May 2016 WGM Montreal, Canada: May 8 to May 13
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Montreal (Quebec) Canada, WGM - May 2016 Patient Care WG Meeting Approved agenda:
Contents
Montreal WGM - May 2016. Patient Care WG Meeting Meeting Minutes
- Sunday, May 8 - International Council Meeting
- - No PCWG meeting
Patient Care WGM, Monday, May 9, 2016
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Monday Q1
Chair: Jay Lyle
Scribe: Michelle Miller
Attendees
- Ayres,Elaine (NIH/Clinical Center)
- Campbell,Keith (U.S. Department of Veterans Affairs)
- Duteau,Katherine (DDI)
- Jones,Emma (Allscripts)
- Leftwich,Russ (InterSystems)
- Lyle,Jay (Ockham Information Services LLC)
- Miller,Michelle (Cerner Corporation)
- Newman,Shu-Fang (University Of Washington Medical Center)
- Nguyen,Viet (Lockheed Martin, Health and Life Sciences)
- Owens,M'Lynda (Cognosante, LLC)
- Parker,David (Defined IT, Inc.)
- Popat,Amit (Epic)
- Pyke,David (Ready Computing)
- Rehwoldt,Greg (Utah)
- Spielman,Matthew (InterSystems)
- Tan,Michael (NICTIZ Nat.ICT.Inst.Healthc.Netherlands)
Minutes
- Approve last WGM meeting minutes
- January_2016_WGM_Orlando,_Jan_10_to_Jan_15 -- no comments or concerns
- This week's WGM schedule reviewed and updated
- Reviewed FHIR announcements
- Timeline
- Thurs, May 12 - Q3
- What new resources/profiles do you plan to propose?
- What are your FMM targets for STU3? http://hl7-fhir.github.io/resource.html#maturity
- Any issues/concerns?
- Wed, June 1
- All resource and IG proposals for STU3 have been completed, reviewed by WG and submitted
- Connectathon tracks for Sept have been proposed
- Feedback on gForge submitted to FMG
- Sun, July 17 - Substantive content freeze for ballot -- core resources
- Sun, July 24 - Total content freeze, start of QA
- Wed, Aug 10 (midnight) - All QA changes applied
- Fri, Aug 12 - FHIR ballot opens
- Fri, Sept 12 - FHIR ballot closes
- Fri, Sept 16 - FHIR triage complete and ballot content loaded to gForge (or alternate)
- Sept 17-23 - Baltimore WGM
- Sun, Dec 11
- Reconciliation complete/substantive changes applied?
- Just over 10 weeks
- Will re-evaluate at Baltimore based on volume of ballot comments
- Dec 31 - Publish
- Thurs, May 12 - Q3
- FMM level survey
- One input, but could have other considerations
- Take into account volume of responses
- Prioritized resources -- top 20 -- goal is at least level 3
- Patient
- Observation
- Practitioner
- Medication
- Condition -- owned by Patient Care WG
- Allergy -- owned by Patient Care WG
- Org
- Encounter
- MedOrder
- DiagReport
- Immunization
- MedStatement
- DiagOrder
- MedAdmin
- Bundle
- MedDispense
- CarePlan -- owned by Patient Care WG
- Procedure -- owned by Patient Care WG
- Conformance
- Person
- Timeline
- Work group health
- Mission and Charter updated
- Motion: Michael/Amit Abstain - 0, Negative - 0, Approve - 10
- SWOT needs updated
- Motion: Amit/Katherine Abstain - 0, Negative - 0, Approve - 10
- Mission and Charter updated
- FMM Level Goals
- Resource (current FMM level) Goal
- AllergyIntolerance (1) 3
- procedure (1) 3
- Goal (1) 3
- Careplan (1) 3
- Condition (2) 3
- Careteam (0) 2 or 3
- FamilyMemberHistory (1) 2 or 3
- QuestionnaireResponse (2) 2
- Questionnaire (0) 2
- ClinicalImpression (0) 1 or 2
- ReferralRequest (1) 1
- ProcedureRequest (1) 1
- Linkage (0) 1
- Flag (1) 1
- Communication (1) 1
- CommunicationRequest (1) 1
Monday Q2
- Plenary Session
- - No PCWG meeting
Patient Care Monday Q3
Present:
- This session was hosted by O&O. Please refer to their minutes.
Minutes:
- An order does not represent a fulfillment request. To fulfill you need to post the resource with a tag.
- Alternative is to use an operation or message.
- Or use a Task resource.
- The name order will be changed to request, such as MedicationRequest.
- The term request would also refer to referrals, procedure and appointment.
- Lloyd has displayed a request pattern slide.
- The attribute category represents the different states of a request.
- The request can be nested.
- Also the request have response resource as answer.
- The task resource has been developed.
- Besides that there is also and OrderSet and Protocol resource.
- How to use transaction reversal in combination with task is not yet done.
- Test in Connectathon where a patient with a Iphone was requested to schedule a lab-test and after confirming the plan set out to make a ask for the lab. In the end the physician was instructed by a task to look at the results.
- Discussion on the word or versus request. Some want to word order back again, but this is discussion that has already been dealt with.
- Need for examples of use cases. These seem to have been worked out for certain use cases.
- Discussion whether dosage instructions should be a datatype.
Patient Care Monday Q4
Present:
- This session was hosted by O&O. Please refer to their minutes.
Minutes:
- Continuation of the FHIR workflow discussion.
- Using the requisition-id as the grouper.
- Tasks itself has different states. What is going on with the task? There are separate business logic internal flows ( for example checking the authority of the order requester), the state of the tasks could be on hold.
- The relationship between sub-tasks and supertasks is not been worked out yet.
- Has the sequencing been sorted out. No.
- Can it be integrated with BPMN? Graham doesn’t think so. When you have a high volume process where the steps are well defined BPMN will work, but it does not work with ad-hoc flows.
- There are recommendations on the FHIR wiki when to use each method of workflow:
- A tag is kind of throwing it over the wall.
- There is some resistance from some IT vendors who do not feel comfortable with the idea that orders are not actionable.
- HL7 has the ambition to write implementation guides to give guidelines for implementations.
- The attribute category represents something like “mood” or “stage”.
Patient Care Monday Q5: Placeholder for extra meeting if necessary
Present:
Minutes:
Patient Care WGM, Tuesday, May 10, 2016
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Patient Care Tuesday Q1
Chair: Jay Lyle
Scribe: Emma Jones
Attendees
- Heerman-Langford,Laura (Intermountain)
- Matney, Susan (Intermountain)
- Maclean, Andrea (Infoway)
- Huff, Stan(Intermountain)
- Lyle, Lyle (Contractor)
- Linda Bird (Intermountain)
- Demarmels, Marco (HL7 Switzerland)
- Ryan, Sarah (Eckhorn Int Services)
- Zaidi, Shirin (Gevity Consulting)
- Popit, Amit (Epic)
- Nanjo, Claude (Cognitive)
- Rehwoldt, Greg (Deloitte)
- Allen, Kurt, W (Penrod)
- Esmond, Richard (Pen Rad)
- Newman, Shu-Fang (Univ of Washington)
On phone
- Patrick Langford
- Ken Kawamoto
Minutes: Agenda:
- PSS - investigative action - looking at a project to take existing patient care concepts and represent it in CIMI
- PSS thru DESD (response) -
- need to review dates,
- choice of data, artifacts (need a list),
- draft output patterns - some are in CIMI, others may be needed,
- draft output of the composition - how large will CIMI get? medicalPsychiatric condition will be left out for now. CIMI will need to look at conditions/findings. Aim is to have the composition ready for review Sept 2016
- PSS thru DESD (response) -
- Review of scope (the below are specific to ulcers)
- Skin assessment model
- Braden - note made that Braden Q is proprietary and request compensation to be used (ONC is aware)
- review example ADL
- Need to add FHIR as next phase
- Inheritance Map review
- Discuss the use of evaluation Vs observation
- observation is direct observation. Evaluation involves a thought process - per OpenAir
- the distinction is that the thing is done on a patient vs lab things. With things done on the patient can have measured high and low values rather than normal/abnormal
- Need to consider other types of assessment/examination that might fall under this category - e.g. blood pressure and heart rate. May need to compare that modeling. Modeling was done by CIMI.
- SNOMED bindings came from the nursing group working on this at the time it was CAP
- Need to take into consideration the status
- Stan: Root level bindings and code level bindings - in the end this is what's more useful. the root level binding should be to something that captures all the semantics. The code says what the value means - name value pairs. The semantic of the whole model is defined by those things. To be consistent, the binding for the SBP will be a compositon of these things. Intermountain has made a unique ID of the model and uses it as a concept. Therefore will have the whole thing together with all it parts defined and have it's own semantic meaning.
- Linda: agree with Stan. Will understand the meaning of the model itself and the structure which has its own hiercharchy. Separate to that is the clinical concept that is the focus o fteh information recorded. Stan agrees.
- there are different approaches to terminology bindings.
- Skin assessment panel with all these observations that have the various observations
- Code binding will use LOINC for that is used now.
- complete is static -may need to change if needed
- More discussion as to how to model. the example observation came from the lab
- Model binding for the value for this instance. Note made that the logical models have attributes that are fixed that will not be included in the implementation.
- Discuss the use of evaluation Vs observation
Patient Care Tuesday Q2
Present:
Minutes:
Patient Care Tuesday Q3
Present:
Minutes:
Topics:
- Adverse reactions
- Negation
- Condition status
- Care Plan
- Consolidation of clinical workgroups.
Adverse event resource
- RCRIM: Lise Stevens and Mead Walker, have done preliminary work, based on ICSR v3.
- Issue is the scope of the resource to be usable for other settings.
- This session is a restart of the initiative. Goal for today is get this project restarted.
- Questions:
- ICSR was built for adverse event reporting. What do we want now? Do we want to consider to use it also beyond regulatory reporting.
- After starting with Allergy/Intolerance they quit this approach and started with ICSR reporting that is sent to FDA.
- Nobody opposes to limit the adverse event to substance events
- Question to Lloyd about the FHIR planning and deadlines.
- Need content to be frozen by 15 July.
- PC should give the statement of maturity of the product.
- It will be published by the end of the year.
- Team is now set.
- Explanation of Mead’s concept model.
- Identifier
- Type
- Subject
- Date
- Status
- Outcome
- Description
- Field “ severity” is not available.
- According to Julia, FHIR already has a value set for outcome.
- How should you do the profiling? Excluding attributes and remove them from the profile?
- This model will be discussed in the RCRIM group.
Negation
- What are the thoughts of CQI about negation? The PSS for the negation project is to gather the requirements on the negation. Solutions is not the focus.
- CQI will definitely be involved. What is the direction of PCWG for looking for the solutions.
- In radiology: They have a matrix for each modality to decide what is normal. ( for example the size of the hart). The question is, how to decide what normal is in other context.
- Rob Hausam has a slide presentation to explain.
- Proposal 1
- Align renaming of resources
- AllergyIntolerance substance into AllergyIntolerance code.
- The binding to the value set remains the same.
- Create a new allergy-intolerance-negated-code value set.
- Proposal 2
- Follow the OpenEHR solution. Split it out in 2 separate resources that have only positive statements.
- Discussion whether solution 1 would not lead to 2 profiles.
- This discussion will be continued in Q4.
- Proposal 1
Consolidate workgroups.
- Discussion to group workgroups together because of overlapping topics. This is a topic CVS, CQI are working on, but PC could also consider to be involved.
- CIC might also consider participating to gather some clout.
- Laura remarks that this is a recurring topic that returns every 8 years. In the end the burden of the WG becomes so large, that it would split into smaller groups again.
- External parties have difficulty finding the right WG or the need to address different WG.
- Lloyd suggests that the need to be in touch of the progress is to have a conference call once a month to report what each WG has done.
Patient Care Tuesday Q4
Present: Jay Lyle - Chair, Elaine Ayres - Scribe
Agenda:
- OO: multiple answers to a question in a questionnaire
- Negation
- PSS: asking MnM for participation; CQI & PA had expressed interest. Also need to articulate how to engage with existing design & guidance -- design constraints based on legacy environment are requirements.
- Plan
- Collection of use cases
- Classification of use cases
- Including cases out of scope to clarify boundaries
- Identification of principles
- Identification of what can be provided to design groups / how feedback can be addressed
- Review classification current state; solicit gaps
Minutes:
Patient Care WGM, Wednesday, May 11, 2016
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Patient Care Wednesday Q1
Present:
Minutes:
Patient Care Wednesday Q2
Present:
Minutes:
Patient Care Wednesday Q3
Present:
Minutes:
Patient Care Wednesday Q4
Present:
Minutes:
Patient Care WGM, Thursday, May 12, 2016
- Back to Patient Care
- Back to 2016 PCWG WGM Agenda and Minutes
Patient Care Thursday Q1
Present:
Minutes:
Patient Care Thursday Q2 (PCWG, SDWG, Template Joint meeting)
Present:
Minutes:
Patient Care Thursday Q3
Present:
Minutes:
Patient Care Thursday Q4
Present:
Minutes:
Patient Care WGM, Friday, May 13, 2016
- Back to Patient Care
- Back to 2016 PCWG WGM Agenda and Minutes
Patient Care Friday Q0: PCWG Co-Chairs meeting
NOTE: co-chairs to determine whether this will be moved to Thursday Q-Lunch
Present:
Minutes:
Patient Care Friday Q1
(1) Template WG meeting
- - PCWG representative(s) to attend
(2) Agenda: open
- - Possible: Clinical Connectathon
Present:
Minutes:
Patient Care Friday Q2
Agenda: open
- Possible: Clinical Connectathon
Present:
Minutes:
Patient Care Friday Q3
Agenda: open
- Possible: Clinical Connectathon
Present:
Minutes:
Patient Care Friday Q4
Agenda: open
- Possible: Clinical Connectathon
Present:
Minutes: