2017-06-29 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://cernermeeting.webex.com/join/michelle.m.miller		Date: 2017-06-29 Time: 5-6:30pm ET
Facilitator	Michelle M Miller	Note taker(s)	Michelle M Miller
Attendee	Name	Affiliation
X	Elaine Ayres	NIH/Department of Clinical Research Informatics
	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
X	Emma Jones	Allscripts
X	Russ Leftwich	InterSystems
	Tony Little	Optum 360
X	Jay Lyle	Ockham Information Services LLC, VA
	Russell McDonell	Telstra Health
	Lloyd McKenzie	Gevity (HL7 Canada)
	Larry McKnight	Cerner
X	Michelle M Miller	Cerner
X	Lisa Nelson	Life Over Time Solutions
	Viet Nguyen	Lockheed Martin, Systems Made Simple
	M'Lynda Owens	Cognosante
	Mike Padula	The Children's Hospital of Philadelphia
	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	Bob Thompson
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2017-06-22_Patient_Care_FHIR_Call
   • Motion: Russ/Stephen
3. Prior Action Item Follow-up
4. gForge change request

Supporting Information

• 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
• Maintain QA checklist

Minutes

Follow-up

AdverseEvent

• FMG approved the transition of ownership of AdverseEvent to Patient Care
• Elaine will re-assign the open trackers
• There might be a few unapplied trackers as well
• Russ suggested a dedicated call to facilitate the knowledge transfer as part of the transition of ownership
• Terminology work is still needed
• Elaine will coordinate with BRR to identify a Thursday in the next few weeks when we can collectively discuss

Advance Directives / Consent / Care Plan

• GF#11332 has resolution:
  • 1-Update CarePlan scope to say: Self-maintained patient or care-giver authored plans identifying their goals and an integrated understanding of actions to be taken. This does not include the legal Advance Directives, which should be represented with the Consent resource with Consent.category = Advance Directive. Informal advance directives could be represented as a Goal, such as "I want to die at home."
  • 2-Add element to CarePlan as follows: CarePlan.consent, 0..*, Reference(Consent) One or more Advance Directives or Medical Treatment Consent Directives
  • 3-Update Goal boundaries to say: Goal does not include the legal Advance Directives, which should be represented with the Consent resource with Consent.category = Advance Directive. Legal Advance Directives may specify clinical goals that can be represented as a Goal resource as well. Informally, advance directives could be represented as a Goal resource regardless of whether it was included in the legal Consent, such as "I want to die at home."
  • Do not apply changes until we hear back from FMG/CBCC

• Lisa Nelson update on discussion with Lloyd and Grahame around CarePlan/Goal/Consent
  • MyDirectives (UI) --> document (CDA L3 Personal Advance Care Plan) --> FHIR Resources
  • "Submission Set" (DocumentManifest)
  • DocumentReference
  • Composition (many other resources....Goal, PlanDefintion, RequestGroup, Questionnaire, Consent, Contract, List etc)
  • CommunicationRequest
  • Communication
  • These are not orders or proposals -- a person's directives are just preferences (e.g. no decision is made) expressed for the health care power of attorney -- the person doesn't make decision ahead of time, appoint a health care agent, who will make decision in the future and sign the consent.
  • Composition includes:
    • Healthcare Agents will sign official consents
    • Certain Health Conditions (or upon death) -- PlanDefinition -- if terminally ill, how do you feel about XYZ; if brain injury, which activities should be done or not; which would then instantiate a RequestGroup -- activities in RequestGroup (tightly aligned with PlanDefinition)
    • Once you have died, what activities should be done
    • CareExperience --> QuestionnaireResponse
    • Admin -- contract -- who signed and witnessed
  • FHIR Connectathon Opportunities
    • CCDA on FHIR - establish industry norm
    • CarePlan - Demonstrate inclusion of patient generated health data
    • CDS Hooks

Mapping CCDA Document Section/Entry to FHIR Resources

Reviewed Lisa's spreadsheet: https://docs.google.com/spreadsheets/d/1zGbYmNt95-sG-I0hz_XDsaKujJx-C623UNUq-1JG9sI/edit?usp=sharing

gForge Change Requests

Backlog

• GF#8647 Missing codes from Flag.category valueset
• GF#10621 QA 4a: Consider whether CarePlan.activity.detail.category should be bound to an external code system
• GF#11209 Feedback on ClinicalImpression
• GF#13389 Clarify Communication Scope and Usage

Adjourn

Adjourned at 6:34pm Eastern.

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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