2017-10-12 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://cernermeeting.webex.com/join/michelle.m.miller		Date: 2017-10-12 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
	Dave Carlson	VA
X	Stephen Chu	The Australian Digital Health Agency (ADHA)
	Evelyn Gallego	EMI Advisors LLC
	Eric Haas	Health eData Inc
X	Rob Hausam	Hausam Consulting LLC
	Laura Heermann-Langford	Intermountain Healthcare
X	Emma Jones	Allscripts
	Russ Leftwich	InterSystems
X	Tony Little	Optum 360
	Jay Lyle	Ockham Information Services LLC, VA
	Russell McDonell	Telstra Health
	Lloyd McKenzie	Gevity (HL7 Canada)
	Larry McKnight	Cerner
X	Michelle M Miller	Cerner
	Lisa Nelson	Life Over Time Solutions
	Viet Nguyen	Lockheed Martin, Systems Made Simple
	M'Lynda Owens	Cognosante
X	Mike Padula	The Children's Hospital of Philadelphia
	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 2017-10-05_Patient_Care_FHIR_Call
   • Motion: Stephen/Emma
3. High Priority Resources
4. gForge change request

Supporting Information

• FHIR_Ballot_Prep
• FHIR_Conformance_QA_Criteria - remember to check updated workflow patterns, too
• FHIR QA Conformance Tracker
• 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

Minutes

High Priority Resources (AlleryIntolerance, Condition, Procedure)

AllergyIntolerance

• QA 4d. value set should include unknown when minOccurs=1 - AllergyIntolerance.clinicalStatus has invariant that requires it, but it doesn't have unknown -- (similar to tracker we resolved last week for AllergyIntolerance.verificationStatus GF#13997) -- keep it "as is" knowing that the data-absent-reason extension (http://build.fhir.org/extension-data-absent-reason.html) can be used if clinicalStatus is not known

Condition

• GF#13980 condition-related extension cardinality should be 0..* (pre-applied)
• QA 4a. Condition.category is CodeableConcept with FHIR-defined value set - related to past GF#11091 -- Rob H. provided an update -- this is still an open question with next step to talk to Grahame and Ted.
• revisit GF#13026 Condition.clinicalStatus
• QA 4d. value set should include unknown when minOccurs=1 - Condition.clinicalStatus has invariant that requires it, but it doesn't have unknown -- keep it "as is" knowing that the data-absent-reason extension (http://build.fhir.org/extension-data-absent-reason.html) can be used if clinicalStatus is not known

Procedure

• GF#13974 Purpose of Procedure.reasonCode vs. Procedure.reasonReference (Ioana Singureanu)
• GF#13975 Procedure.reasonReference description is incomplete (Ioana Singureanu)
• GF#13976 Procedure.focalDevice description is confusing (Ioana Singureanu)

gForge Change Requests

Communication/CommunicationRequest

• GF#13936 CommunicationRequest - intent value set (Ravi Kuchi)
• GF#13979 QA 4a: Communication.topic needs binding to a value set (Michelle Miller)

CarePlan/Goal backlog

• GF#13903 CarePlan should allow tracking of past activities (i.e. past interventions) (Rick Geimer)
• GF#13904 Consider renaming CarePlan.activity.outcomeCodeableConcept and CarePlan.activity.outcomeReference (Rick Geimer)

BR&R:

• GF#13302 Vocabulary issues with AdverseEvent
• GF#13698 AdverseEvent.suspectedEntity.instance should allow CodeableConcept
• GF#11021 Increase cardinality of substance and make certainty relation to substance, not reaction - 2016-09 core #40
• GF#13892 Need guidance on overlap of AdverseEvent.event.text and AdverseEvent.description (Lloyd McKenzie)
• GF#13893 Correction to AdverseEvent.subject definition (Lloyd McKenzie)
• GF#13894 AdverseEvent.eventParticipant needs work (Lloyd McKenzie)

LHS:

• GF#12509 CareTeam participant (Michelle Miller)

OO:

• GF#12673 How to handle HCT/TP
• GF#12993 Please Create a NonMedicationAdministration object or an Administration object
• GF#13047 Add DosageInstructions to Procedure

SD:

• GF#12676 Guidance request for GP SOAP in FHIR (Alexander Henket) -
  • https://chat.fhir.org/#narrow/stream/implementers/topic/ClinicalImpression

Medium Backlog

• GF#12633 Split Procedure into Procedure and ProcedureStatement (Lloyd McKenzie)
  • Zulip chat asking for implementer feedback: https://chat.fhir.org/#narrow/stream/implementers/topic/Procedure.20vs.20ProcedureStatement
  • Dave commented that there is relevance for ProcedureStatement in context of CarePlan activities (Activity Statements where the activity is a procedure)
• GF#10028 Careplan: Provide ability to specify patient and/or provider preferences (Emma Jones)
  • meet need with a profile for preference on the observation resource. Requirements are a preference category (nutrition, medication, care), the preference priority (high/medium/delayed from C-CDA) and with elements of expressor and recorder.
  • This profile would not be developed for this release cycle
• GF#13140 logical definition of care-plan-category value set may require realignment with SCT changes (Matthew Cordell)
  • pending SNOMED proposal: https://confluence.ihtsdotools.org/display/cmag/Care+plans
  • Rob said he would follow up on the status of the SNOMED proposal

Low Backlog

• GF#10635 QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller)
  • ClinicalImpression is not mature enough to resolve this issue. Ask MnM for an exemption on the QA checklist (re: Condition having a circular reference with ClinicalImpression)
  • Add note: "A known issue exists with circular references between Condition and ClinicalImpression, which is due to the low maturity level of ClinicalImpression. The Patient Care work group intends to address this issue when ClinicalImpression is considered substantially complete and ready for implementation"
• GF#11173 CarePlan needs support for reviews - 2016-09 core #327 (Stephen Chu)
  • Tracking of reviews and plans for reviews is something that applies to many resources, not just CarePlan (e.g. protocols, standing orders, long term care admissions, etc.). This is something probably best handled by "Task" but will require a fair bit of analysis and discussion with other work groups to agree on approach. Defer to R4. Consider transfer to OO who owns Task

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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