2011-01-11 PA WGM Minutes

Patient Administration Meeting - Tuesday January 11, 2011

Tuesday Q1

HL7 Patient Administration Meeting Minutes Location: Room 2.08		Date: 2011-01-11 Time: Tuesday Q2
Facilitator	Irma Jongeneel	Note taker	Alex de Leon
Attendee	Name	Affiliation
.	Irma Jongeneel	NICTIZ
.	Alex de Leon	Kaiser Permanente
.	Beat Heggli	HL7 Switzerland
.	Rene Spronk	HL7 Netherlands
.	.	.
.	.	.
.	.	.
Quorum Requirements Met (Chair + 2 members): <Yes/No>

Agenda

Agenda Topics

1. V3 Work - Encounter ballot preparation

Supporting Documents

• Patient Encounter project Wiki

Minutes

Minutes/Conclusions Reached:

The WG met to review and prepare for joint meeting with Patient Care. The goal here would be to harmonize the encounter and care provision models. In vocal encounter is a specialization of Care Provision, however the patient Care models shows different types of act relationships between the two and different participations as well. Fundamentally we need to discuss with PC if we are really representing two aspects of the same concept, since an administrative view of provided care should not be really different from a clinical view, although different coding systems might be used.

Two issues quickly became apparent during this discussion:

1. The relationship between the patient care provision Act and the encounter Act needs clarification. Are they hierarchical?
2. Should they not have the same participations? What is the meaning of the concepts of “component” and “reference”, given the ambiguity of the relationships?

The WG discussed the three PC/PA harmonization issues presented by Rene which were brought forth as a result of his work with Norway which identified issues due to the lack of harmonization of the PA Encounter and Patient Care models.

Use of Author/Performer/Responsible

The WG discussed the proposed changes:

1. Add the Responsible participation to the CareProvision Act in the Patient Care D-MIM. This to a) align it with the encounter model, b) to align it with the clinical statement pattern, and c) to allow one to identify some party that is legally responsible but otherwise not involved.

2. When it comes to Author: looking at the D-MIMs this seems to play a key role in moods other than EVN, notably in INT mood. The Patient Care D-MIM explicitely documents this; the Scheduling domain (which can be used to schedule encounters, or to schedule care provisions) contains Author and Performer. The moodCode in the Patient Administration D-MIM isn't fixed, as such an Author participation should be added to the Patient Administration D-MIM.

• Requires discussion: both domains may wish to constrain it out in EVN-mood based R-MIMs - a common policy should be defined by both WGs when Author should be constrained out of R-MIMs.
• Needs discussion within PA, probably to distinguish between the Author and the (encounter specific participations) Attender or Admitter.

3. Performer: the fact that one is allowed to use this in an appointment, but not in the actual encounter which is a result from that appointment points out that there is an inconsistency in the Patient Administration domain.

• Needs discussion within PA, probably to distinguish between the Performer and the (encounter specific participations) Attender or Admitter.

Action item: The WG needs to investigate the definitions of Author and Admitter within the RIM. The WG feels that if they are the same, we should change to Admitter, which is better undestood.

The first sub bullet of #2 – If this WG decides that decides that the author is the same as admitter then both domains . If PA decides that they are not the same, then this question should not come up.

The WG needs to investigate the definitions of performer and Attending within the RIM. The WG feels that if they are the same, we should change to Attending which is better undestood.

'Encounter Context' CMET defined by PatientCare

Model has an entry point into an organizational encounter, with a care event CMET. The CMET may have different participations than the current encounter. The link to the CMET, is to say that this encounter is part of this care provision (defined in CMET).

For Norway, Rene explained that the CMET here, is more like an “identified” rather than a “universal”. Since this has less detail, it was less useful for their needs. What Norway was trying to do, is to do a query… give me all encounters related to this concern. This prompted a discussion around the hierarchy from concern.

Rene is proposing the modification of the CMET by patient care to for the proper identification of the context of an encounter, especially having to do with participations. This CMET should be a more constraint from the universal CMET, however, more work would have to be done to define the details of this CMET.

Add Reason to CareProvision D-MIM

The reason act relationship (in general) is used to show the reason or rational for a service. The focal act in most D-MIMs has a reason relationship. The Patient Administration domain contains a reason-for-Encounter; the Patient Care domain doesn't contain a reason-for-CareProvision Proposed change:

• add reason to the CareProvision D-MIM.
• Alternatives considered/rejected: the clinical statement pattern could be used to model 'the reason for an Act X' (inclusive of that Act X itself). This set of objects in turn is associated with the CareProvision through act relationships - this is however not the same semantic concept as the "reason for CareProvision".

Patient care issue: WG would like clarification for Act Relationship between encounter and care provision.

The WG then revisited the feature request #1744 Find encounter query response changes, specifically for the procedure portion. This will need to be co-coordinated with Patient Care, since we are proposing the use of procedure within an administrative context. The WG may consider in a later meeting (e.g. Orlando).

The WG would suggest that a motion be put on the table that PA’s DMIM, be derived from Patient Care’s clinical DMIMs where this information is being used in an administrative setting.

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

Tuesday Q2

HL7 Patient Administration Meeting Minutes Location: Room 2.08		Date: 2011-01-11 Time: Tuesday Q2
Facilitator	Irma Jongeneel	Note taker	Alex de Leon
Attendee	Name	Affiliation
.	Irma Jongeneel	NICTIZ
.	Alex de Leon	Kaiser Permanente
.	Sasha Bojicic	Canada Infoway
.	Beat Heggli	HL7 Switzerland
.	Rene Spronk	HL7 Netherlands
.	.	.
.	.	.
.	.	.
Quorum Requirements Met (Chair + 2 members): <Yes/No>

Agenda

Agenda Topics

1. V3 Work - Encounter ballot preparation

Supporting Documents

• Patient Encounter project Wiki

Minutes

Minutes/Conclusions Reached:

1. Joint meeting with Patient Care WG. Please see the minutes there for details.

Meeting Outcomes

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

Next Meeting/Preliminary Agenda Items .

Tuesday Q3

HL7 Patient Administration Meeting Minutes Location: Room 2.08		Date: 2011-01-11 Time: Tuesday Q3
Facilitator	Irma Jongeneel	Note taker	Alex de Leon
Attendee	Name	Affiliation
.	Irma Jongeneel	NICTIZ
.	Alex de Leon	Kaiser Permanente
.	.	.
.	.	.
.	.	.
Quorum Requirements Met (Chair + 2 members): <Yes/No>

Agenda

Agenda Topics

1. V2.8 Proposals

Supporting Documents

• HL7 V2.x Proposals Database

Minutes

Minutes/Conclusions Reached:

WG reviewed the 2.8 proposals. The three for 2.8 are: 618, 622, 673

618 and 622 were addressed in previous working group meetings.

673 proposed the addition of 2 segments from chapter 11 (Patient Referral) – RF1 and AUT to the following message constructs: A01, A04, A08, A13 to communicate known authorizations and referrals with these ADT transactions.

After reviewing the proposal, the WG reviewed the descriptions of the two segments

RF1 - This segment represents information that may be useful when sending referrals from the referring provider to the referred-to provider.

AUT - segment represents an authorization or a pre-authorization for a referred procedure or requested service by the payor covering the patient's health care.

The WG suggests that the submitter bring this to the custodian for the Financial Management Chapter (6) for possible inclusing within authorization contstructs defined there. If it is felt that it is not within the domain of financial management, then the WG suggests that the submitter first approach the Patient Referral custodians (Patient Care), for inclusion of the proposed fields to segements RF1 and AUT before PA considers including these into the aforementioned ADT events.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Alex owns the action to inform the submitter of proposal 673 that his proposal has been reviewed, the status and WG suggestions.

Next Meeting/Preliminary Agenda Items .

Tuesday Q4

HL7 Patient Administration Meeting Minutes Location: Room 2.08		Date: 2011-01-11 Time: Tuesday Q4
Facilitator	Irma Jongeneel	Note taker	Alex de Leon
Attendee	Name	Affiliation
.	Irma Jongeneel	NICTIZ
.	Alex de Leon	Kaiser Permanente
.	Corinne Gower	HL7 New Zealand
.	.	.
.	.	.
.	.	.
Quorum Requirements Met (Chair + 2 members): <Yes/No>

Agenda

Agenda Topics

1. V3 Work - Scheduling

Supporting Documents

Minutes

Minutes/Conclusions Reached:

The WG reviewed the Scheduling DMIM .

One thing that came up is the participations which needs to be harmonized within scheduling as it does for encounters and care event.

Do we have storyboards for inpatient encounter?

The interaction Appointment Reschedule Notification (PRSC_IN020201UV01) is in the interaction diagram but not included in the interaction list following the diagram. Yet, it is available in the storyboard.2.1.1.2

The WG reviewed the known issues and planned changes. In review of the RMIM – two potential issues came up.

Issue 1– one appointment should reference one schedule, however one schedule should reference many appointments. Issue 2 – if we have managed participations for performer and maybe other resources, should they not be referencing a schedule?

The WG also noted that the participations for scheduling also need to stay in line with harmonization efforts being done between PA and Patient Care.

It should be kept in mind that the Scheduling topic provides a generic model or framework for the activity of scheduling, however the specific scheduling of resources should be defined and published by the WG for that particular domain.

In looking at the ambulatory encounter appointment, it was noted that the encounter appointment models do not fit within the scheduling framework. It seems that the scheduling framework is not being used in the various domains when appointments are being made within that domain.

The WG would like to explore what kind of scheduling implementations currently exist for V3.

In searching for listservs, it was discovered that there are 2 listservs within the older Lyris listserve interface, only one of which is available through the “managed listserve subscription” within My Listerv.

This was discovered while searching for an active scheduling listserv to request information on current implementations of v3 scheduling, including the type of ACTs for which scheduling constructs have been used… for instance, encounters, procedures, etc.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Irma to get information from Tom regarding whether the managed participations should be linked to schedules.

Next Meeting/Preliminary Agenda Items Wednesday Q1, Patient Administration V2.8 Proposals

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