.
• Grahame suggests to look at FHIR patterns. So the approach will be adopted to build a pattern for medication from which FHIR models can be derived for IDMP.
• The pharmacy group has collected the use cases. You recognized two types of attributes;
  • Regulatory type attribute
  • Pharmaceutical type attributes.
• Looking at the FHIR resources the core you can find the medicinal product.
• Rik Smithies wants to submit his IDMP models of FHIR and include them in the normative ballot. ( September ballot). Grahame will discuss this in the FMG.
• Rik also wants to reflect on substances. But substances is owned by O&O ( it is not only medication, but also nutrients). There is a model on substance specifications.

Wednesday Q1

Attendees

• See here
• Chair: Michelle
• Scribe: Emma
• Procedure/Diagnostic Report - picking up this stream: http://lists.hl7.org/read/messages?id=319935
  • Seems to imply using DR to create a ProcedureReport ( e.g. a SX Report, Dental Report, etc)
  • Need to clarify the intent in order to update Proc and DR's scope and boundaries

Discussion

• Procedure.report currently references diagnosisReport.
  • Because procedure covers a large realm of things - education, consults, operative, etc need to make this element more inclusive
  • How is an operative note represented curently? procedure.note uses operative as example in it's definition "Any other notes about the procedure. E.g. the operative notes"
    • This need to be updated - "Note" element should be used as a "brief" note on the procedure.
  • Use of annotation is discouraged because it's not query-able
  • Current implementation of 'procedure' related notes described by implementers
  • See this tracker Clarify Procedure.report, partOf, and note

FHIR Trackers Resolved

• GF#15034 Clarify Procedure.report partOf and note
• GF#12633 Split Procedure into Procedure and ProcedureStatement

Wednesday Q2

• 2 Topics:
  • PA will present Thursday Q4
  • Pattern removed in roles. This raised questions about the semantics. To be discussed on Thursday Q4.

• Organizational role.
  • The reason that practitioner role was separated, was that one individual could have multiple roles. This was pulled out in STU 2, but created problems.
  • Organizational role is similar. This is the relation between organisations. Is this what you want to represent between care teams? This resource has been copied from practitioner role where the names do not cover.
  • It sounds strange that a relationship between organisations would vary ( available time). This sounds more like the different services that organisations deliver between each other. Need more guidance and analysis of the use case.
  • Rename the whole resource. Suggestions could be “affiliation”.
  • The affiliation would be between 2 organisations. It is not the intention to be able name a whole group with 1 affiliation. Each relationship could have an active period and could end between organisation.
  • Attribute Code could be renamed to relationship. Search for value set within SNOMED.
  • Add clarification to describe the boundaries and difference between Service request, ( technical) Service definition and Organization. The service request is usually subject related.
  • Service request is actually owned by O&O.

• Search possibilities for MRN. PA would like such a functionality. Does PCWG also need such a feature. No.
• Issue from John Moerke to be able to link / merge locations and organizations was not persuasive. This could be done by conversion of the ID.

Summary of Decisions

• OrganizationRole - is about relationship between 2 organizations.
• PractitionerRole - is about a single practitioner's role(s)
• TO DO (as it pertains to OrganizationRole):
  • Rename resource (OrganizationAffiliation)
  • Rename code to relationship, too.
  • Make organization and participatingOrg required
  • Add guidance that OrganizationRole shouldn't be used to convey services provided by the org (use child organizations)
  • Remove elements, such as availableTimes
  • Add guidance to OrganizationRole about telecom

FHIR Trackers

• GF#14154 search by identifier type
• GF#10304 org affiliation
• GF#13682 Brian will pull list of all elements that reference Practitioner, but not PractitionerRole
• GF#13264 Organization, Location, and Practitioner need support for Merge/Link/Unmerge (not persuasive)

Wednesday Q3

Official minutes under OO

Bob Milius presented an effort to define a Biologically derived product resource.

• Material substance from biological entity intended to be administered to a patient (blood bank, transplant, stem cells, etc.); based loosely on Specimen.
• This is immature; there are many known needed changes.
• To do
  • Identify more participants to improve and validate, especially domain SMEs.
  • Set up meetings
  • Connectathon Scenarios
  • Use case for hematopoietic cell transplant.
• Aimed for May ballot to R4; draft or higher depends on maturity tbd.
• Discussion: does this include Breast milk?
• Some blood products are carried by pharmacies.
• ISBT 128 Bar code standard says breast milk is included.
• Consistency: order process should be similar to other ordered activities.
• Planning a a FHIR IG for outcomes reporting for stem cell transplants; PSS also specifies a general IG.

Patrick is on the confluence evaluation team: comments to him.

12673: HCT/TP: closed, as new resource will answer question. OO owns it.

12993: Administer resource for non-medications, including request. Many example scenarios are procedures (staple removal,

• Option for blood product, radiation, grafts, etc.:
  • use pharmacy medication request/admin
  • Service Request / procedure (is becoming a monster).
  • Something new (Bob’s?)
  • A generic administration resource for all; question of level of abstraction
• Service request may have gone too far; "monster" resource
• Approach: put together an answer and get feedback from implementers.

13047: add dose to procedure. answer to this depends on answer to previous tracker

• Concern: limited input from radiology SMEs, maturity even of their known requirements
• Reviewed; deferred pending prior tracker resolution.
• Session renewed for Cologne meeting.

Tracker Resolved

• GF#12673 How to handle HCT/TP

Wednesday Q4

• Harmonize the vocabularies in the various standards V2, FHIR and CDA.
• An example is the criticality in allergies and intolerances. This is now being discussed in the FHIR modelling, but they are not willing to change.
• Vocab has a process to maintain the various value sets. Who will maintain other values sets?
• CCDA wants to change all bindings to dynamic binding.

• Ballot reconciliation of Allergies & Intolerances:
  • Should consider including VSAC requirements. The Vocab from allergies and intolerances would be submitted to VSAC. But using VSAC requires a license. Disposition considered as persuasive. Rick Geimer places Motion. Second: Rob McLure.
  • Votes : 14 favor- 0 abstain – 0 against
  • Line 42: more explanation about negation: make clear where we want to go with negation. Be explicit about the strategy. Need to provide solutions
  • Motion Rick Geimer, second Lisa Nelson
  • Votes : 14 favor- 0 abstain – 0 against
  • Line 43: Extra explanation about cross paradigm: seen as persuasive.
  • Motion: Rick Geimer, second David Parker
  • Votes : 14 favor- 0 abstain – 0 against
  • Line 45:Not persuasive. Because this is US realm.
  • Motion David Parker, Second Chris Hills:
  • Votes : 15 favor- 0 abstain – 0 against
  • Line 46: Do not use seafood: Mollusk is missing: seafood has been added in the last call to make the selection easier. You want to keep it for historical reasons, but it should not be selectable. Rob’s advice is to keep it as text, because computers cannot do anything with seafood. Motion to add the missing codes as concepts and add recommendations about terms: Persuasive: Amit Popat, David Parker
  • Votes: 14 favor -0 abstain -0 against
  • Line 48 : Add GSRS code where possible. Jay has looked at the GSRS viewer and concluded that it is quite complete:
    • Ask Larry Callahan if the codes in the GSRS are Unii codes.
    • Ask the availability of the GSRS codes, because the website seems to says DEMO.
    • Ask the exact match of the GSRS code with the codes in the substance list.
  • Disposition persuasive with mod.
  • Motion David Parker, second Chris Hills
  • Votes : 14 favor- 0 abstain – 0 against

Thursday Q1

• See attendees list here
• Chair: Laura
• Scribe: Emma

C-CDA & CDA HL7 C-CDA 2.1 Care Plan Document Template - Lisa Nelson

• Value set updates available today - 107 valusets except 8 of them.
• CDA management group - keeping track of all things CDA. Looking at a roadmap to help CDA and FHIR roadmap. Eventually would like to have a registry of template regardless of where they are updated
• CDA implementhathon - interest in Care Plan docs has greatly increased. Discussed how the linkages work. USCDI work include data provenance - ability to link docs together. will look at it for next implementhathon
• Next need to explore Assessment.
• Distinguishing line between historical and future looking - care plan does a view forward as well as the past - this is getting very confusing. Need to now confusing the information with the visualization of the information

HL7 CDA R2 Personal Advanced Care Plan Document - Lisa Nelson

• Patient goals and preferences. Working on cleaning up the C-CDA templates
• Work was balloted. in the process of making examples

IHE QRPH Early Hearing Detection and Intervention (EHDI) Plan of Care- Lisa Nelson

• No updated provided

Patient Care Care Plan Project (Laura)

Patient Care Care Plan Project.

• Suggest reviewing what extent of the DAM is tied to RIM and the purpose of the DAM related to FHIR
• DAM was not based on the RIM. Do use some correlation in the "colors". May need to address RIM
• Suggest use of FHIR related tools (e.g. Furore)for DAM modeling
  • Modeling tool should not effect implementation design
  • Suggest checking with CIMI about modeling. PC will look at the different modeling
  • CP DAM and FHIR Harmonization - see spreadsheet. Work in progress

HL7 Care Coordination Services (CCS) functional model (Russ)

• CCS was based on CP DAM. Should be a review of the CCS FM relative to CP DAM 2.0

Essential Information for Children with Special Healthcare Needs (Mike Padula)

• Project update

HL7 FHIR Care Plan Resource - LH/EJ

• list of FHIR CarePlan resources reviewed

Social Services

• Bidirectional Social serives referral
• Disease prevention
• Focus on segmented data for specific programs and the data needed for that particular social services programs
• Facilitate awareness and communications between providers
• Plan on doing FHIR and CDA
• Sponsoring WG - Pub health
• Where do social services standards come from? HL7 works on health standards (people think HL7 is not doing social services)
• Suggest looking at IHE closed loop referral profile - 360x
  • Looking at the data as well as the transactions
• Will send the updated PSS to PC
• LHS interested in looking at the PSS as well

eLTSS (Evelyn)

• Sponsored by CMS and ONC
• Defining the data sets
• Goal is to reference these data elements using existing standards
• Working closely with WG that own the applicable resources
• Have learned that some mapping are one to many
• Would like to speak to PC about if existing resource does not need what is needed
• Is a Service Plan, not clinical care plan - not created by EHRs but could be used by the EHRs
  • Is the expectation that service plan will follow the same care plan corner stones
  • Suggest describing it as Not a care plan is a modeling diservice - suggest making it a type of care plan. differences will be talked about in Q4 today.

IHE PCC (Emma)

• Dynamic Care Planning Profile
  • Update: PlanDefinition/ActivityDefinition
  • Tested at FHIR Connecthathon
  • Will continue working on it during Clinician-on-FHIR
• Care Team Managment Profile - EJ
• New: CDA Care Plan Summary Section - EJ
  • Suggestion to use Art Deco for the templates

HL7 Clinical Oncology Treatment Plan and Summary - Jeff Brown/Gay Dolin

• Has been published

NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro

• Laura will send email out for update

Care team project update (Russ)

• Ongoing work.
• Come to LHS Q4 today

Nutrition Care Plan

• Its a C-CDA supplemental template. Balloted this cycle
• Had Assessment steps in the nutrition care process - added Assessment Evaluations and outcomes.
• Suggestion to move the assessment first?
  • The health concern is always first when the patient comes with the complaint. that's the initiation of the process
  • Do you need to reflect that the assessment was done in the care plan or do you reflect the assessment elsewhere
  • Even if patient comes with a concern this is an assessment. Change in the assessment is the progress.
  • Is assessment the process of assessment? - the clinician thought process. Weight is an observation, it's now a concern until someone is concerned about it.
• Suggest to discuss the relationship and timing of assessment when it comes to Care Planning

LOINC - Care Plan LOINC Code

• Definition of the codes -
  • Plan of care is the preferred terminology
  • The care plan codes was deprecated because it was a panel codes
  • Could this group bring a proposal to LOINC
  • What is the capability in LOINC to distinguish doc level code and section level code? - not a distinguishing characteristics they want to make. LOINC defines term for expected information

context. Committee voted to specify codes to identify uniquely the expected content. Will leave it to the designers to determine how to use - wheter as a section or document code.

• • March 22 - LOINC meeting. Agenda is not decided yet. Laura and Daniel will coordinate - folks to forward specific topics
  • Care Plan doc LOINC codes - have a collection of types of care plans. Can LOINC assist with that?
    • Need a distinguishable way to have relationship - there is a set of attributes to relate the parent to the child. Need to be able to design the type of distinction. the framework structure is there.

When a request is made the terminologist determines the relationship to the parent.

• • • Explanation of why plan of treatment code has changed name to become the doc code - decision was they are not changing the concepts

Thursday Q2

• See attendees list here
• Chair: Laura
• Scribe: Emma

Template update (Template co-chair/rep)

• Template versioning is complicated. versioning enables one template to constrain another template
• SDWG uses dates as extension to version templates. This is a manual process.

Structured Doc/CDA update (SDWG co-chairs)

• XDoc - recently balloted
• Gap in CDA IG. C-CDA has an unstructured doc for things none xml. fully structured docs expensive. Needed a minimal CDA. Something that does not required coding. co-sponsored with attachment WG

Uses the US realm header and have some sections. If want to add coded sections take from C-CDA. Allows systems like PM systems that does not have coded entries. Notes from the ambulance is another use case

• starting to ballot supplemental templates to C-CDA - currently defining what should be used. this template can be used for both doc and sections.
• ODH - is in reconciliation

Patient Care update

• Allergy/Intolerance harmonization - short list of about 1000 concepts that are commonly used so not to have to use all of SNOMED, RXNorm, etc
• Balloted - reconciling comments
  • Working on the VSAC drafts
  • Internationalization: US realm so using Rx-CUI and includes the GSRS (no longer UNII codes)

Care Team (PC with LHS)

• Overview provided of work-to-date
• Suggest for SDWG to participate in LHS Q4 quarter

Clinical Status Value-set

• FHIR has the following clinical status
• well-controlled and poorly controlled discussed as an issue in the FHIR discussion
• State model and FHIR does not align - need to expose the problem. The groups doing the work need to be mindful of what has been conceived
• How can we get resolution for this topic? - Allergy problem, observation problem, medication status has the same issue - not taking the med right now but is an active med for the patient
  • tiger team with V2, FHIR, CDA
  • Suggest using a simple use case - observation and the status for it
  • FHIR tech connecthathon with the right people in the room - must have physician involvment
  • These concepts confuses qualifiers with statuses
  • Next steps - PC co-chairs need to discuss and come up with a plan. Need from SDWG (Gay) who the interested folks should be involved. Gay sent list of folks to Laura.
    • Need to document concise requirements.

C-CDA on FHIR

• Approved for SDWG for publication
• Need to lead another update for the May cycle
• take a look at it - FHIR docs with CCDA use case.
• FHIR IG version - based partially on the current build. PA took the organization out of practitioner and created a new practionerRole resource. can create instances on STU 3 but don't use practionerRole
• Hope to make this update concurrent with STU4
• US core explained

Next Steps

• Continue this quarter

Thursday Q3

Chair: Michelle Miller

Scribe: MM (Gforge), JLyle (wiki)

Attendees list here

Agenda: FHIR Change Requests related to AdverseEvent

Trackers discussed

• GF#14238 AdverseEvent.suspectEntity.instance should be expanded to include the Immunization resource (Craig Newman) - also related to GF#14152
• Tracker added: GF#15124 Add Immunization guidance around capturing reactions

Not addressed

• 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#14759 Why can adverse events omit subject have group? - 2018-Jan Core #98

Thursday Q4

LHS hosted (refer to LHS minutes)

eLTSS presentation

CIMI discussion

New trackers logged:

• GF#15127 Update Procedure scope, examples, and category for eLTSS
• GF#15128 Bring back onBehalfOf in workflow patterns
• GF#15129 CareTeam.participant.member should support PractitionerRole