2016-10-06 Patient Care FHIR Call
Contents
Meeting Information
Patient Care FHIR Resources Conference Call Location: Conference Call |
Date: 2016-10-06 Time: 5-6:30pm ET | ||
Facilitator | Michelle M Miller | Note taker(s) | Michelle M Miller |
Attendee | Name | Affiliation
| |
X | Elaine Ayres | NIH/Department of Clinical Research Informatics | |
Stephen Chu | |||
X | Eric Haas | Haas Consulting | |
X | Rob Hausam | Hausam Consulting LLC | |
Laura Heermann-Langford | Intermountain Healthcare | ||
Emma Jones | Allscripts | ||
X | Russ Leftwich | InterSystems | |
Tony Little | Optum 360 | ||
Jay Lyle | Ockham Information Services LLC, VA | ||
Sarah Maulden | VA | ||
Hank Mayers | ReliaTech Consulting | ||
Jim McClay | Univ of Nebraska Medical Center | ||
Russell McDonell | Telstra Health | ||
Lloyd McKenzie | Gevity (HL7 Canada) | ||
Larry McKnight | Cerner | ||
X | Michelle M Miller | Cerner | |
X | Lisa Nelson | Life Over Time Solutions | |
Viet Nguyen | Lockheed Martin, Systems Made Simple | ||
M'Lynda Owens | Cognosante | ||
Craig Parker | Intermountain Healthcare | ||
Scott Robertson | Kaiser Permanente | ||
Simon Sum | Academy of Nutrition and Dietetics | ||
Iona Thraen | Dept of Veterans Affairs | ||
Quorum Requirements Met: yes |
Agenda
Agenda Topics
- Agenda review
- Approve previous meeting minutes 2016-09-29_Patient_Care_FHIR_Call
- Motion: Rob/Russ
- Prior Action Item Follow-up
- gForge change request
Supporting Information
STU 3 Timeline
From FHIR_Ballot_Prep
- Sun Oct. 9
- Last date for change requests (subsequent change requests are auto-punted to release 4)
- Sun Oct. 30
- NIBs due for any IGs balloting in the Jan. cycle
- Sun Nov. 20
- All ballot reconciliation complete
- Sun Nov. 27
- All substantive changes applied to Core
- Sun Dec. 4
- Content freeze for ballot & connectathon & publication QA review
- Sun Dec. 24
- QA review complete, Qa changes begin being applied
- Dec 29 - Jan 3ish
- Publish
FHIR Maturity Levels
[1] 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
Resource |
Current FMM Level | Goal FMM Level | QA Status | QA Reviewer | Implementation | Comments |
AllergyIntolerance | 1 | 3 | Michelle | Argonaut | ||
Condition | 2 | 3 | Michelle | Argonaut | ||
Procedure | 1 | 3 | Michelle | Argonaut | ||
CarePlan | 1 | 3 | Michelle | Argonaut | ||
Goal | 1 | 3 | Michelle | |||
QuestionnaireResponse | 2 | 2 | Lloyd | Lloyd will QA to get to level 3 | ||
Questionnaire | 0 | 2 | Lloyd | Lloyd will QA to get to level 3 | ||
CareTeam | 0 | 2 | NA | Michelle | Aggressive goal (e.g. whether we'll get the implementations needed) | |
FamilyMemberHistory | 1 | 2 | NA | NA | Aggressive goal (e.g. whether we'll get the implementations needed) | |
ClinicalImpression | 0 | 1 | NA | NA | ||
ReferralRequest | 1 | 1 | NA | NA | ||
ProcedureRequest | 1 | 1 | NA | NA | ||
Linkage | 0 | 1 | NA | NA | ||
Flag | 1 | 1 | NA | NA | ||
Communication | 1 | 1 | NA | NA | ||
CommunicationRequest | 1 | 1 | NA | NA |
Note: Bold denotes top 20 resource based on survey
Note: Contraindication and Risk Assessment are owned by CDS, not Patient Care
Minutes
Prior Action Item Follow-up
Drafted ClinicalNote_FHIR_Resource_Proposal
http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_id=677&tracker_item_id=8780 resolved as follows:
"If it's unstructured, but of known type (e.g. a text only referral letter or discharge summary or medication list), then the content should go in the narrative of the resource that would be used for the structured data.
If it's unstructured of unknown or potentially mixed, then using either Basic or perhaps Observation might be appropriate. Composition could be ok if the content is considered a document. DocumentReference wouldn't make sense because you're not referencing a document. Binary wouldn't make sense because you can't have narrative and there's no point making the narrative opaque and hard to render."
Recent Zulip chat: https://chat.fhir.org/#narrow/stream/implementers/topic/Physical.20Exam.20.26.20Review.20of.20Systems when Grahame said "the composition could be the entire contents, but then the contents would be just narrative - effectively, a document. The usual pattern would be for the Composition to wrap a resource that actually captures the clinical content"
gForge Change Requests
Block Vote 1
Block Vote 1 was planned for October 6, but attendees hadn't reviewed yet, so the vote is deferred until next week. Please let Michelle Miller know if you would like any items removed for further discussion.
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10310 ClinicalImpression.investigations should be singular(Lloyd McKenzie) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10601 QA1: Update CarePlan scope and usage(Michelle Miller) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10602 QA 1d: Add entered in error to valueset-care-plan-status(Michelle Miller) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10604 QA 1d: Add entered in error to valueset-goal-status.html(Michelle Miller) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10606 QA1: Update Goal scope and usage(Michelle Miller) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10608 QA 2c: CarePlan examples with extensions should use example prefix(Michelle Miller) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10628 QA 5e & 6b: AllergyIntolerance.onset should be mapped to w5 when.init and appear before attestedDate(Michelle Miller) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10629 QA 5e & 6b: Add Procedure w5 mappings and fix order of elements(Michelle Miller) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10630 QA 5e & 6b: Add CarePlan w5 mappings and fix order of elements(Michelle Miller) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10631 QA 5e & 6b: Add Goal w5 mappings and fix order of elements(Michelle Miller) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10698 CarePlan note is no longer applicable as CareTeam is now its own resource(Michelle Miller) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11118 Goal.description should stay textual. - 2016-09 core #272 (Danielle Friend) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11154 AllergyIntolerance.onset and reaction.onset are duplicates - 2016-09 core #308 (Stephen Chu) Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11161 Include Person in the Procedure.subject reference list - 2016-09 core #315 (Stephen Chu) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11172 CarePlan.status needs suspended - 2016-09 core #326 (Stephen Chu) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11174 Will accept the implementation of Goal.milestone as extension - 2016-09 core #328 (Stephen Chu) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11175 Allow other resources to point to Goal - 2016-09 core #329 (Stephen Chu) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11178 ReferralRequest.status missing resume - 2016-09 core #332 (Stephen Chu) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11180 ProducedureRequest.status missing resume - 2016-09 core #334 (Stephen Chu) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11206 entered-in-error is not "inactive" align with Condition - 2016-09 core #360 (Stephen Chu) Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11207 entered-in-error does not implay inactive - 2016-09 core #361 (Stephen Chu) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11231 Expansion for the QuestionaireResponse.status - is there a need for entered-in-error as a status? - 2016-09 core #385 (Riki Merrick) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11333 Clarify what context means - 2016-09 core #491 (David Tao) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11336 Fix care team example - 2016-09 core #494 (David Tao) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11338 Clarify goal outcome - 2016-09 core #496 (David Tao) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11349 Card is 1..1. (required). Suggest making 0..1 - 2016-09 core #507 (Emma Jones) Persuasive
Block Vote 2
Block Vote 2 planned for next week on Thurs, Oct 13. The first 4 were pulled from the Block Vote #1 due to small updates suggested in the resolution.
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11171 Clarify CarePlan.context and CarePlan.duration - 2016-09 core #325 (Stephen Chu) Not Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11177 Change CareTeam definition - 2016-09 core #331 (Stephen Chu) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11337 Clarify order set - 2016-09 core #495 (David Tao) Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11345 Add CarePlan.activity.detail.prohibited.reason - 2016-09 core #503 (Emma Jones) Not Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=7045 2015May core #110 - Allow the protocol data element to be multi-typed as either text or uri. (Andy Bond) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10403 add condition.onsetDateTime (Marten Smits) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10429 QuestionnaireResponse.questionnaire should be URI (Lloyd McKenzie) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10634 QA 5a: Resource references exist in both directions for CarePlan and ReferralRequest (Michelle Miller) Not Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10723 Add a search parameter for status for the ProcedureRequest resource (Emmanuel Helm) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10755 Questionnaire item required when enabled (Sean McIlvenna) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11001 enableWhen.hasAnswer -> enableWhen.answerEnabled - 2016-09 sdc #67 (Stephen Chu) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11002 item.maxLength -> item.answerMaxLength - 2016-09 sdc #68 (Stephen Chu) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11003 item.initial -> item.prePopInfo - 2016-09 sdc #69 (Stephen Chu) Not Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11004 What's the difference between Questionnaire.subjectType and QuestionnaireResponse.subject? - 2016-09 sdc #70 (Stephen Chu) Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11005 Questionnaire.useContext sounds too much like QuestionnaireResponse.context - 2016-09 sdc #71 (Stephen Chu) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11165 Reword short description for ClinicalImpression.code - 2016-09 core #319 (Stephen Chu) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11166 The goal to use as short as possible concept name should not be at the expense of semantic accuracy - 2016-09 core #320 (Stephen Chu) Not Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11167 ClinicalImpression shouldn't include plan - 2016-09 core #321 (Stephen Chu) Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11202 Flag information should support machine processing and human readability - 2016-09 core #356 (Stephen Chu) Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11203 Add invariant to ensure Flag.duration and Flag.encounter align - 2016-09 core #357 (Stephen Chu) Not Persuasive with Mod
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11204 Suggest rename to "Alert and Warming" - 2016-09 core #358 (Stephen Chu) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11380 Communication basedOn(any) seems too broad - shouldn't it be limited to CommunicationRequest? - 2016-09 core #538 (Paul Knapp) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11923 Required value set is missing "entered-in-error" concept - 2016-09 daf #7 (Calvin Beebe) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12071 Need to differentiate when to use each nesting approach for item (Lloyd McKenzie) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12168 Future observations need to be included in goals (Floyd Eisenberg) Not Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12169 Expand the scope of the entryFormat Questionnaire extension (Michele Mottini) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12171 careplan.activity.detail.prohibited description "Do NOT do" is misleading and confusing (Emma Jones) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12172 The spec use Questionnaire in many places where they should use QuestionnaireResponse (Michele Mottini) Persuasive
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12188 Add search parameters to ProcedureRequest (Elliot Silver) Persuasive
In Person
In Person Requests:
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11354 Substance identified in both AllergyIntolerance.code and reaction.substance is problematic - 2016-09 core #512 - Robert McClure - Oct 20
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12136 Searching on optional attribute is dangerous (e.g., allergyintolerance.category)- Mark Kramer - TBD
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11281 Overall Condition.clinicalStatus and Condition.verificationStatus Condition body site - 2016-09 core #435 - Clem McDonald - TBD
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11290 clinical impression and condition - 2016-09 core #444 - Clem McDonald - TBD
Discussion
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10662 Clarify how medical history should be handled - Lisa, Rob, Russ, and Eric will provide examples to vet against our thinking noted in the gForge comments
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11116 Better define the careplan.activity.outcome field - Michelle to follow up with Laura/Emma to understand context of why it was added with http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10027
- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10642 QA 5c: Default value needed for AllergyIntolerance.status since minOccurs=0 and is-modifier element - started the discussion, but need to consult Workflow to ask to handle statuses like Condition does
Adjourn
Adjourned at 6:45PM Eastern
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