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:

• Patient Care WGM Jan 2015 San Antonio - FINAL Agenda - updated 2015-1-19

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

• Sunday, January 17 - International Council Meeting

- No PCWG meeting

Patient Care WGM, Monday, January 19, 2015

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== Monday Q1

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Monday Q2

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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)

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.

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

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

Patient Care Monday Q5: Placeholder for extra meeting if necessary

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Patient Care WGM, Tuesday, January 20, 2015

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Patient Care Tuesday Q1

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Patient Care Tuesday Q2

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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

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.

Patient Care Tuesday Q4

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Patient Care WGM, Wednesday, January 21, 2015

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• Back to 2015 PCWG WGM Agenda and Minutes

Patient Care Wednesday Q1

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Patient Care Wednesday Q2

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Patient Care Wednesday Q3

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Patient Care Wednesday Q4

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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

Patient Care Thursday Q1

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Patient Care Thursday Q3

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Patient Care Thursday Q4

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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

Patient Care Friday Q0: PCWG Co-Chairs meeting

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Patient Care Friday Q1

(1) Template WG meeting

- PCWG representative(s) to attend

(2) Agenda: open

- Possible: Clinical Connectathon

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Patient Care Friday Q2

Agenda: open

Possible: Clinical Connectathon

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Patient Care Friday Q3

Agenda: open

Possible: Clinical Connectathon

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Patient Care Friday Q4

Agenda: open

Possible: Clinical Connectathon

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