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2016-02-18 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: https://www147.livemeeting.com/cc/_XML/cerner/join?id=8FNF2S&role=attend&pw=m9Kd%7Cx9

Date: 2016-02-18
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 Stephen Chu
X Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
Emma Jones Allscripts
X 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
Lisa Nelson Life Over Time Solutions
X Viet Nguyen Systems Made Simple
Craig Parker Intermountain Healthcare
Scott Robertson Kaiser Permanente
X Simon Sum Academy of Nutrition and Dietetics
Iona Thraen Dept of Veterans Affairs
Quorum Requirements Met: yes

Agenda

Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2016-02-11_Patient_Care_FHIR_Call
    • Motion: Rob/Lloyd Abstain - 2, Negative - 0, Approve - 7
  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

Minutes

Prior Action Item Follow-up

Care Team

Care Team (which includes the patient and/or related persons) will hopefully be on the FMG agenda next week.
CareTeam_FHIR_Resource_Proposal -- moved Russ/Russell: abstain-0; negative-0; approve -10

ClinicalNote

Listserv thread [2] with ClinicalNote resource strawman, which looks a lot like Composition (e.g. has sections, titles). Can still send discretes (e.g. prescription, allergies) without document/composition. If want to send H&P, what is the structure/root to be used before applying the human-presentation or organization of sections/titles?

ClinicalNotes can range from pure narrative to partial narrative to fully encoded. More common to be pure narrative or partial narrative. Less commonly fully encoded (may not be efficient to do so). Often the "structure" is just a bold piece of text within the note.

Composition supports structured notes well, but the question is the narrative.

FHIR tries to avoid having a general resource for any narrative. It is preferred to add narrative to a specific resource. There isn't a good solution for capturing text such that the EHR doesn't have the context to know which specific resource it applies to. Undifferentiated narrative (e.g. nursing note "saw patient, consult report coming")

If there is a document type, then use that to determine which resource is appropriate. Can a dictated H&P (all text) be Composition? Composition is never the primary source of information. Purpose of Composition is to define TOC of a full blown clinical document.

Annotation is meant to be a collection of who said what when.


ClinicalNote
identifier 0..1 Identifier The logical identifier for the contents.
dateAuthored 1..1 dateTime The ‘clinically relevant’ time of the note E.g. when the user saw the patient.
dateReleased 1..1 dateTime The date and time the note was marked 'complete' or 'signed' by the author(s)
author 1..n Reference(Practitioner) The person or group that contributed that contributed to the note content.
actor 0..n Backbone Element Other people/devices that played some role in the note creation or (e.g. scribes, voice to text or transcriptionists), or played some role in the note such as cosigning.
- role 1..n Code data entry person |data entry device | witness | officiating
- time 0..n dateTime The date/time of the action.
- actor 1..n Reference(Practitioner|Patient|Related Person|Device|Organization).
subject 1..n Reference(Any) The patient or group or subject that this note is about. Typically 1, but may be 2 (patient/mother) or groups in psychotherapy
code 0..n CodeableConcept Identifies what kind of note - E.g. LOINC code for 'H&P'
title 0..1 string A name for the note.
status 1..1 Code preliminary, final, amended, etc.
encounter 0..n Reference(Encounter) The associated encounter(s). Typically 1, but often ambiguous such as for telephone notes
content Reference(Media) If the note is a scanned image or pdf, or sound file, etc.


Removed
confidentiality 0..1 Code As defined by affinity domain. -- Reason: FHIR already has a way to communicate
body.text Narrative If small note or even large text dictation, the note might be just a single unparsed piece of text only identified by the note code. -- Reason: DomainResource.text (Narrative) could support this, but then we can't differentiate between question (code) and answer (body of text)

Next step:
Viet/Russell/Rob: Need to define constraints on when to use existing resource Narrative versus this new resource.

gForge Change Requests

N/A - ran out of time

Adjourn

Adjourned at 7:00 PM Eastern.

Meeting Outcomes

Actions
  • Michelle will start the new FHIR resource proposal wiki for clinical note, including past comments from Lloyd on FHIR principals.
  • Viet/Russell/Rob: Need to define constraints (scope/boundaries) on when to use existing resource Narrative versus this new clinical note 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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