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2016-01-28 Patient Care FHIR Call

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Meeting Information

Patient Care FHIR Resources Conference Call

Location: Conference Call
Phone Number: +1 770-657-9270
Participant Passcode: 943377
Live Meeting:

Date: 2016-01-28
Time: 5-6:30pm ET
Facilitator Michelle M Miller Note taker(s) Michelle M Miller
Attendee Name Affiliation

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
X Emma Jones Allscripts
Russ Leftwich InterSystems
Jay Lyle Ockham Information Services LLC, VA
Sarah Maulden VA
Jim McClay Univ of Nebraska Medical Center
X Russell McDonell Telstra Health
X Lloyd McKenzie Gevity (HL7 Canada)
Larry McKnight Cerner
X Michelle M Miller Cerner
Lisa Nelson Life Over Time Solutions
Viet Nguyen Systems Made Simple
X M'Lynda Owens
Craig Parker Intermountain Healthcare
Scott Robertson Kaiser Permanente
X Simon Sum Academy of Nutrition and Dietetics
Iona Thraen Dept of Veterans Affairs
X Margaret Dittloff
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes: 2016-01-21_Patient_Care_FHIR_Call
    • Motion: Rob/LLoyd Abstain - 0, Negative - 0, Approve - 5
  3. FHIR Maturity Model Level
  4. Block Vote
  5. Prior Action Item Follow-up
    • annotation/note element name
    • new note resource
    • new care team resource
    • negation next steps
  6. gForge change requests

Supporting Information

FHIR Resources owned by Patient Care
Maturity levels [1]

  • Questionnaire (2) -- Lloyd will QA to get to 3
  • Questionnaire Response (2) -- Lloyd will QA to get to 3
  • Condition (2)
  • AllergyIntolerance (1) -- Rob
  • Procedure (1)

Connectathon candidates

  • CarePlan (1)
  • Goal (1)
  • Referral Request (1)
  • FamilyMemberHistory (1)

Lower priority resources

  • Procedure Request (1)
  • Flag (1)
  • ClinicalImpression (0) -- goal to move to level 1 by next release
  • Communication (1)
  • CommunicationRequest (1)

Note: Contraindication and Risk Assessment are owned by CDS, not Patient Care


Block Vote


  • Elliot Silver
  • Eric van der Zwan
  • Jesper Haffgaard
  • Lloyd McKenzie
  • Michele Mottini
  • Michelle Miller
  • Riki Merrick
  • Russell McDonell
  • Sean Moore

Line Items

  • 9174 QuestionnaireResponse 'subject' search parameter reference types (Michele Mottini) Considered - Question Answered
  • 9210 Include Dental Procedures in Procedure.Category (Sean Moore) Not Persuasive
  • 8646 Change allergy criticality codes to FHIR-defined (Lloyd McKenzie) Persuasive
  • 8791 AllergyIntolerance note cardinality (Michelle Miller) Persuasive
  • 8984 Add category to search criteria for Procedure (Elliot Silver) Persuasive
  • 9192 Questionnaire item type resource with a profile? (Eric van der Zwan) Persuasive
  • 8604 FamilyMemberHistory needs explanation of how to record Patient's own history (Russell McDonell) Persuasive with Mod
  • 8962 update the definition for FamilyMemberHistory.status (Riki Merrick) Persuasive with Mod
  • 8963 add description how to capture statement about How many siblings, how many male siblings with condition X? (Riki Merrick) Persuasive with Mod

Pulled from block vote

  • 9207 FamilyMedicalHistory does not sufficiently meet adoptive relations (Sean Moore) Not Persuasive
  • 8931 Need a way to capture ruled out diagnoses (Lloyd McKenzie) Persuasive
  • 8940 Goals also needs CodeableConcept as description (Jesper Haffgaard) Persuasive with Mod

Motion to approve block vote: Lloyd/Russell, abstain-1, negative-0, approval-5

Prior Action Item Follow-up

Annotation/Note element name: Michelle logged gForge 9384 for MnM to update build tool validation by renaming note element to annotation to avoid confusion with other standalone clinical notes

New Clinical Note Resource: Grahame joined Patient Care FHIR conference call to continue listserv discussion related to 9304, which was a request for a new clinical note resource

  • Composition -- package related to workflow -- set of sections with supporting data/content
  • Clinical Impression (formally known as Clinical Assessment) -- note that only contains text (could be wrapped into composition) -- scope and usage says "Some clinical assessments simply result in an impression recorded as a single text note in the patient 'record' (e.g. "Progress satisfactory, continue with treatment")..."
  • IF PatientCare proceeds with a new resource for Clinical Note, then there needs to be a clear boundary between ClinicalImpression, Observation, and the new ClinicalNote resource

New CareTeam Resource: PA/PC joint discussion led to a proposal to pull out Care Team into its own resource, per gForge 9261. A new resource proposal is drafted CareTeam_FHIR_Resource_Proposal, but some listserv discussion about whether to use Group instead

  • Purpose of Group is underspecified -- some think the data elements look similar, so reuse/profile it -- Lloyd expects Group is useful for research and public health where we want to treat a collection of people/animals (herd, cage, pond) -- actions are taken on the Group, but Groups don't do things, nor do they have legal responsibilities
  • CareTeam (as a whole) is not expected to be an actor. Rather, the individuals within the care team are the actors.
  • CareTeam is more about relationships -- not something to be acted upon
  • More FMG discussion next week

gForge Change Requests

gForge 8931


Adjourned at 6:30 pm Eastern.

Meeting Outcomes

  • Michelle will solicit input from Argonaut to see which vendors have implemented resources (and tested, but not necessarily in prod): Allergy, Procedure, Family History, CarePlan, and Goal most likely
  • Lloyd will check with genomics about testing FamilyMemberHistory at Connectathon
  • Lloyd will check with Keith about testing a workflow scenario with CarePlan, Referral, and Goal
  • Michelle will send QA spreadsheet and Wiki to listserv with list of resources that are candidates for maturity level 3
  • Michelle will update block vote gForge items
  • Update from Rob/Jay on whether to schedule dedicated call for negation
  • Define boundaries between ClinicalImpression, Observation, and a new ClinicalNote resource
Next Meeting/Preliminary Agenda Items
  1. Agenda review
  2. Approve previous meeting minutes
    • Motion: <moved>/<seconded> Abstain - <#>, Negative - <#>, Approve - <#>
  3. gForge change request

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