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Difference between revisions of "January 2018 WGM New Orleans; Jan 27 to Feb 8"

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==Tuesday Q2==
 
==Tuesday Q2==
 +
'''Chair''':  Michelle Miller<br>
 +
'''Scribe''':  Emma Jones
 +
 
'''Occupational data for health'''
 
'''Occupational data for health'''
 
*Goal is to align with other resources
 
*Goal is to align with other resources
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* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=14818 GF#14818] detail.reasonCode redundant with Goal.description - 2018-Jan Core #158
 
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=14818 GF#14818] detail.reasonCode redundant with Goal.description - 2018-Jan Core #158
 
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=14817 GF#14817] detail.kind is redundant with reference - 2018-Jan Core #157
 
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=14817 GF#14817] detail.kind is redundant with reference - 2018-Jan Core #157
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=14483 GF#14483] Use of reference for planDefinition in carePlan need to be added back.  
+
* [http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=14483 GF#14483] Use of reference for planDefinition in carePlan need to be added back.
  
 
==Tuesday Q3==
 
==Tuesday Q3==

Revision as of 13:24, 31 January 2018


New Orleans WGM - Jan 2018 Patient Care WG Meeting Draft/Approved agenda:
NOTE- to view WGM meeting minutes: follow the link for each quarter in Event column of the agenda below

Attendee List https://tinyurl.com/ydc62s7j

Agenda

Day Time Qtr Room # Event Host Joining Chair Scribe
Sunday
Jan 28
AM Q1
Q2
PM Q3
Q4
Day Time   Room # Event Host Joining Chair Scribe
Monday
Jan 29
AM Q1 Windsor - 3rd Floor 20 * Agenda: PCWG Admin Patient Care Michelle Michael Tan
Q2 Jefferson Ballroom - 3rd Floor 20
Patient Care Accepted: SD, FHIR-I,EC Michael Jay
Q2b TBD NA Podiatry Functional Profile Head EHR NA TBD
PM Q3 Jefferson Ballroom - 3rd Floor NA * Agenda: Mega Report Out
* Meeting notes - refer to EHRWG meeting minutes and Mega Report Out Slides
* PCWG presentation slide deck: insert here
EHR Accepted: Patient Care NA Jay/Laura - Present; Emma - Scribe
Q4 Commerce - 3rd Floor NA * Agenda: Joint Session with FHIR & OO on FHIR workflow *Meeting Notes FHIR-I Accepted: PC NA Emma
Day Time   Room # Event Host Joining Chair Scribe
Tuesday
Jan 30
AM Q1 Jefferson Ballroom - 3rd Floor 40 * Agenda: FHIR/PCWG - CIMI - Skin Care model meeting
* Meeting notes
Patient Care Accepted: CIMI, EC Jay Laura
Q2 Magazine - 3rd Floor 20 * Agenda: FHIR Change requests
* PHER will join PC to discuss the new OccupationalData resource

CarePlan / Goal / CareTeam trackers

  • GF#14870 Goal.outcome should support Quantity - 2018-Jan Core #210
  • GF#14818 detail.reasonCode redundant with Goal.description - 2018-Jan Core #158
  • GF#14817 detail.kind is redundant with reference - 2018-Jan Core #157
  • GF#14760 Why can care teams omit subject have group? - 2018-Jan Core #99 Gay Dolin-InPerson
  • GF#14483 Use of reference for planDefinition in carePlan need to be added back. Jeffrey Danford-InPerson
  • GF#13903 CarePlan should allow tracking of past activities (i.e. past interventions) (Rick Geimer)
  • GF#14819 No submission - 2018-Jan Core #159
  • GF#10028 Careplan: Provide ability to specify patient and/or provider preferences (Emma Jones)
    • meet need with a profile for preference on the observation resource. Requirements are a preference category (nutrition, medication, care), the preference priority (high/medium/delayed from C-CDA) and with elements of expressor and recorder.
    • This profile would not be developed for this release cycle
  • GF#13140 logical definition of care-plan-category value set may require realignment with SCT changes (Matthew Cordell)
  • GF#11173 CarePlan needs support for reviews - 2016-09 core #327 (Stephen Chu)
    • Tracking of reviews and plans for reviews is something that applies to many resources, not just CarePlan (e.g. protocols, standing orders, long term care admissions, etc.). This is something probably best handled by "Task" but will require a fair bit of analysis and discussion with other work groups to agree on approach. Defer to R4. Consider transfer to OO who owns Task
Patient Care Declined: FHIR-I Michelle Michelle/Emma
PM lunch ?
Q3a Magazine - 3rd Floor 20 * Agenda: FHIR Admin and Change requests
* Nutrition Transitions of Care IG

Procedure

  • GF#14869 Procedure.statusReason has the wrong value set - 2018-Jan Core #209

AllergyIntolerance

  • GF#14801 Add a field for Approximate onset date - 2018-Jan Core #141
  • GF#14800 AllergyIntolerance.code should be 1..1 - 2018-Jan Core #140

Family Member History

  • GF#14825 Clarify FamilyMemberHistory.date meaning - 2018-Jan Core #165

Condition

  • GF#14820 Recorder card should be marked as 1..1 - 2018-Jan Core #160

Workflow Alignment

  • GF#14446 PatientCare resources do not have a clean Workflow report


Patient Care Accepted: FHIR-I Michelle Michelle
Q3b TBD NA * Agenda: SD Hosted Joint Quarter: C-CDA Score Card; Advance Directive Templates
* Meeting notes:
SD NA Emma
Q4 Jefferson Ballroom - 3rd Floor 40 * Agenda:
* Negation
* harmonization across specification families
* other vocab topics
* Michael T to Pharmacy/BRR re medication knowledge
* Meeting notes:
Patient Care Accepted: CIMI, Vocab, Clin Genomics, SD, OO Jay Emma
Day Time   Room # Event Host Joining Chair Scribe
Wednesday
Jan 31
AM Q1 Magazine - 3rd Floor 20 * Agenda: FHIR Change requests - with OO representatives
  • GF#14732 How are dependent relationships represented? - 2018-Jan Core #54 Claude Nanjo-InPerson
  • GF#12633 Split Procedure into Procedure and ProcedureStatement (Lloyd McKenzie)
  • ServiceRequest - trackers and open issues
  • Procedure/Diagnostic Report - picking up this stream: http://lists.hl7.org/read/messages?id=319935
    • Seems to imply using DR to create a ProcedureReport ( e.g. a SX Report, Dental Report, etc)
    • Need to clarify the intent in order to update Proc and DR's scope and boundaries
  • Update on ClinicalNotes from Mon Q2 discussion with SD, FHIR-I, and PC.
  • Other areas of common interest
  • Meeting notes
Patient Care Accepted: OO Michelle Emma
Q2 Durham - 3rd Floor NA * Agenda: PA hosted joint meeting -- Episode of Care; Care Team
* Should OrganizationRole be added to CareTeam?
* onBehalfof / reminder about Friday
Meeting notes:
PA Accepted: PC NA Michelle / Michael
PM lunch TBD
20 * Agenda: Clinician-On-FHIR Preperation meeting
* Meeting notes
Patient Care Russ Emma
Q3 Jefferson Ballroom - 3rd Floor NA * Agenda: Focus on BiologicallyDerivedProduct
  • GF#12673 How to handle HCT/TP
  • GF#12993 Please Create a NonMedicationAdministration object or an Administration object
  • GF#13047 Add DosageInstructions to Procedure
Meeting notes:
OO Accepted: PC
Invited: CQI, CDS, Pharmacy, OO, PA, FHIR-I
NA Michelle
Q3b TBD NA * Agenda: Common Clinical Registry Framework
* Meeting notes:
CIC Accepted: PC
Invited: CQI
NA Laura
Q4 Magazine - 3rd Floor 30 * Agenda: Allergy/Intolerance topic meeting. Drug list approach & Issues. Allergy resource maturity
* Meeting notes:
Patient Care Accepted: Pharmacy, Vocab Jay Michael T
Day Time   Room # Event Host Joining Chair Scribe
Thursday
Feb 1
AM Q1a St James - 3rd Floor 35 Care Plan -invite FHIR, Structured Docs, Pharmacy
  • Evelyn Gallego
    • Care Plan Survey - Implementations, pilots, proposals
  • CDA
    • HL7 C-CDA 2.1 Care Plan Document Template - Lisa Nelson
    • HL7 CDA R2 Personal Advanced Care Plan Document - Lisa Nelson
    • IHE QRPH Early Hearing Detection and Intervention (EHDI) Plan of Care- Lisa Nelson
  • Patient Care Care Plan Project
    • HL7 Care Plan Domain Analysis Model/FHIR Harmonization - Laura Heermann/Emma Jones
    • HL7 Care Coordination Services (CCS) functional model - LH/EJ
    • Essential Information for Children with Special Healthcare Needs (Mike Padula)
    • HL7 FHIR Care Plan Resource - LH/EJ
  • IHE PCC
    • Dynamic Care Planning Profile- EJ
      • Update: PlanDefinition/ActivityDefinition
    • Care Team Managment Profile - EJ
  • HL7 Clinical Oncology Treatment Plan and Summary - Jeff Brown/Gay Dolin
  • NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro
  • Learning Health Systems
    • Care team project update (Russ/Laura/Emma)
  • Bidirectional Social Services Referrals
  • Others
Check the minutes ....
Patient Care Accepted: Pharmacy, LHS, SD Laura Emma
Q1b TDB NA Joint meeting with OO, CDS, PC, Templates (Note: editorial resp for V2 - Chapters 11 & 12) OO Accepted: Patient Care NA Rob H
Q2 Jackson - 3rd Floor 25 Joint meeting with SD and Templates


Proposed agenda:
Template update (Template co-chair/rep)
Template versioning;
Structured Doc/CDA update (SDWG co-chairs)
Patient Care update:
Allergy/Intolerance harmonization
Care Team (PC with LHS)
Clinical Status Value-set -
C-CDA and FHIR

Patient Care Accepted: SD
Invited: Templates
Laura/Rob H/Jay Emma
PM lunch TBD
10 Co-Chair Admin Meeting Patient Care Michelle Michelle
Q3a St James - 3rd Floor 20 *Agenda: FHIR Change Requests related to AdverseEvent
  • GF#14238 AdverseEvent.suspectEntity.instance should be expanded to include the Immunization resource (Craig Newman) - also related to GF#14152
  • GF#13302 Vocabulary issues with AdverseEvent
  • GF#13698 AdverseEvent.suspectedEntity.instance should allow CodeableConcept
  • GF#11021 Increase cardinality of substance and make certainty relation to substance, not reaction - 2016-09 core #40
  • GF#14759 Why can adverse events omit subject have group? - 2018-Jan Core #98 Gay Dolin-InPerson
Meeting notes: - Need to invite CIMI
Patient Care Accepted: BRR, FHIR-I Michelle Michelle
Q3b TBD NA Joint meeting with CS, OO, and PC.
* Meeting notes - PC Not Needed anymore
CS Accepted: Patient Care NA NA
Q4 Norwich - 3rd Floor NA * Agenda: LHS - CareTeam DAM
  • ONC/CMS eLTSS Project
  • GF#14334 allow careteam.participant,member to reference a Practitioner role
  • GF#12509 CareTeam participant
    * Meeting notes
LHS Patient Care NA Emma
Q5 Ascot - 3rd Floor NA L-Forms demo; Simplifier demo Patient Care NA NA
Day Time   Room Event Host Joining Chair Scribe
Friday
Feb 2
AM Q1 St Charles Ballroom - 3rd Floor ClinFHIR  
Q2 St Charles Ballroom - 3rd Floor ClinFHIR        
PM Q3 St Charles Ballroom - 3rd Floor ClinFHIR        
Q4   No meeting        



Meetings

Attendee List http://bit.ly/HL7PC_Attendees

Monday Q1


  • Chair: Michelle Miller.
  • Scribe: Michael Tan


  • Approve minutes HL7 WGM September 2017:
    • Motion: Laura Heermann Langford
    • Second: Jay Lyle
  • Approving the agenda of the current WGM. No additions and no corrections applied to the agenda.
    • Demo from Michel Rutten about the FHIR registry. Combine with L-froms on Thursday Q5. See HL7 wiki agenda.


  • DMP review: do we need to adjust the DMP?
    • Quorum: Our current DMP requires 3 persons. We still tend to keep this quorum to have enough diversity of standpoints.
    • Electronic voting: Our current DMP is identical to the standard DMP, but the section on the quorum does not seem viable, because it is difficult to calculate the 90% of a previous call or WGM.
    • 3 options:
  1. Stick to the default DMP (90% of last meeting)
  2. Stick to the standard quorum. (co-chair +3, organizing person + 3))
  3. Equal to the amount of co-chair ( 7 people).
  • Vote:
    • 2 persons for option 1
    • 4 persons for option 2
    • 2 persons for option 3.
  • Option 2 prevails. This means that PCWG will divert for the default DMP and use the same calculation the standard quorum calculation.
  • Action Item for Michael Tan to add the adjustments to DMP.


  • Chat.HL7.org.
    • Wayne Kubrick has e-mailed a proposal to use Zulip as a chat platform.
    • A chat fills a need for fast moving discussions. The FHIR folks usually Zulip for this purpose. The speed of the chat is too high for normal discussion.
    • A list server discussion requires more structure and is more appropriate for a working group.
    • Most attendants prefer to stick to e-mails thru the list server. Zulip can still be used occasionally for certain events such as the Clinicians on FHIR.


  • Discussion on CIMI and the relationship with CDA.
    • The CIMI should be responsible for the content.
    • The CDA is more about infrastructure.
    • There should be a CIMI management board. CIMI would guard that a CIMI product would be consistent in CDA, FHIR or V2. This CIMI management group would resemble the FHIR management group.
    • There is a call for volunteers to join the CIMI chair. Jay is considering.
    • Amit Popat reminds the attendees of a request from Austin about the future of HL7v2. This is planned for Monday Q3. **Amit is assigned as the official representative of Patient Care WG.


Monday Q2

  • Chair: Michael Tan
  • Scribe: Jay Lyle

Brett Marquard presented an approach for modeling Notes in FHIR. After grappling with some of the content questions, the team decided that the key differentiator is structure, and that a Note is likely a chunk of text, a document, a reference to a resource, or a mixture of these. This approach defers the definition of note content, supporting a richer variety of use cases, while supporting the ability to identify notes via some classification such as the LOINC document ontology.

  • Most attendees felt this is a reasonable approach.
  • MM: also address state changes, e.g., signature
  • LM: docRef is for locating documents on servers. That could be changed.
  • KB: But it shouldn’t, because you’ll break things that already work.
  • Brett will arrange for this to be tested in the Cologne connectathon.

Alexander Henket presented an approach for recording SOAP notes as Compositions

  • There is a draft profile on Simplifier
  • Discussion ensued on whether Composition should contain text not derived from referenced resources.
  • Decision on table: allow new content in Composition or create another resource.

Concern

  • Do Condition & Linkage support requirements for Concern? Suggested it does, if Linkage supports heterogeneous resources. Others dissent.
  • Clinical Impression maturity
  • Maturity is low. PC priorities are currently focused on advancing most mature resources.

Monday Q3

Monday Q4

  • See here for Attendees list
  • Chair: Lloyd
  • Scribe (PC): Emma Jones
  • FHIR workflow - project run by FHIR-I
    • Objective 1 - consistency in recording what need to be done with what was done
    • Objective 2 - to define and make clear to folks the different ways to ask for something to be done and not rely only on the request resource but to follow-up on whether it was done.
  • Workflow was to increase the consistency.
  • Focus for this session
    • Workflow reports that identified request or event patterns that need to be fully aligned or intentional not. Allows override. Some workgroups have done this. Impoertant to do this if hte resource is moving to normative (# or above)

Once that is done, the workflow project will review. Want to encourage consistency where they can get.

    • Look at the patterns - some changes have occurred since STU 3
    • exampleScenario resource - hope to have it publishable as part of STU4. A mechanism for seeing the different flows related to the original request.
    • Provide review of what exists in the workflow space

Review workflow space

  • Patterns - Request, Event
    • Workgroups should have received an xml file
    • for things that should not have the pattern applied paste into the suppressedIssues to make if clear this is a conscious decision to not apply the workflow pattern
    • Patterns should not drive decisions. Implementations should drive decisions.
      • For care plan - PC has a change request against carePlan.instantiates to have a reference + uri.

exampleScenario

  • new resource - ExampleScenario
    • Overview of what this resource does
    • May be in the May ballot
    • when working on scenarios will be able to see this
    • Allows an out if a resource is not used as part of the scenario
    • Is available to start playing with the resource.
    • Hope to have this built into the build project
    • Explore introducing this into CoF on Friday
    • May want to start with a smaller set and maintain the deltas between them
    • May tie into the vision of where we want parts of the connecthathon to go into cross track scenarios
    • Indepth discussion about the degree of the examples that is also needed for clinical examples.

Change requests

  • Describe relationship between FHIR workflow and Healthcare Business Process happening in OMG
  • Consider applying the SOA work to workflow
  • Workflow calls are mondays and wednesdays at 2 pm EST
  • This quarter continues at next WGM - FHIR-I will host.

Tuesday Q1

Attendees: see the online log

  • Skin and wound CIMI model
    • slide deck update provided by Susan Matney. Susan Matney CIMI Update Slides
      • See the slide deck to see how this work aligns with previous DAM work.
      • The slide deck also discusses the different Terminology work occurring in this area.
    • Link to the CIMI browser http://www.clinicalelement.com/cimi-browser/#/
    • Link to Open CEM Browser http://www.opencem.org/#/
    • Governance question re: when are CIMI models approved? Ans = acceptance by the CIMI group, but also to ballot through HL7. The question is the level that gets balloted. Balloting works ok for the major patterns - but balloting each individual model will not work too well. It may need to be a crowdsourcing approach of reporting on successful use for those.
    • How do CIMI compliant claims get validated? - it is up to CIMI, validating models is not up to implementers - but there is not any type of process or people set up to approve these yet. That process needs to be determined and put in place. Will also need to look at how to validate equivalence.
  • Adverse Event update provided by Claude - work has started but it will be continuing, Please contact Claude Nanjo if you are interested to join future calls.

Tuesday Q2

Chair: Michelle Miller
Scribe: Emma Jones

Occupational data for health

  • Goal is to align with other resources
  • Has population health use
  • CDS alignment with these data elements.
  • FHIR resource in the ballot modeled around what was done in CDA.
  • Content
    • employment status
    • retirement status
    • combat zone
    • usual occupation
    • PastOrPresent Jobs
    • etc
  • New information trying to get into the clinical health record
  • Currently systems are collecting usual occupation for cancer reporting
  • Working with a couple of clinical settings about collecting the data - 3 engagements have been using work around
  • Billing collects some information but not for social history purposes
  • also have a functional profile htat is balloted
  • Valuesets harmonization is needed.
  • expectation is this data will be collected by EHRs
    • Case reporting - if there is an opportunity to collect the data there should be a means of getting the data collected
    • CDS - if patient has refractory diabetes, ask about their work - this is not the use case for this
    • Need to recognize there is a challenge for capturing the data in a clinical setting. Should Public Health be collecting this data directly?
      • Public Health does collect this data during an investigation. Illegal for collecting the data in advance
      • Working on a FHIR app so the patient can provide the data.
      • Also want to assist the care provider in facilitating awareness of certain predisposing situations
      • May not be collected by the care provider but can be collected by academia and schools
  • Is academia and school related work in scope for this resource?
    • Students was in the occupation scope but was removed because not within the boundary because it did not meet the definition of work (census does not record homemaker and student as occupations)
      • Do we need to expand the boundary for common practice? Could include based on local use. Need to define where the boundaries are.
    • Agreement on being transparent about scope
  • Suggest scope and boundaries around observation - as it relates to social history. The resource does not reference observation
    • Questionaire can contain social history
    • Observation can contain social history
    • could live in observation as an option (profile observation)
    • can use a profile to make the observation more specific to occupation data.
  • Next steps - either invite PC to PHER call if assistance needed or come to PC Thursday FHIR calls

Trackers Discussed

  • GF#14870 Goal.outcome should support Quantity - 2018-Jan Core #210
  • GF#14818 detail.reasonCode redundant with Goal.description - 2018-Jan Core #158
  • GF#14817 detail.kind is redundant with reference - 2018-Jan Core #157
  • GF#14483 Use of reference for planDefinition in carePlan need to be added back.

Tuesday Q3

Chair: Michelle Miller
Scribe: Michelle Miller

Nutrition Transitions of Care IG

  • 67 comments on ballot
  • 20 of which were negative
  • 2 more outstanding (the rest were resolved earlier in the WGM)
  • more specific value sets needed

Resolved the following trackers:

  • GF#14869 Procedure.statusReason has the wrong value set - 2018-Jan Core #209
  • GF#14801 Add a field for Approximate onset date - 2018-Jan Core #141
  • GF#14800 AllergyIntolerance.code should be 1..1 - 2018-Jan Core #140
  • GF#14825 Clarify FamilyMemberHistory.date meaning - 2018-Jan Core #165
  • GF#14820 Recorder card should be marked as 1..1 - 2018-Jan Core #160

Started discussion on

  • GF#14446 PatientCare resources do not have a clean Workflow report

Tuesday Q4

Agenda

  1. Negation
    1. capture cases well-represented
    2. usage cases needed
  2. Harmonization
    1. Does PC specify value sets, or only semantics of value sets?
    2. Is PC responsible for maintenance and harmonization of value sets?
    3. Can PC suggest FHIR use SD values, or vice versa?
    4. Should FHIR data type policy trump interoperability?
    5. Does legacy momentum count? I.e., should C-CDA have more weight than FHIR?
    6. Or realm? I.e., should FHIR have more weight than C-CDA?
    7. Should PC simply specify values in the DAM and expect SD & FHIR to conform?
    8. Or maintain concept maps for divergent value sets?
    9. Who should be in the discussion

Attendees

Negation

  • Goal: align requirements so divergent syntactical specifications can be translated
  • Capture of representation cases: B
  • Identification of desiderata:C
  • Capture of usage cases (query):F
    • CQL May 1

harmonization across specification families

  • Allergy Criticality
    • C-CDA
        • CRITL: low criticality
        • CRITH: high criticality
        • CRITU: Unable to assess criticality
    • FHIR
      • low: Low Risk
      • high: High Risk
      • Unable-to-assess
  • Current
    • Identical clinical requirements
    • Similar model elements & term semantics
  • To do
    • Design global approach (governance, evaluation, solutions)
    • Criteria (clinical, technical, practical)
    • Solution (Pick one, Merge, Map, other?)

Discussion

  • FHIR has this as a code element so can only do FHIR defined terminology. Will never use the mapping if mapped to another code.
  • Question of risk vs criticality
  • Intended to mean the same
  • How big of a problem is this?
    • What happens if CDS needs a SNOMED code? Will need to map to the needed code
    • The issue is the strict FHIR methodology
  • Issue with the use of strings
  • Where FHIR has bounds to code- the workgroup encourage mappings to V2, V3 so automated translation can occur.
  • PC workgroup looked at SNOMED and did not find adequate codes

other vocab topics

  • Allergy Type conceptially maps but there are gaps
    • CCDA has it pre-coordinated (food allergy; drug allergy)
    • FHIR is not (food; drug)
    • FHIR has a structured transformation instead of a structure translation. If you have something that does not fit, can do it as extension
    • Harder to map
  • From a process perspective, what are next setps
    • Vocab UTT project to get all HL7 code systems and value sets in the same place.
      • Few efforts to get there - observation interpretation. There are others that are similar but not there yet.
  • Please forward any further use cases

Tracker Items

Wednesday Q1

Wednesday Q2

Wednesday Q3

Wednesday Q4

Thursday Q1

Thursday Q2

Thursday Q3

Thursday Q4