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2018-03-28 Learning Health Systems Call

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Facilitator Russell Leftwich Note taker(s) Emma Jones
Attendee Name Affiliation

X Russell Leftwich InterSystems
John Roberts Tennessee Department of Health
X Stephen Chu Individual
X Evelyn Gallego ONC
Kathy Walsh LabCorp
Asim Muhammad Philips Research Europe
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Jeff Brown Cancerlinq
Lisa Nelson Individual
Dave Carlson VA
Chris Melo Phillips Healthcare
Michelle Miller Cerner
Benjamin Kummer Columbia University
Matt Rhan
Michael Padula
Joseph Quinn
Thomson Kuhn
Rob Hausum
Serafina Versaggi VA
Ann Whiz
Adam Horn
Bridget McCabe
X Claude Nanjo
X Bridget Burke
Bridget McCabe


  • Chair: Russell Leftwich
  • Scribe: Emma Jones


  • CIMI Modeling- Claude Nanjo
  • Other business

General Discussion

  • Entered in error - need to consider how to handle as part of the Care Team DAM
    • Incorrect PCP is common in the US because sometimes hospital systems required a PCP is entered as part of the admission process or the incorrect PCP is used from the insurance card.
    • In Australia - the concept of having the patient have a PCP is encouraged but not commonly used.

CIMI tool overview

  • found at CIMI Tool
  • Reviewed the use cases
    • Condition focused Care team
    • Lots of discussion in CIMI about participation and attribution
    • What are the limitations in FHIR Care Team?
      • Relationship to the patient and to each other. Need to be more fine grained that they are in the current concept of practitioner role that is more about job title and licensure. From a PA perspective, it all ties onto billing.
      • Coverage - when care team members covers for other care team members
      • PA organizationRole and practitionerRole - financial aspects. Considers practioner as an entity but lacks the context of care. Also very facility oriented. Don't imagine care in a community

(outside of a facility). Not considering community care.

    • CIMI need to seperate out the financial from the clinical use.Then use that as potential model to refactor what exists in FHIR.
    • Clinical layer of CIMI the role is specialized. practitioner itself is a role so FHIR has a role on a role.
    • In FHIR person is an abstract concept that instantiates patient, related person and practitioner
    • Start by representing the concepts in a logical way and then submit the changes the FHIR
    • Discription of CIMI mapping process.
    • Care team is defined as members and roles within the care team and the function they play. What they do on a specific care team.
    • Organization, department can be members of care team
    • One entity can have multiple roles and a role can be played by many entities.
    • Can be active on a care team for a period of time and can also be inactive for a period of time
    • Some care team members are responsible for contributing to the plan and others can just provide a service
    • Members can relate to each other and specify the type of relationship
    • Members don't have to be clinical
    • Members may not have an IT system - IT system may be needed for communication purposes, clinical function such as medication management, devices as end-point
    • AI - Amazon is working on devices that will be providing services to individuals in their home.
    • Keep in mind that the patient is a memeber of the care team
    • Team expertise - capabilities of the care team members
    • Communication - how can you be reached? Escalation policy
    • Communication use case - where CIMI is coming from on this requirement. Calude will send a few bullet points to Stephen to work on. Will send unified communication service document CIMI submitted to HL7.

Value set follow up

  • Value set template work sent to Russ
  • Rob McClure has it and will submit to SNOMED.