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2017-09-28 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: 2017-09-28
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
Dave Carlson VA
X Stephen Chu The Australian Digital Health Agency (ADHA)
Evelyn Gallego EMI Advisors LLC
Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Russ Leftwich InterSystems
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
X Iona Singureanu
Serafina Versaggi Dept of Veterans Affairs
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-08-31_Patient_Care_FHIR_Call
    • Motion: Elaine/Stephen
  3. WGM recap
  4. gForge change request

Supporting Information


WGM Recap

Patient Care WGM minutes: PC_Sept_2017_WGM

  • FHIR Admin FHIR_Ballot_Prep
    • QA guidelines have changed: FHIR_Conformance_QA_Criteria
    • New QA guidelines for value sets, profiles, etc. FMG is talking about RIM mappings, but haven't dropped it yet. RIM mappings will now be needed for extension as well.
    • Extensions will have their own FMM (can be different than core resource)
    • QA Checklist will capture date, not just 'x'
    • No PC resources are currently targeted for normative, but we can still evaluate
    • Need an updated gap analysis against workflow patterns - report of gaps will need to be evaluated to see if the gap was intentional or not.
    • What are target FMM levels for R4?
      • AllergyIntolerance - questions about reaction/AdverseEvent - is this just writing down boundaries?
      • Condition - questions about health concern/linking - need Connectathon planned around concern management, need use cases (from domain analysis) and scenarios to test and recruit implementers to participate
      • Procedure - questions about splitting Procedure (performed) vs ProcedureStatement (history/ patient stated) - need to draft resources as a starting point and sync with Russ on whether we need a more generic patient activity statement resource

gForge Change Requests

  • GF#13936 CommunicationRequest - intent value set (Ravi Kuchi)

CarePlan/Goal backlog

  • GF#13877 CarePlan example names are all either patient or person related (not careplan) (Brian Postlethwate)
  • GF#13895 goal-pertainstogoal extension is mis-named (Lisa Nelson)
  • GF#13903 CarePlan should allow tracking of past activities (i.e. past interventions) (Rick Geimer)
  • GF#13904 Consider renaming CarePlan.activity.outcomeCodeableConcept and CarePlan.activity.outcomeReference (Rick Geimer)


  • GF#13302 Vocabulary issues with AdverseEvent
  • GF#13698 AdverseEvent.suspectedEntity.instance should allow CodeableConcept
  • GF#11021 Increase cardinality of substance and make certainty relation to substance, not reaction - 2016-09 core #40
  • GF#13889 AdverseEvent.category should be 0..* CodeableConcept with extensible binding (Lloyd McKenzie)
  • GF#13890 AdverseEvent.subject should include Group (Lloyd McKenzie)
  • GF#13891 AdverseEvent.subject should not include ResearchSubject (Lloyd McKenzie)
  • GF#13892 Need guidance on overlap of AdverseEvent.event.text and AdverseEvent.description (Lloyd McKenzie)
  • GF#13893 Correction to AdverseEvent.subject definition (Lloyd McKenzie)
  • GF#13894 AdverseEvent.eventParticipant needs work (Lloyd McKenzie)

LHS: Sept 29 at 4pm Eastern

  • GF#12509 CareTeam participant (Michelle Miller)


  • GF#12673 How to handle HCT/TP
  • GF#12993 Please Create a NonMedicationAdministration object or an Administration object
  • GF#13047 Add DosageInstructions to Procedure


Medium Backlog

  • 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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