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Difference between revisions of "January 2015 WGM San Antonio: Jan 18 to Jan 23"

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=== Monday Q1 =
+
=== Patient Care 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.
 
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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=== Monday Q2 ===
+
=== Patient Care Monday Q2 ===
 
Attendees:
 
Attendees:
 
Chair – Michael Tan
 
Chair – Michael Tan
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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.   
 
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.   
 +
 +
<BR>
 +
 +
===Patient Care Monday Lunch===
 +
Nutrition Terminology Lunch
 +
 +
Present:
 +
Elaine Ayres – Chair
 +
Scott Brown
 +
Pavla Frazier
 +
Christina Knotts
 +
Jim Case
 +
Russ Leftwich
 +
Cathy Welch
 +
Margaret Dittloff
 +
Jay Lyle
 +
Galen Mulrooney
 +
Darrell Woelk
 +
Rob McClure
 +
Lisa Nelson
 +
Julia Skapik
 +
Koichiro Matsumoto
 +
Jane Millar
 +
 +
Minutes:
 +
Agenda Review/Questions:
 +
VA foods (Jaye Lyle) – Needing to identify exact compounds but rather difference between canned tomatoes (referring to food “composition”, i.e., what are the additives) and fresh.
 +
 +
Medications can have composition but not foods (per Jim Case). No concept in SNOMED – to create composition for foods – and this is not going to change;
 +
Russ – commented that this is low priority, few reproducible cases as additives
 +
Rob McClure – the way to handle this as a database – to figure out; bad to link it in a terminology. So we won’t attempt this in a terminology – instead point to a proprietary database to access that level of information. If we can identify the specific reactant – it could go in independently but not in the composition sense, (but as a pre-coordinated concept).
 +
C-CDA R2 work.
 +
 +
The C-CDA model allows us to document the Nutrition Care Process. Question: what are the terminology bindings?
 +
 +
The direction the Academy is taking is to mimic terminologies that RD's use in their scope of practice. Many of these terms are in SNOMED and we are in the process of submitting many terms to LOINC.
 +
 +
Nutrition Status Observation & Nutrition Recommendations
 +
US Edition SNOMED CT
 +
 +
Note on the IHTSDO2015 work plan – work being proposed last year and not done but were related to diets; have not pushed forward. Are these terms migrating past the US? Jim Case said this is not on the 2015 work plan. The concern is that they do not want to do this work piecemeal. Jay said he is putting a group together. Jim Case said that we have not forwarded it to international until we have it all and we need to understand what these mean, e.g., nutrition status observation.
 +
 +
Lisa Nelson and Jim said that they do not know what nutrition status observation means (Lisa and Jim). To them, it looked like the NutrtitionStatusObservation led to the NutritionAssessment. Elaine explained that every NutritionStatusObservation shall have a NutritionAssessment.
 +
 +
Elaine - To move forward, should we do a white paper? (This information is already in the CCDA). Jim Case said there is not obstacle to getting the terms into the US Extension, except understanding the meaning of the concepts.  Getting them promoted to International level –depends on resources.
 +
 +
Jane (IHSTDO), what is the purpose of this CCDA what is the implementation use case, and is it used internationally? Answer: this is a series of templates to support the NCP. Yes, the NCP is standardized internationally. Jane: is this using the terms they produced (eNCPt)?  Elaine - we have said they cannot use internal terms any more. This is getting the terms in SNOMED and LOINC. The focus is on terms that support the NCP with a goal of integrating the information into the EMR.
 +
 +
Rob – If the concepts that are being created are US Ext. and balloted internationally, - then how to IHTSDO users know that this concept is coming from a US Extension?
 +
C-CDA – is US Realm only ballot
 +
IHTSDO needs to hear from member countries to prioritize the work.
 +
 +
Example:  VA is working on SMART forms pulling from these concepts (has IDNT in VistA). So we’ve been talking about creating value sets.
 +
Jane (IHTSDO) – Was going to report on what we were going to do last year and when they see it fitting in.  Need to get the countries asking for this directly from IHTSDO If you want terms to be moved into the international realm.  Not about development but more about are you going to implement.  Submit to try to get on the project list for 2016. If you are going to implement it, we could prioritize it for 2016.
 +
 +
Margaret said the Dietitians of Australia are interested.
 +
Jim Case: If this is done, it would cause a lot of churn, because it would require retiring several hundred terms and this could be an impact. So they need to be reassured that this is a true benefit. Bottom line: get Australia and Europe to lobby for these terms.
 +
***Lobby – NEHTA to push for this.\\
 +
 +
Rob - Ongoing issue of putting this in ballot – invisible concepts –
 +
US Edition of SNOMED (have to reference the code system used). This is a Version.
 +
Needs to be clear in the ballot where do you go get these codes.
 +
Status of SNOMED – has this improved the clinicians; Academy will reconsider these terms for future eNCPT
 +
 +
Margaret. The terminology bindings only exist for the US. She gave the example of how since the terms are not licensed outside the US. For example, our FHIR xml would not render on the FHIR server in Australia. This is the practical outcome.
 +
Status of mapping NCPT to SNOMED
 +
Now RD's will go to SNOMED or LOINC instead of the local coding.
 +
LOINC mapping is underway. CCDA R2. OIDS are in there for CCDA R2.
 +
Rob McClure asked a question about the terms which were rejected (as seen on the slide). Did this information go back to the clinicians who were using the terms?  Rob McClure said that in his opinion if the words were needed to meet practice needs the Academy should discuss how to respond. Jim Case said there was extensive discussion on the terms which were rejected. The reasons were that either the terms were duplicates, or too obscure.
 +
Nutritional Recommendations.
 +
We are showing value sets from CCDA R2, but they have not made their way to VSAC.
 +
Nutrition Status Observation or Nutritional Status Observation (nutrition or nutritional)
 +
Be consistent about use of nutrition vs nutritional
 +
Take the hyphen out of SNOMED CT
 +
 +
Jim Case suggests not using grouper terms like "feeding regime" even if it expands the value set significantly". These terms are each examples of……? Suggestion: remove the top 5 items since they are header terms".
 +
 +
Rob McClure suggested that we need an intentional (query based) concept. Query based – intentional definition of the value set – those top five - that concept and all its descendants; not this concept but all its descendants’ e.g. Modeling of this could include a relationship type of thing – (print names) swallowing difficulty – caused by or result in
 +
Jim Case, can we get a more precise picture of what this definition for Nutritional Status means? Describes the overall nutritional status of the patient including findings
 +
Difficult for a clinician to pick what they want and differentiate better (c-CDA value sets need work). Elaine said we want to change the value sets which are already in CCDA.
 +
Margaret Dittloff reviewed the Nutrition Order Terminology work
 +
 +
=Nutrition Order Resource proposal in FHIR=
 +
We are looking to use our work here. Margaret presented the Resource. It's very similar to V3 in that we can separate the texture modification and food types (ground meat, etc.)
 +
 +
=Encounter-hospital Diet=
 +
In some of the editing it got bound to our food preference modifier. Jim Case said that these are all dietary regimes and they should all be pulled out of the regime hierarchy. (Every diet is a dietary regime: map this to dietary regime). Rob McClure: there should be a cardinality of 0 to many.
 +
Gs1:  they have same – without pork and without beef 
 +
Cardinality = 0..Many
 +
Fluid Consistency in FHIR
 +
 +
Discussion of “Dietary Regime” vs “Substance”
 +
- Get advice from
 +
- The fluid is a substance (qualifier is the honey-thick)
 +
- Focus of the concept is fluid
 +
- Complex problem – needs further discussion
 +
o Finding it in the sea of SNOMED –
 +
o Consistency in the qualifier – if I have an attribute that describes this.  (the attribute would (for example “dietary consistency qualifier”, have values like honey thick" , "nectar thick", etc. Jane mentioned that other disciplines would use this such as nurses and speech therapists. We mentioned we got these terms from the dysphagia terminology. (If we do this, then they would retire some other terms).
 +
This is our first start at putting enterals, formulas, etc. into the SNOMED product hierarchy.
 +
 +
 +
  
 
<BR>
 
<BR>

Revision as of 04:14, 21 January 2015


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




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


Patient Care 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.


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



Patient Care Monday Q2

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


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.


Patient Care Monday Lunch

Nutrition Terminology Lunch

Present: Elaine Ayres – Chair Scott Brown Pavla Frazier Christina Knotts Jim Case Russ Leftwich Cathy Welch Margaret Dittloff Jay Lyle Galen Mulrooney Darrell Woelk Rob McClure Lisa Nelson Julia Skapik Koichiro Matsumoto Jane Millar

Minutes: Agenda Review/Questions: VA foods (Jaye Lyle) – Needing to identify exact compounds but rather difference between canned tomatoes (referring to food “composition”, i.e., what are the additives) and fresh.

Medications can have composition but not foods (per Jim Case). No concept in SNOMED – to create composition for foods – and this is not going to change; Russ – commented that this is low priority, few reproducible cases as additives Rob McClure – the way to handle this as a database – to figure out; bad to link it in a terminology. So we won’t attempt this in a terminology – instead point to a proprietary database to access that level of information. If we can identify the specific reactant – it could go in independently but not in the composition sense, (but as a pre-coordinated concept). C-CDA R2 work.

The C-CDA model allows us to document the Nutrition Care Process. Question: what are the terminology bindings?

The direction the Academy is taking is to mimic terminologies that RD's use in their scope of practice. Many of these terms are in SNOMED and we are in the process of submitting many terms to LOINC.

Nutrition Status Observation & Nutrition Recommendations US Edition SNOMED CT

Note on the IHTSDO2015 work plan – work being proposed last year and not done but were related to diets; have not pushed forward. Are these terms migrating past the US? Jim Case said this is not on the 2015 work plan. The concern is that they do not want to do this work piecemeal. Jay said he is putting a group together. Jim Case said that we have not forwarded it to international until we have it all and we need to understand what these mean, e.g., nutrition status observation.

Lisa Nelson and Jim said that they do not know what nutrition status observation means (Lisa and Jim). To them, it looked like the NutrtitionStatusObservation led to the NutritionAssessment. Elaine explained that every NutritionStatusObservation shall have a NutritionAssessment.

Elaine - To move forward, should we do a white paper? (This information is already in the CCDA). Jim Case said there is not obstacle to getting the terms into the US Extension, except understanding the meaning of the concepts. Getting them promoted to International level –depends on resources.

Jane (IHSTDO), what is the purpose of this CCDA what is the implementation use case, and is it used internationally? Answer: this is a series of templates to support the NCP. Yes, the NCP is standardized internationally. Jane: is this using the terms they produced (eNCPt)? Elaine - we have said they cannot use internal terms any more. This is getting the terms in SNOMED and LOINC. The focus is on terms that support the NCP with a goal of integrating the information into the EMR.

Rob – If the concepts that are being created are US Ext. and balloted internationally, - then how to IHTSDO users know that this concept is coming from a US Extension? C-CDA – is US Realm only ballot IHTSDO needs to hear from member countries to prioritize the work.

Example: VA is working on SMART forms pulling from these concepts (has IDNT in VistA). So we’ve been talking about creating value sets. Jane (IHTSDO) – Was going to report on what we were going to do last year and when they see it fitting in. Need to get the countries asking for this directly from IHTSDO If you want terms to be moved into the international realm. Not about development but more about are you going to implement. Submit to try to get on the project list for 2016. If you are going to implement it, we could prioritize it for 2016.

Margaret said the Dietitians of Australia are interested. Jim Case: If this is done, it would cause a lot of churn, because it would require retiring several hundred terms and this could be an impact. So they need to be reassured that this is a true benefit. Bottom line: get Australia and Europe to lobby for these terms.

      • Lobby – NEHTA to push for this.\\

Rob - Ongoing issue of putting this in ballot – invisible concepts – US Edition of SNOMED (have to reference the code system used). This is a Version. Needs to be clear in the ballot where do you go get these codes. Status of SNOMED – has this improved the clinicians; Academy will reconsider these terms for future eNCPT

Margaret. The terminology bindings only exist for the US. She gave the example of how since the terms are not licensed outside the US. For example, our FHIR xml would not render on the FHIR server in Australia. This is the practical outcome. Status of mapping NCPT to SNOMED Now RD's will go to SNOMED or LOINC instead of the local coding. LOINC mapping is underway. CCDA R2. OIDS are in there for CCDA R2. Rob McClure asked a question about the terms which were rejected (as seen on the slide). Did this information go back to the clinicians who were using the terms? Rob McClure said that in his opinion if the words were needed to meet practice needs the Academy should discuss how to respond. Jim Case said there was extensive discussion on the terms which were rejected. The reasons were that either the terms were duplicates, or too obscure. Nutritional Recommendations. We are showing value sets from CCDA R2, but they have not made their way to VSAC. Nutrition Status Observation or Nutritional Status Observation (nutrition or nutritional) Be consistent about use of nutrition vs nutritional Take the hyphen out of SNOMED CT

Jim Case suggests not using grouper terms like "feeding regime" even if it expands the value set significantly". These terms are each examples of……? Suggestion: remove the top 5 items since they are header terms".

Rob McClure suggested that we need an intentional (query based) concept. Query based – intentional definition of the value set – those top five - that concept and all its descendants; not this concept but all its descendants’ e.g. Modeling of this could include a relationship type of thing – (print names) swallowing difficulty – caused by or result in Jim Case, can we get a more precise picture of what this definition for Nutritional Status means? Describes the overall nutritional status of the patient including findings Difficult for a clinician to pick what they want and differentiate better (c-CDA value sets need work). Elaine said we want to change the value sets which are already in CCDA. Margaret Dittloff reviewed the Nutrition Order Terminology work

Nutrition Order Resource proposal in FHIR

We are looking to use our work here. Margaret presented the Resource. It's very similar to V3 in that we can separate the texture modification and food types (ground meat, etc.)

Encounter-hospital Diet

In some of the editing it got bound to our food preference modifier. Jim Case said that these are all dietary regimes and they should all be pulled out of the regime hierarchy. (Every diet is a dietary regime: map this to dietary regime). Rob McClure: there should be a cardinality of 0 to many. Gs1: they have same – without pork and without beef Cardinality = 0..Many Fluid Consistency in FHIR

Discussion of “Dietary Regime” vs “Substance” - Get advice from - The fluid is a substance (qualifier is the honey-thick) - Focus of the concept is fluid - Complex problem – needs further discussion o Finding it in the sea of SNOMED – o Consistency in the qualifier – if I have an attribute that describes this. (the attribute would (for example “dietary consistency qualifier”, have values like honey thick" , "nectar thick", etc. Jane mentioned that other disciplines would use this such as nurses and speech therapists. We mentioned we got these terms from the dysphagia terminology. (If we do this, then they would retire some other terms). This is our first start at putting enterals, formulas, etc. into the SNOMED product hierarchy.




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

Present:



Minutes:



Patient Care WGM, Tuesday, January 20, 2015


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



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.




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


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.



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


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


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


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



Present:


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Patient Care Friday Q2


Agenda: open

Possible: Clinical Connectathon


Present:


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Patient Care Friday Q3


Agenda: open

Possible: Clinical Connectathon


Present:



Minutes:




Patient Care Friday Q4


Agenda: open

Possible: Clinical Connectathon


Present:



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