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January 2017 WGM San Antonio, Jan 14 to Jan 20

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San Antonio, WGM - Jan 2017 Patient Care WG Meeting Draft/Approved agenda:

Agenda

Day Time   Room Event Host Joining Chair Scribe
Sunday
January 15
AM Q1 ?
Q2 ?
PM Q3 ?
Q4 ? FHIR co-chair updates
Day Time   Room Event Host Joining Chair Scribe
Monday
January 16
AM Q1 Frio Patient Care WG Administration Meeting Review agenda for the week, Update the PCWG documents - DM, M&C, SWOT, 3 year plan - Must do the DMPand the 3 year plan - consider moving the SWOT and M&C to the same timeline. Michael Jay
Q2 Rio Grand East Mega joint session EHR Laura
PM Q3 Nueces FHIR Change requests - Care Plan, Care Team, Goal
  • GF#11342 - Add CareTeam.relatedTeam or other composition relationship - 2016-09 core #500
  • GF#11344 - Allow CarePlan.activity.detail.performer to be CareTeam - 2016-09 core #502
  • GF#10624 - QA 4a: Consider whether Goal.priority (CodeableConcept) should be bound to an external code system such as SNOMED
  • GF#10613 - QA 4e: Clean up valueset-goal-status
FHIR Michelle Michael
Q4 Rio Grande Center Joint Session with FHIR & OO on FHIR workflow FHIR Emma
Q4 Frio Continue Q3 discussion on CarePlan, Goal, and CareTeam trackers
  • GF#10613 - QA 4e: Clean up valueset-goal-status
  • GF#11116 - Better define the careplan.activity.outcome field. - 2016-09 core #270
  • GF#10615 - QA 4: Clean up valueset-goal-status-reason
Michelle
Day Time   Room Event Host Joining Chair Scribe
Tuesday
January 17
AM Q1 Rio Grande Center FHIR/PCWG - CIMI - Skin Care model meeting. Stefan Hufnagle project CLIM CIMI and FHIR - I, ECWG Laura Emma
Q2 Rio Grande Center FHIR requests including updating condition scope to include concern events FHIR-I Michelle Michael
PM lunch ?
Q3 Rio Grande Center FHIR CarePlan, Goal, and CareTeam value sets as part of ONC Care Coordination
  • GF#10725 - QA 4: CareTeam CodeableConcepts need a binding to a value set
  • GF#11334 - Constrain participant role value set - 2016-09 core #492
  • GF#10620 - QA 7a: CarePlan.activity.outcome needs a binding to a value set
  • GF#10623 - QA: Goal CodeableConcept elements are missing a binding to a value set
Michelle Lisa
Q4 Rio Grande Center Negation + other topics; OO, FHIR-I, Vocab, Clin Genomics, CIMI, SD, ED Jay Emma
Day Time   Room Event Host Joining Chair Scribe
Wednesday
January 18
AM Q1 Regency East #1 PCWG-FHIR trackers for clinical resources - Procedure and applying workflow patterns (for procedures)
  • GF#12595 - Condition needs a search parameter for Condition.evidence.detail
  • GF#11162 - Suggest include reference to remedial treatment(s) - 2016-09 core #316
  • GF#10626 - QA: Procedure.usedCode needs a binding to a value set
  • GF#10627 - QA 4a: Consider binding Procedure.focalDevice.action (CodeableConcept) to codes from an external coding system - vocab
  • GF#10293 - Apply FHIR workflow standardization changes to Patient Care Resources
Michelle Emma
Q2 ? Episode of Care; Care Team PA will host PA Michelle/Michael
PM lunch Blanco
Clinician-On-FHIR Preperation meeting
Q3 Rio Grande Center PC/RCRIM/CIC Joint meeting - Topic: Adverse Event (RCRIM) CIC, RCRIM, PC Elaine
Q3 Nueces FHIR/PCWG Joint meeting (PCWG Hosting FHIR reps)
  • GF#12608 - CarePlan - Add ReferenceGroup to the list of supported references
  • GF#11119 – Differentiate ProcedureRequest and DiagnosticRequest and align their elements (Danielle Friend) - related Zulip Chat
  • GF#11026 – Relationship between Condition and Observation (Jay Lyle)
FHIR, CDS, CQI, RCRIM, OO Michelle
Q4 Rio Grande Center Allergy/Intolerance topic meeting

Medication value set subproject

Food substance value set subproject
Elaine
Day Time   Room Event Host Joining Chair Scribe
Thursday
January 19
AM Q1 Rio Grande Center Care Plan -invite FHIR, Structured Docs, Pharmacy

HL7 C-CDA 2.1 Care Plan Document Template - Lisa Nelson HL7 Care Plan Domain Analysis Model/FHIR Harmonization - Laura Heermann/EMma Jones HL7 Care Coordination Services (CCS) functional model - LH/EJ HL7 CDA R2 Personal Advanced Care Plan Document - Lisa Nelson HL7 FHIR Care Plan Resource - LH/EJ IHE PCC Dynamic Care Planning Profile- EJ IHE QRPH Early Hearing Detection and Intervention (EHDI) Plan of Care- Lisa Nelson HL7 Clinical Oncology Treatment Plan and Summary - Jeff Brown NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro Care team members definition update (Laura/Emma) Child special needs Care Plan/Care Team Implementations

Check the minutes ....
SD, Pharmacy, LHS, CH, FHIR-I Laura Emma
Q2 Regency East #3 Joint meeting with SDWG and Template Topic: Care plan, Allergy Intolerance (criticality), Clinical status SD, Templates Russ Elaine
PM lunch Blanco
Co-Chair Admin Meeting
Q3 Pecos Assessment scales - ballot reconciliation; SDC update; Michael Michael
Q3 Live Oak FHIR Ballot Reconciliation - Reviewing workflow patterns for conditions, Condition/ClinicalImpression, and CommunicationRequest
  • GF#10293 - Apply FHIR workflow standardization changes to Patient Care Resources
  • GF#10635 - QA 5a: Resource references exist in both directions for Condition and ClinicalImpression
  • GF#11209 - Feedback on ClinicalImpression - 2016-09 core #363
  • GF#10387 - CommunicationRequest needs ability to describe the location that the communication is about (John Moehrke)
FHIR Michelle Michelle
Q4 Live Oak Dynamic Care Planning and Dynamic Care Team Management FHIR Profile and other interoperability related projects Primary work: FHIR ballot reconciliation FHIR, HSI Emma Michelle
Day Time   Room Event Host Joining Chair Scribe
Friday
January 20
AM Q1 ClinFHIR  
Q2   ClinFHIR        
PM Q3   ClinFHIR        
Q4   No meeting        



San Antionio WGM - January 2017. Patient Care WG Meeting Meeting Minutes

Sunday, January 15

International Council Meeting
- No PCWG meeting


Patient Care WGM, Monday, January 16, 2017


Monday Q1

Chair: Michael Tan
Scribe: Jay Lyle

Attendees Michael Tan, Jay Lyle, Russ Leftwich, Rob Hausam, Amit Popat, Michelle Miller, David Pyke, Emma Jones, Laura Heerman, Elaine Ayres, William Goossen

Minutes

  • Need to look at urgent FHIR work & prioritize; ensure we can cover what's needed
    • Get through ballot reconciliation by Feb 5
      • Ballot: 27 GForge items + 9 trackers. Average 30 minutes.
      • Prioritize by resource? List as shown seems reasonable.
      • Can we transfer Questionnaire & Response to FHIR-I?
      • Maturity includes things other than ballot resolution.
      • It may be appropriate to leave some at a lower maturity level. Plan items look unlikely to get to 3.
        • If FHIR-I doesn't take Questionnaire, move it above Plan resources in priority.
    • Motion: Approve transfer of stewardship for Questionnaire & Response from PC to FHIR-I
      • withdrawn
    • Motion: Ask FHIR-I to assume responsibility of Questionnaire/QuestionnaireResponse to get it through STU3 (e.g. reconciling outstanding tracker issues, applying changes, and addressing any QA messages and checklist items) (Gforge 12512)
      • Moved by Laura; Russ seconds
      • Vote: 11, 0, 0
    • 224 warnings
    • 125 elements need examples
        • A volunteer task force coordinated to provide examples for most of these
      • 29 related to value sets. Rob to see what he can do.
    • Deferred trackers: done
    • Applying resolved trackers. Michelle & Rob.
    • FMM spreadsheet.
    • Info. 46 RIM mappings; John Hatem to assist. Some example issues; see team above.
    • Workflow mappings - Michelle
    • QA volunteers: Emma, Russ, Jay, Rob. Michelle to give the go.
  • GForge reconciliation in meetings
    • To be time-boxed
  • Agenda for the week
    • MQ3 primarily Goal items
    • Tue Q4: possibly time for additional GForges
    • WQ3: Adverse Event; also plan definition, OO/PC trackers. Trying to get a second room; otherwise, just Adverse Event.
      • RCRIM scheduled with CIC this slot; perhaps that room is available.
      • Russ to coordinate with CIC.
    • WQ4: Elaine to chair; Jay to scribe
    • Need a home for Criticality discussion. Th Q2 Allergy
    • THQ2: Russ to chair; Elaine to scribe
    • THQ3 split into 2: assessment scales in one meeting; FHIR ballot
    • THQ4 agenda thin: use for FHIR ballot reconciliation
  • ClinFHIR
    • Process is now pretty mature
    • Need to look at having groups interact
    • Options
      • Take it on the road. Chile. AMIA
      • Support connecting to other points. Just servers, or do we need organizational barriers?
  • Co-chairs: Review Product Matrix. List on web site may be out of date.
    • Elaine to find later version if available; Michael to coordinate with staff. Revisit on Thursday.
    • Ditto decision making process: next call.



Monday Q2

Chair:
Scribe:


Attendees



Minutes




Monday Q3

FHIR Change requests - Care Plan, Care Team, Goal Chair: Michelle Miller
Scribe: Michael Tan

Attendees

  • Michelle Miller
  • Emma Jones
  • Tracey Coleman
  • Dave Carlson
  • Viet Nguyen
  • Russ Leftwich
  • Rob McClure
  • Laura Heermann Langford
  • Michael Tan

Minutes
GF#11342 - Add CareTeam.relatedTeam or other composition relationship - 2016-09 core #500

  • Care teams can have nested sub care teams. Can you relate a team to another team.
  • What does “newer” mean in newer team.
  • Do we need a a value set such as : replaces, consists of,
  • Point that the relationship is partly overlapping the role.
  • This resources should not be used to track the teams.
  • Future consideration will be adding a new element to convey the RACI elements for lead vs consult, but that is deferred from this G-forge.
  • Vote : 8- 0 -0


GF#11344 - Allow CarePlan.activity.detail.performer to be CareTeam - 2016-09 core #502

  • Is an activity performed by the whole team or a specific person?
  • Changing the definition of the care team. The Care team is not an actor, but the individual members of an individual organization are.
  • Vote : 8 -0- 0


GF#10624 - QA 4a: Consider whether Goal.priority (CodeableConcept) should be bound to an external code system such as SNOMED. This value set is probably not available in SNOMED ( high priority, medium priority, low priority) . Should the value be a FHIR or an v3 code set? Rob has confidence in a FHIR code set. This is the new thinking. Where code sets can be found easily.

  • The recommended value set would be:
    • High priority
    • Medium Priority
    • Low priority.
  • Vote 8 -0-0


GF#10613 - QA 4e: Clean up valueset-goal-status

  • The value set on goal status have different types of meaning. Some our outcome, some are status.
  • Is the outcome reported through the goal? It is not reported thru the activity outcome reported in a new care plan.
  • Example of use case of COPD.
    • Goal: stop Smoking cessation
    • Goal outcome result: former smoker.
    • Goal status: met
  • This value set looks very much like the value set of goal achievement. Is this a similar value set?
  • Suggestion to simplify the value set to : met/ not met/ in progress.



Monday Q4

Cont FHIR Change requests - Care Plan, Care Team, Goal

Chair: Michelle Miller
Scribe: Emma Jones

Attendees

  • Michelle Miller - Cerner
  • Emma Jones - Allscripts
  • Tracey Coleman - Allscripts
  • Dave Carlson - VA
  • Viet Nguyen - Leidos
  • Russ Leftwich - InterSystems
  • Laura Heermann Langford - Intermountain Health Care
  • Margaret



Minutes

The following gForge items were discussed

  • GF#10613 - QA 4e: Clean up valueset-goal-status
    • Item brought to a resolution: Updated valueset-goal-status to have hierarchy; fixed status defintions; fixed type
  • GF#11116 - Better define the careplan.activity.outcome field. - 2016-09 core #270
    • Item brought to resolution: Definitions cleaned up
  • GF#10615 - QA 4: Clean up valueset-goal-status-reason
    • Item brought to resolution: Changed the statusReason from CodeableConcept to be a string instead
  • GF#12622 - QA: CarePlan.relatedPlan.plan Name of child (plan) overlaps with name of parent (relatedPlan)
    • Item brought to resolution:Rename CarePlan.relatedPlan.plan to CarePlan.related.plan

Minutes of joint session on FHIR Workflow
Hosted by FMG

  • STU 3 has patterns of how workflows are used in practice.
  • Logical models can be mapped to represent a status. Should we have patterns for other categories of resources such as catalog entry, entity role?
  • There was some inconsistencies detected between de different resources. Should this be resolved? No one stood up.
  • There is a lot of good things about V3 where it was clear what the workflow pattern was.
  • The status can be found on the task, updated by the owner of the task.
  • Can you send out multiple task requests and until a service provider accepts that task, then the other tasks will be withdrawn. No one interested to pursue this topic.
  • How do you manage a task if you are going beyond the wall’s of the organization. How do you manage between different systems? Answer given that this can be fulfilled.


Monday Q6: Placeholder for extra meeting if necessary

TSC, DESD Present:



Minutes: See minutes from DESD



Patient Care WGM, Tuesday, January 17, 2017


Tuesday Q1

Chair:
Scribe:


Attendees



Minutes




Tuesday Q2

Chair: Michelle Miller
Scribe: Michael Tan


Attendees

  • Michael Tan
  • Jay Lyle
  • Michelle Miller
  • Emma Jones
  • Guillaume Rossignol
  • Fahri Besetta
  • Martin Hurrell
  • Russ Leftwich
  • Jukimori Konishi
  • Massake Hirai
  • Dave Carlson
  • Tessa van Stijn
  • David Tao
  • Lisa Nelson
  • Josh Mendell
  • Amit Popat



Minutes

  • GF#10090 - Condition Introduction
    • Objective of this meeting is to deal with the FHIR resource of condition. We are not changing the model, but defining the scope of what is a condition. The original specification is quite limited and the discussion is whether we should relax the restrictions. This has the risk that certain information could be also registered as other FHIR resources such as family history, allergy or procedure.
    • A health concern is an issue of which a person ( could be care provider) is concerned about.
    • A problem list consists of conditions. ( and diagnosis?)
    • Is unemployment also a valid entry as a condition? This depends on the context where it is used. In a mental healthcare setting this could be a valid problem for a depressed patient treated by a psychiatrist.
    • A condition does not necessarily have to be a problem, such as a pregnancy. The wording has been simplified.
    • The definition has been revised paragraph by paragraph. Motion to approve the revised definition:
    • Vote 18 P -0 N-0 A
  • Next issue about Condition Onset and Condition Abatement.
  • One issue ( no Gforge number yet) is about a circular definition of the word condition. This has been modified to clinical condition.
    • Vote 17 P-0 N- 1 A.
  • GForge nr.10635 Issue of circular reference of condition and clinical impression. Is it always pointing to the same condition? This issue was not resolved during this quarter.


Tuesday Q3

Chair: Michelle Miller
Scribe: Michael Tan


Attendees



Minutes

Main topic is FHIR issues about the Care Team

  • GF#10725 - QA 4: CareTeam CodeableConcepts need a binding to a value set
    • Other comparable resources have a code for a status
    • Active/ on hold / inactive / Entered in error.
    • The suggestion to add “held” as a status has been withdrawn.
    • Misunderstanding about a relationship between a patient and a care team. The assignments from a care plan can be cancelled, but the care team still exists.
    • Motion to add a code list:
    • Viet/ Margeret:
    • Vote : 9 P- 0 N- 4 A
  • CareteamCategory:
    • Encounter focussed team ( one single encounter)
    • Episode of care focused team
    • Longitudinal team
    • Research team
    • The issue is to distinguish the differences between these various codes. The is a hierarchy between these codes, which is not always obvious.
    • Motion to move this table:
    • Viet/ Dave
    • Vote: 7 P– 0 N - 6 A
  • GF#11334 - Constrain participant role value set - 2016-09 core #492
    • Currently this a large list of about 900 values of which some do not make sense for a role. However the binding is a not compulsory. The value set is an example and an implementer can constrain values or choose an alternative code system. The comment is not regarded as persuasive.
    • Motion moved
    • Viet / Michael
    • Vote : 7 P – 0 N – 6 A



Tuesday Q4

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Patient Care WGM, Wednesday, January 18, 2017


Wednesday Q1

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Wednesday Q2

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Wednesday Q3

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Wednesday Q4

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Patient Care WGM, Thursday, January 19, 2017


Thursday Q1

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Thursday Q2

Joint with SDWG and Template WG

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Thursday Lunch: Co-Chairs Meeting

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Thursday Q3

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Thursday Q4

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Patient Care WGM, Friday, January 20, 2017

Clinician-on-FHIR


Friday Q1

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Friday Q2

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Friday Q3

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Friday Q4

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