2014-01-21 PA WGM Minutes

Patient Administration WG Minutes - Tuesday January 21, 2014

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Tuesday Q1

HL7 Patient Administration Meeting Minutes Location:		Date: 2014-01-21 Time: Tuesday Q1
Facilitator	Irma Jongeneel	Note taker	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel
X	Line Saele	HL7 Norway
X	Steve Fine	Cerner, USA
X	Alex de Leon	Kaiser Permanente
X	Lloyd McKenzie	HL7 Canada
X	Rene Spronk	Ringholm
X	Rik Smithies	HL7 UK
X	Iryna Roy	Gordon Point Informatics
X	Po Yam Lee	IHIS
X	Joon Hyun Song	IHIS
X	Douy Il Jeomy	IHIS
X	Robert Worden	HL7 UK
X	Brian Postlethwaite	HL7 Australia
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

• V3 FHIR Comment Ballot Reconciliation

Supporting Documents

• FHIR v0.06 Ballot For Comment Material

Minutes

Minutes/Conclusions Reached:
FHIR QA one item having to do with Location resource Telecom defined as 0..1. Comment is about changing this to 0..*. Examples will be added. Description will change to support the change in cardinality. This lead to a discussion as to whether the address cardinality which is now 0..1 should also be changed. The WG discussed this and found that the definition on this resource shows it to be the physical location however, the datatype of “address” shows this to be a postal address. After discussion, the group decided to keep the cardinality of address to 0..1. He will note that this is a known issue to be taken care of after publication. Iryna moves to change the cardinality of Location telecom attribute. Line seconds Vote: 10/0/1 Lloyd continued with thanking and congratulating the PA group for working diligently to develop FHIR resources within its domain, noting that we are one of the very few groups that have started to work to develop resources on their own. Episode of care should be joint with patient care, however, it may be that PA will lead the effort for development of this resource. Along with the 4 appointment related resource and the healthcare services resource, this would be 6 total for FHIR work moving forward. Irma noted that there may be more for financial management: claim, account, coverage. Lloyd said that the FHIR management group is expecting that next steps should include review of already developed resources to assure all resource relationships and attributes are covered. This effort should include further examples as well as failure examples to test the constraints. Also the groups should look at the attribute order to support implementation as well as support consistency. Whether in a document or a wiki page, the FHIR management group will provide these criteria so that the work groups can assess their resources against these criteria.
Irma asked how feedback would be provided by implementers for FHIR. Lloyd answered that the discussion widget that has been used in the development of the resources will be used for capturing feedback. One or more PA members should subscribe to the tracker. GFORGE will have a change request incorporated with the tracker.
Irma asked about the feedback, not only of issues, but of things that are working well, or items that perhaps were included in a resource based on the 80%, but are subsequently not being used. Lloyd responded that the FHIR management group will be providing metrics that will expose usage of attributes and such.
Alex asked about the mechanisms for signing up to tracking and following the feedback discussions. Lloyd noted that the FHIR management group will provide guidance on WG review and tracking points and how and when to subscribe to the mechanisms needed to address feedback. Discussion tracker and GFORGE (bug) tracker.
Profiles
The FHIR management group will provide the editing tool for profile.
Quality metrics will be provided end of Feb beginning of March. A review of the PA WG resources is expected for Sept WGM. Final QA and ballot is targeted for January ballot cycle.
Lloyd mentioned that directions for monitoring will most likely be provided before metrics are provided to allow the work group to stay on track with the timelines.
The FHIR management group will be monitoring the discussions and GFORGE tracker to assure that the groups are responding.
One objective for January DSTU is to have profiles in place for CCDA. Since we are not orders and observations, we will probably need to provide only one for each used. PA might think about other profiles that could come out of the group for existing specifications.
In considering working on profiles, the group should consider if the profile will be used in the next year or two.
Lloyd described 3 “levels” of profile submission to HL7:

1. Profile with extension “published” via HL7 methods.
2. Profile with extensions published, etc., and reviewed and endorsed by the appropriate work group(s)
3. Profiles with extensions reviewed and endorsed by appropriate work group(s) and balloted.

Rick asked about the direction above and whether this will be written and communicated so that “official” extensions will be known.
Schedule for inclusion of the FHIR Management Group will lessen, however Lloyd noted that they will still be available.
Irma asked about FHIR implementers who are present and what their work might be at this time. Cerner is in the exploratory stage. Lloyd will be implementing using patient, but as a study subject. Maybe Encounter. Robert Wording from the UK might be using patient and appointment resources. Brian working on appointments, patient, location organization and practitioner. Kaiser is working on a lab result message to map from v2 to FHIR messaging. Rick is working on mapping lab messaging to a shared format, which is considering FHIR. Iryna like Irma’s connection to fhir is mainly during the calls and specification. Line has also been working on the development of FHIR specification but has noted that there is interest in FHIR work within Norway so is expecting uptake very shortly.
Lloyd noted one more request.
The encounter.location.period is currently 1..1. period of time that the patient was at that location. Should be reviewed with the intention of not making it required.

The WG continued with the review of the appointment related resources.
Specifically, we reviewed the Availability resource.
Based on the discussion yesterday:

• Type is now 0…*
• Authored date to lastModifiedDate

The WG reviewed the reference to a resource for the Availability.individual. Ewout noted that this can be extended to include other. Otherwise, there is a method of extending since every element is extensible, but you might have. After discussion, the WG felt it best to use Any for the resource reference to allow use of any defined resource. Irma asked if you could use Other. Ewout and Brian responded that Other is a specific resource rather than using any which would allow the use of any resource, including the Other resource. The metrics will help show what is actually being used during the DSTU period.
There was a comment regarding the identifier which is now 0..*. Should this be mandatory. The comment seems to ask for it to be 0..1.
Slots
WG reviewed this resource which is the bookable unit of time. Subdivisions of time can be handled by business rules within the applications. Irma noted that this should be included in the description to help implementers.
Slot.freeBusyType Codes The WG reviewed the freeBusyType attribute which have the codes:

• Busy
• Free
• Busy-Tentative
• Busy-Unavailable

After discussion, it was decided to leave these codes as is, but add an attribute to flag “overbooked” to answer the use case wherein a user has tried to book fee slots, but then tried to book slots that allow to be overbooked or a tentative slot that is now available. Author attribute removed from the slot and authorDate changed to last modified date. The WG discussed the workflow of appointments. Addressing – find resource or resource type to book Check availabilities (optional) Request

• appointment plus participants in system A (pending status)
• appointment for each participant in each of their appropriate systems (linking back to the original appointment – for replies)

Reply

• Update MY appointment with accepted, and reply to requester with acceptance status (or reject if desired).
• Organize checks the status of all responses and renegotiates if needed.

At this point the WG adjourned for lunch.

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

Tuesday Q2

HL7 Patient Administration Meeting Minutes Location: Room #1301		Date: 2014-01-21 Time: Tuesday Q2
Facilitator	Irma Jongeneel	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	HL7 Norway
X	Irma Jongeneel	HL7 Netherlands
X	Ewout Kramer	Furore
X	Micheal Steine	BT
X	Robert Worden	HL7 UK
X	Alex de Leon	Kaiser Permanente
X	Brian Postlethwaite	PCA eHealth, Australia
X	Christian Hay	HL7 GS1
X	Alexander Henket	HL7 Netherlands
X	Do Youn Lee	IHIS
X	Joon Hyun Song	IHIS
X	Dont Il Jeong	IHIS
Quorum Requirements Met (Chair + 2 members): Y

Agenda

Agenda Topics

• V3 FHIR Comment Ballot Reconciliation

Supporting Documents

• FHIR v0.06 Ballot For Comment Material

Minutes

Minutes/Conclusions Reached:
Brian moved to change location.period from 1…1 to 0..1. Alexander Henket seconded.
Discussion: none
Vote: 11/0/0

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

Tuesday Q3

HL7 Patient Administration Meeting Minutes Location: Room #1301		Date: 2014-01-21 Time: Tuesday Q3
Facilitator	Irma Jongeneel	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	HL7 Norway
X	Irma Jongeneel	HL7 Netherlands
X	Brian Postlethwaite	HL7 Canada
X	Micheil Steine	BT
X	Rene Spronk	Ringholm
X	Pal Espen Reinertsen	Helse Vest IKT, Norway
X	Marius Wefring	Helse Vest IKT, Norway
X	Elisabeth Moldehlev	Helse Vest IKT, Norway
X	Christian Hay	GS1
X	Robert Worden	HL7 UK
X	Alex de Leon	Kaiser Permanente
X	Iryna Roy	Gordon Point Informatics, Canada
X	Steinan Sandirk	Helse Vest IKT, Norway
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

• FHIR Discussion - Next Steps

Supporting Documents

• FHIR Website

Minutes

Minutes/Conclusions Reached:
Introductions.
The WG continued with the appointment resource content.
Line brought up the idea that in an appointment always has a participant but the participant class cardinality is currently 0..*. After discussion, it seems that there is no use case in which there is no participants for an appointment. This will be changed to 1..*.
Appointment.priority – meant to convey order, not necessarily importance in case there are more than one appointment for the same patient.
Appointment.status bindings are to v3. The WG looked at the v2 codes in user defined table 0278 (filler status code). The decision of the WG is to use the v2 codes except for blocked instead of the v3 codes.
Appointment.schedule this is meant to represent repetition. This will be changed to recurrence retaining the datatype of schedule (which is what FHIR chose to call a recurring value). New property for recurrence reference and an appointment #. The WG continued with the very complex issue of recurring appointments. The WG considered the possibility of removing this, however decided to table this until a later discussion.
Appointment.slot. After the discussion, it seems that this should be moved to the participant. So, this will be done.
As a side discussion, it was noted that individual is 0..* within the participant which is also 0..*. Brian noted that the individual should be 0..1.
Appointment.Participant.individual will include “any” as a choice.
This lead to a discussion around how the participant and individual should be modeled.
The WG decided to remove the observation from Appointment.Participant
Appointment.recorder changed to lastModifiedBy
Appointment.recordedDate changed to lastModifiedDate

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

Tuesday Q4

HL7 Patient Administration Meeting Minutes Location: Room# 2761		Date: 2014-01-21 Time: Tuesday Q4
Facilitator	Irma Jongeneel| width="25%" colspan="1" align="right"|Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	HL7 Norway
X	Irma Jongeneel	HL7 Netherlands
X	Brian Postlethwaite	DCA eHealth, Australia
X	Michael Steine	BT
X	Alex de Leon	Kaiser Permanente, USA
X	Hugh Glover	Blue Wave Informatics, UK
X	Christain Hay	GS1
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

• FHIR

Supporting Documents

Minutes

Minutes/Conclusions Reached:
The WG continued the discussion to update Hugh Glover, as our FHIR facilitator. As we did this, we discussed the use of the term Schedule which has been used in the work on the medication resource elements within the Pharmacy Work Group. This lead to a decision on whether the availability should be called “resourceSchedule” or “appointmentSchedule”.
The WG continued to examine the attributes as they currently defined. One outcome was to change the term of “period” to “planningHorizon”.
Back to the terminology, Hugh offered to present this to the FHIR Management Group and present both sides to see what they opinions there are.
After much discussion, the WG decided to keep the Availability, Appointment and Slot names and have a heading within the FHIR website that shows that these resources are part of the “Scheduling” activity.
The WG was advised by Hugh that we need to complete the appropriate paperwork to create the resources we were have been working on.
The WG adjourned at 4:51.

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

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