Latest revision as of 00:17, 31 January 2017

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Introduction

The January 2017 Clinician-on-FHIR event will be hosted on Friday January 20, 2017.

Weekly preparatory conference calls are being hosted on Tuesdays at 5:00 - 6:00 pm US Eastern.

First Clinician-on-FHIR call starts: Tuesday October 4, 2016

Conference call details: please see HL7 email broadcast

Planning

Master Plan for San Antonio Clinicians on FHIR - January 2017 - draft - date: 2016-10-25

Tracks to be addressed

Care Plan
Emergency care, covering:
Medication
Diagnostic Request, Report and Observation
Family Member History - Clinical Genomics

- Details of planning notes for each track can be accessed through the following wiki page:

- January 2017 Clinician-on-FHIR Planning Notes

Goal = create at least one (or more if possible) meaningful example(s) (actual JSON resource instance) for each FHIR resource otherwise the limitation of the FHIR resource is identified.

Supporting Tool and Information

Tool

- Participants registered for the Clinician-on-FHIR event are strongly recommended to familiarise themselves with the clinFHIR tool

- A new user interface has been created to support creation of clinical story built from a set of FHIR resources based on the clinical scenario described in the Tracks section below

- Logon to the clinFHIR site:

- [clinFHIR.com/]

- Connect to the FHIR servers by selecting the appropriate Data Server (e.g. Public HAPI DSTU3), Conformance Server and Terminology Server

- click on the "Tool" icon on the top right hand corner of the clinFHIR page and select "simple builder" option

(Note - "simple builder" will soon be changed to "scenario builder")

Supporting Information

- Dr David Hay has provided some very useful information on this new "simple builder" ("scenario builder") tool.

- clinFHIR "simple builder" Getting started guide (created by Emma Jones)

- Information on this tool can be accessed from his blog:

- Building a set of Resources in FHIR

Clinician-on-FHIR Tracks

Care Plan

Track lead: Emma Jones/Laura
Clinical Secenario

- Patient with Type 2 Diabetes managed by multi-disciplinary care team with PCP as care coordinator

- Multi-disciplinary care plan created by PCP after discussions with patient to coordinate care management

FHIR resources used in this track:

- CarePlan which references the following resources:

CareTeam, Goal, Condition, Observation, DiagnosticRequest, ReferralRequest, MedicationRequest

+/- Vaccination

Issue to be resolved - what to use for Patient Instruction?

Diabetic Care Plan Test Data

Emergency care

Track lead: Jim McClay/Laura
Clinical Scenario

- Patient presents at ED suspected of exhibiting communicable disease signs and symptoms

- ED intake/triage workflow is initiated

- Physician/Nursing evaluation workflow is initiated

- Travel history screening, Observation and diagnostic tests, triggering CDC communicable diseases management protocol

FHIR Resources used:

Questionnaire, QeustinnaireResponse, Observation, DiagnosticRequest, DiagnosticReport, ClinicalImpression, Condition

+/- MedicationRequest, ReferralRequest

ED Workflow information: Refer to HL7 Domain Analysis Model: Emergency Care Release 1 - US Realm January 2016

Diagnostic Track

Track lead: Rob Hausam
Clinical Scenario

- Type 2 Diabetes patient

- PCS instructs patient to perform the following at home as per CarePlan

- BSL x 3/day; BP x 1/day; Body weigh x1/week

- At follow-up consultation in 4 weeks, PCP reassess patient and requested:

- Fasting blood glucose, Fasting lipids

- At follow-up consultation, patient also complains of productive cough (greenish sputum) and fever

- PCP requested: sputum for microbiology test

FHIR Resources used:

Observation, DiagnosticRequest

Medication

Track leads: Melva/John Hatem
Clinical Scenario

- Type 2 DM patient

- PCP reviews patient's medication history, performs medication reconciliation where necessary, requests diabetic medications (and other relevant medications, e.g. antibiotics for respiratory infection), updates medication list, medications dispensed by pharmacist, and administered by patient

FHIR Resources used:

Medication, MedicationRequest, MedicationDispense, MedicationAdministration, MedicationStatement, MedicationList (List resource)

Questions: what about new instructions to patient? recommendation to prescriber?

Plan medication management in CarePlan resource: medication order through to administration

Family Member History

Track lead/co-leads:Grant Wood/Gil Alterovitz
Scenario

- To be completed

Technical Connectathon

The HSSP community is running a project, which is a FHIR based Care Coordination Service.
Details about this project are available at the Clinicial-on-FHIR planning notes wiki page:

January 2017 Clinician-on-FHIR Planning Notes

What's new for the January 2017 Technical Connectathon?

- There will be a small team of clinicians working alongside the FHIR developers to test how well the clinical workflow may work alongside the technical workflow

- The CarePlan track has been selected for this new joint initiative

- Care Plan test data created by the Care Plan team will be used in this track

- Lessons learnt from the technical connectathon will be used as inputs into the Clinician-on-FHIR CarePlan track in the Friday event

Difference between revisions of "Clinician on FHIR - January 2017, San Antonio"

Latest revision as of 00:17, 31 January 2017

Contents

Introduction

Planning

Tracks to be addressed

Supporting Tool and Information

Clinician-on-FHIR Tracks

Care Plan

Emergency care

Diagnostic Track

Medication

Family Member History

Technical Connectathon

Navigation menu

Personal tools

Namespaces

Variants

Views

More

Search

Navigation

groups

meetings

general

Tools

@@ Line 23: / Line 23: @@
 =Planning=
-[[Media:Clinicians on FHIR Jan 2017 Master Plan_2016-10-25.docx | Master Plan for Baltimore Clinicians on FHIR - January 2017 - draft - date: 2016-10-25]]
+[[Media:Clinicians on FHIR Jan 2017 Master Plan_2016-10-25.docx | Master Plan for San Antonio Clinicians on FHIR - January 2017 - draft - date: 2016-10-25]]
 <br>
 <br>
@@ Line 49: / Line 49: @@
 :: - A new user interface has been created to support creation of clinical story built from a set of FHIR resources based on the clinical scenario described in the Tracks section below
 :: - Logon to the clinFHIR site:
-::: - [clinFHIR.com/ clinFHIR tool]
+::: - [clinFHIR.com/]
 ::: - Connect to the FHIR servers by selecting the appropriate Data Server (e.g. Public HAPI DSTU3), Conformance Server and Terminology Server
 ::: - click on the "Tool" icon on the top right hand corner of the clinFHIR page and select "simple builder" option
@@ Line 56: / Line 56: @@
 * '''Supporting Information'''
 :: - Dr David Hay has provided some very useful information on this new "simple builder" ("scenario builder") tool.
+::: - [[Media:Clinfhir cheatSheet Jan 2017.docx | clinFHIR "simple builder" Getting started guide (created by Emma Jones)]]
 :: - Information on this tool can be accessed from his blog:
 ::: - [https://fhirblog.com/2017/01/09/building-a-set-of-resources-in-fhir/#more-159489 Building a set of Resources in FHIR]
 <br>
-==Planning Notes for Each Track==
+=Clinician-on-FHIR Tracks=
-Seven tracks have been identified for the January 2017 Clinician-on-FHIR event.
+==Care Plan==
+* Track lead: Emma Jones/Laura
+* '''Clinical Secenario'''
+:: - Patient with Type 2 Diabetes managed by multi-disciplinary care team with PCP as care coordinator
+:: - Multi-disciplinary care plan created by PCP after discussions with patient to coordinate care management
+*  FHIR resources used in this track:
+: - CarePlan which references the following resources:
+:: CareTeam, Goal, Condition, Observation, DiagnosticRequest, ReferralRequest, MedicationRequest
+:: +/- Vaccination
+:: Issue to be resolved - what to use for Patient Instruction?
-===Care Plan===
+* [[Media:FHIRCare Plan_Resource_Test_DataV2-1.xlsx |Diabetic Care Plan Test Data]]
-* For discussion on: 01 November 2016 conference call<br>
-''Track lead/co-leads'':<br>
-: - Laura
-: - Emma
-<br>
-''Scope'':<br>
-: - To include: Instruction, Care Team
-<br>
-''Goals/Objectives''<br>
-:- What is the best way to do instruction?
-* Communication does not seem to meet the needs of what is needed (demonstrate why. meta data? what is missing).
-* Careplan.activity.... does not seem to mee the needs (demonstrate why, what is missing?)
-* Use the list resource and list them as text (why does this work or why not?)
-<br>
-''Lessons from previous Clinician-on-FHIR''<br>
-<br>
-''Use cases / Scenarios''<br>
-:- define what is meant by instruction
-* Discharge instruction (Take this med, get this follow up, follow this activity or diet)
-* First set (MU)
-:-a. Diet: Diabetic low salt diet
-:-b. Medications: Take prescribed medications as advised.
-:-c. Appointments: Schedule an appointment with Dr Seven after 1 week. Follow up with Outpatient facility for Immunosuppression treatment.
-:-d. For Fever of > 101.5 F, or onset of chest pain/breathlessness contact Emergency.
-* Second Set (MU)
-:-a. Appointments: Schedule an appointment with Dr Seven after 1 week. Follow up with Outpatient facility.
-:-b. In case of fever, take Tylenol as advised in plan of treatment.
-* Vaccine Instruction
-* Care activity instruction
-* Fellow provider instruction -
-: - Examples:
-:: -- Shoulder arthroscopic repair
-::: Post op: patient sees Physical Therapist (PT) before each follow-up session with the surgeon
-::: PT may receive instructions from the surgeon to:
-:::: - assess and record shoulder joint mobility/ROM, pain level
-:::: - PT exercises with the following restrictions, e.g. for week 2 post-op follow-up
-::::: ~ PROM FL < 150 degree
-::::: ~ Scaption to < 150 degree
-::::: ~ ER neutral to 30 degree
-::::: ~ IR in 55 degree
-:: -- (Instruction to pharmacy)
-* Post procedure protocol/instructions (post CABG instructions to patient (the full written page of instructions), post colonoscopy intsruction sheet)
-: - Examples:
-:: [http://digestivehealth.ca/post-colonoscopy-instructions/ Digestive Health Clinic, Canada: post-colonoscopy patient instructions]
-:: [[Media:Post-CABG-discharge-patient-instructions.pdf | Post-CABG discharge instructions for patient]]
-* Goals - MU allows text only.
-:-a. Get rid of intermittent fever that is occurring every few weeks.
-:-b. Need to gain more energy to do regular activities
-:-"c. Negotiated Goal for Body Temperature
-LOINC 8310-5 98-99 degrees Fahrenheit
-Date-6/22/2015
-Related problem: 386661006 SNOMED-CT Fever (finding)
-/22/2015 – Start Date
-Active
-"
-* Health Status evaluation outcomes -
-:-"a. Outcome Observation #1:
-:-i. Refers to Goal Observation for Weight
-:-ii. Refers to the Intervention Act #1
-:-iii. Progress Towards Goal of Weight – Goal Not Achieved as of 6/22/2015"
-:-"b. Outcome Observation #2:
-:-i. Refers to Goal Observation for Body Temperature
-:-ii. Refers to Intervention Act #2
-:-iii. Progress Towards Goal of Body Temperature – Goal Achieved as of 6/24/2015"
-NEED SCENARIOS for CARE TEAM
-<br>
-''Processes''<br>
-<br>
-===Conference call 22 November 2016===
-* For discussion on: 22 November 2016 conference call<br>
-Present:<br>
-: - Stephen
-: - Emma
-: - Laura
-: - Rob Hausam
-: - Jim McClay
-: - Joe Quinn
-<br>
-Discussions on the scope of clinical documentation
-Agreed that the scope can be extensive
-Suggestions:
-(1) Limit the scope to Condition, Procedure, Observation - use for Medical History <br>
-(2) Incorporate Allergy/Intolerance and Clinical Documentation into Emergency Care Track
-Quick overview of the Emergency Care workflow DAM
-Decision: <br>
-(a) to review the Emergency Care workflow DAM <br>
-(b) to pick steps in the workflow and suggest FHIR resources for testing
-(c) to discuss and finalise at the 29 November conference call
-<br>
-===Emergency care===
-* For discussion on: 29 November 2016 conference call<br>
-: - Follow-up conference call discussion on 6 December 2017
-''Track lead/co-leads'':<br>
-: - Jim
-: - Laura
-<br>
-''Scope''<br>
-- To include: Condition, Observation, Questionnaire, Questionnaire Response, Procedure, Referral Request, Clinical Documentation <br>
-- Other possible candidate: Protocol, Standing Orders (order sets) (to be discussed further on 20 December conference call) <br>
-- Focus on the Screening Needs of the ED (See EC DAM EC Screening Process) <br>
-- Look at the triage section of the ED DAM with eyes on future use of the Triage date for decision support, research use etc.
 <br>
-''Goals/Objectives''<br>
-- Complete intake/triage of patient <br>
-- Complete Screening documentation for each of the screenings required in the EC DAM page 34.
-<br>
-''Lessons from previous Clinician-on-FHIR''<br>
-<br>
+==Emergency care==
-''Use cases / Scenarios''<br>
-- Patient attended ED after return from overseas trip and presenting with complaints such as fever, headache ..... <br>
-- Triggers intake/triage workflow <br>
-- Triggers travel history screening <br>
-- Triggers intervention protocol and standing orders (order set) as per CDC recommendations/advisory <br>
-<br>
+* Track lead: Jim McClay/Laura
-''Action item''
+* '''Clinical Scenario'''
-- Create travel history questionnaires (to be done in advance) <br>
+: - Patient presents at ED suspected of exhibiting communicable disease signs and symptoms
-- Action owner: Dr Jim McClay
+:: - ED intake/triage workflow is initiated
+:: - Physician/Nursing evaluation workflow is initiated
+::: - Travel history screening, Observation and diagnostic tests, triggering CDC communicable diseases management protocol
+* FHIR Resources used:
+: Questionnaire, QeustinnaireResponse, Observation, DiagnosticRequest, DiagnosticReport, ClinicalImpression, Condition
+:: +/- MedicationRequest, ReferralRequest
+* ED Workflow information: Refer to HL7 Domain Analysis Model: Emergency Care Release 1 - US Realm January 2016
 <br>
-===Medication===
+==Diagnostic Track==
-* For discussion on: 13 December 2016 conference call<br>
-''Attendance'': <br>
+* Track lead: Rob Hausam
-* Stephen Chu
+* '''Clinical Scenario'''
-* Emma Jones
+: - Type 2 Diabetes patient
-* Rob Hausam
+:: - PCS instructs patient to perform the following at home as per CarePlan
-* Russ Leftwich
+::: - BSL x 3/day; BP x 1/day; Body weigh x1/week
-* John Hatem
+:: - At follow-up consultation in 4 weeks, PCP reassess patient and requested:
-* Melva Peters
+::: - Fasting blood glucose, Fasting lipids
+:: - At follow-up consultation, patient also complains of productive cough (greenish sputum) and fever
-''Track lead/co-leads'':<br>
+::: - PCP requested: sputum for microbiology test
-: - Melva
+* FHIR Resources used:
-: - John Hatem
+: Observation, DiagnosticRequest
 <br>
-''Scope'':<br>
-: - To include: Medication, Medication Order, Medication Dispense, Medication Administration, Medication Statement
-<br>
+==Medication==
-''Goals/Objectives''<br>
-* To test all medication resources: MedicationRequest, Medication Dispense, Medication Administration, Medication Statement
-* To test medication reconciliation process
-<br>
-''Lessons from previous Clinician-on-FHIR''<br>
-* The medication resources had been quite extensively tested in the past clinician-on-FHIR events
-* It will be useful to test the process/workflow through medication reconciliation process
-* Participants comes either to explore/learn about medication resources, or come with use cases and want to test the resources per their requirements
-<br>
+* Track leads: Melva/John Hatem
-''Use cases / Scenarios''<br>
+* '''Clinical Scenario'''
-* Medication reconciliation starting with review of medication list and other medication resource instances including order/request, dispense and administration, reconciliation process resulted in updated medication list, new medication order/request ...
+: - Type 2 DM patient
-: - Questions: what about new instructions to patient? recommendation to prescriber?
+:: - PCP reviews patient's medication history, performs medication reconciliation where necessary, requests diabetic medications (and other relevant medications, e.g. antibiotics for respiratory infection), updates medication list, medications dispensed by pharmacist, and administered by patient
-* Plan medication management in CarePlan resource: medication order through to administration
+* FHIR Resources used:
+: Medication, MedicationRequest, MedicationDispense, MedicationAdministration, MedicationStatement, MedicationList (List resource)
-<br>
+* Questions: what about new instructions to patient? recommendation to prescriber?
-''Processes''<br>
+:  Plan medication management in CarePlan resource: medication order through to administration
-* John Hatem suggested to use first half hour of clinician-on-FHIR to discuss and finalise test scenarios
-* Emma Jones suggested to use medication test data from meaningful use for medication reconciliation, order, dispense and administration
-* Stephen Chu to start email thread to explore the capability of clinFHIR in supporting clinical process (e.g. in ED screening and medication reconciliation
 <br>
-===Diagnostic Request, Report and Observation===
+==Family Member History==
-* For discussion on: 3 and 10 January 2010 conference call<br>
+* ''Track lead/co-leads'':Grant Wood/Gil Alterovitz
+* '''Scenario'''
-''Track lead/co-leads'':<br>
+: - To be completed
-: - Rob
-<br>
-''Goals/Objectives''<br>
-* To test the diagnostic request, report and observation resources using chronic disease (diabetes) management storyboard
-* To test clinical workflow pertinent to these FHIR resources in collaboration with the Care Plan track
-<br>
-''Lessons from previous Clinician-on-FHIR''<br>
-<br>
-''Use cases / Scenarios''<br>
-* Patient diagnosed with Type 2 Diabetes
-* Care plan activities include:
-: - Patient to perform daily BSL tests at home and record BSL readings (Observation resource)
-: - Patient to perform weekly weight measurement at home and record weigh measurements (Observation resource)
-* Patient to return to PCP clinic for follow-up in 4 weeks
-: - Patient complaints of fever, productive cough, shortness of breath and lathargy on follow-up visit (chief complaints - observation resource)
-: - Diagnostic test request
-:: # Fasting lipids and fasting blood glucose (DiagnosticReqeust resource)
-:: # Sputum for microbiology tests (diagnosticRequest resource)
-:: # weigh measurement (observation resource)
-<br>
-''Processes''
-* Diagnostic tests performed
-* Path lab returns test results to PCP (DiagnosticReport resource)
-* Patient observation results integrated into Care Plan - for outcomes evaluation
-* Path test findings integrated into Care Plan - for outcome evaluation
-<br>
-===Family Member History===
-* For discussion on: 20 December 2016 conference call<br>
-''Track lead/co-leads'':<br>
-: - Grant Wood
-: - Gil Alterovitz
-<br>
-''Scope'':<br>
-: - To include clinical genomics
-<br>
-''Goals/Objectives''<br>
-<br>
-''Lessons from previous Clinician-on-FHIR''<br>
-<br>
-''Use cases / Scenarios''<br>
-<br>
-''Processes''<br>
-<br>
-==ClinFHIR Tool Review==
-* Date: 10 January 2017 Conference call
-<br>
-* Details - TBA
@@ Line 351: / Line 139: @@
 <br>
 The HSSP community is running a project, which is a FHIR based Care Coordination Service. <br>
-The project:
+Details about this project are available at the Clinicial-on-FHIR planning notes wiki page:
+* [[January 2017 Clinician-on-FHIR Planning Notes]]
-- plans to define services and profiles that allow care coordination across clinical teams for a patient (e.g. manage teams, care plans, etc)
+* What's new for the January 2017 Technical Connectathon?
-- expects to use FHIR resources, profiles, operations etc to define a "Care Coordination Service"
+: - There will be a small team of clinicians working alongside the FHIR developers to test how well the clinical workflow may work alongside the technical workflow
-- has use cases, and some preliminary architecture
+: - The CarePlan track has been selected for this new joint initiative
-- plans to hold a connectathon track at the January meeting
+: - Care Plan test data created by the Care Plan team will be used in this track
-- is working towards an initial submission date of Feb 2017, and is being lead by AllScripts
+: - Lessons learnt from the technical connectathon will be used as inputs into the Clinician-on-FHIR CarePlan track in the Friday event
-The project is seeking participation from the FHIR community, including all those that are already working on (or have in production) solutions around coordinated care, both inside USA and outside as well.
-A proposal has been initiated for a Care Plan track to be run at the Jan FHIR connectathon (technical connectathon) that would focus on testing CarePlan, CareTeam, and Goal.  And any any profiles that are available or proposed at that time, e.g. US-Core profiles and the IHE Dynamic Care Plan IG.
-More details about the proposal can be found at this link:
-http://wiki.hl7.org/index.php?title=201701_Care_Plan
-Resource subscription function may be useful in care planning collaboration:
-http://wiki.hl7.org/index.php?title=201701_Resource_Subscription_Track
-<br>
-=Appendix=
-<br>
-===Allergy/Intolerance and Adverse Reaction===
-* Discussed on 8 November 2016 conference call<br>
-Allergy/Intolerance track to be incorporated into Emergency Care track
-Contents set aside for future use
-<br>
-''Goals/Objectives''<br>
-: - To test changes to the Allergy/Intolerance resource since the last Clinician-on-FHIR event
-: - To assess the clinical usability and quality of the Allergy/Intolerance resource (and as potential candidate for Level 3 maturity)
-<br>
-''Lessons from previous Clinician-on-FHIR''<br>
-<br>
-''Use cases / Scenarios''<br>
-: (1) Documenting patient allergy/intolerance histories on:
-:: - allergic reaction to a penicillin drug during a previous healthcare encounter
-:: - parent assertion of history of allergy to a sulphur drug when patient was a child
-:: - allergic reaction to ionized particles from a cobalt-chromium alloy knee prosthetic implant
-:: - allergic reaction to an environmental agent (e.g.  Fel d 1 (a secretoglobin) and Fel d 4 (a lipocalin))
-:: - allergic reaction to seafood
-:: - adverse reactions after a meal at an Asian restaurant
-: (2) negation examples:
-:: - no known allergy
-:: - allergy to tree nuts but no known allergy to peanut
-: (3) generating an allergy/intolerance list from allergy/intolerance and adverse reaction history
-: (4) Decision support scenario
-:: - Scenario 1: patient allergy/intolerance list shows previous mild allergic reaction to oral amoxicillin (e.g. rash, diarrhoea)
-::: * patient is scheduled for prosthetic knee replacement
-:::: o Pre-operative prophylactic antibiotic prescription by junior registrar as per hospital protocol: cefuroxine 1.5g IV 60 min before surgery
-:::: o DSS returns a caution/low criticality alert on cross sensitivity - patient has allergy to amoxcillin with previous mild allergy reaction
-:: - Scenario 2: patient allergy/intolerance list shows previous severe allergic reaction to oral amoxicillin (e.g. severe rash, swelling of tongue, difficulty in breathing)
-::: * patient is scheduled for prosthetic knee replacement
-:::: o Pre-operative prophylactic antibiotic prescription by junior registrar as per hospital protocol: cefuroxine 1.5g IV 60 min before surgery
-:::: o DSS returns a high criticality alert on cross sensitivity - patient has allergy to amoxcillin with previous severe allergy reaction, cefuroxine is contraindicated
 <br>