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2018-05-14 PA WGM Minutes

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Patient Administration Work Group Minutes - May 14, 2018

Monday Q1

HL7 Patient Administration Meeting Minutes

Location: Maritime Hotel, Cologne, Salon 20 Fulda

Date: 2018-01-29
Time: Monday Q1
Facilitator Line Saele Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Alex de Leon Kaiser Permanente, USA
X Line Saele HL7 Norway
X Brian Postlethwaite Telstra Health, Australia
X Cooper Thompson EPIC, USA
X Christian Hay GS1, Switzerland
X Bidyut Parruck Interface ED, USA
X Simone Heckmann HL7 Germany
X Hans Buitendyjk Cerner, USA
X Andrew Torres Cerner, USA
X Kathy Pickering Cerner
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics
Welcome and introductions Joint meeting with Financial Management - FHIR

  • Invoice draft review
  • ChargeItemDefintion draft review
  • ProductPlan review
  • Payment/Adjustment resource?

Supporting Documents

Plenery

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action:


Next Meeting/Preliminary Agenda Items
  • .

Monday Q2

HL7 Patient Administration Meeting Minutes

Location: Hotel Maritim, Cologne, Salon 20, Fulda

Date: 2018-05-14
Time: Monday Q2
Facilitator Brian Postlethwaite Scribe Alex de Leon
Attendee Name Affiliation
X Brian Postlethwaite Telstra Health, Australia
X Irma Jongeneel HL7 Netherlands
X Alex de Leon Kaiser Permanente, USA
X Line Saele HL7 Norway
X Cooper Thompson EPIC, USA
X Kathy Pickering Cerner, USA
X Christian Hay GS1, Switzerland
X Simone Heckmann HL7 Germany
X Bidyut Parruck Interface ED, USA
Quorum Requirements Met (Chair +2 members): Yes

Agenda

Agenda Topics

  1. FHIR New Proposals
  2. Feedback from Connectathon

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions

Minutes/Conclusions Reached:
Introductions
Joint session with FM. The WG began with the review of the Invoice resource.
Simone noted that in the last call, the WG was asked to build the invoice looking forward to the approval of this invoice.
Mary Kay noted that there were no quantities involed. Simone explained that the invoice is moer like a summary of the charge items. This would require a bundle to be included to actually use this resource. The operation would be a submit of the invoice that would create the bundle of charge items and paitient information. This would require approval by FM.
http://build.fhir.org/invoice.html
Irma asked if this should follow the workflow pattern.

Irma moves to accept this resource proposal to move forward., Iryna seconds.
Discussion: This is to move forward with the proposal. Vote (for/against/abstain): 12/0/0
The WG looked generally at the charge item resource to gain approval to move forward with tis as well.

http://wiki.hl7.org/index.php?title=ChargeItemDefinition_FHIR_Resource_Proposal

The pricing details or catalog also services available.

The WG reviewed the elements involved for the context of ChargeItem Definition
Patient, Encounter,

Simone reviewed some of the relevant elements within the proposed ChargeItemDefnition

The Instance element was discussed. FM felt that the reference which currently included Medication, Substance and Device can be expanded.

The joing workgroups had a lively enough discussion on the elements within the ChargeItemDefinition as currently defined to merit moving forward with this proposal.
There were value statements from Germany, Australia, and US for the use of this resource. Each had some use cases which would be supported by this resource.

Action: FM noted that there should be a way to indicate related definition. The Example rule is … there are 10 items that can be charged but only one can be charged. This is one thing that needs to be accounted for.
MaryKay moves to accept the resource proposal for moving forward. Simone seconds.
Discussion: None
Vote: 10/0/1

The WG moved on to review the ProdcutPlan. To be able to have an insurer express their basic product (a set of coverages) and plan where plans are the risk share. For one product, there could be many different ways you can handle risk. This is a structure that allows you to define this.
http://build.fhir.org/productplan
This is not doing billing, it’s doing coverage and risk sharing. Structure of the plan.

Location was supposed to change from 0..1 to 0..*.

The FM work group invited any interested parties to review this.

Brian noted that there is another FM joint session on Thursday Q2.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • None
Next Meeting/Preliminary Agenda Items
  • .

Monday Q3

HL7 Patient Administration Meeting Minutes

Location: Hotel Maritim, Cologne, Salon 20, Fulda

Date: 2018-05-14
Time: Monday Q3
Facilitator Line Saele Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Line Saele HL7 Norway
X Brian Postlethwaite Telstra Health, Australia
X Alex de Leon Kaiser Permanente, USA
X Toril Reite HL7 Norway
X Cooper Thompson EPIC, USA
X Oyvind Aassve HL7 Norway
X Michelle Miller Cerner
X Tricia Chitwood Cerner, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

  1. FHIR Ballot Reconciliation

Supporting Documents

  • 14333 - Provide more clarity between administrativeGender, sex, and gender identity
  • 14154 - Searching a patient by Identifier Type
  • 14099 - Guidance on how to request a new identifier (e.g. MRN)
  • 14341 - Replace "hermaphrodite" with "intersex"
  • 14174 - herd should be able to reference the owner

Minutes

Minutes/Conclusions Reached:
Introductions

Introductions

The WG decided to review the agenda for the week. Included V2.9 ballot reconciliation Thursday Q3. Also included v2.9 proposal 716 included with Patient care joint session.

The WG also noted that FHIR ballot reconciliation for Patient should take presendence so changed Monday, Q4 and Tuesday Q1, Q2 and 3, to include 3 ½ quarters to get through .
Motion was made by Brian to approve the new agenda, seconded by Irma. Discussion: None Vote (for/against/abstain): 6/0/0
Reviewed the mission and charter. No changes.

Work group help. Although there was an email sent that the PAWG would accept the outcome, HL7 headquarters did not record this. Line will follow up with Anne as it was stated that it would be taken care of. Given this, the PAWG shold get a star for 2018 May.
The WG reviewed the 3 year work plan. Updated by adding the ChargeItemDefinition. The WG noted that the project ID did not need to change as

The WG continued to review the SWOT .

Block vote motion by Irma to accept PA Mission and Charter, 3 year work plan and SWOT, Brian seconded.
Discussion: None
Vote (For/against/abstain): 6/0/0

The WG continued with the FHIR tracker items.

16319 Marital Status Code System Missing Values
The Marital Status Code code system referenced from the FHIR home page for the Patient normative material only lists one concept and also states "This Code system is not currently used". The value set used is fully loaded and references the HL7 V3 Code System. The latter is valid. But including the former with just one value is at least confusing. Suggest to remove that code system, or include a reasonable set of concepts.

16516 - Marital Status Code System Missing Values The normative ballot includes CodeSystem Marital status, with the canonical URL defined as "http://hl7.org/fhir/marital-status".
However, the page says "This Code system is not currently used.
This is verified by the ValueSet for Marital status (http://hl7.org/fhir/2018May/valueset-marital-status.html) which does not include the above code system URL, instead it includes all the codes in "http://hl7.org/fhir/v3/MaritalStatus" and a single code from "http://hl7.org/fhir/v3/NullFlavor".
Why ballot something that is not used as Normative?

16616 - Add codes for missing Marital Status' - 2018-May Core Norm Patient #42
Codes for married, separated, divorced, and widowed are missing.

16597 - 4.3.1.29 Value Set http://hl7.org/fhir/ValueSet/marital-status - 2018-May Core Norm Patient #13
4.3.1.29 Value Set http://hl7.org/fhir/ValueSet/marital-status

Block move as persuasive. Codes system is not used anywhere in the FHIR specification. The marital status value set references the v3 code system, hence is leftover from where FHIR defined it’s own codes. This redundant Codeset will be removed. By Brian. Seconded by Drew.
Discussion: None. Vote (for/against/abstain): 6/0/0

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)
  • Action:
  • Action:
Next Meeting/Preliminary Agenda Items
  • .

Monday Q4

HL7 Patient Administration Meeting Minutes

Location: Hilton New Orleans Riverside, Durham Conference Room

Date: 2018-01-29
Time: Monday Q4
Facilitator Irma Jongeneel Scribe Alex de Leon
Attendee Name Affiliation
X Irma Jongeneel HL7 Netherlands
X Line Saele HL7 Norway
X Brian Postlethwaite Telstra Health, Australia
X Alex de Leon Kaiser Permanente, USA
X Christian Hay GS1, Switzerland
X Cooper Thompson EPIC, USA
X Hanhong Lu EPIC, USA
X Simone Heckman HL7 Germany
X Drew Torres Cerner, USA
X Isabel Gibaud HL7 France
X Tricia Chitwood Cerner, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

  1. FHIR Ballot Reconciliation - Encounter

Supporting Documents

Minutes

Minutes/Conclusions Reached:
Introductions

  1. 14099 - Summary: Guidance on how to request a new identifier (e.g. MRN) (cont.)


Guidance will be provided in the section “8.1.3 Patient Id’s and Patient resource id’s”. Where there is a need to implement an automated MRN Identifier creation for a patient record, this could be achieved by providing an identifier in the patient with the MRN type, an appropriate assigner and no value assigned. Internal business rules can then detect this and replace/populate this id with 1 or more ids (as required).
Drew moves/Brian
Persuasive
Vote: 8/0/2

  1. 14823 Add search for Encounter.account –

Brian moves/Drew seconds to accept as persuasive.
Vote: 9/0/1

  1. 14824 - Encounter.class should be 1..1

Class cardinality should be 1..1 as mentioned in section 8.11.4 Notes
The class element describes the setting (in/outpatient etc.) in which the Encounter took place. Since this is important for interpreting the context of the encounter, choosing the appropriate business rules to enforce and for the management of the process, this element is required. Moreover in class history it is marked as 1..1, so unless it is mandatory in current encounter, there won't be way to have it mandated in history

Encounter.class should be 1..1
This seems reasonable to the WG.
Alex/Simone second
Vote: 9/0/1

  1. 14499 - Encounter.class description/definition contains duplicates (not in value set)

Description/definition says "inpatient | outpatient | ambulatory | emergency +"
The format of that description/definition usually implies those are specific codes in the value set, but the value set doesn't differentiate between outpatient and ambulatory. There is a single code for ambulatory, so it seems a bit misleading to imply there are codes for both.
The WG discussed this and decided upon a different description.
“Concepts representing classifciatin of patient encounter such as ambulatory (outpatient), inpatient
Simone moves/Line seconds
Vote: 9/0/0

  1. 14758 - Summary: Add example to Encounter.diagnosis.rol to address principal diagnosis for an Encounter as noted in the comment provided (or add an additional role of principalDiagnosis). - 2018-Jan Core #95

Clinical quality measures need to address the concept of a Principal Diagnosis defined by statute as the coded diagnosis/problem established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. The roles provided do not directly address principal diagnosis. FHIR tracker (https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10544) suggest that encounter-primaryDiagnosis and encounter-relatedCondition extensions will be removed as they are redundant with the core resource (using Encounter,diagnosis.role and Encounter.diagnosis.rank. However, the extension remains. And the example in Encounter.diagnosis.role does not address principal diagnosis. Encounter.diagnosis.role should include an example for definiing Principal diagnosis (e.g., role = billing diagnosis AND rank = 1, or role = discharge diagnosis AND rank = 1. Alternatively, add a role of "principalDiagnosis" to enable clinical quality measures and clinical decision support.

Add example to Encounter.diagnosis.role to address principal diagnosis for an Encounter as noted in the comment provided (or add an additional role of principalDiagnosis).
The encounter-primaryDiagnosis and encounter-relatedCondition will be removed as being redundant to Encounter.diagnosis.role and Encounter.diagnosis.rank.
As for the example reference, Simone suggested to make this an example binding. THe WG determined to update example
The redundant extension will be removed.
Example f202 will be updated to remove the extension and clarify the usage.
Cooper Thompson moves and Tricia Chitwood seconds to make this persuasive with mod
Vote: 8/0/2

  1. 14477 - Encounter.serviceType needs binding to value set

Encounter.serviceType needs a binding to a value set.
After some research, it seems the binding is there, but the references from the Encounter.type does not point to the existing binding set which is an example set.
Brian moves, Alex seconds to move this persuasive.
Vote: 8/0/1

  1. 14451 - PA resources do not have a clean Workflow report

The workflow project has put together a report identifying places where resources don't align with patterns, as well as a mechanism for work groups to mark as "ignored" if they don't feel alignment is appropriate/necessary. Your work group has resources that are still showing up on the report - meaning that an alignment review has not been completed (or there are issues with the suppression process - in which case please let me know). Alignment is most critical for normative resources, but should be completed for all resources that are FMM3 or higher (and should be considered for resources with lower FMM levels)
After discussion our FHIR SMEs decided to “divide and conquer” the work based on the specific resources defined in the tracker item:

* ChargeItem - Simone
  • Encounter - Drew
  • EpisodeOfCare - Cooper
  • AppointmentResponse – Brian
  • Appointment - Brian


Meeting Outcomes

Actions (Include Owner, Action Item, and due date)

Next Meeting/Preliminary Agenda Items
  • .

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