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2016-02-04 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: 2016-02-04
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
X Jean Bouche
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
X 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)
X Larry McKnight Cerner
X Michelle M Miller Cerner
X Sean Moore Epic
Lisa Nelson Life Over Time Solutions
Viet Nguyen Systems Made Simple
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 Topics

  1. Agenda review
  2. Approve previous meeting minutes: 2016-01-28_Patient_Care_FHIR_Call
    • Motion: Jay/Lloyd Abstain - 1, Negative - 0, Approve - 5
  3. Prior Action Item Follow-up
  4. gForge change request

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


Prior Action Item Follow-up

  • Michelle solicited input from [2] to see which vendors have implemented resources (and tested, but not necessarily in prod).
    • AllergyIntolerance has been implemented by Cerner, Dentrix, and xG. Procedure is on a future sprint for Argonaut
    • RelayHealth -- AllergyIntolerance, Procedure and FMH
    • Epic -- AllergyIntolerance, FamilyMemberHistory (used with SMART on FHIR growth chart)
  • Michelle solicited volunteers to help with QA checklist via | Patient Care listserv
  • Michelle updated last week's block vote gForge items
  • MnM feedback on [3] Will seek feedback from impacted work groups. Concern it's of marginal benefit, so look to see what implementers think. However, if we're going to change, now is the time to do it. OO voted and did not find the change request persuasive.
  • Lloyd checked with genomics about testing FamilyMemberHistory at Connectathon - waiting on their feedback
  • Lloyd checked with Keith about testing a workflow scenario with CarePlan, Referral, and Goal - waiting on Keith's feedback
  • Negation PSS has been drafted.

Define boundaries between ClinicalImpression, Observation, and a new ClinicalNote resource

  • Possible boundaries could be differentiating between Clinical Notes (condition oriented) vs Non-Clinical Notes (e.g. notes about administration, not care itself -- clinicians communicating about the patient; not necessarily about a condition; example might be transportation), but most systems use the same workflow/user interface for both clinical and non-clinical content; may need to consider changing the name (and/or definition) to clarify not all content is clinical.
  • ClinicalImpression may need to have an element for the subjective textual content
  • Would note be a profile on other resources, like composition? Composition references content, but composition could have section with text.
  • ClinicalImpression has optional action and plan, that is what makes it distinct -- about a problem with corresponding finding/action/plan. Impression (not plan) is the focal point of the ClinicalImpression.
  • A note could have one or more clinical impressions.
  • Could the boundary be whether or not it is part of the medical record? Most things ARE part of the medical record. (e.g. contact another provider when patient hits a given milestones)
  • ClinicalImpression brings together other resources (like a care plan not encoded yet; informal observations; narrative on condition evolution). Could be narrative only that eventually could get encoded and represented more structurally as a traditional clinical impression.
  • Still struggling with whether ClinicalImpression is part of one to many note(s). Need to consider what systems do today.
    • Some systems can only handle narrative blob of text -- stored as narrative blob
    • Some systems do everything in a structured format -- view generated with composite content
    • Everything in between: starts structured, persisted as text OR starts narrative and NLP structures it
    • Conclusion: use a single resource, but which one?
      • Composition is intended for creation of full blown clinical documents (referral letter, discharge letter, patient summary). Could treat a CarePlan as a document-ish thing, but still opt for CarePlan resource (collection of goals, care team, etc). Document is a way of organizing information, but not the information itself. A daily progress note (with SOAP or ISBAR components) is not exchanged, but not really in scope of documents. A discharge summary doesn't need to be a document/composition, all components within it lives elsewhere with encounter as the root. For care plan document, root is care plan. For SOAP or clinical note, the root is what? Composition resource doesn't nest content. Sections can have sub-sections. Content is only at leaf level about how human will read it.
      • Observation has a code and value, but isn't as intuitive for storing narrative blob. What is code? Type of note? Title is the Observation.code.text. Need to define boundary between clinical impression/note and observation
      • Suggestion: Changing the scope and name of ClinicalImpression and adding support for subjective element. Clinical Impression depends on inputs (other resources) -- and will put into narrative if not present. Belief that the ClinicalImpression is part of a note, it is focused, making a statement about a problem or condition.

gForge Change Requests


Adjourned at 06:38 PM Eastern.

Meeting Outcomes

  • Update from Rob/Jay on whether to schedule dedicated call for negation
  • Larry (and others) draft boundaries between clinical impression and clinical note, so we can test whether systems make the same distinction or not.
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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