Clinician on FHIR - May 2016 Montreal, Canada

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Planning Notes for May 2016 in Montreal

Observation

Rob to host

• Goals for “Observation”
  • Explore the boundaries of observation (fit for purpose?)
    • How do we represent microbiology – culture and sensitivity/susceptibility?
      • Rob – will find examples
  • Inpatient vs Outpatient – how do you follow observations over time for outpatient visits over different encounters….? (may be synchronous capture or asynchronous capture)
    • Document Vital signs over one encounter (inpatient) – can we trend?
      • HR
      • Temp
      • POx
    • Document Vital signs (Height, Weight, glucose?) over multiple encounters (Outpatient visits)
      • – can we trend? i.e H and/or W on a growth chart?
  • How is a panel observation like apgar scores documented? (synchronous capture)
    • Apgar Score (put values here)
    • hemodynamic monitoring – Swan Ganz data (BP, HR, RR, Temp, Pox, (BP/MAP), wedge, CVP – Swan ganz – things that are together and stay together?)
    • How are they captured, how are they managed as a set maintaining their relationship – such as the systolic is always linked to its relative diastolic?
  • Provide observation use cases to work through during the session –
    • Perhaps in Aug/Sept - Explore the workflow in OO/FHIR – lab orders and lab results back in observation?

Care Plan

Emma and Laura to host

• Begin looking at the cardinalities – are they correct for each of the parts and pieces? Such as – activities… can only reference one thing—
• Work Profiles (profiling to the care plan resource so it can fulfill the intentions of the storyboard) in Care Plan
• Instantiate the DAM using FHIR resources.

Plan for May 2016 Care Plan

• We want to profile the care plan resource so it can reflect a longitudinal or dynamic care plan.
• Use the chronic conditions story board in the DAM work.….
• (Emma) Group 1- Profile the care plan to work with this storyboard.
  • Get/post/distribute the storyboard. (posted on the Clinicians on FHIR wiki - )
  • Check to see or create new discipline specific plans to be used at this event to nest into one Care Plan. Note the coordinates of these care plans in the prep sheet a few days before the Friday event in May. (assure the plans are there and where they are).
  • Review the care plans that currently exist on the ClinFHIR server – and make sure they have the level of detail needed for this exercise… otherwise need to create them.
  • Ask about what testing is happening on Care Plan the previous weekend…. (attend the technical connectathon the weekend before) – there is a LIVE spreadsheet that indicates which resources/profiles are being tested there. Rob – can help us find that. (Not sure when the Montreal list will be available. Once it is, then go look for the Care Plan resource use)
  • Storyboard is fairy complicated…. Will commit to 3 different care plans to be nested into one Care Plan resource?
  • Address: Care Team Resource – analysis between FHIR and the DAM http://hl7-fhir.github.io/careteam.html
  • Address: Care Plan Resources – analysis between FHIR and DAM.
• (Laura) Group 2- Instantiate the DAM using FHIR resources and do Purposeful review of the cardinalities in the DAM and their support or not within the FHIR resources. Come up with examples as to why or why not the cardinalities as defined in the DAM are needed.
  • Surface DAM information model –

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Genomics/Family History

Montreal – Will begin a tutorial that they taught for clinical genomics - on Thurs.

• Have a number of new profiles - observation, diagnostic report, family sequencing, etc
• Very dev focus about moving data from one place to another.
• Who are the clinical resources?
  • For example - working with Kevin Hughes on fam hx- may want to extend and add in the genomics to enable scenarios that would build on what we have. It takes the pedigree data and calculate a risk. Used the V3 model and was able to represent the patient who did have the disease but was unable to represent fam members who did not have the disease. The calculating the risk part is fuzzy.

• • Test ordered for the patient is a service. As a collection of these. Ask clinical questions and have a genetic test that's run. Clinical things that could be representative.

• • Suggestion that Developers would work on the services.
  • Clinicians would be looking at the resources for collecting and storing the data.

• Action - survey HL7 community about those who would be interested in clinical genomic and related work on it and also to do a re-requisite webinar.

http://wiki.hl7.org/images/1/16/Family_History_Risk.docx

Medications

Melva and John to host

• End to end process around medication ordering, admin, documentation, etc.
• Chemotherapy?

First Time Attendees

Viet to host

• Q1 = walk through basics and
  • create a practitioner,
  • create a set of problems for the patient,
  • create a medication order for the patient,
  • tie in FHIR concepts manifested through the clinFHIR tool.
• Q2 - Tackle order resources and create orders based on the needs of the Care Plan track. Then see if the orders created work in the Care Plan profile.

Planning Calendar

Preparation Master Plan