2018-05 15 PA WGM Minutes

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Patient Administration Work Group Meeting - Tuesday May 15, 2018

Tuesday Q1

HL7 Patient Administration Meeting Minutes ‘‘‘Location: Maritime Hotel, Cologne, Salon 20 Fulda’’’		Date: 2018-01-30 Time: Tuesday Q1
Facilitator	Brian Postlethwaite	Scribe	Alexander de Leon
Attendee	Name	Affiliation
X	Brian Postlethwaite	HealthConnex, Australia
X	Alex de Leon	Kaiser Permanente, USA
X	Irma Jongeneel	HL7 The Netherlands
X	Line Saele	Helse Vest IKT, Norway
X	Stefan Sigle	University of Chile
X	Drew Torres	Cerner, USA
X	Patrick Werner	Heilbronn University, Germany
X	Christian Hay	GS1
X	Ewout Kramer	Firely, The Netherlands
X	James Agnew	Smile CDR, USA
X	Simone Heckmann	HL7 Germany
X	Tricia Chitwood	Cerner, USA
X	Cooper Thompson	EPIC, USA
X	Jenni Syed	Cerner, USA
X	Michel Rullen	Firely, The Netherlands
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
Coordination with FHIR Infrastructure

• 14154 - Searching a patient by Identifier Type
• 14880 - Move Patient.animal to a standard extension - 2018-Jan Core #272

Supporting Documents

• Media: A friendly reminder that FHIR deadlines are coming.pdf
• Media: Tracker Issues.pdf
• Media: FHIR Tracker Summary from 2018-01-02 to 2018-01-08.pdf
• [FHIR Ballot Schedule]
• [FHIR QA report]
• 14154 - Searching a patient by Identifier Type

• 14880 - Move Patient.animal to a standard extension - 2018-Jan Core #272

Minutes

Minutes/Conclusions Reached:
Introductions
The WG started with introductions since there were many new attendees.
The WG then moved to the FHIR deadlines reminder from Lloyd, with the subject “A friendly reminder that FHIR deadlines are coming sooner than you wish they were...”

Brian updated where the provider directory project was at this time..

1. 14154 - Searching a patient by Identifier Type
   

It would be beneficial to add a standard search criteria for Identifier Type. For example to allow for a search for a patient with MRN 123 using Identifier.type= http://hl7.org/fhir/v2/0203 | MR with a value of xyz .

The WG discussed that this could be a query.
This may be a PA issue (which will also be relevant for Practitioner, and likely others) and considered that this should be covered at the search token level so it can be used on the other resources with the identifier.
Including the full identifier.syste.type and code
Patient?ident-with-type=http://hl7.org/fhir/v2/0203#MR%7C1234

Patient?ident-with-type=http:/hl7.org.au/dental#MR|1234

Patient?ident=http:.regionalmrn|1234
This is a current search, which required
Patient?ident=http..dept-A-mr|1234
For any identifier search does this need to be a more generalized solution, or if it is more a PA related issue.
Irma moved to move this tracker item to FHIR infrastructure/Drew
Discussion: None
Vote: 13/0/0

1. 14880 - Summary: Move Patient.animal to a standard extension - 2018-Jan Core #272
   

The WG discussed the option of making the Patient a modifier extension rather than keeping it in the core. This is the feeling of the group.
Simone noted that this would actually entail one of the following choices:

• Move the elements as standard extension.
• Remove altogether
• Create a new resource.
• Another option from Lloyd is to leave it and flagging the “animal” portion as “non-normative”.

The work group discussed the various options. The least preferable was leaving it and marking as non-normative. The most viable seems to be to create a modifier extension.
Drew moved to move the animal element portion into a modifier extension/Simone.
Discussion: None
Vote: 13/0/0

Having gone through the agenda items, the WG moved on to review the Gender issues that have come up for review with Ewout.

1. 14767 - Loosen binding for AdministrativeGender - 2018-Jan Core #107
   

Existing Wording: Patient.gender of type "code", required value set "Admnistrative Gender"
Proposed Wording: Patient.gender of type "Codeable" with "preferred" value set "Administrative Gender"
Changing this datatype allows juridictions to localize the "admnistrative gender" while at the same time it identifies a "preferred" value set..
Loosen binding for AdministrativeGender
The WG updated this with decision made on previous requests of this type: # 11930, 3070,
Cooper moved to disposition this as non-persuasive, cooper seconded
Vote: 13/0/0

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Action Item: Owner: , Due:

Next Meeting/Preliminary Agenda Items .

Tuesday Q2

HL7 Patient Administration Meeting Minutes ‘‘‘Location: Hilton New Orleans Riverside, Durham Conference Room’’’		Date: 2018-01-30 Time: Tuesday Q2
Facilitator	Irma Jongeneel	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	HL7 The Netherlands
X	Brian Postlethwaite	HealthConnex, Australia
X	Alex de Leon	Kaiser Permanente, USA
X	Drew Torres	Cerner, USA
X	Isabel Gibaud	HL7 France
X	Christian Hay	GS1, Switzerland
X	Cooper Thompson	EPIC, USA
X	Simone Heckmann	HL7 Germany
X	Keith Boone	General Electric, USA
X	Tricia Chitwood	Cerner, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. FHIR Ballot Reconciliation – ChargeItem, Account

Supporting Documents

• [Claim Resource]
• [Account Resource]
• [Episode of Care Resource]
• [Charge Item]

Minutes

Minutes/Conclusions Reached: Introductions
FHIR Ballot reconciliation for ChargeItem and Account
There were 6 ballot items for Account and 3 ballot items for ChargeItem.

1. 14811 - Status card should be marked as 1..1 it specify that the account is either active or not. - 2018-Jan Core

Status card should be marked as 1..1 it specify that the account is either active or not.
THe WG reviewed various status’ for the templates and patterns, and all other status’ have 1..1 cardinality but include “unknown”, “other”, and/or “entered-in-error”.
The WG then discussed the values currently in Status, which is the record status, and the lifecycle status. The group seems to lean toward making this a lifecycle status. Then the status list would then need to be extensible.
The WG considered potential Account lifecycle status: Open Discharged/Not Billed, Billed, Zero Balance, Bad Debt, Voided, Closed, Archived, Combined.
Action: Cooper to create a tracker item to crearte a new element to cover lifecycle status’s.
Cooper did this: 14963
The WG then added statuses of hold and other will be included.
Drew moves to disposition this persuasive with mod. Cooper seconded.
Vote: 8/0/1

1. 14812 - Subject should be marked as required as it specify the reference to any on resource.
   

Subject should be marked as required as it specify the reference to any on resource.
After discussion, the submitter withdrew based on the idea that the account can be used for more than just patient accounts, so the cardinality will be left as optional.

In the analysis, Cooper noted that he thinks subject should be 0..*.

Action: Cooper to create tracker for this to be brought to the group.

As for current tracker item, it is withdrawn by submitter (in the form of Keith Boone in the room). No vote needed as withdrawn.

1. 14813 - Drop account.active
   

There was a lively discussion around the description of both period and active.
Account.period - Identifies the period of time the account applies to; e.g. accounts created per fiscal year, quarter, etc.
It is possible for transactions relevant to a coverage period to be posted to the account before or after the coverage period, however the services that are being charged for must be within this period.

Account.active - Indicates the period of time over which the account is allowed to have transactions posted to it. This period may be different to the coveragePeriod which is the duration of time that services may occur.
Accounts are able to be active only during a specific period, and the dates to which charges should be able to be applied.
Proposal:
The Account.period should be renamed to account.servicePeriod and the description clarified from “Identifieds the period of time the account applies to e.g. accounts created per fiscal year, quarter, etc.” to “The date range of services related to this account.”
The comments section will be updated
This helps clarify the situation but does not address the tracker. After discussing this and the impact of Account.status and addition lifecycle status. So, the account.active property.
Drew moves to disposition this as Persuasive with Mod. Keith seconds.
Vote: 8/0/1

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

Tuesday Q3

HL7 Patient Administration Meeting Minutes ‘‘‘Location: Hilton New Orleans Riverside, Durham Conference Room’’’		Date: 2018-01-30 Time: Tuesday Q3
Facilitator	Brian Postlethwaite	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	HL7 The Netherlands
X	Brian Postlethwaite	HealthConnex, Australia
X	Alex de Leon	Kaiser Permanente, USA
X	Cooper Thompson	EPIC, USA
X	Micheal Donnelly	EPIC, USA
X	Andrew Torres	Cerner, USA
X	Isabel Gibaud	HL7 France
X	Ken Ruben	Department of Veterans Affairs, USA
Quorum Requirements Met (Chair + 2 members): Yes/No

Agenda

Agenda Topics

• FHIR Ballot Reconciliation – Scheduling Resources

Supporting Documents

Minutes

Minutes/Conclusions Reached: There were 9 tracker items for appointments

1. 12474 - Changes to the appointment status value set
   

There are several changes we would like to propose to the status value set on appointment:
Changed the definition of arrived:
Some of the patients have arrived and is awaiting to be seen.
Add checkedIn status with a definition of:
Patient has proceeded to the room/area for treatment
The text of the arrived status will be udpated to:
"Some of the patients have arrived and are awaiting to be seen" - May even change this to be singular, with an additional note on what it would mean when more than one patient is involved.

A new concept "checkedIn" will be added to the status:
This will imply that all pre-encounter administrative work is complete, and the encounter may commence. (where multiple patients are involved, they are all present too)

Will add checked in and clarify the definition of arrived.
Drew moved as persuasive with mod. Irma seconded.
Vote: 8/0/0

1. 14806 - Support actual start/end - 2018-Jan Core #146
   

Minutes duration can be less than the difference between start and end. If minute duration is less than difference then there should be some field where we can specify actual start and actual end time of appointment.
Support actual start/end
After some discussion and thinking, Drew noted that the question is not clear, but has two options:
Either the question is around actual start/end date/time of when the appointment occurred, or the question is around the actual start/end period of the appointment itself.
In the former, the answer is in the Start/End of the associated encounter. In the latter, the answer is in Appointment.start and Appointment.end.
Ken moves to disposition this as not persuasive with mod. Drew seconds.
Vote: 7/0/0

1. 14805 - Need appointment type for practitioner discussion
   

Appointment type current has values CHECKUP, EMERGENCY, FOLLOWUP, ROUTINE, WALKIN. There is no code listed which could be used when appointment is scheduled between 2 practitioners to discuss some case. There can be some code added for such appointment types.
This is for AppointmentType element. This element is “preferred” rather than “extensible”.
Additional comments will be added to cover provider to provider scheduling scenarios.
Cooper moves to disposition as Not persuasive with Mod. Drew seconds
Discussion: None
Vote: 6/0/2

1. 14804 - Field to identify whether patient-practitioner or multi-practitioner appointment
   

Also, there can be field which specifies if the appointment created is between patient and practitioner or between 2 practitioners.
THe WG feels that there is enough information in the appointment elements (through participants and/or appointment type) to derive if the appointment is patient-practitioner or multi practitioner. No change to the specification is needed.
Action: Cooper will clean up the example around appointment between two doctors.
Irma moves to disposition this as persuasive. Drew seconded.
Vote: 6/0/1

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

Tuesday Q4

HL7 Patient Administration Meeting Minutes ‘‘‘Location: Hilton New Orleans Riverside, Durham Conference Room’’’		Date: 2018-01-30 Time: Tuesday Q4
Facilitator	Line Saele	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	Helse Vest IKT Norway
X	Brian Postlethwaite	HealthConnex, Australia
X	Irma Jongeneel	HL7 The Netherlands
X	Alex de Leon	Kaiser Permanente, USA
X	Cooper Thompson	EPIC, USA
X	Scot Robertson	Kaiser Permanente, USA
X	Elysa Jones	OASIS, USA
X	Riki Merrick	Vernetzt, LLC, USA
X	Genny Luensman	Centers for Disease Control/NIOSH, USA
X	Drew Torres	Cerner, USA
X	Lori Forquet	E Healthsign, USA
X	Nancy Orvis	DOD MHS, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. Updates from Steering Division
2. Harmonization proposals
3. v2.9 Work

• Occupational Data for Health topic.
• HAVE Project Update
• ARV segment addition to other segments within ADT segments

Supporting Documents

Minutes

Minutes/Conclusions Reached: Introductions.

The WG started with the HAVE project update. Scott Robertson, in support of the HAVE project, reported back that the balloted material had no real negative dispositions.
There are some affirmative comments which will be handled but otherwise it can be published.
There were about 26 participants for it.
The next step is to request to publish.
Action: Scott Robertson will do the Request to Publish with HL7.
Action: Scott Robertson will notify the two people to withdrawal
Elysa commented that Nancy Orviz and she had a discussion about the use of this in the VA/DOD space. There may or may not be a PA issue, but Scott noted that there may be a PSS having to do with mapping between v2 and DOD/VA.

Lori Forquet and Genny Luensman spoke regarding the Occupational Data for Health (ODH) subject stating that there still needs work to be done to include this into the specification now that it may be included when ready. The WG reviewed the working document to identify existing elements to use and/or create new elements for inclusion in v2.9x. The analysis determined that creating new elements to support communicating this information was required. The WG felt some concern regarding being able to finish the work to create these elements before the publication deadline which is the first week in March. However, all efforts can be made between now and then to finalize the needed elements for inclusion.

The WG reviewed some definitions needed for this work:
Employment Status – Employed, Not employed, Not in Labor Force Work Schedule – Rotating shift, Day Shift, Night Shift (9 values including other) Work Classification – e.g. Self Payed, unpaind, volunteer, gov, armed services (7 values)
There were efforts made to add to LOINC codes, but Final value sets could be referenced in the standard with a URL.
After must consideration, and with the participation of Vocab, the best way to do to this is to work using HL7 tables to add the values needed.
Request conference call to discuss changes to vocabulary and elements.
PD1 changes for retirement rather than create a new segment.

The WG then moved on to proposal 866 having to do with information restrictions. The proposal seeks to allow the ARV segment to be used after any segment which has potentially sensitive information.
RIki moves to add the two fields (7-Security Classification Tag and 8-Privacy and Security Handling Tags), to the ARV segment use to codify the restrictions authorization, Alex seconded.
Discussion: None
Vote: 5/0/2

The WG reviewed the minutes from the last WGM (San Diego, Sept 2017)
Motion to approve the minutes by Brian. Drew seconds
Discussion: None Vote: 7/0/1

The WG continued with the draft agenda for May WGM 2017. From the last quarter, we understand that we still will want a joint sesson with SOA but PA will host at that time.

In addition, Alex noted that the status of the V2.9 is that it will go through a second ballot round, but it is unclear which cycle now. Therefore V2 work will be kept on the agenda

Action: Line to request rooms for next meeting.

Action: Discuss with Publishing regarding the “replacement” of the ROL segment with the PRT segment.

Action: Discuss addition of IAM segment as an optional segment where AL1 segments exist in the trigger events. This might mean that the WG would have to consider the deprecation process for the AL1 segment.

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

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