2017-03-09 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: 2017-03-09 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
	Pushpalatha Bhat
	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
   • Motion: <moved>/<seconded>
3. STU3 FMM Levels
4. STU3 QA Work (checklist, warnings, and suggested changes/clarifications)
5. STU3 Substantive Changes FMG Approved (or pending approval)
6. gForge Change Request
7. Zulip - ClinicalImpression for a cancer therapy decisions

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 workflow patterns)

Minutes

STU3 FMM Levels

• VOTE: CareTeam to FMM=1
• Note: Lloyd suggested FamilyMemberHistory move to FMM=2 due to past Clinical Genomics connectathon tracks

STU3 QA Work

• New QA warnings! GF#12973 QA Warnings for Condition.onset search parameters
• Update QA checklist for resources that we want to be FMM = 3
• QA Topics
  • extension-procedure-causedby -- review beefed up description - "This procedure is because of the related item"
  • extension-condition-criticality -- no value set binding
  • flag -- questionable QA feedback
    • As “flag” has numerous usages in FHIR, this particular use should somehow be distinguished. Might it be a “clinical flag?”
    • A flag is typically presented as a label in a prominent location in "the a paper chart or visual rendering of an electronic" record to notify the clinician of the potential issues
    • given the volume of information frequently found in patients' records and the potentially serious consequences of losing sight of some facts, this redundancy is deemed appropriate -- Deemed by whom? HL7? We don’t make this kind of policy. Suggest “deemed important by the users of an information system.”
    • Patient has large dog at home -- This doesn’t seem like a credible example of the semantics for a flag, even under the “other” category.
    • The Flag resource is sometimes known as "patient notes" -- This is definitely beyond the scope of QA but there seems to be a serious conflict here between the notion of flags as a highly concise representation of information preselected for its urgency or relevance to workflow and a more general topic of patient notes, which could be wide ranging, couldn’t they?
  • goal - HgbA1c level =<5.6% -- Is this a clinically credible example? Yes

FMG Patch Approval

• GF#12942 Change AllergyIntolerance.category data type to code -- patch sent to Grahame and Lloyd to apply

Pending FMG Approval

• GF#12943 Condition.stage cardinality
• GF#12973 QA Warnings for Condition.onset search parameters

gForge Change Requests

• GF#12988 Wrong mapping for Condition.clinicalStatus to HL7 V2 DG1-6
• GF#12973 QA Warnings for Condition.onset search parameters

Zulip

• Using ClinicalImpression for cancer therapy decisions

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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