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May 2015 WGM Paris, France: May 10 to May 15

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Paris, France, WGM - May 2015 Patient Care WG Meeting Approved agenda:



Paris, France WGM - May 2015. Patient Care WG Meeting Meeting Minutes

  • Sunday, May 10 - International Council Meeting
- No PCWG meeting


Patient Care WGM, Monday, May 11, 2015


Monday Q1

Plenary Session. Pt care attended plenary sessions and did not meet.

Present:



Minutes:



Monday Q2

Plenary Sessions. Patient Care attended the plenary meeting and did not have individual meetings.

Present:



Miutes:



Patient Care Monday Q3

EHR hosted multiple clinical groups including Patient Care. All groups, including Patient Care provided updates on the work completed, work in progress and areas where member engagement could occur.

Present:



Minutes:




Patient Care Monday Q4

Present:

  • Elaine Ayres ( chair)
  • Emma Jones
  • Laura Heermann Langford
  • Jay Lyle
  • Michael Tan (scribe)


Patient Care Administration Slide Deck Monday Q4


Minutes:

  • The minutes from San Antonio was approved. Moved by Laura, second by Michael.

Vote 4 approve, 0 against, 0 abstain.

Agenda review

  • CQI not present, so preparation of Connectathon Geneva will be added to the agenda. Laura will chair and Emma to scribe.
  • Brett wants to discuss some ballot comments on allergies on the joint meeting Wednesday.
  • We need a room for the co-chair lunch. This is instead of the Friday Q0. * Invite Stephen for Concern topic on Thursday.
  • Agenda moved by Laura and second by Emma: 4, 0,0.

WG Health

  • Patient Care has a healthy track record. We got a gold star again.
  • Co-chair elections have been deferred.
  • Elaine Ayres, Russ Leftwich, Laura Heermann Langford, Michael Tan's positions are due for re-election.
  • Extension of Elaine's co-chair position will not be likely , due to change of management at her office.

3 year planning

  • We will close project 1086.
  • What do we do with the DSTU of allergies and intolerances project 1004. We need to give comments before we can put it forware to Normative Edition. Please
  • Project 927 Vital Signs will be closed.
  • Project 881 Allergies DAM is completed and can be closed.
  • Need to check on assesment scales project 664 with William Goossen.
  • Check on project 661 on DCM for medical devices with Anneke Goossen.

New Projects

  • Care Plan EHR-functional model
  • HSI ( Healthcare Systems Integration) Reconciliation. This has been tested in IHE with CDA templates. The intention is to test this with FHIR resources.
  • Stephen Hasley: Maternal Health
    • Has organized active parties in maternal health.
    • Put up a data-set of about 600 data elements.
    • Project would probably look very similar to the CIC effort or the DEEDS project. Stephen would probably look for funding. Is Hasley a HL7 member?
    • This would also need a co-chair to guide the project. Would Russ pick up this project?



Patient Care Monday Q5: Placeholder for extra meeting if necessary

Present:



Minutes:




Patient Care WGM, Tuesday, May 12, 2015


Patient Care Tuesday Q1

Present:

  • Michael Tan
  • Ken Chen
  • Laura Heerman Langford (chair)
  • Michelle Miller
  • Stephen Royce
  • Joshua Mandel
  • Jay Lyle (scribe)
  • Michel Rutten
  • Michael Donnelly
  • Emma Jones
  • Richard Errema
  • David Hay
  • Lloyd McKenzie (lead)
  • Simone Heckmann
  • Richard Kavanagh
  • (one more unsigned)


Minutes:

PC Q1 FHIR There are over 200 items for PC

Target: apply changes by mid-July; target early July to finish review.

  • 6866: Reaction issue. openEHR influence. Why won’t this meet use case requirements? Tabled pending participation of Elaine and Russ.
  • 7121: Procedure status. This could possibly be two resources: one a statement of fact (patient had an appendectomy on this date) and a more detailed resource to track procedure as it occurs. Alternatively, there are simple procedures and complex ones; perhaps address more granular statuses in extension for heavy procedure.

Could procedure be compositional, including steps that may or may not be resources?

How do systems act? Some interfaces focus on one procedure; some query sets.

We agree it needs to be a single resource: you don’t have to worry about which one to use. Cost is that the 80% boundary is fuzzy. Either make a small one and use extensions, or large one that can be profiled down. Implementers agree: one. Use an extension for additional statuses, via list of steps or procedures. FMG will create a common extension for this purpose.

    • PC task: define the detailed procedure extension. Not a July task.

Laura & Jay moved: 3 abstain; 0 against; 12 affirmative

  • 7123: Clem, procedure category vs type. Category is broad. Type is specific.

Codes make level clear, but rationale unclear. Need better definition for category, and change name for type to code, to align with Observation. No, make it “name.”

Add a note recognizing that care should be taken to avoid letting these elements could be semantically out of synch.

Michael moves; Jay seconds. Abstain: 4; Against: 0; Affirmative: 11

  • 7124: site. Approach vs. target site. Clem suggests target is always precoordinated.

Group feels both are needed, but they need disambiguation.

Perhaps this is target, and approach should be an extension?

No; add a coded property to body site to specify which. Optional, for legacy support. Role.

Jay moves; Stephen seconds. Abstain: 4; against: 0; affirmative: 11.

  • Lloyd provided a preview of 7128 (procedure note) & 7185 (impression) future discussion.



Patient Care Tuesday Q2

Present:


Michael Tan (Chair), Elaine Ayres (Scribe), Jay Lyle, Emma Jones, Laura Heermann-Langford, Stephen Chu (remote,) Thomas Kuhn, Lori Simon

Minutes: Michael reviewed the current status of the Health Concern project. There are three variations of use cases. 1. Someone may or may not be concerned with something someone else has put on the list. 2. Care team members may disagree about a judgment. 3. A patient disagrees that something is a concern.

In the Care Plan there is a concept of "expressed by" attribute associated with health concern. This should be represented in the health concern model. The health concern in care plan as expressed by role with 1..* cardinatlity. In Health Concern have "Concern Author" but the cardinality is 1..1.

Other roles in health concern - author, custodian and monitor. Care plan has an author and custodian of the care plan. Is the author of the care plan also the author of the health concern?? (modeled this way currently in care plan as it preceded the health concern work).

What if a concern is expressed in different terms (e.g. different words)? Is this a fourth use case? A diagnosis can be "Name 1" and "Name 2" as the issue evolves. Diagram has a replaces function but noted that arrows should support replaced by. Need to be able to support labels for "expressed" by patient, mom, spouse. Need to be able to distinguish between the author of the concern vs. the author of an event (e.g. a different diagnosis).

The concern has one author, but there can be multiple names of the concern that could be authored by one or more individuals (to support the many events within a concern). Therefore, need to associate authors and events.....

1. Actions - attached an author to an event. Create an expressed by concept with the associated term used by the "expressor".

Note similarities to Chief Complaint -- what the patient said, vs. coded chief complaint. An HPI (history of present illness) will add additional information. A narrative associated with a health concern would help with the creation of chief compliant.

The first expression by the patient -- should that be retained or is it a snapshot? Retaining the term will allow for tracking over time. Would you be able to find this term without the "expressed by".

2. Expressed by will be associated with the event level not the concern level. Cardinality will be 1..* This will allow the dare plan to point to the health concern (grey box). This removes the risk of inconsistency.

The notion of a Concern focal event needs to be addressed as well.


MOTION: To ensure many naming events (1..*) are captured, add expressed by to ConcernFocalEvent as a relationship. This is a role property and will be a separate associated box. Will rename the ConcernFocalEvent box as part of this change.

MOVE: Jay/Laura Object - 0, Abstain - 0, Approve - 6

Issue - SDWG -- deprecated "Clinical Status" in C-CDA 2.0. SDWG recommended use of mood codes. Discuss during Thursday Q2.

NOTE: Include the ED group in the near term to review these changes.

Other issues with the model? no other issues noted.

Other topics -- older models, FHIR, review use cases.

Re FHIR -- look at Condition resource and compare to the Health Concern model.


Patient Care - Nutrition Lunch

Present: Elaine Ayres (Chair), Donna Quirk (Scribe), Eric Haas, Rob McClure, Mark Roche, Jeff Brown, Rob Hausam, Suzanne Maddox, Julia Skapik, Vada Perkins, Mary Ann Slack


Minutes:

  • C-CDA R2 Templates

Elaine Ayres reviewed the C-CDA R2 templates and their representation of the Nutrition Care Process. There have been concerns around Healthy Weights due to public health groups using “reported” height and weight. After discussions with Lantana, the HIMSS Interoperability Showcase included a Healthy Weight vignette. In the vignette, data was exchanged between a PCP and community nutritionist using the Lantana Camara Document Editor with the patient entering data via a patient portal. This was a FHIR based C-CDA exchanging narrative and structured data. Terms have been mapped to SNOMED and LOINC. As of Sunday, May 10, 2015, 4 value sets have been published in VSAC to support the C-CDA R2 nutrition templates. The steward of the value sets is AND (Academy of Nutrition and Dietetics).

  • Allergy and Intolerance

Elaine asked for guidance on terminology binding for allergies and intolerances – UNII vs. SNOMED CT – and how to best represent food in CDA templates and other HL7 standards e.g. diet orders and allergies and intolerances.. It is currently a struggle and terminology does not support the HL7 models. It was discussed that there is nothing in CCDA that dictates one vocabulary over another. Need to give better guidance as a first step, i.e. always look at value sets in domain you are working with. If not there then use this. Might want to put the guidance in the C-CDA IG. A definition of substance vs. product was requested. A substance stands alone (i.e. ingredient). A product is a substance that has had something done to it or combination of substances.

  • SPL and GS1

Elaine reviewed parallel projects to obtain all substances on an ingredient list in a structured format. Continue to look for full ingredient list in structured data format. Right now companies have no incentive to give the FDA their list of ingredients on a food label in electronic format. It is possible to create the Nutrition Facts label in a structured format except for the ingredient list which is a text “blob”. Ingredient lists could be structured in the future. What does the FDA expect? There are still logistical issues such as manufacturers change ingredients frequently and regulations dictate how soon they need to inform FDA or CFSAN of the changes. Could create an index of food products like RxNorm if information is available. Still do not know path forward. Attendees from the FDA will follow-up with CFSAN.



Patient Care Tuesday Q3

Patient Care did not meet this quarter.



Patient Care Tuesday Q4

Present:

  • Michelle Miller
  • Robert Haussam
  • Elaine Ayres
  • Emma Jones
  • Jay Lyle
  • Pamela Sicluna
  • Donna Quirk
  • Viet Nguyen
  • Laura Heermann Langford (chair)
  • Michael Tan (scribe)
  • Lloyd McKenzie


Minutes:

FHIR topics:

  • Which resources does PCWG own? The ones owned by Patient Care are:
    • Condition
    • Procedure
    • Questionnaire
    • Allergy & Intolerance
    • Clinical Impression
    • Referral Request
    • Familymemberhistory
    • Care Plan
    • Goal
    • Flag
    • Communication
    • Communication request
  • Comment 7855: asserter is ambiguous. What is the meaning of asserter. The asserter is person who believes the information is tru and important enough may be important enough to be recorded. The asserter is the individual who is making the condition statement.
  • If the data enterer is different than the asserter, then this person can be entered under provenance instance pointing to the condition.
  • We need to add "related person" under asserter under the resource "condition".
  • Motion move by Viet. Second by Jay.
  • Voting : 1 abstain, 7 in favor, 0 against.
  • Comment 7859 : Rename "asserted date " to "recorded date". The definition should also change. "date the condition statement was documented".
  • Move Viet, second Emma: Vote: 1 abstain, 7 in favor, 0 against.
  • Comment 6132: The conditon/problem/diagnosis does not contain any (codes for) problem.
  • The chapter heading should perhaps be named "condition category codes". The codes are regarded as mutually exclusief according to Lloyd.
  • Another option is to leave problems as "unknown" . The code set is required.
  • The text e.g. should be removed.
  • This issue was difficult to resolve. Lloyd suggests to modify: required into preferred.
  • Vote 1 abstain.0 against 7 approve.


Patient Care WGM, Wednesday, May 13, 2015


Patient Care Wednesday Q1

Present: Elaine Ayers, Emma Jones, Laura Heermann Langford, Michael Padula, Donna Quirk, Kevin Coonan, Julie Murugi,


Minutes: Hosting Child Health Review of progress of the Child Health DAM and Essential Information for Children with Special Healthcare Needs Working on Storyboards. 4 are in development. Working on flushing out the use cases to make it clear where the points of intersection occur, when points of documents are getting populated. Questions on how to get more input and review on the documents. Suggestion made to take the documents/storyboards through a ballot process. Discussion re: level of specificity for the DAM and the Essential Information for Children with Special Healthcare Needs and the importance to be specific and include examples in the documents as appendices so it does not get interpreted in a more detailed way then intended.




Patient Care Wednesday Q2

Patient Care reps attended the Patient Administration WG. Determined to keep same quarter at the next meeting, Also, will add Thursday Q3 to the agenda as a PA/PC meeting hosted by PA.



Patient Care Wednesday Q3

Present: Michael Tan (Chair), Elaine Ayres (scribe), Laura Heermann-Langford, Tim McNeil, Donna Quirk, Emma Jones, Eric Haas, Rob Hausam, Cecil Lynch, Paul Lomayesva, George Cole, Kevin Coonan, Lloyd McKenzie, William Goossen, Ron Shapior, Lorraine Constable, Magnus Alsaher, Ken Chen, Viet Nguyen.



Minutes: Joint OO/PC

  • GFORGE: 6216 change word "concern" to goal addresses. Short description needs to be changed. Goal question. Goal concern can reference many resources but it is more the reason a goal exists. Change short definition to: Issues addressed by this goal

Move: Eric/Laura Abstain - 1, Object - 0, Approve - 16

  • Procedure request vs. Diagnostic Order -- Boundaries and Relationships. Will take the wording for procedure request and apply to diagnostic order (Eric Haas).
  • GFORGE 6253 Body Site -- move to a data type is proposed vs. a resource. Use case for bodysite -- tracking a lesion, tracking a fetus, a clinical trial with multiple test sites. Reference body site as an extension, as a codeable concept is usually sufficient.

Move: Eric/Rob re recommendation. Abstain - 2, Object - 0, Approve - 15

  • GFORGE 6213 -- withdrawn by voter. Deferred in version 2.1
  • GFORGE 6214 -- food not included as a substance in Care Plan in product - add codeable concept to allow for food. Change the data type the detail.product codeable concept for medication/substance

Move: Eric/Rob Persuasive with Mod. Abstain - 0, Object - 0, Approve - 15

  • GFORGE 6215 Careplan activity detail vs. Careplan activity notes. Rename /careOkab,activity.notes to.progress. Change short display for CarePlan.activity.progress from Comments about the activity to comments about the activity status progress.

Change short display for CarePlan.activity detail.notes from "Extra info on activity occurrence" to "Extra info describing activity to perform"

Change the long definition for CarePlan.activity.progress from notes about the execution of the activity to notes about the adherence status of the activity.

Add the usage note - does not describe the activity to be performed.

Rename CarePlan.notes to CarePlan.note

MOVE: Eric/Rob Abstain - 0, Object - 0, Approve - 17

  • GFORGE 6250 Communication vs. CommunicatioStatement Appears to be like Medication and Medication Statement. Communication is a statement of what has occurred. In communication request -- planned, vs. communication e.g. what was done. CDS may use current communication patterns. This current resource is a record of an event. Comment is withdrawn. Retain same name.
  • GFORGE 6251 Communication.payload definition should accomodate single and multi-part messages. change to "the communicated conet or for multi-part communications, one protion of the communication.

MOVE: Eric/Laura Abstain - 0, Against - 0, Approve - 17

Note that in communication request the same issue exists. Therefore amend the disposition to include communication request as well.

Retain this quarter for combined PC/OO/CDS/FHIR at the next WG meeting.



Patient Care Wednesday Q4

Present: Chair: Elaine Ayres, Scribe: Emma Jones Michael Tan, Viet Nguyen, Gay Dolin, Brett Marguard, Sarah Gaunt, Donna Quirk, George Cole, Rob Hausam,



Minutes: Review DAF Profile ballot comments

  • Discussion about the date elements in allergyIntolerance. Clarification needed. Brett will reach out to submitter for clarification.
  • Condition resource - severity - change the valueset to mild/moderate/severe
  • List resource - core resource cannot represent "No known …" is present. Resolution: pass the ballot comment back to FMG.
  • smoking status - observation status has a fixed value of final. Discussion: The use of the data based on a business rule should not happen.
  • Block vote on resolved items. Vote results: Moved - Brett, Second: Gay: against 0 - abstain 0- Approved 9

Per Brett - Ballot spreadsheet is not formatted to support import into GForge. Will format sheet and import PCWG Resources comments. The rest of the ballot comments will be handled using spreadsheet only. Elaine request that comments PCWG has voted on should please get added appropriately so not to have to review them again. Agreement from the group.

Allergies and intolerances discussion -

  • Outstanding question of if SDWG will accept proposed changes as an errata
    • Of the changes, the biggest issue is the representation of severity and criticality - preference should be given to this issue.
  • Other changes include -
    • renaming the allergy concern act
      • Have to maintain the LOINC name
    • Allergy adverse event type value sets
      • can change the name of the value set but cannot change the identifier
      • updated the value set concepts
      • extensive discussion about value sets and binding to value set.
      • Discussion of changes to the structure of the observation code and value structure.
      • Still work on the substance piece
      • Would like to work on the difference between severity and criticality first.

Elaine with post list of changes on wiki and notify Brett of its location

SDWG made aware of cardinality of medication reaction in CCDA 1.1 and 2.0 - 0..1. Need to increase to 0..*. Per Gay, this issue was carried forward from CCD. Direction from SDWG to enter this change as erratas against CCDA 1.1 and CCDA 2.0. Emma will enter erratas



Patient Care WGM, Thursday, May 14, 2015


Patient Care Thursday Q1

Present:


Minutes:



Patient Care Thursday Q2 (PCWG, SDWG, Template Joint meeting)

Present:

  • Elaine Ayres (chair)
  • Jeff Brown
  • Frederic Larcoche
  • Emma Jones
  • Jeffrey Ting
  • George Cole
  • Tessa van Stijn
  • Sarah Gaunt
  • Benjamin Flessner
  • Rob McClure
  • Gay Dolin
  • Mark Shafarman
  • Tim McNeil
  • Keith Boone
  • Jari Porrasmaa
  • Rob Hausam
  • Michael Tan
  • William Goosen
  • Kai Heitmann
  • Simeon
  • David Parker
  • Craig Gabron
  • Donna Quirk
  • Jay Lyle (scribe)
  • Kevin Coonan



Minutes:



Patient Care Thursday Q3

Present:



Minutes:




Patient Care Thursday Q4

Present:



Minutes:



Patient Care WGM, Friday, May 15, 2015


Patient Care Friday Q0: PCWG Co-Chairs meeting

Present:


Minutes:




Patient Care Friday Q1


(1) Template WG meeting

- PCWG representative(s) to attend

(2) Agenda: open

- Possible: Clinical Connectathon



Present:


Minutes:



Patient Care Friday Q2


Agenda: open

Possible: Clinical Connectathon


Present:


Minutes:



Patient Care Friday Q3


Agenda: open

Possible: Clinical Connectathon


Present:



Minutes:




Patient Care Friday Q4


Agenda: open

Possible: Clinical Connectathon


Present:



Minutes:



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