2011-01-10 PA WGM Minutes

Patient Administration Meeting - Monday January 10, 2011

Monday Q1

HL7 Patient Administration Meeting Minutes Location: Room 2.08		Date: 2011-01-10 Time: Monday Q1
Facilitator	Irma Jongeneel	Note taker	Alex de Leon
Attendee	Name	Affiliation
.	Irma Jongeneel	NICTIZ
.	Alex de Leon	Kaiser Permanente
.	Ron Parker	Canada Infoway
.	.	.
.	.	.
.	.	.
Quorum Requirements Met (Chair + 2 members): <Yes/No>

Agenda

Agenda Topics

1. Welcome/Introductions
2. Agenda review and approval
3. Review Mission and Charter
4. Review Decision Making Practice
5. Review 3-year Work Plan

Supporting Documents

• Sydney agenda
• Mission and Charter (2010-01-19)
• Current DMP (2010-10-04)
• 3-year work plan (2010-10-07)

Minutes

Minutes/Conclusions Reached:

1. Welcome/Introductions
2. Review and Approve Agenda

The WG will verify with the Patient Care working group to see if they are still hosting on Tuesday, Q1, as it was not present in the current Sydney on-site meeting schedule.

V2.8 – New proposal. Alex will review and see if there are any new proposals for this work.

• Motion (made by Alex/ seconded by Ron): Approve agenda as modified to allow for inclusion of major stakeholders within the interdependent registries discussions.
• Vote: 2 / 0 / 0 (for, against, abstain)
• Discussion:

Since a major stakeholder from Canada Infoway is not available for the current agenda slot (currently Tues, Q3, Q4) the WG will be changing the agenda as such:

Interdependent Registries, (currently on the agenda for Tuesday Q3 and Q4) is being moved to Wednesday Q1 and Q2.

V2.8 proposals (currently Wednesday Q1) will be moved to Tuesday Q3 and v3 Scheduling Domain (currently Wednesday Q2) is being moved to Tuesday, Q4

1. Review Mission & Charter

Ron introduced the concept of program with regard to what is currently being covered in the charter: The ability to declare a program (diabetes, asthma, etc.) that registries would support. Within the discussion, it was brought up that his may be something that should be covered/addressed by the patient care domain. This idea was discussed in the previous WG Meeting.The WG will review the previous minutes to see how the concept of program was discussed at that time.

1. Review 3-Year Work Plan

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

Monday Q2

HL7 Patient Administration Meeting Minutes Location: Room 2.08		Date: 2011-01-10 Time: Monday Q2
Facilitator	Irma Jongeneel	Note taker	Alex de Leon
Attendee	Name	Affiliation
.	Irma Jongeneel	NICTIZ
.	Alex de Leon	Kaiser Permanente
.	Ron Parker	Canada Infoway
.	.	.
.	.	.
.	.	.
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. V3 Work - Encounter DSTU findings

Supporting Documents

• HL7 DSTU Comments site
• Patient Encounter project Wiki

Minutes

Minutes/Conclusions Reached:

1. DSTU Comments Site - No comments from PA DSTU
2. Patient Encounter Project Wiki -

The Patient Encounter wiki was accessed to review the 4 proposals. The WG first addressed Proposal 1: Replace the current 9 encounter topics with a single Patient Encounter topic.

• Motion (made by Ron/ seconded by Alex): Approve agenda as modified to allow for inclusion of major stakeholders within the interdependent registries discussions.
• Discussion:The WG agrees to decrease the complexity. Ron proposed keeping the use cases and provide a functional profile.

In consolidating and removing the types, we still need to support the functional needs (behaviors). What that means is that we may need to separate the idea of conformance to have structural conformance with optional elements and have another level of conformance against the functional profile to ensure the requirements of the diff types of encounters in different healthcare settings and realms are supported. We want to support this type of functional behavior conformance. The only way to make this work, is if the mechanics of the events (states, trigger events, message types, etc.) are essentially the same regardless of the setting. This raises an interesting issue that may involve the EHR WG, as they created the EHR functional models but they’re not connected the actual structural messages. We may want to involve MnM.

• Vote: 2 / 0 / 0 (for, against, abstain)

• Questions:

By reducing the set are we addressing the original objective of this effort? If we agree to reduce, are we overburdening certain messages with being overcomplex to address the needs? Were there states that were missed in the original analysis (for instance, changing emergency encounter to in-patient)? Do these proposals address the various levels of encounters as put forward by Norway?

The WG then reviewed the individual proposals one at a time.

Proposal 1 – Replace the current 9 encounter topics with a single Patient Encounter topic.

• Motion (made by Ron/ seconded by Alex): Approve reduction of the topic into a single topic, with the option to create subtopics to support implentation.

• Discussion: The WG feels as this is a viable and makes a lot of sense.
• Vote: 2/0/0

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

Monday Q3

HL7 Patient Administration Meeting Minutes Location: Room 2.08		Date: 2011-01-10 Time: Monday Q3
Facilitator	Irma Jongeneel	Note taker	Alex de Leon
Attendee	Name	Affiliation
.	Irma Jongeneel	NICTIZ
.	Alex de Leon	Kaiser Permanente
.	Ron Parker	Canada Infoway
.	Rene Spronk	HL7 Netherlands
.	Michael van Campen	Candada Infoway
.	John Koisch
.	.	.
.	.	.
.	.	.
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. V3 Work - Encounter ballot preparation

Supporting Documents

• Patient Encounter project Wiki

Minutes

Minutes/Conclusions Reached:
V3 Work - Encounter ballot preparation - The WG reviewed some of the basic concepts/decisions made last quarter. Mainly having two “levels” of conformance: Structural, versus functional which may make for less RMIMs. The WG then reviewed the remaining proposals: Proposal 2 - Reduce the current 33 message types to 14 Proposal 3: Reduce the current 49 trigger events and interactions to 20 Proposal 4: Retain the current 34 storyboards Proposal 5: Retain the detailed constraints as an Informative Annex that provides PA's implementation suggestions

• Motion (Made by Rene, Seconded by Michael):Accept proposals 2-4
• Discussion:There is an assumption that there will be RMIMs to reflect the 14 types. Michael raised a question was brought up as to whether there were implementers using the original 33 message types that might be effected by this.

It was clarified that this is actually a response to Norway implementers who thought that the complexity of this (including message types) made it harder to implement. Rene clarified that there are two regions in Norway and the CSC in Denmark are implementers for this DSTU. Rene brought up a concern about the list. He is in favor of reducing the list, however, prefers to view this as a vote on the strategic direction of reducing the message types rather than defining these particular message types as this list. It was made clear that the lists in the proposals are not “closed” that items could be added, as us cases came forth as needs.

• Vote:4/0/1 (for, against, abstain)

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

Monday Q4

HL7 Patient Administration Meeting Minutes Location: Room 2.08		Date: 2011-01-10 Time: Monday Q4
Facilitator	Irma Jongeneel	Note taker	Alex de Leon
Attendee	Name	Affiliation
.	Irma Jongeneel	NICTIZ
.	Alex de Leon	Kaiser Permanente
.	Michael van Campen	Canada Infoway
.	Beat Heggli	HL7 Switzerland
.	Corinne Gower	HL7 New Zealand
.	.	.
.	.	.
.	.	.
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. V3 Work - Encounter ballot preparation

Supporting Documents

Minutes

Minutes/Conclusions Reached:
1. The WG decided to address the features requests for encounters: 1716 – change to new context conduction approach – no need to discuss.

1719 – Add participationFunction to CON participation? ConsultantParticipation. The 2009-04 Harmonization added a concept domain for ConsultantParticipationFunction so consult participation can be further elaborated. For example, cardiologist, anesthetist, dietician. The WG reviewed the active inpatient encounter model. It does not appear that this necessitates changes to the model.

1720 - Replace Participation.sequenceNumber with priorityNumber where appropriate. Harmonization of 2009Nov added new priorityNumber attribute to Participation. In several cases PA used sequenceNumber to convey priority. The WG also looked at the active inpatient encounter model. It seems appropriate to replace the sequence number with priority in the attender participation which seems to be the only managed participation that uses sequence number in the model. This will hold true for all the encounter models (which we hope to combine into one).

1738 - Add dischargingPractitioner.id query parameter. Work group approved proposal at the October 2010 Working Group Meeting in Cambridge, MA 1739 – Add activeAttending Practitioner.id query parameter. This would also be included in the below.

The WG reviewed the Find Encounters Query. We will add a new query parameter of dischargingPractitioner.id. The WG discussed whether there is a need for more variants for query encounter (e.g. different roles). The proposal (reviewed by the WG) originally included dischargingPractitioner.id activeAttendingPractitioner.id careEventId. The WG discussed the probable need of querying by practitioner id in a particular role, which would require two query parameters. One is practitioner and one for the role type. Currently, there is no domain or xdomain within the vocabulary to use only the participation types used within patient encounters, so we suggest using an xdomain for that. In discussion, it appears that inclusion of a status would support the use cases for this.

1740 - It was noted that careEventId is already included in the model. So this can be closed.

1744 – Find encounter query response changes. The WG approved the following changes to PRPA_RM900350UV Class = EncounterEvent

• add priorityCode attribute
• add inFulfillmentOf ActRelationship to A_Appointment [universal]
• add reason ActRelationship to A_ObservationDx [minimal]
• add pertinentInformation ActRelationship to Procedure (classCode, moodCode,

id, code, text, effectiveTime)

• add componentOf ActRelationship from A_CareEvent [identified] – see below
• add discharger Participation of R_AssignedPerson [universal]
• change location Participation, replacing R_ServiceDeliveryLocation [universal] with explicit model that differs from current CMET:
  • add name attribute to ServiceDeliveryLocation
  • add part/partOf RoleLink to ServiceDeliveryLocation
  • change scoping entity from E_Organization [universal] to E_Organization

[identified]

The WG is not comfortable with making these changes based on earlier discussions in Q3. The WG is not clear on what the use case is for addition of these elements. We will ask Rene Spronk, the originator of this proposal for clarity.

2. Bugs for encounters 1723 - Remove Admission Dx note from active and revise encouter RMIM The Active Encounter and Revised Encounter R-MIMs include the note"Admission DX" attached to A_ObservationDx CMET. This is an editing error in the Revised Encounter R-MIMs; there is no intended restriction on the type of diagnoses that can be sent in a Revise Encounter interaction. This is also not correct in the Active Encounter R-MIM when it is used in a Reactivate Encounter interaction. The note should be removed from the R-MIMs when Encounter content is updated. After reviewing the Completed Inpatient Encounter model, the WG agreed that the note should be removed.

1724 – Rename QueryByParameterPayload class to QueryByParameter. Already approved in Sept 2009 WGM. No discussion needed.

1741 - Usage note about correcting an erroneous Change Attender. WG intent is that an incorrect Change Attender should be canceled and a corrected transaction sent. This needs to be documented in the Encounter material. Reviewed.

1742 - Usage note about correcting an erroneous Change Organization. Reviewed

1743 – Usage note about correcting an erroneous Change Patient Location. Reviewed.

1750 - PRPA_TE401001UV V2 Reference Error – Reviewed.

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items Tuesday Q1 meeting hosted by Patient Care in Room 6.04 Modeling of Care Provision vs. Patient Encounter

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