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2016-09-15 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

Date: 2016-09-15
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
Russ Leftwich InterSystems
X Tony Little Optum 360
Jay Lyle Ockham Information Services LLC, VA
Sarah Maulden VA
Hank Mayers ReliaTech Consulting
Jim McClay Univ of Nebraska Medical Center
Russell McDonell Telstra Health
Lloyd McKenzie Gevity (HL7 Canada)
Larry McKnight Cerner
X Michelle M Miller Cerner
Lisa Nelson Life Over Time Solutions
Viet Nguyen Lockheed Martin, Systems Made Simple
M'Lynda Owens Cognosante
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 2016-09-08_Patient_Care_FHIR_Call
    • Motion: Stephen/Rob
  3. Prior Action Item Follow-up
  4. WGM Agenda
  5. FHIR QA / Ballot Feedback Summary
  6. gForge change request

Supporting Information

STU 3 Timeline

  • Mon, Sept 12 - FHIR ballot closes
  • Fri, Sept 16 - FHIR triage complete and ballot content loaded to gForge (or alternate)
  • Sept 17-23 - Baltimore WGM
  • Sun, Dec 11
    • Reconciliation complete/substantive changes applied
    • Just over 10 weeks
    • Will re-evaluate at Baltimore based on volume of ballot comments
  • Dec 31 - Publish

FHIR Maturity Levels


  • Level 3 requires the artifact has been verified by the work group as meeting the DSTU_2_QA_guidelines and has been subject to a round of formal balloting; has at least 10 implementer comments recorded in the tracker drawn from at least 3 organizations resulting in at least one substantive change
    • Substantive changes (element names, sort order, vocabulary bindings, etc.) need to be applied by ballot freeze (Aug 10).
    • Unapplied QA checklist changes can be logged as ballot issues to be applied Sept-Dec. Substantive changes after ballot should be driven by ballot.
    • Non-substantive changes are fine
  • Level 2 requires artifact has been tested and successfully exchanged between at least three independently developed systems leveraging at least 80% of the core data elements using semi-realistic data and scenarios based on at least one of the declared scopes of the resource (e.g. at a connectathon). These interoperability results must have been reported to and accepted by the FMG.
Current FMM Level Goal FMM Level QA Status QA Reviewer Implementation Comments
AllergyIntolerance 1 3 Rob Argonaut
Condition 2 3 PCWG Argonaut
Procedure 1 3 Argonaut
CarePlan 1 3 Argonaut
Goal 1 3
QuestionnaireResponse 2 2 Lloyd Lloyd will QA to get to level 3
Questionnaire 0 2 Lloyd Lloyd will QA to get to level 3
CareTeam 0 2 NA NA Aggressive goal (e.g. whether we'll get the implementations needed)
FamilyMemberHistory 1 2 NA NA Aggressive goal (e.g. whether we'll get the implementations needed)
ClinicalImpression 0 1 NA NA
ReferralRequest 1 1 NA NA
ProcedureRequest 1 1 NA NA
Linkage 0 1 NA NA
Flag 1 1 NA NA
Communication 1 1 NA NA
CommunicationRequest 1 1 NA NA

Note: Bold denotes top 20 resource based on survey
Note: Contraindication and Risk Assessment are owned by CDS, not Patient Care


Prior Action Item Follow-up

WGM Agenda

PC Agenda:
FHIR Agenda:

Quarter PC Agenda FHIR Agenda Comments
Mon Q3 FHIR Workflow Workflow (FHIR-I, CDS, FM, II, MnM, OO, PC - LM, GG, EK)
-- and --
Mon Q4 FHIR Workflow Workflow (FHIR-I, CDS, FM, II, MnM, OO, PC - LM, GG) OK
Tues Q2 condition/concern/linkage PC, EC, FHIR-I - JM
Tues Q3 CQI and CDS - Condition Status, Allergy Intolerance and Care Plan QDM RCRIM - Adverse event RCRIM - LM? OK
Tues Q4 negation
* GF#9335 ( Orders to not do things - to gather implementer feedback since we haven't heard anything via yet
Negation modelling & vocab discussions (PC, CIMI, EC, Vocab, FHIR-I, OO, Pharm - LM) OK
Wed Q1 Joint meeting with Child Health, ED, CBCC , SDWG, Learning Health Systems (LHS), Care Team,
Agenda: children with special needs, consumer generated contingency/emergency directive
Personal Advance Care Plan - Lisa Nelson
Wed Q2 PA/PC
* GF#10544 ( Add condition extension(s) to represent a role in context of Condition.encounter (e.g. Primary/Sequence Admit Discharge etc.)
* Care Team
TO DO: update FHIR agenda wiki
Wed Q3 FHIR/PCWG Joint meeting (PCWG Hosting FHIR reps) Family CDS-CQI-RCRIM-OO-FHIR -
* Order sets/PlanDefinition - how does it coordinate with various work groups that own request resources, such as CarePlan
Wed Q4 PCWG-FHIR clinical resources ballot reconciliation PC - FHIR clinical resources ballot reconciliation OK
Thurs Q1 Care Plan -invite FHIR, Structured Docs, Pharmacy
Pharmacy Care Plan - PSS (Shelly Spiro)
C-CDA on FHIR: care plan template (Rick Geimer)
C-CDA - clinical oncology treatment plan (Jeff Brown)
HL7 Care Plan model - FHIR - C-CDA harmonization (Laura, Emma, Lisa Nelson)
CCS update (Emma)
Care team members definition update (Laura, Emma)
Thurs Q2 Joint with SD
Structured Doc, CDA update (SDWG co-chairs)
Clinical status vs Act
PC, SD, Templates, FHIR-I - EK
Thurs Q3 PCWG - Ballot reconciliation
* Assessment scale
*FHIR - AllergyIntolerance resource
Thurs Q4 Dynamic Care Planning FHIR Implementation
Laura to invite HSI to join this meeting
TO DO: Add to FHIR agenda

FHIR QA / Ballot Summary

91 FHIR ballot comments to be loaded into gForge (additional ballot comments tied to existing gForge items)

  • AllergyIntolerance 15
  • CarePlan 15
  • Condition 14
  • CareTeam 8
  • ClinicalImpression 7
  • ProcedureRequest 6
  • Goal 5
  • Flag 3
  • Procedure 2
  • Questionnaire 2
  • (blank) 2
  • FamilyMemberHistory 2
  • Communication 2
  • Questionnaire, QuestionnaireResponse 1
  • CommunicationRequest 1
  • QuestionnaireResponse 1
  • AllergyIntolerance,Condition 1
  • ReferralRequest 1
  • Procedure, Medication 1
  • Condition, Observation 1
  • Procedure,ProcedureRequest 1

Michelle started QA on AllergyIntolerance, CarePlan, Condition, Goal, Procedure (resources targeted for FMM level 3) focusing on anything that might be a substantial change, which warranted a ballot comment. Below is a summary of the findings (with gForge ballot comments logged if changes are needed).

QA Checklist AllergyIntolerance CarePlan Condition Goal Procedure CareTeam
1a. Contexts identified Y 10601 Y Y Y
1b. Resource differentiated from peers Y 10601 10090 10606 Y
1c. Non-examples provided Y Y 10090 Y Y
1d. Definition for 'entered in error' Y 10602 10603 10604 Y 10725
2a. Examples cover all contexts & elements Y 10090 10607
2b. Examples ok for clinical/business w/ comments Y Y Y
2c. Extensions have valid/example URLs N/A 10608 N/A Y N/A
3a. RIM mappings ok
3b. External mappings provided Y
4a. Valuesets draw from right code systems Y 10615, 10621, 10620 10091 10615, 10622, 10624 10627 10725
4b. Value sets "representative" where possible example, not preferred example, not preferred example, not preferred example, not preferred example, not preferred
4c. FHIR codes have good definitions Y Y Y Y Y
4d. Code used for structural or FMG-cleared many codes! what are structural elements? Y Y Y
4e. Code types cover all scenarios, don't collide 10369, 10642 10617 10618 10613 10625
5a. References point right way Y 10634 10635 Y 10636 Y
5b. Inline content only where appropriate Y Y Y Y Y Y
5c. isModifier appropriately declared 10642, 10645 10643 10641 Y Y Y
5d. Summary appropriately declared 10646 Y 10546 Y Y
5e. W5 column filled in and verified 10628 10630 Y 10631 10629 Y
6a. Names appropriately consistent Y Y Y Y Y Y
6b. Elements sorted appropriately 10628 10630 y 10631 10629
7a. Todos resolved Y 10615, 10622 LOG GFORGE 10623 LOG GFORGE 10725
7b. Definitions follow best practices
7c. Rationale provided where needed
7d. Committee notes filled in
8a. Constraints allow narrative-only Y Y Y Y Y y
8b. Constraints not over-restrictive Y Y Y Y Y Y
9a. Search criteria meet 80%
9b. Search descriptions complete

gForge Change Requests




Adjourned at 6:35PM Eastern.

Meeting Outcomes

  • Input from Viet, Russell, and Rob on Michelle's drafted ClinicalNote_FHIR_Resource_Proposal
  • Daniel Lanphear (submitter of gForge 8458) to draft new resource proposal for transfusion.
  • Rob to help fill in value sets for CareTeam status and type
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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