2016-02-04 Patient Care FHIR Call
|Patient Care FHIR Resources Conference Call
Location: Conference Call
Time: 5-6:30pm ET
|Facilitator||Michelle M Miller||Note taker(s)||Michelle M Miller|
|Elaine Ayres||NIH/Department of Clinical Research Informatics|
|X||Eric Haas||Haas Consulting|
|X||Rob Hausam||Hausam Consulting LLC|
|Laura Heermann-Langford||Intermountain Healthcare|
|X||Jay Lyle||Ockham Information Services LLC, VA|
|Jim McClay||Univ of Nebraska Medical Center|
|X||Russell McDonell||Telstra Health|
|X||Lloyd McKenzie||Gevity (HL7 Canada)|
|X||Michelle M Miller||Cerner|
|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 review
- Approve previous meeting minutes: 2016-01-28_Patient_Care_FHIR_Call
- Motion: Jay/Lloyd Abstain - 1, Negative - 0, Approve - 5
- Prior Action Item Follow-up
- gForge change request
FHIR Resources owned by Patient Care
Maturity levels 
- 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)
- 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  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  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.
|Next Meeting/Preliminary Agenda Items|
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