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2017-01-12 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: 2017-01-12
Time: 5-6:30pm ET
Facilitator Michelle M Miller Note taker(s) Michelle M Miller
Attendee Name Affiliation

X Elaine Ayres NIH/Department of Clinical Research Informatics
X Stephen Chu
Danielle Friend Epic
Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
X Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
X Russ Leftwich InterSystems
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
X 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
X Evelyn Gallego
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-01-05_Patient_Care_FHIR_Call
    • Motion: Stephen/Emma
  3. WGM agenda review
  4. gForge change request

Supporting Information

STU 3 Timeline

From FHIR_Ballot_Prep

  • Sun. Nov. 27 Ballot substantive resource freeze (prioritize resources that IGs will be based on)
  • Sun. Dec. 4 Ballot total freeze
  • Sun. Dec. 9 (or a day or two earlier) Freeze released - all changes allowed
  • Sun. Feb. 5 Ballot reconciliation deadline - All ballot comments must be reconciled, tracker issue report must be clean
  • Sun. Feb. 19 Publication substantive resource freeze
  • Sun. Feb 26 Publication total freeze
  • Mon. Feb 27 QA period opens
  • Tue. Feb 28 FMM QA spreadsheet updated for all WG resources
  • Sun. Mar. 13 QA period closes
  • Sun. Mar. 20 All QA applied

The "following week" STU 3 is published!

FHIR Maturity Levels

[1] 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

Current FMM Level Goal FMM Level QA Status QA Reviewer Implementation Comments
AllergyIntolerance 1 3 Michelle Argonaut
Condition 2 3 Michelle Argonaut
Procedure 1 3 Michelle Argonaut
CarePlan 1 3 Michelle Argonaut
Goal 1 3 Michelle
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 Michelle 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


WGM agenda

Quarters dedicated to FHIR ballot reconciliation

  • Mon Q3 - CarePlan, CareTeam, and Goal
    • GF#11116 - Better define the careplan.activity.outcome field. - 2016-09 core #270
    • GF#11342 - Add CareTeam.relatedTeam or other composition relationship - 2016-09 core #500
    • GF#11344 - Allow CarePlan.activity.detail.performer to be CareTeam - 2016-09 core #502
    • GF#10620 - QA 7a: CarePlan.activity.outcome needs a binding to a value set
    • GF#10623 - QA: Goal CodeableConcept elements are missing a binding to a value set
    • GF#10613 - QA 4e: Clean up valueset-goal-status
    • GF#10615 - QA 4: Clean up valueset-goal-status-reason
  • Tues Q2 - Condition/Concern
    • GF#10090 - Condition Introduction (taking into account concerns)
  • Tues Q3 - CareTeam value set discussion
    • GF#10725 - QA 4: CareTeam CodeableConcepts need a binding to a value set
    • GF#11334 - Constrain participant role value set - 2016-09 core #492
  • Wed Q1 - FHIR ballot reconciliation
    • GF#11162 - Suggest include reference to remedial treatment(s) - 2016-09 core #316
    • GF#10626 - QA: Procedure.usedCode needs a binding to a value set
    • GF#10627 - QA 4a: Consider binding Procedure.focalDevice.action (CodeableConcept) to codes from an external coding system - vocab
    • GF#10393 revisit workflow patterns; review gap analysis attached to the gForge
  • Thurs Q3 - FHIR ballot reconciliation - joint with OO for second half
    • GF#10635 - QA 5a: Resource references exist in both directions for Condition and ClinicalImpression
    • GF#11209 - Feedback on ClinicalImpression - 2016-09 core #363
    • GF#10387 - CommunicationRequest needs ability to describe the location that the communication is about (John Moehrke)
    • GF#11026 – Relationship between Condition and Observation (Jay Lyle)
    • GF#11119 – Differentiate ProcedureRequest and DiagnosticRequest and align their elements (Danielle Friend) - related Zulip Chat

gForge Change Requests

FHIR Publication / Backlog Status

After today's meeting....

  • 27 unresolved tracker items (all ballot comments)
    • 8 requested input from vocab (value set related ballot comments)
    • 1 waiting for input
    • 18 ready for discussion at WGM (including 2 that are joint with OO) or conference calls
  • 29 Resolved - Change Request tracker items
    • 27 ballot or high maturity resource (+ 2 non-ballot, non-priority resource)
    • 14 are substantive (+ 15 are non-substantive)
      • 4 related to new extensions/profiles
      • 1 workflow pattern
      • 1 new resources (AdverseEvent/Reaction)
      • 8 ready to be applied

Waiting for Input

  • GF#7185 ClinicalImpression is poorly thought out (

Block Vote 1 (scheduled for Jan 12)

Emma/Rob H - 5-0-3

  • GF#9044 - Need extension to track FHIR data type
  • GF#12400 - Add Goal search parameter for startDate
  • GF#12418 - add status search parameter to CarePlan
  • GF#12442 - QA: Questionnaire.item.enableWhen.answer and Questionnaire.item.initial bindings missing
  • GF#12434 - Remove answerInstant from Questionnaire(Response)
  • GF#12517 - add diagnosticrequest to context of procedure-targetbodysite
  • GF#12511 - Questionnaire.item.type optional problem
  • GF#12430 - Make clear that QuestionnaireResponse must align with corresponding Questionnaire

Ready for Discussion

Continue discussion on...

  • GF#11346 - suggest adding 'modified' element to indicate when the careTeam was last updated. - 2016-09 core #504 -- resolved!


  • GF#12186 - Proposed Changes to Questionnaire / Questionnaire Response from Tuesday evening discussion -- resolved!


  • GF#10391 - Communication.reason needs to be searchable (John Moehrke) -- resolved!
  • GF#10390 - CommunicationRequest query on reason (John Moehrke) -- resolved!
  • GF#10387 - CommunicationRequest needs ability to describe the location that the communication is about (John Moehrke) -- to be continued at WGM....

AllergyIntolerance/AdverseReaction (last 30 minutes)

  • GF#11021 - AllergyIntolerance.reaction should be removed and replaced with a choice of references to either a CodeableConcept OR a new AdverseReaction resource -- to be continued at WGM...

Vocab Assistance

  • GF#10621 - QA 4a: Consider whether CarePlan.activity.detail.category should be bound to an external code system
  • GF#10622 - QA 4a: Consider whether Goal.category should be bound to codes from an external code system
  • GF#10624 - QA 4a: Consider whether Goal.priority (CodeableConcept) should be bound to an external code system such as SNOMED
  • GF#11351 - AllergyIntoleranceCategory should be SNOMED - 2016-09 core #509
  • GF#11355 - CarePlan category value set is out of date or wrong - 2016-09 core #513
  • GF#11357 - Re-use the procedure value set instead of wrapping it - 2016-09 core #515
  • GF#11358 - Should not make a new value set ehre - use the Problem value set that also includes Events and SWEC concepts. - 2016-09 core #516
  • GF#11359 - Why only one medication in an activity? And the value set is problematic (but example) - 2016-09 core #517


Adjourned at 6:45PM Eastern.

Meeting Outcomes

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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