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2017-10-05 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: 2017-10-05
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
Stephen Chu The Australian Digital Health Agency (ADHA)
Evelyn Gallego EMI Advisors LLC
Eric Haas Health eData Inc
Rob Hausam Hausam Consulting LLC
Laura Heermann-Langford Intermountain Healthcare
Emma Jones Allscripts
Russ Leftwich InterSystems
Tony Little Optum 360
Jay Lyle Ockham Information Services LLC, VA
Russell McDonell Telstra Health
Lloyd McKenzie Gevity (HL7 Canada)
Larry McKnight Cerner
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
Joe Quinn Optum
Simon Sum Academy of Nutrition and Dietetics
Iona Thraen Dept of Veterans Affairs
Serafina Versaggi Dept of Veterans Affairs
Quorum Requirements Met: yes


Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-09-28_Patient_Care_FHIR_Call
    • Motion: <moved>/<seconded>
  3. High Priority Resources
  4. gForge change request

Supporting Information


High Priority Resources

AllergyIntolerance Condition
asserter Short: Source of the information about the allergy

Long: The source of the information about the allergy that is recorded
w5: who.source

Short: Person who asserts this condition

Long: Individual who is making the condition statement

assertedDate Short: Date record was believed accurate

Long: The date on which the existance of the AllergyIntolerance was first asserted or acknowledged
w5: when.recorded

Short: Date record was believed accurate

Long: The date on which the existance of the Condition was first asserted or acknowledged. The assertedDate represents the date when this particular Condition record was created in the EHR, not the date of the most recent update in terms of when severity, abatement, etc. were specified. The date of the last record modification can be retrieved from the resource metadata
w5: when.recorded

recorder Short:




recordedDate Short:





  • GF#13997 - QA 4d. value set should include unknown when minOccurs=1 - AllergyIntolerance.verificationStatus - Zulip discussion
    • Similar discussion for AllergyIntolerance.clinicalStatus
    • Similar discussion for Condition.clinicalStatus
  • QA 5e. W5 mappings - AllergyIntolerance.asserter = w5 who.source whereas Condition.asserter = w5
    • Similar to questions on how to map AllergyIntolerance.assertedDate = IAM-20 (Statused at Date/Time) or IAM-13 (Reported Date/Time)?
    • AllergyIntolerance.assertedDate says "The date on which the existance of the AllergyIntolerance was first asserted or acknowledged" as well as "Date record was believed accurate"
    • AllergyIntolerance.asserter says "The source of the information about the allergy that is recorded"


  • GF#13980 condition-related extension cardinality should be 0..* (pre-applied)
  • QA 4a. Condition.category is CodeableConcept with FHIR-defined value set - related to past GF#11091
  • revisit GF#13026 Condition.clinicalStatus
  • QA 4d. value set should include unknown when minOccurs=1 - Condition.clinicalStatus has invariant that requires it, but it doesn't have unknown


  • GF#13974 Purpose of Procedure.reasonCode vs. Procedure.reasonReference (Ioana Singureanu)
  • GF#13975 Procedure.reasonReference description is incomplete (Ioana Singureanu)
  • GF#13976 Procedure.focalDevice description is confusing (Ioana Singureanu)

gForge Change Requests


  • GF#13936 CommunicationRequest - intent value set (Ravi Kuchi)
  • GF#13979 QA 4a: Communication.topic needs binding to a value set (Michelle Miller)

CarePlan/Goal backlog

  • 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#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)


  • 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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