Conference call minutes 3 April 2014

Health Concern Topic

Patient Care WG April 3, 2014

Attendees

• Michael Tan – Chair
• Elaine Ayres – Scribe
• Stephen Chu
• Becky Angeles
• Larry McKnight
• Emma Jones

Previous minutes

Approved minutes as amended of March 20, 2014 - Larry McKnight Voting: No – 0, Abstain – 1, Approve - 4

Phoenix WGM Agenda

Health Concern topic at Phoenix WG meeting – will adjust schedule to hold a health concern topic earlier in the week. (Monday Q3)

Discussion on list server

The topic of Health Concern popped up in several Discussions about FHIR Allergies and CCDA. See also notes below.

Review of the Domain Analysis Model

Two key concepts are:

1. Health Concern
2. Health Concern Tracking

Larry McKnight is re-engaging in the project. Confusion with C-CDA and FHIR using the “concern” and concern tracking. FHIR does not use the concept of concern tracking. FHIR does not feel there is the need for a concern resource. Because the C-CDA and CCD models do have the concern concept, the two representations are incompatible. In C-CDA there is the problem concern act, allergy concern act and health concern. In C-CDA the allergy concern act is set a 1..1 or mandatory. A health concern should not be mandatory.

The DAM should include a comparison to C-CDA. FHIR resources may wait until a later time.

Stephen has added graphical use cases to the wiki.

The current iteration of the DAM is on the wiki.File:Health concern use cases.docx

Additional use cases/storyboards are needed. Michael has added an introduction and an additional use case. Members are kindly requested to review the document.

We need to finalize the definition of the concern tracking. Tracking -- the concern is a tracker and it tracks events. There are events that occur and the concern itself is a collection of events. On the problem list – Breast Cancer. The history may include scans, biopsies etc. The concern spans time and collects events/observations. The EHR has the events and the concern ties these together. The concern is on the problem list.

When you send information to another system – events that are related need to be represented. Time point one – penicillin allergy with rash. Time point two – update to allergy to Beta-lactan. In receiving system – looks like two events, rather than one updated event. The concern is the monitoring plan. Recommend changing the mind map so that the health concern is at the top and the condition/concern is the event. When something is on a “list” it has a status of “active”. That means the concern is active. Different providers may have different views on whether a concern is active or not.

Pneumonia – may be documented in the progress note as the event. Vs. the problem list which may indicate that pneumonia would need to be followed. Can an inactive condition be a concern in this model? Even if a condition is not active, may still monitor.

Stephen will reconstruct the mind map to reflect the conversation today and then send out to the group.

Next meeting

Thursday, April 17 at 4 PM ET.