2015-10-15 Patient Care FHIR Call
Contents
Meeting Information
| Patient Care FHIR Resources Conference Call Location: Conference Call |
Date: 2015-10-15 Time: 5-6:30pm ET | ||
| Facilitator | Michelle M Miller | Note taker(s) | Michelle M Miller |
| Attendee | Name | Affiliation
| |
| X | Michelle M Miller | Cerner | |
| X | Elaine Ayres | NIH/Department of Clinical Research Informatics | |
| X | Stephen Chu | Queensland Health | |
| X | Rob Hausam | Hausam Consulting LLC | |
| . | Laura Heermann-Langford | Intermountain Healthcare | |
| X | Craig Parker | Intermountain Healthcare | |
| X | Emma Jones | Allscripts | |
| X | Russ Leftwich | InterSystems | |
| X | Russell McDonell | Telstra Health | |
| X | Viet Nguyen | Systems Made Simple | |
| X | Larry McKnight | Cerner | |
| X | Lisa Nelson | Life Over Time Solutions | |
| X | Lloyd McKenzie | ||
| X | Iona Thraen | ||
| X | Eric Haas | ||
| Quorum Requirements Met: yes | |||
Agenda
Agenda Topics
- Agenda review
- Approve previous meeting minutes Patient Care FHIR Minutes 2015-9-10
- Motion: Elaine/Emma Abstain - 3, Negative - 0, Approve - 7
- Review DSTU 2.1 timeline and frozen resources
- Recap Clinicians on FHIR
- Negation
- Adverse Events - new resource?
- Protocol - new resource?
- gForge change request
Supporting Information
DSTU 2.1 Timeline
FHIR Resources owned by Patient Care
- AllergyIntolerance (1) -- frozen
- Condition (1)
- Procedure (1) -- frozen
- CarePlan (1)
- Goal (1)
- Referral Request (1)
- Questionnaire (1)
- Questionnaire Answer (1)
- FamilyMemberHistory (2) genomics / Jonathan Holt – Vanderbilt - interested in contributing to this resource.
- Procedure Request (2)
- Flag (2)
- ClinicalImpression (3)
- Communication (3)
- CommunicationRequest (3)
Note: Contraindication and Risk Assessment are owned by CDS, not Patient Care
Note: Substantive changes to frozen resources in DSTU2.1 are prohibited unless FMG explicitly approves the substantive change
Minutes
Review DSTU 2.1 timeline and frozen resources
AllergyIntolerance and Procedure are frozen
Condition is not frozen (need to resolve what was formally known as negation)
Recap Clinicians on FHIR
Viet/Stephen's table was focused on family medical history. Good level of consistency. Created patient in advance. Didn't test extension for condition or parent/child. Stephen said that the negative family history wasn't well tested.
Russ's table tested MedicationOrder resource, which can contain a Medication resource, but didn't get to AllergyIntolerance. Found and reported glitches in the tool around timing. Went well. The Medication value set had substances, but not products. If a medication was ordered for a problem on the problem list (e.g. cough), but then the condition changes to something else (e.g. anxiety). Need to reference a "static" version of the condition that was relevant at the time of order.
Emma's table tested Procedure and CarePlan. A few tooling issues (saving to local cache instead of a server). Discussion about how FHIR handles protocols or standing orders.
Negation discussion on Friday. Ideas documented October_2015_WGM_Atlanta:_Oct_4_to_Oct_9#Patient_Care_Friday_Q3. If trying to make a statement "I didn't observe condition" -- discussion about whether to use lists, status, or value on Condition to convey this. Subtle differences between 'never existed' versus 'doesn't exist at this point in time' -- could be represented as an observation since it is a point in time assertion and could change in time.
Look for existing SNOMED codes (e.g. No Known Allergies, No Known Problems) to prevent double negatives. Ongoing discussions about how much should be handled via terminology.
Stephen is working on a negation wiki, which could get renamed: Representing_Negation. Structured Doc, OO, Pharmacy, Genomics, CDS are all interested in participating. Depending on how much FHIR DSTU 2.1 volume there is, then this topic will be discussed next Thurs, Oct 22 (and Tues, Oct 27 if needed).
Negation lessons from CDA:
- Given that the structure of observation has both a code and value, negation needs to convey whether negating code or value?
- Need to negate all act classes with same approach (it was a mistake not to think through supply or encounter)
Lessons Learned:
- Participants from multiple working groups (genomics, pharmacy, patient care) helped go deeper and answer questions. Having other working group participants was worthwhile.
- Prep to build underlying resources (e.g. Patient)
- Helpful to have a technical person at the table to navigate resources.
Negation
Adverse Events - new resource?
Protocol - new resource?
gForge Change Requests
Adjourn
Adjourned at <hh:mm am/pm> <timezone>.
Meeting Outcomes
Actions
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Next Meeting/Preliminary Agenda Items
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