2018-05-14 PA WGM Minutes

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Patient Administration Work Group Minutes - May 14, 2018

Monday Q1

HL7 Patient Administration Meeting Minutes Location: Maritime Hotel, Cologne, Salon 20 Fulda		Date: 2018-01-29 Time: Monday Q1
Facilitator	Line Saele	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	HL7 Netherlands
X	Alex de Leon	Kaiser Permanente, USA
X	Line Saele	HL7 Norway
X	Brian Postlethwaite	Telstra Health, Australia
X	Cooper Thompson	EPIC, USA
X	Christian Hay	GS1, Switzerland
X	Bidyut Parruck	Interface ED, USA
X	Simone Heckmann	HL7 Germany
X	Hans Buitendyjk	Cerner, USA
X	Andrew Torres	Cerner, USA
X	Kathy Pickering	Cerner
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
Welcome and introductions Joint meeting with Financial Management - FHIR

• Invoice draft review
• ChargeItemDefintion draft review
• ProductPlan review
• Payment/Adjustment resource?

Supporting Documents

• PA mission & charter
  
• PA decision making practice
• PA 3-year work plan
  
• [SWOT
  ===Minutes===

Plenery

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Action:

Next Meeting/Preliminary Agenda Items .

Monday Q2

HL7 Patient Administration Meeting Minutes Location: Hotel Maritim, Cologne, Salon 20, Fulda		Date: 2018-05-14 Time: Monday Q2
Facilitator	Brian Postlethwaite	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Brian Postlethwaite	Telstra Health, Australia
X	Irma Jongeneel	HL7 Netherlands
X	Alex de Leon	Kaiser Permanente, USA
X	Line Saele	HL7 Norway
X	Cooper Thompson	EPIC, USA
X	Kathy Pickering	Cerner, USA
X	Christian Hay	GS1, Switzerland
X	Simone Heckmann	HL7 Germany
X	Bidyut Parruck	Interface ED, USA
Quorum Requirements Met (Chair +2 members): Yes

Agenda

Agenda Topics

1. FHIR New Proposals
2. Feedback from Connectathon

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions

Minutes/Conclusions Reached:
Introductions
Joint session with FM. The WG began with the review of the Invoice resource.
Simone noted that in the last call, the WG was asked to build the invoice looking forward to the approval of this invoice.
Mary Kay noted that there were no quantities involed. Simone explained that the invoice is moer like a summary of the charge items. This would require a bundle to be included to actually use this resource. The operation would be a submit of the invoice that would create the bundle of charge items and paitient information. This would require approval by FM.
http://build.fhir.org/invoice.html
Irma asked if this should follow the workflow pattern.

Irma moves to accept this resource proposal to move forward., Iryna seconds.
Discussion: This is to move forward with the proposal. Vote (for/against/abstain): 12/0/0
The WG looked generally at the charge item resource to gain approval to move forward with tis as well.

http://wiki.hl7.org/index.php?title=ChargeItemDefinition_FHIR_Resource_Proposal

The pricing details or catalog also services available.

The WG reviewed the elements involved for the context of ChargeItem Definition
Patient, Encounter,

Simone reviewed some of the relevant elements within the proposed ChargeItemDefnition

The Instance element was discussed. FM felt that the reference which currently included Medication, Substance and Device can be expanded.

The joing workgroups had a lively enough discussion on the elements within the ChargeItemDefinition as currently defined to merit moving forward with this proposal.
There were value statements from Germany, Australia, and US for the use of this resource. Each had some use cases which would be supported by this resource.

Action: FM noted that there should be a way to indicate related definition. The Example rule is … there are 10 items that can be charged but only one can be charged. This is one thing that needs to be accounted for.
MaryKay moves to accept the resource proposal for moving forward. Simone seconds.
Discussion: None
Vote: 10/0/1

The WG moved on to review the ProdcutPlan. To be able to have an insurer express their basic product (a set of coverages) and plan where plans are the risk share. For one product, there could be many different ways you can handle risk. This is a structure that allows you to define this.
http://build.fhir.org/productplan
This is not doing billing, it’s doing coverage and risk sharing. Structure of the plan.

Location was supposed to change from 0..1 to 0..*.

The FM work group invited any interested parties to review this.

Brian noted that there is another FM joint session on Thursday Q2.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) None

Next Meeting/Preliminary Agenda Items .

Monday Q3

HL7 Patient Administration Meeting Minutes Location: Hotel Maritim, Cologne, Germany, Salon 20 Fulda		Date: 2018-05-14 Time: Monday Q3
Facilitator	Line Saele	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	HL7 Netherlands
X	Line Saele	HL7 Norway
X	Brian Postlethwaite	Telstra Health, Australia
X	Alex de Leon	Kaiser Permanente, USA
X	Toril Reite	HL7 Norway
X	Cooper Thompson	EPIC, USA
X	Oyvind Aassve	HL7 Norway
X	Michelle Miller	Cerner
X	Tricia Chitwood	Cerner, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. FHIR Ballot Reconciliation

Supporting Documents

• 14333 - Provide more clarity between administrativeGender, sex, and gender identity

• 14154 - Searching a patient by Identifier Type

• 14099 - Guidance on how to request a new identifier (e.g. MRN)

• 14341 - Replace "hermaphrodite" with "intersex"

• 14174 - herd should be able to reference the owner

Minutes

Minutes/Conclusions Reached:
Introductions

Introductions

The WG decided to review the agenda for the week. Included V2.9 ballot reconciliation Thursday Q3. Also included v2.9 proposal 716 included with Patient care joint session.

The WG also noted that FHIR ballot reconciliation for Patient should take presendence so changed Monday, Q4 and Tuesday Q1, Q2 and 3, to include 3 ½ quarters to get through .
Motion was made by Brian to approve the new agenda, seconded by Irma. Discussion: None Vote (for/against/abstain): 6/0/0
Reviewed the mission and charter. No changes.

Work group help. Although there was an email sent that the PAWG would accept the outcome, HL7 headquarters did not record this. Line will follow up with Anne as it was stated that it would be taken care of. Given this, the PAWG shold get a star for 2018 May.
The WG reviewed the 3 year work plan. Updated by adding the ChargeItemDefinition. The WG noted that the project ID did not need to change as

The WG continued to review the SWOT .

Block vote motion by Irma to accept PA Mission and Charter, 3 year work plan and SWOT, Brian seconded.
Discussion: None
Vote (For/against/abstain): 6/0/0

The WG continued with the FHIR tracker items.

16319 Marital Status Code System Missing Values
The Marital Status Code code system referenced from the FHIR home page for the Patient normative material only lists one concept and also states "This Code system is not currently used". The value set used is fully loaded and references the HL7 V3 Code System. The latter is valid. But including the former with just one value is at least confusing. Suggest to remove that code system, or include a reasonable set of concepts.

16516 - Marital Status Code System Missing Values The normative ballot includes CodeSystem Marital status, with the canonical URL defined as "http://hl7.org/fhir/marital-status".
However, the page says "This Code system is not currently used.
This is verified by the ValueSet for Marital status (http://hl7.org/fhir/2018May/valueset-marital-status.html) which does not include the above code system URL, instead it includes all the codes in "http://hl7.org/fhir/v3/MaritalStatus" and a single code from "http://hl7.org/fhir/v3/NullFlavor".
Why ballot something that is not used as Normative?

16616 - Add codes for missing Marital Status' - 2018-May Core Norm Patient #42
Codes for married, separated, divorced, and widowed are missing.

16597 - 4.3.1.29 Value Set http://hl7.org/fhir/ValueSet/marital-status - 2018-May Core Norm Patient #13
4.3.1.29 Value Set http://hl7.org/fhir/ValueSet/marital-status

Block move as persuasive. Codes system is not used anywhere in the FHIR specification. The marital status value set references the v3 code system, hence is leftover from where FHIR defined it’s own codes. This redundant Codeset will be removed. By Brian. Seconded by Drew.
Discussion: None. Vote (for/against/abstain): 6/0/0

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Action: Action:

Next Meeting/Preliminary Agenda Items .

Monday Q4

HL7 Patient Administration Meeting Minutes Location: Hotel Maritim, Cologne, Germany, Salon 20 Fulda		Date: 2018-01-29 Time: Monday Q4
Facilitator	Irma Jongeneel	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	HL7 Netherlands
X	Line Saele	HL7 Norway
X	Brian Postlethwaite	Telstra Health, Australia
X	Alex de Leon	Kaiser Permanente, USA
X	Christian Hay	GS1, Switzerland
X	Cooper Thompson	EPIC, USA
X	Hanhong Lu	EPIC, USA
X	Simone Heckman	HL7 Germany
X	Drew Torres	Cerner, USA
X	Isabel Gibaud	HL7 France
X	Tricia Chitwood	Cerner, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. FHIR Ballot Reconciliation - Encounter

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions

16615 - Split Marital Status code = 'U' into two codes - 2018-May Core Norm Patient #41
The existing valueset (from v3) that is bound to patient.maritalStatus already has these concepts separately defined>
Brian moves as not persuasive, Alex seconds. Discussion: none Vote: 7/0/0

16155 - Inconsistency between "Patient.managingOrganization" and Search Parameter "organization"
The description of the search parameter will be updated to be consistent with the property.
Motion made by Brian to find this prrsuasive. Seconded by Alex. Discussion: None Vote (for/against/abstain): 5/0/2

16128 - General Grammar Review
Brian moved to dispiosition as persuasive. Alex seconded

8/0/0

16129 - The definition of Patient.active is "Whether this patient's record is in active use". This definition seems to imply that the Patient resource represents the patient record rather than a reference to the patient entity or role. Would this attribute not below on the patient record (e.g. Composition) rather than on the patient resource? FHIR needs to provide explicit guidance on how the patient resource is used and how a patient record is formed using FHIR. Waiting for input from submitter.

16130 - birth/death attributes should be structures - Recommend that birth and death be structures rather than simple types since a number of other attributes will be added pertaining to each. A structure provides a place to add these additional attributes. For instance, birth/deathAddress, birthPlurality, birthOrder, birth/deathCertificateNumber, etc... Extending primitives is really not the way to go. Adding sibling attributes would not make it clear that these attributes are related the birth/death data for this patient. For instance, we would propose a birthData attribute of type BackboneElement with two attributes in FHIR core: birthDate and multipleBirth. The would provide a cleaner future extension path for Patient.

Brian moves this as not persuasive, Drew seconds Discussion: the WG discussed the “in person” request. The WG decided to vote and reopen it if the submitter wants to discuss during the Cologne WGM. Vote (for/against/abstain): 7/0/1 15935 - The Patient $match and $everything operations should not be normative in R4 The operations on the Patient resource were not intended to be marked as normative (I believe). $match certiantly isn't ready, and $everything probably isn't either. The WG considered this persuasive, as it is not normative. The 2 patient operations ($match and $everything) will be removed fom the normative status to STU. Discussion: This is what the WG intends to do. The WG decided to vote now and validate with FHIRI tomorrow Q1. Action: This will be referred to FHIRI Moved as persuasive by Brian, seconded by Line. Vote (for/against/abstain): 7/0/01 16422 - Patient: Remove animal from "scope and usage" description Drew moved as non-persuasive, Brian seconded. Discussion: None Vote (for/against/abstain): 7/0/1 16429 – Inclusion of STU comments on Normative content Should a normative section of the standard still referencing feedback via an STU Note? The patient Merge section is not intended to be a normative section, as it has not been tested or completed and requires further work when the community is ready to advance it. THe WG discussed and decided to move the “STU” portion of the “STU Note:” as this would be a more general description. It was noted that the section in question is not substantive and contains no operations. The submitter being in the room, he was satisfied wit this. Drew moved to disposition this as persuasive, iryna seconds. Vote: 7/0/1 16592 - Patient Contact needs a date associated with it as patient contacts change. - 2018-May Core Norm Patient #7 The patient contact element has a period associated with it which indicates the dates that the contact i applicable for use. The patient resource as a whole has the meta.lastUpdated which indicates when the resource was updated. Checking in history you could determine when the specific change occurred. There is no special date which shows when the backbone element/property was changed. Iryna moves this as non persuasive with mod, Brett Esler seconds. Vote (for/against/abstain): 7/0/1

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)

Next Meeting/Preliminary Agenda Items .

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