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Difference between revisions of "Negation Requirements Project Minutes 6 April 2016"

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'''Minutes/Conclusions Reached:'''<br/>
 
'''Minutes/Conclusions Reached:'''<br/>
  
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# Add link to PSS: it's on project wiki. Perhaps this referred to the TermInfo wiki.
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# PSS status: still pending Vocab approval
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## PSS status: still pending Vocab approval
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# Reviewed FHIR/Allergy discussion on patterns. Use to confirm requirements can help make these decisions.
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# Provenance
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## single field, renamed from 'substance' to 'code' to accommodate negatives
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## Provenance may affect interpretation of a negated fact, e.g., patient asserts no allergies. If there is a record of an reaction, this is reason to doubt such an assertion. However, positive assertions are also subject to trust and validation. Provenance is important, and may be a requirement for displaying allergy negation, but it's not specific to negation. This topic remains out of scope for this project.
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## dual field: present things and absent things
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# Use cases introduced by quality measure use case: need to identify actions not taken for cause.
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## dual field: thing and presence vs absence value
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## This information should not be specifically created for the measure calculation: if it's important enough for the measure, it should be in the record. Persistence is necessary to support cases such as "discontinued medication," which would presumably influence future opportunities for administration.
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# Patterns
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## QDM models a property, "negation rationale," for recording such causes.
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## Pattern documentation does seem to make assumptions, not about information model solution but about terminology semantics
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## Whether such a note automatically excludes a patient from the denominator depends on the design of the rule -- for some rules, there are value sets of valid exclusion kinds.
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## Separation of the "absent" assertion from the thing that is absent seems clear, as well as possible context
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## These reasons are not limited to contraindications; they may include patient refusal.
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### though context of thing (patient, family) may be different from context of absence (today, historical)
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## Note that the reason is distinct from the assertion that the act was not performed.
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## The thing itself seems to align with the SCT idea of an observable; i.e., not a finding or anatomical entity. This may mean requesting new SCT concepts.
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## There was some discussion of identifying whether an act is not done# "intentionally." The "reason" property seems to at least offer the ability to identify intentionally omitted acts, and possibly some unintentional. All unintentionally omitted acts would be an infinite set, so we are not concerned with modeling it.
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### SCT is not the only target terminology solution, but it seems to be the richest, so we anticipate solutions that accommodate it will fit simpler ones, too
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## Current systems handle this case in a variety of ways.
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### If "spleen size" is one possible observable (values PQ, or ordinal small medium large), can "absent" describe an observable "spleen", or do we need a "spleen presence" observable?
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### Reason may annotate the order.
 
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### It may not be saved in a predictable place.
 
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### CDA template design: _act.negation, entryRel.reason: observation reason.
 
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## VA is considering ways to handle this issue.
 
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## CQL logical design under discussion.
 
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# New examples: see items 73 - 86 in spreadsheet.
 
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# Examples other than observations
 
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## Procedures & substance administrations pretty well covered above
 
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## Encounter: follow-up not needed; patient did not show up
 
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## Supply: did not provide electric wheelchair; did not use antithrombotic device on legs (as a supply item within a larger order or without order)
 
  
 
===Meeting Outcomes===
 
===Meeting Outcomes===

Latest revision as of 16:54, 6 April 2016


Back to Negation Minutes

Minutes

Meeting Information

HL7 PC-CIMI-POC Meeting Minutes

Location: PC call line

Date: 2016-03-30
Time: 11:00-12:00 ET
Facilitator Jay Lyle Note taker(s) Jay Lyle
Attendee Name Affiliation


Jay Lyle JP Systems
Serafina Versaggi
Lisa Nelson
Rob Hausam
Carmela Couderc

Agenda

Agenda Topics

  1. FHIR/allergy topic
  2. patterns

Minutes

Minutes/Conclusions Reached:

  1. PSS status: still pending Vocab approval
  2. Reviewed FHIR/Allergy discussion on patterns. Use to confirm requirements can help make these decisions.
    1. single field, renamed from 'substance' to 'code' to accommodate negatives
    2. dual field: present things and absent things
    3. dual field: thing and presence vs absence value
  3. Patterns
    1. Pattern documentation does seem to make assumptions, not about information model solution but about terminology semantics
    2. Separation of the "absent" assertion from the thing that is absent seems clear, as well as possible context
      1. though context of thing (patient, family) may be different from context of absence (today, historical)
    3. The thing itself seems to align with the SCT idea of an observable; i.e., not a finding or anatomical entity. This may mean requesting new SCT concepts.
      1. SCT is not the only target terminology solution, but it seems to be the richest, so we anticipate solutions that accommodate it will fit simpler ones, too
      2. If "spleen size" is one possible observable (values PQ, or ordinal small medium large), can "absent" describe an observable "spleen", or do we need a "spleen presence" observable?

Meeting Outcomes

Actions
  • review examples for completeness, classification for accuracy (all)
  • secure Vocabulary co-sponsorship (Rob H)
  • request involvement from SD & FHIR (Jay)
  • consolidate wiki pages (Jay)
Next Meeting/Preliminary Agenda Items
  • none identified

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