View source for January 2015 WGM San Antonio: Jan 18 to Jan 23


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'''San Antonio WGM''' - January 2015 Patient Care WG Meeting Approved '''agenda''':

*[[Media:HL7PatientCare-WGM-Agenda_San_Antonio_2015-01_FINAL.xlsx| Patient Care WGM Jan 2015 San Antonio - FINAL Agenda - updated 2015-1-19]]



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== '''San Antonio WGM - January 2015. Patient Care WG Meeting Meeting Minutes''' ==

* Sunday, January 17 - International Council Meeting
: - No PCWG meeting

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=='''Patient Care WGM, Monday, January 19, 2015'''== 

* Back to [[Patient Care]]

* Back to [[Patient Care Work Group meeting Agenda and Draft Minutes]]

* Back to [[2015 PCWG WGM Agenda and Minutes]]

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=== Monday Q1 =

Present:Present: Attendees: Elaine Ayres (Chair), Michael Tan, Ashu Ravichander, Brady Keeter, Matthew Graham, Emma Jones, Russ Leftwich, Kevin Coonan, Ken Chen, Jay Lyle, Larry McKnight, William Goossen.

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Minutes:
Minutes: 
1.	Approve meeting agenda
Note all minutes must be pasted into the wiki – will check on status on Friday morning
Agenda approved – MOVE – Russ/William  Abstain – 0, Negative – 0, Approve - 11

2.	Approve minutes of the September WG meeting – Chicago
Russ/Jay    Abstain – 0, Neg – 0  Approve - 11

3.	Review status of WG documents for compliance

a.	Mission and Charter - Michael
b.	Decision making practices - Updated
c.	SWOT - Michael

4.	Status of Co-Chair positions
a.	Three openings in May – Michael, Elaine, Russ
b.	Discuss possible candidates

5.	Co-Chair administrative meeting – Friday at 8 AM

6.	Review of projects and status – three year plan
a.	Care Plan – V3, FHIR
b.	Care Plan SOA – next phase of Care Coordinated Services – question dependencies on V3 and FHIR.  OMG working on an RFP.
c.	Health Concern – finish work on the DAM and FHIR.
d.	Allergy and Intolerance – V3, C-CDA, FHIR.
e. 	PSS   William/Russ    Abstain – 0, Negative – 0, Approve - 11
f.      FHIR Resources
g.	Anesthesia – Anesthesia working on but no significant updates.  Not meeting this WG.
h.	Other projects – IHE PCC – proposal evaluated and accepted.  Will create volume I of profile (end of Feb).  There is an HL7/IHE work group being formed.  PC will be a co-sponsor.  
i.	New project proposals – 
j.	Allergy and Intolerance terminology implementation guide

K.	IHE IMIA/HIMSS/ICN Showcase – Geneva Switzerland 2016 meeting
*Use HL7 standards and IHE profiles.  
*PSS approval as co-sponsor – MOVE - Russ/Emma  Abstain – 1, Negatives – 0, Approval – 
7.	Clinician Connectathon


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=== Monday Q2 ===
Attendees:
Chair – Michael Tan
Scribe – Elaine Ayres
Jay Lyle
Larry McKnight
Margaret Dittloff
David Pyke
Ken Chen
Kevin Coonan

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Minutes:**Health Concern Ballot Reconciliation**
Ballot reconciliation – Health Concern DAM – informative ballot, R2

27 comments total
•	2 Negative Major comments
•	11 Negative Minor comments

Larry has sent out a new drawing.  The health concern is what tracks the health care concern components.    Links in the care plan and adds a health concern list object.  Each problem is a concern and each concern has an event.  Note that different clinicians may view a concern differently – e.g. an allergy from a clinician vs. an allergist need to be accommodated.   Can have a goal – proposed or met?  

Does a tracker function need to be included or is this more a list of health concerns?
A FHIR resource has condition – the attributes include an event.  

There is an inconsistency with current DAM – Larry has suggested changes.    Discussed changes in format – move additional introductory prose before the model.  

Previously – was condition, and updated to concern.  There is inconsistency across all HL7 models.   Can stick to these names if they remain consistent.  

Is a FHIR resource needed for health concern, vs. using existing resources with some extensions?  Need to make a definitive determination.   

Add a glossary to the DAM.  How does this relate to model names and definitions.   Pull in model as a text based document.  

Ballot reconciliation – began with negative majors.  Two items.

Jay/Ken moved   Abstain – 0, Neg – 0, Approve – 6 for both negative majors.  
Ballot reconciliation moved to negative minors.  Who owns a health concern?  Is this a terminology issue?   Who is responsible?  The concern has an author – but who is the custodian?  Who do you send an update to?  

Need to be clear on the author, the custodian (system or organization) and who can allow modifications.  Are these in scope?  Have the identifier, but not  addressed but other issues.  

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=== Patient Care Monday Q3 ===
'''CCS/SOA for CCS RFP'''

Present: Russ Leftwich (Chair), Ken Rubin (presenting), Emma Jones (scribe), Martin Rosner, Dave Pyke, Michael Tan, Christina Knotts, Laura Heerman-Langford, 
Kevin Coonan, Enrique Meneses (on phone)


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What is OMG (Object Management Group)? - Standards body that does not write standards. They adopt standards. The Task force puts together the RFP, people respond to it with a candidate standard which become the standard. Goal is to get competing submitters to work together on a standard that is implementable. Process includes an initial submission and a revise submission. Typically during revise submission stage, the competing submissions agree to work together. The goal of the submitters are to commit to a specification as well as implementation. They have 18 months to complete the specification submission. 

The OMG process begins with an OMG RFP. The CCS FM RFP will be issued at OMG March 2015 meeting in Reston VA.


'''CCS FM RFP Review'''
Introduction - provides the context of the SFM and the dates for the RFP. Note that the most recently published version of the artifact.
Section 1-5 - copyrights info, info about OMG, etc
Section 6 - CCS FM specific information. This section is sub-divided into four areas. 
	1. Mandatory requirements that have to be addressed in the specification submission
	2. Optional requirements that submitters may elect to address. This provides opportunity to address nice-to-haves. Goal is to provide an opportunity to not set the interoperability too high (hindering adoption) or too low (stifling interoperability). 
	3. Issue for discussion - e.g. FHIR - addresses requirements that submitters need to consider but don't want to be bound to implementing
	4. Evaluation criteria - Preference will be given to submissions based on (e.g.) CP DAM. This is a way to inform the voting pool on what is important for the RFP.


Noted CCS FM gaps/updates (need from PCWG): [need to have updates to CCS FM done by Feb 18, 2015]
	1. Need to clarify care plan fulfillments  - things that have been done. Need to be clearly defined in the functional model. Laura/Kevin will forward email to Enrique to make note to update the CCS FM. 
	2. Need to re-visit Profile Grouping - may need more flushing out to provide additional functionalities.
	3. CCS FM speaks well to care plan management more than it does to care coordinating. Need more clarification and better explanations of care coordination. 

'''PCWG Next Steps:''' 
Patient Care need to schedule calls to address these issues - Enrique will send availability for Tues and Wed (for the next few weeks until feb 18). 


'''OMG Timeline'''
RFP completion - need to be ready for approval by OMG March 2015
Submitters Letter of Intent due Dec 2015
Submitters initial submission due March 2016
Submitters revised submission due Sept 2016
Expect adoption Late 2016 - by this point, implementers should be in EA. 
Submitters call for the votes. 





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=== Patient Care Monday Q4 ===


Present: Laura Heerman Langford, Russ Leftwich, Lisa Nelson, Kevin Coonan, Thom Kuhn, Emma Jones, Michael Tan, Brian Scheller, Lawrence McKnight, Darrell Woelk, Ashu Ravichander, Christina Knotts, David Pyke, Matthew Graham, Becky Angeles


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Minutes:
Chair:  Laura Heerman Langford    Scribe: Russ Leftwich

Lenel James/Lisa Nelson Care Plan Storyboard 8 presentation
    encounters: annual exam, ED visit for asthma, CM/DM, PCP f/u
    analysis of alignment with C-CDA R2 Care Plan 19 issues to address prioritized by importance from A to D
    as potential solution to evolution of care plan Lisa Nelson demonstrates 8 document template stages that represent evolution
    C-CDA Care Plan document template has 4 sections - Goals, Concerns, Assessments/Outcomes, Interventions - but sections complex
    multiple different care plans can be distinguished separately within one Care Plan document; human readable information distinguished and
        people's involvement/acceptance of plan, timing of the plan

    issues raised during discussion: ability to represent different views, longitudinal views, patient friendly language, conflicting goals and concerns,   
       prioritization of goals, machine readable data that is not represented as human readable text

    the presenters intend to seek implementers for draft versions of templates that address the issues identified, but do not have a current plan to 
        provide feedback to the C-CDA R2 DSTU

    A copy of this presentation will be uploaded to the wiki. 

Discussion of next steps for Care Plan ensued and the incomplete nature of the FHIR Care Plan resource.  

Review of FHIR resources that belong to patient care, includes Care Plan, and submission of change orders through G-forge to accomplish changes in PCWG designated resources, as well as reconciliation of Care Plan ballot comments. 

Russell Leftwich


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=== Patient Care Monday Q5: Placeholder for extra meeting if necessary ===

Present:


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Minutes:



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=='''Patient Care WGM, Tuesday, January 20, 2015'''== 

* Back to [[Patient Care]]

* Back to [[Patient Care Work Group meeting Agenda and Draft Minutes]]

* Back to [[2015 PCWG WGM Agenda and Minutes]]

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=== Patient Care Tuesday Q1 ===

Present: Russ Leftwich (Chair), Laura Heerman-Langford (Chair), Emma Jones (scribe/presenting), Lloyd McKenzie (FHIR Rep), Thom Kuhn, Ray Murakami, Gayathri Jayawardena, J. Hyun Song, Yukonori Konishi, Sadamie Takaseki, Masaaki Hirai, Jeffrey Ting, Matt Jensks, Brad Arndt, Michael Donnelly, David Parker, Russell Ott, Erik Pupo, Brady Keeter, Michael Tan, Brian Scheller, Ken Chen, Kevin Coonan, Chris Brancato,  Peter Pork, Chris Melo, David Pike


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Minutes:
'''IHE PCC RECON Profile'''
Overview of IHE RECON profile provided - Will be a work item out of the new IHE/HL7 work group with PCWG involvement
* Past work with CDA artifacts
* Current work to use FHIR Resources
Goal of the profile is to communicate that a list has been reconciled, who did the reconciliation, when the reconciliation occurred and the source from which the reconciled items were obtained. Need FHIR group to provide insight into which FHIR artifact to use for this. 

Per Lloyd, recommend use of Resource Provenance with focus on the list that is being reconciled. Resource Provenance that be further constrained via profile for specifics that are needed. 

'''Discussion'''
* What happens during the reconciliation process? In theory, two lists are compared and the result is a third list that becomes the "active" list. Some systems may retained records of the previous two lists in case there is need to access again. 
* In the case of reconciling care providers - FHIR does not yet have a out-of-box list of providers (this may need to be added). In the case of reconciling care team members, this may need to be done by applying Resource Provenance to Care Plan (where Care team members are defined). By doing this, can apply provenance to goals, interventions, etc - other components of care plan. 
* Immunization - Can also use Resource Provenance to reconcile immunization recommendations with immunization history. 
* Reconciling a group may be a big stretch 

Overview of IHE profile process and timeline provided. IHE RECON profile calls are every other Tuesday at 11:00 EST. Call information is available at https://himss.webex.com/mw0307l/mywebex/default.do?siteurl=himss&service=1

Updated RECON profile is available at ftp://ftp.ihe.net/Patient_Care_Coordination/yr11_2015-2016/Technical%20Committee/RECON_on_FHIR/
	
Recommendation to use Resource Provenance - will need to profile this resource to be able to specify what is needed for reconciliation. 
http://hl7-fhir.github.io/provenance.html

'''Change Requests''' (facilitated by Lloyd)

tracker item 5456  - PC need to review with OO

Gforge tracker item 5401 - Care plan always a document? Need to be able to exchange care plan without it being a document. There are multiple resources for care plan - need to stick with a single resource and have multiple profiles. Design is to aim for a single resource. There will be numerous profiles. Need to look at real world situations and create profiles from that. Comment rejected. 

Gforge tracker item 5332 - Care Plan Activity does not link to the participant it's associated with. Need to provide ability for the activity to have a participant and reflect the role of this participant. Discussion about tying goals/activity to participants. Resolution provided. 





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=== Patient Care Tuesday Q2 ===

Present:
Michael Tan – Chair
Elaine Ayres – Scribe
Russ Leftwich
Larry McKnight
Jay Lyle
David Pyke
Thomson Kuhn
Ken Chen
Kevin Coonan

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Minutes: *Health Concern Ballot Reconciliation*
Statement how to related current terms to legacy terms.  The comparison of naming conventions in C-CDA and Contsys.  

Reviewed Larry McKnights revised diagram 5.  

HealthConcernList replaces health concern tracker.  Health concern event is related to the health concern.
Concern owner includes provider, patient family and group.

Larry related to 2008 ballot.  
Includes reference to older terms.

Who is an owner?  This is the person who voices the concern.  That determines the status of the concern, not the status of the observation per se.  When is a problem done, vs. a health concern.  The custodian of the health concern will need to set policies and procedures for health concern.  

The group continued with ballot reconciliation of negative minors.  Figure 5 in document and proposed diagram will require additional discussion and modeling.  Proposed diagram is not a UML diagram, so we will need to develop a strawman.  

1.	Jay will draft a new model and then send to Larry to review.
2.	Will keep care plan as a side entity but can point to it with a change in arrow structure.
3.	Remove health concern tracker box, provider box, and concern identifier (author and custodian instead). 
4.	Change clinical status to status
5.	Link author to concern not concern name
6.	Author and custodian will be attached to the concern – events are linked but the concern itself is related to the author.  

Note that the “list” will have pointers.  The lists may not be the same between providers.

Issues related to the understanding of work flow – may inform the DAM.  

List of to do items for changes:
1.       prefer legacy terms; terms from Larry’s diagram
2.       make identifier ‘ConcernAuthor’
3.       create “ConcernCustodian” -- check on whether that’s right
4.       concern status not clinical status
5.       Author to concern not name
6.       add list. PCP, nurse, specialist. Pointers, owner, sequence.
*Concern owner diff from list owner
7.       Remove tracker, identifier
8.       Problem list, allergy list as specializations
9.       Add concern owner - person, organization; see V3. Allow delegation, transfer.
10.   Relationships: see 2008 ballot
11.   OK to keep plan as ‘out of scope’
12.   Imported concern
*You can decide to bring it in and make it yours
*You can decide to bring it in and keep original owner
*Either way you need origin data for reconciliation
*Events copied; concern merges
13.   Include dynamic model for reconciliation

Motion – Larry/David for changes to diagram #5 as discussed.  Against – 0, Abstain – 0, Approve – 8
Motion – Larry/Elaine typos to be fixed by document editor.  Against – 0 , Abstain – 0, Approve - 8

One more quarter – Thursday Q4 for health concern discussion.  

Ongoing phone call for PC Health Concern calls – Thursdays at 4 PM starting January 29 on a weekly basis.  


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=== Patient Care Tuesday Q3 ===

Present:Russ Leftwich, Elaine Ayers, Floyd Eisenberg, Laura Heermann Langford, Emma Jones, Rob McClure, Cathy Welsh, Shelly Spiro, Margaret Ditloff, Laurence McKnight, Brady Keeter, Darrell Woelh, Michael Tan, Katherine Duteau, Juliet Pruloni, Martin Rosner, Colin Wright, Patty Craig, Gay Dolin, Dave Parker, Evelyn Gallego, Julia Skopik, Kendra Hanley

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Minutes:

Gaye Dolin Presenting
:Review of work done previously. (Anatomy of Allergy Intolerance Templates.)
:Review of Allergy Types: value set of SNOMED-CT codes (value set including Medication drug class, clinical drug ingredient, unique ingredient identifier, substance other than clinical drug.  
:Review Proposed plan coming out of Materials Summit ---  validate and expose intensional definition of these value sets, propose resolution to ONC/CMS folks, get value sets added to VSAC, get clarifications/guidance add to R2 companion guide including value set URLs (find out the current status of the R2 companion guide).  

* Discussion re: how do we represent substances, why do we need to represent substances?
* rethinking - do we really need to represent every substance?  Or just a subset that are known reactants?

* Discussion point: there needs to be some sort of larger picture on how things fit in (such as vaccines are medications)

* Discussion point: We need a way to maintain a list of agreed allergens - but a valid place to hold the information.  USP?  to evaluate and map to a drug classification?

* Discussion - what do we do know?  We have CDA 1.1 where it cannot be expressed well, then we have the improved version that won't be seen for a little while - what can we do in the interim?  Code set to use in system for now?  Idea - look at the workflow proceeses that cannot be incorporated into the standard.  Don't get into the weeds (storage etc) as they can be solved before really needed.  Wondering if we can use value set defined in R2 in R1 while we wait for field to catch up.  If so then, need complete/finalize the value sets.  

* 11/24/2014 Next Steps:
** suggest--  Rob, Jim and Brett will work together with Olivier to determin time lines to accomplish making available drug class value sets with linked lists of RxNorm codes. 
** When LOE and time lines are estimated, this group will reconvene to - 1) discuss the remaining issues, 2) Plan for communication to the community.  
** Create robust DSTU comments on both C-CDA R1.1 and R2, HL7, DSTU comment pages
** Propose resolution to ONC/CMS folks
** Get value sets added to VSAC
** Discuss "sub-value ("min") set of "(99orsomenumber)" codes"
** Get clarifications/guidance added to R2 companion guide including Value set URLs find out the current status of the R2 companion guide).  
  
* Today Next Steps:
**We need a list of the substances that cause reactions and somebody needs to maintain that list.  
**We will replicate this conversation at Thurs Q2 Structured Documents for further discussion. 

PCWG/CQI - will keep this quarter as a joint meeting going forward.  


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=== Patient Care Tuesday Q4 ===

Present:


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Minutes:



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=='''Patient Care WGM, Wednesday, January 21, 2015'''== 

* Back to [[Patient Care]]

* Back to [[Patient Care Work Group meeting Agenda and Draft Minutes]]

* Back to [[2015 PCWG WGM Agenda and Minutes]]

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=== Patient Care Wednesday Q1 ===

Present:

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Minutes:



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=== Patient Care Wednesday Q2 ===

Present:

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Minutes:



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=== Patient Care Wednesday Q3 ===

Present:


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=== Patient Care Wednesday Q4 ===

Present:


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Minutes:



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=='''Patient Care WGM, Thursday, January 22, 2015'''== 

* Back to [[Patient Care]]

* Back to [[Patient Care Work Group meeting Agenda and Draft Minutes]]

* Back to [[2015 PCWG WGM Agenda and Minutes]]

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=== Patient Care Thursday Q1 ===

Present:

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Minutes:



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=== Patient Care Thursday Q3 ===

Present:


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=== Patient Care Thursday Q4 ===

Present:


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Minutes:



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=='''Patient Care WGM, Friday, January 23, 2015'''== 

* Back to [[Patient Care]]

* Back to [[Patient Care Work Group meeting Agenda and Draft Minutes]]

* Back to [[2015 PCWG WGM Agenda and Minutes]]

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=== Patient Care Friday Q0: PCWG Co-Chairs meeting ===

Present:

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Minutes:



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=== Patient Care Friday Q1 ===
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(1) Template WG meeting
: - PCWG representative(s) to attend

(2) Agenda: open
: - Possible: Clinical Connectathon


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Present:

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Minutes:



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=== Patient Care Friday Q2 ===
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Agenda: open
: Possible: Clinical Connectathon

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Present:

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Minutes:



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=== Patient Care Friday Q3 ===
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Agenda: open
: Possible: Clinical Connectathon

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Present:


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Minutes:




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=== Patient Care Friday Q4 ===
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Agenda: open
: Possible: Clinical Connectathon

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Present:


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Minutes:



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