2016-05-12 PA WGM Minutes

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Patient Administration Work Group Minutes - May 12, 2016

Thursday Q1

HL7 Patient Administration Meeting Minutes Location: Salon Hemon		Date: 2016-05-12 Time: Thursday Q1
Facilitator	Line Saele	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	HL7 Netherlands
X	Alex de Leon	Kaiser Permanente
X	Line Saele	HL7 Norway
X	Brian Postlethwaite	HealthConnex, Australia
X	John Roberts	PHER Work Group
X	Craig Newman	Northrop Gruman, USA
X	Erin Holt	Tennessee Department of Health, USA
X	Nell Lepres	EPIC, USA
X	Toril Reite	HL7 Norway
X	Christian Hay	GS1, Switzerland
X	Laura Rappleye	Alterum Institute, USA
X	Matthew Graham	Mayo Clinic, USA
X	Elysa Jones	OASIS, USA
X	Cooper Thompson	EPIC, USA
X	Angus Miller	NEHTA, Australia
X	Andy Bond	NEHTA
X	Daniel Pollock	CDC, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
Welcome/introductions

• HAVE Project/TEP

Supporting Documents

• May 2014 WGM

Minutes

Minutes/Conclusions Reached:
Introductions

HAVE/TEP

The joint spec (TEP) Transformation Spec ADT has passed ballot. It will be published by both HL7 and OASIS. All copyrights and understandings have been ironed out and in the next PHER meeting the NIB will be worked on.

OASIS has been asking HL7 about HAVE spec and how to “endorse” this. Endorsement of an implementation guide written by another SDO has been done in the past. .

HL7 has declined to endorse the HAVE standard because it’s been written and owned by another SDO. So, the way it will be endorsed, according to the HL7 executive committee is if it is jointly published. This will be taken up at the next OASIS meetings. .

The WG discussed any issues or questions that the HL7 community might raise. John Roberts asked what the WG thought might be some of the questions that would come up. Alex raised the maintenance and SMEs that may or may not be around in the future to keep this maintained. John and the PHER WG answered that there are emergency response SMEs and public health SMEs that can answer to the content and that the actual specification describes a very simple XML based format that contains approximately 6 data elements.

The joint WGs reviewed the HAVE specification.

John Roberts asked what comments might be received after looking at the specification. One comment made by Matt Graham that the submitters might want to be very clear that the ballot is around the content and not entirely a technical review of the specification as it does not conform to v2, v3 nor FHIR balloting constructs. Irma also noted that while that is hard to predict what the community might comment, one issue to consider is generating interest in this within the HL7 community. There might be a need to advertise this more.

The joint WG then moved to discussing the examples. The recommendations on the table are to either put them in a separate implementation guide or put them in the specification and note them as non-normative.

Next step. PHER will produce a PSS for the next ballot with a clear note to balloters about the content. Considerations of what level to ballot this at. Normative might be a good level. A question came up as to whether this has been submitted to mobile health.

The WGs considered whether there should be a joint session in next WGM. We do have a need.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Action:

Next Meeting/Preliminary Agenda Items .

Thursday Q2

HL7 Patient Administration Meeting Minutes Location: Salon Hemon		Date: 2016-05-12 Time: Thursday Q2
Facilitator	Irma Jongeneel	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	HL7 Netherlands
X	Alex de Leon	Kaiser Permanente, USA
X	Brian Postlethwaite	HealthConnex, Australia
X	Kevin Paprocki	EPIC, USA
X	Cooper Thompson	EPIC, USA
X	Michael Donnelly	EPIC, USA
X	MaryKay McDaniel	Congosante
X	Beat Heggli	HL7 Switzerland
X	Jim Whicker	Cognosante
X	Amit Popat	EPIC, USA
X	Genny Luensman	CDC/NIOSH, USA
X	Paul Knapp	HL7 Canada
X	Benoit Schoeffler	Almerys, Canada
X	Guilloume Rossignol	Almerys, Canada
Quorum Requirements Met (Chair +2 members): Yes

Agenda

Agenda Topics

1. FHIR – Patient Administration and Financial Management joint resources

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions
The WG started with a request for time to discuss ODH elements since v2 elements are within elements under the stewardship of Financial Management but are used and often collected in an administrative setting (presumably under PA scope).

The WGs discussed the “home” for the PSS and where help can be gotten. Discussion continued with PHER, Patient Care, PA. In the end, it’s either PA or Patient Care. There was discussion around whether this should be taken to the TSC. Amit volunteered to introduce Genny Luensmann to Patient Care co-chairs to see if they can steward the PSS and help with this effort.

The WG then went on to review the Coverage resource and shared interests of FHIR financial management concepts.
The WG reviewed the elements in the Coverage and discussed the concept of network. While this is no the coverage resource, there was discussion as to whether this concept works the same globally.

The discussion around network was tabled for the moment while the WGs moved on to discuss the “self pay” concept. There are many use cases specifically in European countries that a patient can act very much like an insurance where the payor is the actual patient.

The WG discussed that the “self pay” is not the same as the guarantor. Self pay actually is a contract that defines pre-defined charges that are covered by the patient, while a guarantor typically defines a global coverage of charges that go over and above what the insurance covers.

So, the issuer needs to have the option to be an organization, related person or patient.

The WGs agreed also to change the name of issuer to “payor”
Also coverage.type will include private party or “self”
Under the “identifier” will contain all contracts.

The WGs discussed changing the “beneficiary” element to “patient”
Identifier moved to the top of the list.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Action:

Next Meeting/Preliminary Agenda Items .

Thursday Q3

HL7 Patient Administration Meeting Minutes Location: Salon Hemon		Date: 2016-05-12 Time: Thursday Q3|-		Facilitator	Brian Postlethwaite	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	HL7 The Netherlands
X	Brian Postlethwaite	HealthConnex, Australia
X	Alex de Leon	Kaiser Permanente, USA
X	Kevin Papracki	EPIC, USA
X	Cooper Thompson	EPIC, USA
X	Alexander Henket	Nictiz, The Netherlands
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. FHIR – Representative from PC will join

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions

The WG continued with FHIR tracker items. The first was having to do with representing family relationships between patients (e.g. mother/child)
The WG looked at the RelatedPerson construct and the Paient resource. There was much discussion about how to depict this. However, the WG returned back to the question submitted through stackoverflow. Even so, there was a
http://stackoverflow.com/questions/37107942/representing-family-relationships-between-patients-in-fhir
The WG discussed and responded in stackoverflow as such:

“This is a valid way of representing this information, however would like to know a little more about your use case for recording this information. Is it to be supporting maternity issues and the linkage of encounters for the mother and baby during a birth encounter. If so then the encounter.partof structure would be recommended for capturing the details of this association”
The WG then discovered a related tracker item:

1. 9366 Summary: Provide guidance on how to link a mother and newborn
   

Provide guidnace on how FHIR enables linking of newborn to its mother’s chart and vice-versa.
To which, after discussion, the WG responded with:

“The relationship between a mother and child can be represented in 2 ways.
1. Within the Patient/RelatedPerson/Person structures for ongoing linkages.
2. With Encounters during a birth using the encounter.partof property.
Additional guidance will be provided on how the encounters should be used for this scenario in the detailed description on encounter.partof, including the organ donor recipient use cases.
To simplify this representation, we will also update the patient link structure to also be able to reference the RelatedPerson resource. and the link type would be the seealso value for this use”

Irma moved to make the changes as outlined above. Alex seconds.

Discussion: Alexander questioned about he link from patient to related person. The question is whether there is a reference back to the patient in related person. The answer is that there is no link back.
Vote: 6/0/0

At this point, the WG skyped Ken Rubin as the representative of the SOA WG to present the subject of a Scheduling Project, as defined in the draft Project Scope Statement (2016-04 Scheduling Service PSS 004.docx), found at:
http://hssp.wikispaces.com/scheduling
Irma questioned what the project was intending. Is this a review of the resources to see what might be missing? Is it a usage of the resources already developed? Ken responded that it is a bit of both, with the intention of producing an artifact like a Service functional model, which would describe the dynamic behavior of the scheduling FHIR resources developed. Irma also asked if IHE has been contacted as they may reside within their scope of work. Ken responded that they have not but are open to collaborating.

Would PA be open to being the primary work group and listing SOA as a supporting. Irma responded that if it were regarding resources within PA’s scope, then yes, but if it concerns more services then we would have to reconsider.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)

Next Meeting/Preliminary Agenda Items •

Thursday Q4

HL7 Patient Administration Meeting Minutes Location: Salon Hemon		Date: 2016-05-12 Time: Thursday Q4
Facilitator	Irma Jongeneel	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Irma Jongeneel	HL7 Netherlands
X	Line Saele	HL7 Norway
X	Alexander De Leon	Kaiser Permanente, USA
X	Micheal Tushan	Lantana, USA
X	Andrew Torres	Cerner, USA
X	Nick Radov	Optum, USA
X	Brian Postlethwaite	Telstra Health, Australia
X	Christian Hay	GS1, Switzerland
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

1. Wrap up
2. Approve next ballot
3. FHIR Planning
4. Address PBX matrix
5. Work Group Health
6. 3 year work plan
7. Address the draft agenda for May
8. Approve the minutes from Atlanta (cont. from Monday)

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions
The WG started with entertaining a proposal for changes to the v2 specification.
MDM

Nick from Optim reviwed the proposal starting with deprecated elements having to do with PV1-9 and PV1-52 having to do with Providers, with notes to use the ROL for those roles. This came up in the context of normalizing their MDM messages internally with the latest standards. This is where they noted the segments.

Apparently the ROL segment has been replaced by PRT segment. This would mean that wherever the noes refer to use the ROL segment, this should refer to other PRT.

The WG was a bit taken aback at this replacement, especially since the ROL segment was originally part of the Personnel Management work group (chapter 15) and the PRT segment seems to be owned by Orders and observations (chapter 7).

Action: Contact Frank Oemig to get background, reasoning, etc. on the deprecation of the ROL segment in favor of the PRT segment. Owner: Alex. Date: 05/24/16.. An email was sent during the meeting to Frank, the co-chairs and the v2 editors.

In going over the work for next ballot, it was noted that v2.9 is now a consideration. If the PRT segment is to replace the ROL segment (and the ROL segment deprecated), then this may delay September ballot for v2.9 and may push it to January 2017. Question for publishing committee.

Additionally, FHIR resources STU3 may need another PSS since we did this for the previous resources that were developed. This new PSS will contain 3 possible new resources: Endpoint, BillableItem and PractitionerRole (broken out from being an element on the Practitioner resource). This would include addressing implementer’s feedback and necessary updates to increase the FMM levels for existing PA resources.

During the meeting, the WG contacted our FHIR facilitator and we came to the decision to
Andrew moved, Brian seconded, to create a PSS for which would cover work for all PA resources for STU3.
Discussion: None
Vote: 5/0/0

Action: Create a PSS which would cover work for all PA resources for STU3 and put into project insight.
Owner: Alex, Due: 05/24/2016

PSS will contain 3 possible new resources: Endpoint, BillableItem and PractitionerRole (broken out from being an element on the Practitioner resource). This would include addressing implementer’s feedback and necessary updates to increase the FMM levels for existing PA resources.
Action: Create the necessary new resource proposals. Owner: Brian. Due: June1, 2016

The WG continued with the review of the PBS metrics and saw that the only “yellow” item was the Real Time Location Tracking reaffirmation, which we took care of in this ballot cycle.

The WG reviewed the resource proposal for Endpoint just created by our FHIR facilitator. http://wiki.hl7.org/index.php?title=Endpoint_FHIR_Resource_Proposal

The WG decided to handle the review the FHIR Endpoint resource proposal on the call.

The WG then discussed the upcoming calls which will be held on Tuesdays, 3EST.
Action: Check with Dave Hamill to see if this slot is open for GoToMeeting scheduling. Ownder: Irma. Due: 05/24/2016.
The WG propose that the calls to begin on 5/31/2016

Line moves to adjourn. Andrew seconds.
Discussion: None
Vote: 4/0/0

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) .

Next Meeting/Preliminary Agenda Items .

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