2017-03-09 Patient Care FHIR Call

Meeting Information

Patient Care FHIR Resources Conference Call Location: Conference Call Phone Number: +1 770-657-9270 Participant Passcode: 943377 WebEx: https://cerner.webex.com/cerner/j.php?MTID=macd64a688fdc3410ab4178adab5820fb		Date: 2017-03-09 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
X	Pushpalatha Bhat
X	Stephen Chu	The Australian Digital Health Agency (ADHA)
	Evelyn Gallego	EMI Advisors LLC
X	Eric Haas	Haas Consulting
X	Rob Hausam	Hausam Consulting LLC
	Laura Heermann-Langford	Intermountain Healthcare
	Emma Jones	Allscripts
X	Russ Leftwich	InterSystems
	Tony Little	Optum 360
	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
	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	Chris Melo	Philips Healthcare
x	Nick Radov	Optum
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2017-03-02_Patient_Care_FHIR_Call
   • Motion: Eric/Rob
3. STU3 FMM Levels
4. STU3 QA Work (checklist, warnings, and suggested changes/clarifications)
5. STU3 Substantive Changes (post-freeze)
6. gForge Change Request
7. Zulip - ClinicalImpression for a cancer therapy decisions

Supporting Information

STU 3 Timeline

From FHIR_Ballot_Prep

• Sun. Feb. 19 Publication substantive resource freeze
• Sun. Feb 26 Publication total freeze
• Mon. Feb 27 QA period opens
• Tue. Feb 28 FMM QA spreadsheet updated for all WG resources
• Sun. Mar. 13 QA period closes
• Sun. Mar. 20 All QA applied

The "following week" STU 3 is published!

FHIR Maturity Levels

Maturity Levels Level 3 requires the artifact has been verified by the work group as meeting the DSTU_2_QA_guidelines and has been subject to a round of formal balloting; has at least 10 implementer comments recorded in the tracker drawn from at least 3 organizations resulting in at least one substantive change

Target FMM levels for STU3 publication

• AllergyIntolerance = 3
• Condition = 3
• Procedure = 3
• CarePlan = 1
• Goal = 1
• CareTeam = 1
• FamilyMemberHistory = 1
• ReferralRequest = 1
• Flag = 1
• Communication = 1
• CommunicationRequest =1
• ClinicalImpression = 0
• Linkage = 0

STU3 Action Items

• Review 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
• Update QA checklist for resources that we want to be FMM = 3
• Apply changes (all "substantive" changes have been applied, except workflow patterns)

Minutes

STU3 FMM Levels

• VOTE: CareTeam to FMM=1; Eric/Russ: 9-0-0
• Note: Lloyd suggested FamilyMemberHistory move to FMM=2 due to past Clinical Genomics connectathon tracks

STU3 QA Work

• New QA warnings! GF#12973 QA Warnings for Condition.onset search parameters
• Update QA checklist for resources that we want to be FMM = 3
• QA Topics
  • extension-procedure-causedby -- review beefed up description - "This procedure is because of the related item"
  • extension-condition-criticality -- no value set binding
  • flag -- questionable QA feedback
    • As “flag” has numerous usages in FHIR, this particular use should somehow be distinguished. Might it be a “clinical flag?”
    • A flag is typically presented as a label in a prominent location in "the a paper chart or visual rendering of an electronic" record to notify the clinician of the potential issues
    • given the volume of information frequently found in patients' records and the potentially serious consequences of losing sight of some facts, this redundancy is deemed appropriate -- Deemed by whom? HL7? We don’t make this kind of policy. Suggest “deemed important by the users of an information system.”
    • Patient has large dog at home -- This doesn’t seem like a credible example of the semantics for a flag, even under the “other” category.
    • The Flag resource is sometimes known as "patient notes" -- This is definitely beyond the scope of QA but there seems to be a serious conflict here between the notion of flags as a highly concise representation of information preselected for its urgency or relevance to workflow and a more general topic of patient notes, which could be wide ranging, couldn’t they?
  • goal - HgbA1c level =<5.6% -- Is this a clinically credible example? Yes

STU3 Substantive Changes (post-freeze)

FMG Patch Approval

• GF#12942 Change AllergyIntolerance.category data type to code -- patch sent to Grahame and Lloyd to apply

FMG Rejected / Deferred to R4

• GF#12943 Condition.stage cardinality

No Approval Needed

• GF#12973 QA Warnings for Condition.onset search parameters

gForge Change Requests

• GF#12988 Wrong mapping for Condition.clinicalStatus to HL7 V2 DG1-6
• GF#12973 QA Warnings for Condition.onset search parameters

Zulip

• Using ClinicalImpression for cancer therapy decisions

Adjourn

Adjourned at <hh:mm am/pm> <timezone>.

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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