2017-02-09 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: 2016-02-09 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
	Stephen Chu	The Australian Digital Health Agency (ADHA)
	Evelyn Gallego	EMI Advisors LLC
	Eric Haas	Haas Consulting
	Rob Hausam	Hausam Consulting LLC
	Laura Heermann-Langford	Intermountain Healthcare
	Emma Jones	Allscripts
	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
	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
	Joe Quinn	Optum
	Simon Sum	Academy of Nutrition and Dietetics
	Iona Thraen	Dept of Veterans Affairs
	Serafina Versaggi	Dept of Veterans Affairs
Quorum Requirements Met: yes

Agenda

Agenda Topics

1. Agenda review
2. Approve previous meeting minutes 2017-02-02_Patient_Care_FHIR_Call
   • Motion: <moved>/<seconded>
3. Prior Action Item Follow-up
4. gForge change request

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 care team invariant and workflow patterns)

Minutes

gForge Change Requests

Review workflow patterns GF#10293

FamilyMemberHistory

• make identifier a summary element
• add definition element -- search parameter / example
• add basedOn as extension (GF#10293) -- search parameter? / example
• add partOf as extension (GF#10293)
• bind status to http://hl7.org/fhir/ValueSet/event-status
• add notDone element
• add notDoneReason element (need to determine value set binding)
• exempt from having a code element
• rename patient element to subject Reference(Patient|Group)
• add context element Reference(Encounter|EpisodeOfCare)
• exempt from occurrence pattern (i.e. don't rename date, keep dateTime data type)
• add performer structure (i.e. role, actor, onBehalfOf)
• add reasonCodeableConcept (need to determine value set binding)
• add reasonReference element

Communication

• exempt from occurrence pattern (i.e. keep sent/received dateTime)
• exempt performer structure (i.e. role, actor, onBehalfOf) and keep sender/recipient elements as is
• add reasonCodeableConcept (need to determine value set binding)
• add reasonReference element

CommunicationRequest

• add supportingInfo as extension (GF#10293)
• add relevantHistory as extension (GF#10293)
• add definition as extension -- search parameter? / example
• add basedOn element -- search parameter / example
• add replaces element -- search parameter / example
• add groupIdentifier element -- search parameter / example
• add intent element -- search parameter / example
• change priority from CodeableConcept to code (and add w5 mapping to grade)
• exempt from having code element added
• require subject 1..1
• rename scheduled element to occurrence and add choice of Timing, too
• rename requestedOn element to authoredOn, add w5 mapping to when.recorded, add aliases (createdOn, signedOn) -- update search param
• align requester element with the agent and onBehalfOf elements (allowing agent to also be Organization|Device)
• exempt from performerType/performer pattern; prefer to keep sender/recipient instead
• rename reason element to be reasonCode
• add reasonReference element
• add supportingInfo element
• add note element
• add relevantHistory element

ReferralRequest

• add definition element -- search parameter / example
• add replaces element -- search parameter / example
• add aliases (grouperId and requisition) to groupIdentifier element
• bind status element to http://hl7.org/fhir/ValueSet/request-status (effectively adding suspended and unknown)
• rename category element to intent and bind to http://hl7.org/fhir/ValueSet/request-intent (pre-applied)
• change priority from CodeableConcept to code
• exempt from having code element added OR rename serviceRequested element to code? (request pattern has 0..1 cardinality, but keep 0..*)
• rename patient element to be subject Reference(Patient|Group) and change to be required 1..1
• rename fulfillmentTime element to be occurrence with choice of dateTime|Period|Timing?
• align requester element with the agent and onBehalfOf elements (allowing agent to also be RelatedPerson|Device)
• exempt from performerType/performer pattern; prefer to keep recipient 0..* instead
• rename reason element to be reasonCode, and increase cardinality 0..*
• add reasonReference element
• add relevantHistory element

ClinicalImpression

• add definition element -- search parameter / example
• add basedOn as extension (GF#10293) -- search parameter? / example
• add partOf as extension (GF#10293)
• bind status to http://hl7.org/fhir/ValueSet/event-status
• add notDone element
• add notDoneReason element (need to determine value set binding)
• add alias (of patient) to subject element
• exempt from occurrence pattern (i.e. don't rename effective, don't add Timing)
• align assessor with the performer structure (i.e. role, actor, onBehalfOf) - can actor Reference(Practitioner|Organization|Patient|Device|RelatedPerson)? or just Practitioner?
• add reasonCodeableConcept (need to determine value set binding)
• add reasonReference element

Resource QA Summary

TOP Priority

• AllergyIntolerance is clean on the QA report!
• Condition is clean on the QA report!
• Procedure is clean on the QA report!

HIGH Priority

• CareTeam - no QA warnings!
• CarePlan - no QA warnings!
  • MnM approved exemptions requested for element names should be singular (addresses and replaces)
• Goal - no QA warnings!
  • MnM approved exemption requested for element names should be singular (addresses)
  • MnM approved exemption requested for Goal.target.detail because target detail is a choice of data types (i.e. Quantity and CodeableConcept could have different value sets) - Observation.value[x] does not show this same QA warning.

MEDIUM Priority

• Flag -- no QA warnings!
• FamilyMemberHistory -- no QA warnings!
  • Stephen Chu's recommendation is to use LOINC 75272-5 Age at onset for the FamilyMemberHistory.condition.onset
  • Motion: Stephen/Elaine: 11-0-1
• Communication -- no QA warnings!
• CommunicationRequest -- no QA warnings!
• ReferralRequest -- no QA warnings!

LOW Priority

• ClinicalImpression -- keep as FMM = 0
  • Stephen Chu will work on examples to cover all elements
    • ClinicalImpression.action Search Parameter 'ClinicalImpression.action' had no found values in any example. Consider reviewing the expression (ClinicalImpression.action)
    • ClinicalImpression.previous Search Parameter 'ClinicalImpression.previous' had no found values in any example. Consider reviewing the expression (ClinicalImpression.previous)
  • PCWG: ClinicalImpression.code Need to provide a binding

• Linkage -- keep as FMM = 0
  • PCWG: Linkage A resource must have an 'entered in error' status
  • PCWG: Linkage All resources should have an identifier
  • PCWG: Linkage.item Element has a todo associated with it (Make this 2..*.)

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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