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2017-08-17 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: 2017-08-17
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
Dave Carlson VA
X Stephen Chu The Australian Digital Health Agency (ADHA)
Evelyn Gallego EMI Advisors LLC
X Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Russ Leftwich InterSystems
X Tony Little Optum 360
X Jay Lyle Ockham Information Services LLC, VA
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
Mike Padula The Children's Hospital of Philadelphia
Craig Parker Intermountain Healthcare
X Joe Quinn Optum
Simon Sum Academy of Nutrition and Dietetics
Iona Thraen Dept of Veterans Affairs
Serafina Versaggi Dept of Veterans Affairs
X Floyd Eisenberg
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-08-10_Patient_Care_FHIR_Call
    • Motion: Stephen/Rob
  3. Prior Action Item Follow-up
  4. Problem Status Value Set
  5. gForge change request

Supporting Information


Prior Action Item Follow-up

Problem Status Value Set

Floyd's question is whether the codes are mutually exclusive (e.g. inactive and remission; active and relapse)?
Stephen mentioned that FHIR has a hierarchy as follows:

  • Active The subject is currently experiencing the symptoms of the condition or there is evidence of the condition.
    • Recurrence The subject is experiencing a re-occurence or repeating of a previously resolved condition, e.g. urinary tract infection, pancreatitis, cholangitis, conjunctivitis.
    • Relapse The subject is experiencing a return of a condition, or signs and symptoms after a period of improvement or remission, e.g. relapse of cancer, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, bipolar disorder, [psychotic relapse of] schizophrenia, etc.
    • Well-Controlled The subject's condition is adequately or well managed such that the recommended evidence-based clinical outcome targets are met.
    • Poorly-Controlled The subject's condition is inadequately/poorly managed such that the recommended evidence-based clinical outcome targets are not met.
  • Inactive The subject is no longer experiencing the symptoms of the condition or there is no longer evidence of the condition.
    • Remission The subject is no longer experiencing the symptoms of the condition, but there is a risk of the symptoms returning.
    • Resolved The subject is no longer experiencing the symptoms of the condition and there is a negligible perceived risk of the symptoms returning.

Floyd said the harmonization didn't reflect the hierarchy. Emma said that the coding system reflects that (not the value set).
Harmonization proposal is about CDA value set and it uses SNOMED, not FHIR. SNOMED codes have a hierarchy, so Rob agrees with Emma that the hierarchy lives in the SNOMED coding system.
SNOMED hierarchy differs from FHIR's code system hierarchy. For example: recurrent episode is not a child of active in SNOMED.
Measure developers want this level of detail, but Floyd questions whether systems captures this level of detail.
Tues Q4 WGM - follow-up on the SNOMED hierarchy during joint quarter with PC/Vocab
Eric thinks there is a tracker for FHIR Publishing to make the hierarchy more clear, so implementers know what the indentation means

gForge Change Requests Backlog (did not discuss)

Aug 10 + WGM: Joint discussion with Pharmacy, OO

Backlog Rady to Discuss

  • GF#12163 Update payload URL to lead to a real file (Guillaume Rossignol)

Medium Backlog

  • GF#12509 CareTeam participant (Michelle Miller)
    • Feedback from LHS, and LHS continues to meet and discuss
    • CareTeam.participant.role (existing) 0..* - need to update definition of role (since it mentions responsibility) Example: PCP - close to finalizing the value set
    • CareTeam.participant.function 0..* (new) - Example: PT, Wound Care - close to finalizing the value set
    • CareTeam.participant.specialty is no longer needed -- instead, get from Practitioner
  • GF#12633 Split Procedure into Procedure and ProcedureStatement (Lloyd McKenzie)
  • GF#10028 Careplan: Provide ability to specify patient and/or provider preferences (Emma Jones)
    • meet need with a profile for preference on the observation resource. Requirements are a preference category (nutrition, medication, care), the preference priority (high/medium/delayed from C-CDA) and with elements of expressor and recorder.
    • This profile would not be developed for this release cycle
  • GF#13140 logical definition of care-plan-category value set may require realignment with SCT changes (Matthew Cordell)

Low Backlog

  • GF#10635 QA 5a: Resource references exist in both directions for Condition and ClinicalImpression (Michelle Miller)
    • ClinicalImpression is not mature enough to resolve this issue. Ask MnM for an exemption on the QA checklist (re: Condition having a circular reference with ClinicalImpression)
    • Add note: "A known issue exists with circular references between Condition and ClinicalImpression, which is due to the low maturity level of ClinicalImpression. The Patient Care work group intends to address this issue when ClinicalImpression is considered substantially complete and ready for implementation"
  • GF#11173 CarePlan needs support for reviews - 2016-09 core #327 (Stephen Chu)
    • Tracking of reviews and plans for reviews is something that applies to many resources, not just CarePlan (e.g. protocols, standing orders, long term care admissions, etc.). This is something probably best handled by "Task" but will require a fair bit of analysis and discussion with other work groups to agree on approach. Defer to R4. Consider transfer to OO who owns Task


Adjourned at <hh:mm am/pm> <timezone>.

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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