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   <td>Joint meeting with SD and Templates
 
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<br> CDA Value Sets with Proposed Changes (Allergy/Intolerance and others ...)
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<br> CDA Value Sets with Proposed Changes (Allergy/Intolerance, Clinical Status and others ...)
 
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* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12676 GF#12676] Guidance request for GP SOAP in FHIR -  
 
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12676 GF#12676] Guidance request for GP SOAP in FHIR -  

Revision as of 00:01, 14 September 2017


San Diego, CA, WGM - Sept 2017 Patient Care WG Meeting Draft/Approved agenda:

Agenda

Day Time Qtr Room # Event Host Joining Chair Scribe
Sunday
Sept 10		 AM Q1
Q2
PM Q3
Q4
Q5 Care Plan DAM harmonization discussion
Emma, Laura, Stephen
Others welcome ...		 FHIR
Day Time   Room # Event Host Joining Chair Scribe
Monday
Sept 11		 AM Q1 Aventine ABCG Plenary
Q2 Aventine ABCG Plenary
PM Q3 Vicino Ballroom Mega Report Out EHR Accepted: PC Attendees: Emma, Laura, Stephen, Elaine
Q4a Aventine D Joint Session with FHIR & OO on FHIR workflow FHIR-I Accepted: Patient Care Stephen
Q4b Palatine B 20 Admin (i.e. approve past WGM minutes; review schedule; 3 year plan)
FYI - Mission and Charter are done; Decision Making Process - Wayne said general update is pending 		Patient Care N/A Michelle Michelle
Day Time   Room # Event Host Joining Chair Scribe
Tuesday
Sept 12		 AM Q1 Barcino 40 60 min - FHIR/PCWG - CIMI - Skin Care model meeting
30 min - Special needs children care plan 		Patient Care Accepted: CIMI, EC Laura Emma
Q2 Palatine A 20 FHIR Change requests
  • GF#13743 Add AllergyIntolerance, Observation, RiskAssessment, and List to CarePlan.addresses

Nutrition Care Plan IG PSS

Patient Care Declined: FHIR-I Michelle Michelle
PM lunch ?
Q3a Portofino A 20 FHIR Admin, Planning, Issues, and Change requests Patient Care Accepted: FHIR-I Michelle Michelle
Q3b Aventine E SD Hosted Joint Quarter: CDA Product Family -This meeting is to provide an update to all interested work groups regarding the formation of a CDA Product Family. There will be many work groups invited to participate, so send representatives only SD N/A Stephen
Q4 Aventine F 40 Negation + other vocab topics
Problem status value set (SNOMED doesn't share the same hierarchy of codes as valueset-condition-clinical) 		Patient Care Invited: Clin Genomics
Accepted: Vocab, CIMI, EC, SD, OO, FHIR-I 		Jay / Rob Emma
Day Time   Room # Event Host Joining Chair Scribe
Wednesday
Sept 13		 AM Q1 OO-Studio Suite 310 (PC was in Portofino A, but PC is joining with OO in Studio Suite 310) 20 FHIR Change requests - Joint with OO to discuss adding instructions to ProcedureRequest Patient Care Accepted: FHIR-I Emma Emma
Q2 Guest Room 311 N/A PA hosted joint meeting -- Episode of Care; Care Team PA Accepted: PC N/A Michelle / Stephen
PM lunch Palatine B
 15 Clinician-On-FHIR Preperation meeting Patient Care Russ Emma
Q3 Vicino Ballroom 40 55 minutes - Boundaries between ProcedureRequest/Procedure vs MedicationRequest/MedicationAdministration for blood transfusions and radiation (i.e. anything with a dose, but isn't a medication)

Do we need a new resource for BiologicallyDerivedProduct? Boundaries between Specimen / Device / Medication boundaries

Related Zulip discussions:

Related trackers:


20 minutes -- HL7 approach to Appropriate Use Criteria [1]

Patient Care Accepted: CQI, CDS, Pharmacy, OO, FHIR-I Michelle Mike / Stephen
Q4 Rhodes 20 Allergy/Intolerance topic meeting. Drug list approach & Issues. Allergy resource maturity Patient Care Accepted: Pharmacy, Vocab Elaine / Jay Emma
Day Time   Room # Event Host Joining Chair Scribe
Thursday
Sept 14		 AM Q1a Syros 25 Care Plan -invite FHIR, Structured Docs, Pharmacy
  • HL7 C-CDA 2.1 Care Plan Document Template - Lisa Nelson
  • HL7 Care Plan Domain Analysis Model/FHIR Harmonization - Laura Heermann/EMma Jones
  • HL7 Care Coordination Services (CCS) functional model - LH/EJ
  • HL7 CDA R2 Personal Advanced Care Plan Document - Lisa Nelson
  • HL7 FHIR Care Plan Resource - LH/EJ
  • IHE PCC Dynamic Care Planning Profile- EJ
  • IHE PCC Dynamic Care Team Management - EJ
  • IHE QRPH Early Hearing Detection and Intervention (EHDI) Plan of Care- Lisa Nelson
  • HL7 Clinical Oncology Treatment Plan and Summary - Jeff Brown
  • NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro
  • Care team members definition update (Laura/Emma)
  • Essential Information for Children with Special Health Care Needs - Mike Padula
  • Naming convention for Care Plans?
  • Care Plan/Care Team Implementations
Check the minutes ....		 Patient Care Accepted: LHS, Pharmacy, SD Laura Emma
Q1b Delphi A Joint meeting with OO, CDS, PC, Templates OO Accepted: Patient Care Stephen
Q2 Barcino - Gallery 1 25 Joint meeting with SD and Templates


Proposed agenda:
CDA Value Sets with Proposed Changes (Allergy/Intolerance, Clinical Status and others ...)


Template update (Template co-chair/rep)
Template versioning;
Structured Doc/CDA update (SDWG co-chairs)
Patient Care update:
Allergy/Intolerance harmonization
Care plan harmonization; Health Concern*
C-CDA Care Plan templates
C-CDA and FHIR

Patient Care Invited: Templates
Accepted: SD		 Stephen Emma
PM lunch Barcino Gallery 1
 10 Co-Chair Admin Meeting Patient Care Michelle Michelle
Q3a Syros 20 FHIR Change Requests - Joint with BR&R to discuss AdverseEvent / AdverseReaction
  • GF#13302 Vocabulary issues with AdverseEvent
  • GF#13698 AdverseEvent.suspectedEntity.instance should allow CodeableConcept
  • GF#11021 Increase cardinality of substance and make certainty relation to substance, not reaction - 2016-09 core #40
 Patient Care Accepted: BRR, FHIR-I Michelle Michelle
Q3b Andros Joint meeting with CS, OO, and PC.
Per Hans, typically this one is very short (as it is in maintenance mode). Rest of the quarter is strictly OO. OO doesn't want to lose it from the radar, but no problem if PC declines, or puts down one representative who can check whether anything worthwhile comes up 		CS Accepted: Patient Care Stephen
Q4 Palatine A LHS - CareTeam DAM LHS Accepted: Patient Care Stephen, Emma, Laura?
Day Time   Room Event Host Joining Chair Scribe
Friday
Sept 15		 AM Q1 ClinFHIR  
Q2   ClinFHIR        
PM Q3   ClinFHIR        
Q4   No meeting        





San Diego, WGM - Sept 2017. Patient Care WG Meeting Meeting Minutes

Sunday, Sept 10

International Council Meeting
  • PCWG Care Plan
Q5
Discussion re: CP DAM 2.0
- Attendance:
- Emma Jones
- Laura Heernman
- Stephen Chu
- Notes:
Discuss Care Plan DAM 2.0: What to include/what does 2.0 look like:
• Orders (pull it up more visible). Figure 6 in the DAM. We need to improve the figure to represent activities and orders into other (higher level diagrams Level 0, or 0.5? Unpack the order set concepts. (what has been done in the FHIR Connectathons – how the library of activity definition fits into the activity box itself to form into Order Sets.
• Address Order Sets – how are they derived? How do they fit into the Care Plan? Address protocols… Evidence based guidelines.
• Advance Directives – is there stuff we need to do there? Write to it? How do they fit together?- Are these the same as Patient Orders? A Patient Specified Protocol?
• Health Concern – bring in the latest and greatest from the work that has been done there.
• Reconciliation – being in the latest and greatest from the work that has been done there.
• Care Team – bring in the latest and greatest from the work that is being done there.
• Allergies - bring in the latest and greatest from the work that is being done there.


- Make any changes to the diagram as learned from the FHIR harmonization.
- Write a paragraph – or section regarding FHIR and the harmonization work.

CCDA? Write a paragraph/section to that?



Patient Care WGM, Monday, Sept 11, 2017


Patient Care Monday Q1

Minutes

General Plenary session No meeting from Patient Care



Patient Care Monday Q2

General Plenary session No meeting from Patient Care


Patient Care Monday Q3

Chair: EHR
Scribe:


Attendees

Minutes


Patient Care Monday Q4

Q4B Chair: Michelle Miller
Scribe: Michelle Miller


Attendees

Minutes

  • Approve May_2017_WGM_Madrid,_Spain:_May_6_to_May_12 -- not enough attendees who were at the Madrid meeting to approve minutes
    • Ask Emma to add WGM meeting minute approval to upcoming PC general (bi-weekly) call
  • Review schedule
  • Eyecare PSS - motion to approve: Mike/Jay - abstain (0), against (0), for (4)
    • Follow-up with OO to ask if any of the 3 implementers are server vs client (should have at least one each).
    • Follow-up with OO to ask if retinal exam findings is within scope for all ages (including infants)
  • 3 year plan -- notes are in attached Excel HL7PatientCareProduct_Matrix_2017Sep-v010
    • Ask Emma to add 3 year plan to upcoming PC general (bi-weekly) call

Q4A - FHIR workflow with OO

FHIR Workflow Update

  • Lloyd will post his slides here [[2]]
  • Agenda
    • Pattern changes
    • Pattern Changes report
    • WorkflowExample resource
    • Change request

Standardizing workflow patterns

    • workflow is about getting things done
    • Need to get the request acted on by some other parties
    • Variation of who own what
  • Runs under FHIR infrastracture and participated in by a number of different WGs
  • Conference calls 2Xweek

Event

  • Logical models
  • defintion - points back to the orderset this is based on
  • change event.reasonNotDone to reasonNotDoneCode and move it beside reasonCode
  • Can reflect something that is 'happening'
  • Collapse event.performer to be reference with the same resource as event.performer.agent, getting rid of agent, onBehalOf ...
  • Add care tean to event.performer
  • performerFunction - what it is that they are doing - this can be an extension if it's not in the 80%

Request

  • Collapse request.requester in the same wayas event.performer
  • Add careTeam to Request.performer
  • Add diagnosticeReport to request.reasonReference
  • add healthcareService to request.performer
  • add request.insurance as 0..* Reference (coverage|claimResponse)

Definition

  • remove healthcareService from definition.performer

resource workflowExample - new resource

  • not workflow definition
  • identification and description of the actors involved
    • gives the sequence
    • gives description of what's being accomplished
    • purpose is to create a story and present in a consisten style
    • work thru a scenario where you pass back collections of resources
    • Not for implementers to use but to be used to convey a sample of what is being done.
    • Taking a collection of examples and explain how it's exchanged.
    • Change name to exampleScenario

Change request -

  • gForge 11217 - Thoughts on combining SupplyRequest, DeviceUseRequest and VisionPrescription - 2016-09 core #371



Patient Care Monday Q5: Placeholder for extra meeting if necessary

  • No PCWG meeting

Present:


Minutes:


Patient Care WGM, Tuesday, Sept 12, 2017


Patient Care Tuesday Q1

Chair: Laura

Scribe: Emma

[Please see here for attendance list]

Agenda

  1. Skin Progress report
    1. Spreadsheet for SME input; latest changes.
    2. SOLOR authoring in process. Demo of TermSpace, publication 10/30.
    3. Target January for full CIMI publication of skin and wound assessment domain with all bindings
    4. Update to LOINC panel; update to DAM
  2. Process/methodology discussion: CIMI @ CIC Wed Q2
  3. Special Needs Children Care Plan


Minutes
30 min - Essential Information for Children with Special Health Care Needs - Care Plan

60 min - FHIR/PCWG - CIMI - Skin Care model meeting Jay's Slides

  • CIMI ballot postponed
    • Jan target for full skin assessment
  • Terminology authoring in progress
    • CIMI is trying to get the concepts created by using SOLAR - SOLOR content is due to be published october
    • New use cases - tissue app, podiatry
  • Will eventually get loaded into VSAC
  • Currently working with the modeling infrastructure
  • First phase is the wound pressure injury
  • Meeting with CIC about the process and methodology
  • Discussion about data quality issue - equivalence depends on definition
    • mapping of the SNOMED codes to the CIMI model
    • Architect model approach is similar
  • Review Model request process
    • uses spreadsheet to request content. The spreadsheet is the initial input for the tooling.
    • use of present/absent - use is to qualify clinical statement. this is the highest level of the abstract model, not expected as part of the implementation.
    • Initial attempt is to have the information to get started
    • Question is the assertion, answers are in the value set
  • Podiatry use case
    • Foot wound has additional attributes
    • Identifying not only what the wound looks like but the etiology of the wound and additional attributes to understand options for treatment.
    • Using the same attributes in the model but will have different value set
  • Interest in looking at the evidentry source information - will CIMI capture the source of where the information came from? DOJ can not copy. Is it in scope that the foot wound source information was not copied from the PE 6 months ago
  • CIMI has an extensive provenance infrastruture
  • Implementation is not in the model
  • Missing extra properties that may be needed. This is the first pass with the goal of getting the process in place. Next stage will be the analysis
  • Have to start modeing based on the requirements you have. The model will evolve.
  • Project meets friday morning weekly
  • Interest from DEEDs on how to consume it. How do we reference it?
    • This is related to the governance. Need to know who is using what so if changes will need to notify the user.
  • Adverse event CIMI modeling - PC Thursday Q3
  • Challenges - more thatn one way to represent information. In a given situation, what is the information I should collect?
    • Need to differentiate the preferred way to collect the information is being dealt with the CIIC group.
    • CIIC have broad represention from care providers of multiple discipline. Specialty societies is represented.
    • Next meeting is DEC 5-6 in New Orleans as part of HL7 interoperability Conference



Patient Care Tuesday Q2

Chair: Michelle
Scribe: Emma

[Please see here for attendance list]

Nutrition PSS

  • PSS
  • HL7-Sept-2017-CCDA-Nutrition-IG
  • Academy of Nutrition and Dietician have seventy thousand national and international members
  • Majority work in clinical care
  • HITECH ACT -2009 - got involved to get non-providers input included
  • Goal is to get nutrition to go with the patient wherever they're going
  • Nutrition Standards exists
  • Contributes to key HL7 projects
  • PSS - Nutrition in C-CDA Based Care documents
    • PC as interested party or co-sponsor?
      • Patient care wants to be co-sponsor due to ownership of care plan. Elaine will be PC liason
      • Stephen moved, Jay Second - 0 abstain/0 against/18 for - motion pases
      • PC request formal content review prior to ballot. PC will get monthly updates
  • Nutrition centered use cases to support patient needs, provider needs, quality reporting and public health
  • Great presentation
  • PSS -
    • Harmonization with CCDA and FHIR will be handled as part of the analysis
    • Nutrition assessment correlates with clinical impression. Discussion
    • Requirements for vendors (in progress)
    • Modeling facilitator
    • Suggestion for CBCC to be a co-sponsor
    • Goal is a concise way to update the existing templates to support nutrition domain needs
    • Disadvantages of making section in the CDA document required when data is not always present
    • Who are the transaction partners - folks interested in implementing?

carePlan.addresses reference only condition discussion



Minutes

Patient Care Tuesday Q3

Chair: Michelle Miller
Scribe: Michelle Miller


Attendees

Minutes

  • FHIR Admin FHIR_Ballot_Prep
    • QA guidelines have changed: FHIR_Conformance_QA_Criteria
    • New QA guidelines for value sets, profiles, etc. FMG is talking about RIM mappings, but haven't dropped it yet. RIM mappings will now be needed for extension as well.
    • Extensions will have their own FMM (can be different than core resource)
    • QA Checklist will capture date, not just 'x'
    • No PC resources are currently targeted for normative, but we can still evaluate
    • Need an updated gap analysis against workflow patterns - report of gaps will need to be evaluated to see if the gap was intentional or not.
    • What are target FMM levels for R4?
      • AllergyIntolerance - questions about reaction/AdverseEvent - is this just writing down boundaries?
      • Condition - questions about health concern/linking - need Connectathon planned around concern management, need use cases (from domain analysis) and scenarios to test and recruit implementers to participate
      • Procedure - questions about splitting Procedure (performed) vs ProcedureStatement (history/ patient stated) - need to draft resources as a starting point
  • GF#13705 Communication.topic and CommunicationRequest.topic underdefined and overlap with .reasonRequest
  • GF#13389 Clarify Communication Scope and Usage
  • GF#10352 Change Encounter or and element to remove referencial limitation to on Encounters -- Paul was not available and we ran out of time, so we did not discuss


Patient Care Tuesday Q4

Minutes

Chair: Jay

Scribe: Emma

[Please see here for attendance list]

Agenda

  1. Problem Status value set
  2. Negation Requirements
  3. CDA human readable rendering

Clinical Status - Stephen Chu

  • Proble status valueset - condition and allergy status clinical status
  • Agreed to two value set - both PC and SDWG acceptance
  • CQI raised a question about patient safety - PC explained the hierachy. they complained that C-CDA did not show the hierachy
  • Question - what is the solution to this issue?
  • FHIR: required to be FHIR defined but can have SNOMED mappings
  • SNOMED concepts don't have the same concept of the hierachy
  • Question: what if the condition is poorly controlled relapse?
    • Clinical judgement is made on how this is used.
    • Mixes two concepts
    • Three things: 1)whether the problem is ongoing; 2)do you want on your problem list; 3)just something you want to know because its episodic
  • Problem clinical status in CDA - active, inactive, resolve. Has nothing to do with if this is on the list or not on the list. In CDA, the problem concern puts it on the list
  • FHIR - problem list does not have anything to do with this. its all about the existance in the subject.
  • Stephen expalined the status concepts with examples
  • Vendors input at time of valuset construction - Well controlled; poorly controlled - not used as clinical status values by cerner, epic and Allscripts
  • not just used by cancer conditions but also used for psychiatric conditions
  • Not too far off from what is done. Is it worth trying it?
  • Why did we invent a different valueset for FHIR from CDA?
    • Came to the conclusion that the CDA valueset was not adequate
  • Suggestion to take well-controlled and poorly control off the list and move forward with the other values
  • Difference between the status of a problem and the state of the disease
  • Agreement these are 3 different concepts 1)disease phase - 2)response to therapy - 3)status
    • Disagreement with this definition with explanation as to how this was derived. How do we progress this forward?
  • Suggestion to take well controlled and poorly controlled in a different element. Need to represent active when it's active for the first time.
  • Agree that SNOMED need to do some work on this.
  • Next steps -
  • gForge13026 - will discuss this during the next thursday PC FHIR call
  • CCDA and SNOMED mapping will be based off the FHIR decision

Negation - Jay Lyle

  • Have not made much progress
  • want to get it back in the Jan ballot
  • Need to do the planning for gettting this done
  • Plan on providng guidance on
    • translation/transformation
    • consistency
    • Inference
  • Group meet bi-weekly on wednesday mornings
    • Suggest making the meetings weekly meetings
  • CIMI dealt with the problem of present/absent - suggest picking one of the meetings to discuss this.
  • Tasks
    • Include examples (SDWG examples)and consumptions cases (e.g. quality measures; CDS rules)
    • Confirm classification
    • Define outcome
      • best practices
      • Policy recommendation
    • Writing

CDA Rendering - Lisa Nelson

  • Explain how to do narrative text linking where the human readable is linked with the machine part
  • Document describing how to go about linking the narrative
  • Review of the document
  • Can this be used for NLP where the entry is pulled from the text?
  • In CDA the human only looks at the human readable
  • would this be used in FHIR?
    • Opted to not include this in the FHIR core spec. Can stick ID elements where you want and place extension to be able to render.



Patient Care WGM, Wednesday, Sept 13, 2017


Patient Care Wednesday Q1

Chair: David
Scribe: Eric/Rickie

Minutes

OO (hosted quarter)/Patient care

VS profileconstrains the .value and component.value to Quantity (a number and includes a unit and a few other things). CP is to relax the dataType

Will discuss futher with FM.

  • ProcedureRequest name change to service request. Will float name change on Zulip for input.


Patient Care Wednesday Q2

Chair: Brian P. (Patient Admin hosted quarter)
Scribe: Michelle Miller

Minutes

  • GF#13786 - Clarify Practitioner classification extension (and PractitionerRole.specialty) -- remove extension
  • GF#13517 - PractitionerRole.active has the wrong definition - update definition
  • GF#12940 - PractitionerRole should leverage existing security role valueset - update PractitionerRole.code value set, but don't use the security value set

Patient Care Wednesday Q3

Chair: Michelle Miller
Scribe: Mike Padula


Attendees


Minutes

Blood Transfusion Background (55 min)

Related Zulip discussions:

Related trackers:

  • GF#13047 (request to add DosageInstructions to Procedure)
  • GF#12993 (request for a new Administration resource)
  • GF#8458 (request asking for a new BiologicallyDerivedProduct resource)


CQI - Appropriate Use Criteria (20 min) - Floyd

Patient Care Wednesday Q4

Chair: Jay

Scribe: Emma


Agenda

  1. Allergy Substance ballot comment overview
    1. Key negatives
  2. Allergy resource maturity
  3. Allergy terminology harmonization

Minutes


Patient Care WGM, Thursday, Sept 14, 2017


Patient Care Thursday Q1

Chair:
Scribe:
Agenda

  • HL7 C-CDA 2.1 Care Plan Document Template - Lisa Nelson
  • HL7 Care Plan Domain Analysis Model/FHIR Harmonization - Laura Heermann/EMma Jones
  • HL7 Care Coordination Services (CCS) functional model - LH/EJ
  • HL7 CDA R2 Personal Advanced Care Plan Document - Lisa Nelson
  • HL7 FHIR Care Plan Resource - LH/EJ
  • IHE PCC Dynamic Care Planning Profile- EJ
  • IHE PCC Dynamic Care Team Management - EJ
  • IHE QRPH Early Hearing Detection and Intervention (EHDI) Plan of Care- Lisa Nelson
  • HL7 Clinical Oncology Treatment Plan and Summary - Jeff Brown
  • NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro
  • Care team members definition update (Laura/Emma)
  • Essential Information for Children with Special Health Care Needs - Mike Padula
  • Naming convention for Care Plans?
  • Care Plan/Care Team Implementations


Attendees



Minutes

Patient Care Thursday Q2

Chair:
Scribe:


Attendees



Minutes




Patient Care Thursday Lunch: Co-Chairs Meeting

Chair:
Scribe:


Attendees



Minutes





Patient Care Thursday Q3

Chair:
Scribe:


Attendees



Minutes


Patient Care Thursday Q4

Chair:
Scribe:


Attendees



Minutes





Patient Care WGM, Friday, Sept 15, 2017

Clinician-on-FHIR


Patient Care Friday Q1

Chair:
Scribe:


Attendees



Minutes




Patient Care Friday Q2

Chair:
Scribe:


Attendees



Minutes




Patient Care Friday Q3

Chair:
Scribe:


Attendees



Minutes




Patient Care Friday Q4

Chair:
Scribe:


Attendees



Minutes





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