2010-02-11 Call Minutes

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HL7 Ambulatory Oncology Functional Profile Meeting

Meeting Logistics

Date/Time: Thursday, February 11, 2010 / 1:00 PM – 3:00 PM EST

Location: Telecon 866 564 2805 x9306830#

Attendees

• Helen Stevens (co-chair)
• Carla Wood (co-chair)
• Dr. Marla Hawkins, MD (Pediatric Oncologist)
• Christine Vester (NCI clinical analyst)
• John Ritter (coChair HL7 EHR Workgroup)
• Dr. John Ellerton (Medical Oncologist, Nevada CCOP)
• Dr. Kevin Hughes (Surgical Oncologist)
• Andrew Johnson (IKnowMed)
• Dr. Peter Harrison (IKnowMed)

Minutes

1. Welcome and Introductions
2. Agenda review and approval
3. Modular EHR Discussion
   • Refer to article provided by Dr. Kevin Hughes (DrohanHughes2009BreastModularEHR.pdf)
     • Kevin Hughes, MD and Carla Wood review the article “Electronic health Records and the Management of Women at High Risk of Hereditary Breast and Ovarian Cancer”. Discussion of knowledge bases, clinical decision support, modular (feeding of other software and modular).
     • Dr. Hughes asks committee to consider building to allow all software to communicate to one another. He has been working on a pedigree system. The specialty software houses the science, the knowledge-base and improves in their own Product Development model. By improving their software, all products to which it is attached or a modular piece, would be improved.
     • How do we motivate the specialists software to interface with EMRs? What is the business proposition to allow them to fund product development. Rumor is CCHIT will certify modular components at some point. It would be an important step to have the certification bodies address this important point.
     • ACTION: Helen will discuss the DrohanHughes2009BreastModularEHR.pdf with the caEHR project team at the NCI and provide comment back to the team on how this relates to the NCI architectural plans.
     • ACTION: Dr. Hughes will draft some language about interoperability with the HL7 Genomics standards that can be incorporated into the Patient History section of the functional profile.
4. Document Review Session
   1. FP Overview Document - Types of oncology discussion
      • The following comments were received from Dr. Hughes and margorie Van Der Pas:
        • Surgical Oncology Definition- provided by Dr. Hughes

          The Surgeon and/or the Surgical Oncologist is one of the 3 major specialists involved in the treatment of cancer. The surgeon is involved in the identification of high risk individuals, and the screening, prevention, diagnosis and treatment of cancer.

          The surgeon is involved in determining the appropriate cancer screenings that should be undertaken, and is often responsible for ordering or doing screening procedures (e.g., colonoscopy)

          The surgeon sees patients with issues that may be cancer and is involved in undertaking invasive and non-invasive approaches to determining benign vs malignant.

          The surgeon is involved in prophylactic surgery (Removing organs to prevent cancer) and is involved in prescribing chemopreventive medications. This requires the identification and quantification of risk (eg, risk models and genetic testing) and the determination of what prophylactic or chemopreventive interventions may be of use.

          The surgeon is involved in the surgical management of cancer, and does this in coordination with other members of the team.

        • Radiation Oncologist Definition- provided by Margorie Van Der Pas

          A physician who specializes in the use of radiation to treat cancer.

          The Radiation Oncologist uses a Radiation Oncology specific EHR (RO EHR). The RO EHR communicates with Treatment Planning Systems, Treatment Management Systems, Treatment Delivery Systems and image viewing systems.

          The RO EHR controls, verifies, and records all aspects of each individual radiation treatment.

      • How do we want to represent the definition of this in our overview document? In the TOC section, shall we add a section to insert language about the scope of this profile and oncology? We include medical oncology. Are we including surgical and radiology oncology? Shall we define the scope for these? Pediatric oncology is included, but there is a pediatric oncology aspect to each medical, surgical, radiology. Also consider gynecological oncology, as a part of the three broad categories.
      • John Ritter asks about the purpose of the introduction. It would be helpful for those readers who are not oncologists. The goal should be that the reader knows how to use this functional profile, as part of a whole solution. Helen describes the reader likely would be a technical person.
      • Helen would like an additional section to speak to not just the topics and roles of the document (pediatric crossed surgical, medical, and radiology).
      • ACTION Marla will write some specifics around pediatric oncology, items that are unique to pediatrics or how the scope of practice is defined. Take into consideration any adjustment any change we need to make to the profile.
      • Helen asks if there are any specifics that should be written regarding geriatric oncology.
      • ACTION Christine to develop scope/introductory language on Geriatric Oncology with Dr. John.
   2. FP Overview Document - 1.5.1 Glossary
      • FP Section 1.5.1 Glossary
      • Two definitions will be added to the Glossary (section 1.51). The definitions are: algorithms (link to the Duke website) after discussion to better describe as medical algorithms including Christine’s submission. Additionally, “Lifetime Cumulative Dose” will be reviewed and potentially added. A definition for “Cumulative Dose” was discussed and put forward. “Patient Care Coordinator” was added. Refer to attached document for all revisions.
      • Helen reports the yellow highlighted definitions were taken from clinical research profile. We can add to the Glossary as needed in the development process of the document.
      • ACTION All team members to review glossary and submit changes/comments for next call.
   3. FP Overview Document - 2.1 Storyboard Care of Oncology Patient - FP Section 2.1 Storyboard
      • Comments received from Dr. Kevin Hughes, Marjorie Van Der Pas and caEHR Domain Team
      • Helen reviews use case one paragraph at a time with the group approved each or edited as necessary.
      • Marla will add a point regarding some information is not appropriate to go to a health information record and the timing of information that is passed to the patient.
      • ACTION Christine will add “Nurse Navigator” to the glossary as it compares to “Care Coordinator”.
      • ACTION Marla to provide Helen to generic drug names so we don’t use brand names in the use case.
      • Refer to attached file for current state and outstanding revisions.
   4. FP Overview Document - other comments
      • Not discussed due to lack of time.
5. Decision on document review for next 2 weeks.
   • Last two paragraphs of the Storyboard: File
   • Glossary definitions: File
   • Direct Care Sections 1.0 to 1.5 inclusive. DC1 File

     Note: Helen will post updated DC Section to the Wiki by end of day Friday, 2/12/2010. Helen has made some updates based on her ongoing incorporation of appropriate sections from the proposed HL7 FM Release 2 up to section DC.1.2.

6. Other business
   • none raised
7. Meeting adjourned.
   • 3pm EST.