January 2012 WGM San Antonio

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• patient care work group meeting draft minutes

San Antonio WGM 2012 Jan

Jan 16 Monday Q1

Present: Stephen Chu (chairing the meeting), Wlliam Goossen, Michael Tan, Susan Matney, Hugh Leslie, David Rowed, Kai Haitmann, Adel Ghlamallah, Rajan RAI, Meredith Lewis, Jennifer Sisto, Michael van der Zel, Ray Simkus, Kevin Coonan.

Action items Q1:

1. Short introduction of members present in the meeting.
2. Agenda setting for the week: The agenda was changed. Move to accept the changed agenda v05. 1st Kevin, 2nd Susan vote: 0 opposed, 0 abstain, 13 in favor. This file has been mailed via PC HL7 mailing list.
3. Tooling Micheal van der Zel is our official toolsmith. He asks if PC has requirements for tooling. He will collect these and summarize.
4. Plan for D-MIM / 3 R-MIM ballots
   • Motion to accept the D-MIM and any combination of Patient Care ‘Care Provision’ R-MIM topic artifacts for ballot content (referral, acceptance, query, and care record) to move to ballot. 1st William 2nd Kevin: vote: 0 no , 0 abstain, 12 in favor. Do we need an out of cycle meeting to arrange this? Nictiz is willing to organize this in February 2012.
     • Action item for Michael Tan.
5. WG Mission and Charter on website review
   • The mission and charter was briefly reviewed.
     • Motion to leave the existing PC mission and charter as it currently is. 1st William, 2nd Hugh, vote 0 against, 0 abstain, 12 in favor.
6. 3 year Workplan 2012-2014: 3 year workplan to be discussed and re-approved
   • The spreadsheet with the PC project was reviewed. Some items have finished, and will be removed. Others are ongoing priorities such as D-MIM and R-MIMs for Care Transfer Topic (refer and promise) Care Record Query Topic, and Care Record Topic.
     • Motion to accept the changes in Excel workplan 2012 version 0.88. Moved: 1st William 2nd Kai, votes: 0 against, 1 abstain, 12 in favor.
   • Business Plan PC: handled as part of the 3 year workplan.
   • Planning of conference phone calls and other work plans: due to time deferred to meeting on Wednesday.
   • PC planning of work items and meetings for next WGM: due to time deferred to meeting on Wednesday.

Jan 16 Monday Q2

Present: Stephen Chu, Wlliam Goossen (chairing the meeting), Michael Tan, Ray Simkus, Hugh Leslie, David Rowed, Kai Haitmann, Meredith Lewis, Robert Dunlop, J.D. Baker.

Walk through and discussion of Patient Care wiki on Care Provision

What are the core R-MIMs?

1. Care Record 2. Care Transfer (Referral and Promise, 2 R-MIMS altogether) 3. Query of patient record contents relevant to the referral

The topic Query of referral status – early work has been done - does get no further development.

Use of template – can be in form of R-MIM or clinical content as xml; application of constraints to HL7 domain models, CSP, etc; and for creation of validation artefacts.

Confusions on template still exist in HL7 at large. Need to find a “standardized” way how to express template and use them in CDA, Care Record, etc – need to work with Structure Document WG on this issue.

Need also to consider moving away from representing templates as graphic notations and consider use of some form of constraint language (and constraint statements) to express templates. Also need to move away from the entry points for each artifact in D-MIM. Need to look for a better way and harmonize with templates.

Ballot materials – beneficial to add information pertinent to different target audience view points, e.g. clinician, modellers, implementers. Each view point also needs to consider the level of abstraction

Kai to review section on “template” and update contents where necessary

Issue of cascading changes when made in one artefacts need to flow through to other forms of artefacts. Model driven tools to support such changes are lacking.

Motion 1:

Accept that each patient care template shall have a template ID according to HL7 methodology and this identifier shall be used for every expression of the same template in different formats including MIF, R-MIM, xml, uml, xmi, etc

Kevin (move), Ray (second)

0 against, 1 abstain, 9 support

Motion 2:

Patient care shall adopt a single approach to template ID generation, and Patient Care shall prescribe the use of template ID.root and template ID.extension for all patient care templates

Tabled for further discussion in another session.

Storyboard – copy and paste from current ballot materials

Jan 16 Monday Q3

Meeting was cancelled. Individual PC members have worked on the ballot D-MIM work preparations.

Jan 16 Monday Q4. O&O Hosting PC

Care Provision D-MIM was updated with inclusion of the statement collector choice box between the Care Provision and Clinical Statement CMET allowing simplifying R-MIMs that use this. Pertinent information act relationship from care provision to statement collector en component from statement collector to clinical statement.

Care Record D-MIM was updated to replace the care statement with the clinical statement CMET. The structure on D-MIM with Statement Collector needs to be modeled on Care Record The CareEvent CMET has been removed in favor for the Act Class itself. DMIM model is updated, needs correction of choice-box. Care Record needs the choicebox completed and the CareEventClass needs to have all the attributes from the CMET ActClass.

Three kinds of templates for PC D-MIM: Kai identified three types of templates we need in PC for the D-MIM and R-MIMs. 1. Root level templates (care provision class) that constrain a whole message (composition of the message) and reside in the care provision class 2. Structural templates, that allows the CMETs, 3. Clinical Statement Level template that applies to the clinical statement choice box which allows entry-level template levels.

Criterion: have one solution that allows referring to (long) lists of templates, without having to redo the D-MIM every time when a new template is created.

Action item: changes on care record to be done in a similar manner for the request and the promise R-MIMs.

Action item: continue to model this and discuss in PC meeting later this week and have motions to approve.

PC Tuesday 17th Jan 2012

Q1 Present: Michael Tan, David Rowed, Susan Matney, Stephen Chu (chairing), Ray Simkus, Hugh Leslie, Nicholas Oughtibridge, Kevin Coonan, Elaine Ayres, William Goossen (scribe). Nicholas Oughtibridge gave an overview of the work on ISO 13940 Contsys and the content of this standard. It covers the description of health care works, and actors and processes in it. His presentations and weblinks will be provided. The draft standard could be made available to HL7 PC due to the linkage through the JIC work where Contsys was added recently. Several items seem to overlap with PC materials. But it does not seem a perfect match. Discussion to accept Contsys as DAM for PC lead to conclusion it is too early, but it needs to be considered as candidate. This can follow up on earlier gap analysis and adaptation, such as the concern tracker being similar to health issue thread. < Motion to be included here from the slides> Motion moved by Ray Simkus 2nd by William: votes 0 against, 1 abstain, 8 in favor.

William presented the results of the modeling with O&O of Monday: Care Provision D-MIM RM000000 version 800.3 statement collector introduced between Care Provision Act and Clinical Statement. This to ease up models downstreams and to allow any collection of clinical statements be linked to the care provision. Care Record R-MIM update to include the clinical statement collector, To include the same statement collector and to have the CareEvent change from CMET to full class because it is only one Act Class. Motion to tentatively accept these current D-MIM and R-MIM Care Record as changed in the joint PC and O&O meeting versions as the ones to working towards normative ballot in May 2012 (so ready by March). Pending a resolution of the following action items: - ongoing harmonization work with PA on encounter (Kevin and Irma Jongeneel). - class type List versus Container (Kevin). moved by William 2nd by Michael Tan, 0 against, 0 abstain, 10 in favor. Q2 Tuesday PC. Present: Michael Tan, Susan Matney, William Goossen (no motions due to too limited number) Report back on the question on list versus container: Jean Duteau said that container is just for documents. ActList is the proper act class for creating lists. However, Jean suggested to remove the choicebox and the category act and just have the ActList class with 0..* relationship to CP and CS. Hence DM 000000 version 800.4 created where the StatementCollector choice box is removed in favor of the Modeling Facilitator’s advice to replace that with the StatementCollectorActList class. RM002000 Referral changed to version 800.1 - Replaced Care Statement CMET with SupportingClinicalStatement CMET - Replaced StatementCollector CMET with StatementCollectorActList class after advice from MnM on Jan 17, 2012 - Replaced ConditionTrackingEvent local CMET with ConcernTracking local CMET

RM003000 Promise not changed, because no needed but updated to version 800.1 REPC_RM004000UV CareRecord changed to version 800.1

- Replaced Care Statement CMET with SupportingClinicalStatement CMET - Replaced StatementCollector CMET with StatementCollectorActList class after advice from MnM on Jan 17, 2012 - Replaced PatientCareProvisionEvent CMET with PatientCareProvisionEvent Act Class