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May 2017 WGM Madrid, Spain: May 6 to May 12

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Madrid, Spain, WGM - May 2017 Patient Care WG Meeting Draft/Approved agenda:

Agenda

Day Time Qtr Room # Event Host Joining Chair Scribe
Sunday
May 7		 AM Q1 ?
Q2 ?
PM Q3 ?
Q4 ? FHIR co-chair updates
Day Time   Room # Event Host Joining Chair Scribe
Monday
May 8		 AM Q1 TBD 15 Plenary Room Requested
Q2 Oxford Mega joint session EHR Accepted N/A Laura
PM Q3 Estraburgo 20 Admin recap; FHIR Change requests Accepted: FHIR-I Michelle Michael
Q4a Burdeos Joint Session with FHIR & OO on FHIR workflow FHIR Accepted N/A Emma
Q4b Estraburgo 20 FHIR Change requests Declined: FHIR-I Michelle
Q4c Marsella Learning Health Systems Hosted Joint meeting LHS Accepted N/A Laura
Day Time   Room # Event Host Joining Chair Scribe
Tuesday
May 9		 AM Q1 Munich 50 FHIR/PCWG - CIMI - Skin Care model meeting. Stefan Hufnagle project CLIM Declined: FHIR-I

Accepted: ECWG, CIMI		 Laura Emma
Q2a Esquivias 20 FHIR Change requests Accepted: FHIR-I Michelle Michael
Q2b La Puebla SOA Hosted Joint Quarter: Care Coordination SOA Accepted invite from SOA N/A Emma
PM lunch ?
Q3a Marsella 20 FHIR Change requests Accepted: FHIR-I Michelle Michelle
Q3b Estrasburgo SD Hosted Joint Quarter: CDA Product Family -This meeting is to provide an update to all interested work groups regarding the formation of a CDA Product Family. There will be many work groups invited to participate, so send representatives only SD Accepted invite from SD N/A Emma
Q4 Estrasburgo 40 Negation + other topics;
GF#12633 Split Procedure into Procedure and ProcedureStatement 		Invited: Clin Genomics, SD, ED

Accepted: OO, Vocab, CIMI, FHIR-I 		Jay Emma
Day Time   Room # Event Host Joining Chair Scribe
Wednesday
May 10		 AM Q1 Burdeos 20 FHIR Change requests Accepted: FHIR-I Michelle Emma
Q2a Potsdam PA hosted joint meeting -- Episode of Care; Care Team PA Accepted invite from PA N/A Michelle/Michael
Q2b Burdeos Learning Health Systems Hosted Joint meeting LHS Accepted N/A Laura
PM lunch Santa Olalla
 15 Clinician-On-FHIR Preperation meeting Room Requested
Q3a TDB PC/RCRIM/CIC Joint meeting - Topic: Adverse Event (RCRIM) RCRIM (confirm) CIC, RCRIM, PC Elaine
Q3b Estrasburgo 40 FHIR/PCWG Joint meeting (PCWG Hosting FHIR reps)
GF#12966 ProcedureRequest - add DosageInstructions or Quantity
ReferralRequest / ProcedureRequest boundaries		 Accepted PC Invite: CDS, CQI, OO, FHIR-I Michelle
Q4 Estrasburgo 20 Allergy/Intolerance topic meeting. Drug list approach & QA. Christian Hay to present on IDMP. Invited: Pharmacy

Accepted: Vocab 		Elaine / Jay
Day Time   Room # Event Host Joining Chair Scribe
Thursday
May 10		 AM Q1a Munich 25 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 ....		 Invited: SD, CH

Accepted: Pharmacy, LHS, FHIR-I		 Laura Emma
Q1b Stuttgart OO hosted joint meeting with CDS, PC, Templates - Per Hans, topic is anything that has a joint interest, such as FHIR ProcedureRequest, other tracker items of mutual interest OO Tentatively Accepted N/A Michelle
Q2 TDB Joint meeting with SDWG

Topic: Care plan, Allergy Intolerance (criticality), Clinical status, International Patient Summary

PC hosting; room reserved by Sd		 SDWG N/A Emma
PM lunch Esquivias
 10 Co-Chair Admin Meeting Requested Room
Q3a Esquivias 5 Assessment scales - ballot reconciliation; SDC update; Room Requested Michael Michael
Q3b Munich 20 FHIR Change requests Accepted: FHIR-I Michelle Michelle
Q3c Stuttgart Clinical Statement hosted joint meeting with OO and PC. Per Hans, typically this one is very short (as it is in maintenance mode). Rest of the quarter is strictly OO CS Tentatively Accepted N/A ??
Q4
Day Time   Room Event Host Joining Chair Scribe
Friday
May 11		 AM Q1 ClinFHIR  
Q2   ClinFHIR        
PM Q3   ClinFHIR        
Q4   No meeting        





Madrid, Spain, WGM - May 2017. Patient Care WG Meeting Meeting Minutes

Sunday, May 7

International Council Meeting
- No PCWG meeting


Patient Care WGM, Monday, May 8, 2017


Patient Care Monday Q1

Minutes

General Plenary session No meeting from Patient Care



Patient Care Monday Q2

Chair: EHR Hosting other WG



Minutes

  • EHR: many functional profiles, completed & in process
  • CQI: consolidation of measure and decision support tactics
  • PC presented slides




Patient Care Monday Q3

Chair: Michelle Miller
Scribe: Michael Tan


Attendees

  • Ewout Kramer
  • Marten Smits
  • Russ Leftwich
  • Stefan Lang
  • Masaaki Hirai
  • Yukimori Konishi
  • Sadama Takaraba
  • Jay Lyle
  • Beau Bannerman
  • Emma Jones



Minutes

  • Review agenda of WGM agenda
    • Wednesday RCRIM no invitation received. Is this still on?
    • No one from PC on Thursday Q3
    • Wednesday Q3 is a joint with O&O. Negation will be discussed on Tuesday Q4..
    • Wednesday lunch session for Clinicians on FHIR will be in Santa Ollalla.
    • Patient Care Tuesday Q1 will need to discuss a PSS dietary. This will be discussed during the CIMI session.
    • No further comments on the agenda.
  • Meeting notes of HL7 WGM January
    • Laura moved to approve the notes WGM January 2017. Emma seconds
    • 13 in favour, 0 against, 0 abstentions.
  • FHIR
    • E-mail from Lloyd to all co-chairs. Which resources are candidates for the next normative publication? Deadline is April 2018. Allergies, Conditions and procedures have reached maturity level 3 and are the candidates to be promoted. The maturity level defines which resources are tested and proven that are mature enough to go to level 4. The gut feeling is that we are not ready for December.
    • Allergy and intolerances still have issues with adverse events.
    • The issue with Condition are about Health Concerns. Clinical Status still raises discussions on the value set. ( active, recurrence. Relapse, well controlled, poorly controlled, inactive, remission, resolved).
    • Procedure and Procedure statements could be split, similar to medication and medication statement, for example a patient saying he has had an operation when he was a kid.
    • Discussion arises how maturity is decided. We should have a general approach for accepting normative. For example a QA spreadsheet or looking at Zulip. Should be measurable and formalized by FMG.
    • This concludes that we have no resources fit for promotion to normative status.
    • Are there specific preferences for PC resources to be put on the short lists for the normative?
    • Are there any new resources to be developed? Adverse event, procedure statements,( not PC).
    • Maturity levels changed? Care Plan , Goal and Care team are now level 2. Family member history also 2. Has there been any experience in a Connectathon? Ewout is looking at technical connectathons. But the result is usually a self-report. It is more a sense of how stable a resource is.
    • There is some feeling about which resources are being referenced in Zulip. Nobody has a firm finding which resources are mature.
    • Should we make distinction between technical maturity and clinical maturity? Issue for the FMG? Laura has worries, especially if patient safety is concerned.
    • Emma brings in the vendors point of view, that IT vendors want to roll out FHIR structures without the risk of redeveloping the software on a new release. You will also need to convince users to start using the resources.


Patient Care Monday Q4a

Chair: OO
Scribe: Emma


Attendees


Minutes


Patient Care Monday Q4b

Chair: Michelle Miller
Scribe: Michael Tan


Attendees
Michelle Miller
Michael Tan
Dennis Patterson
Danielle Friend
Marten Smits
Ardon Toonstra
Jay Lyle


Minutes
Flag

  • GF#12798 Flag resource should allow for a Condition reference as subject (Ardon Toonstra) -- withdrawn

FamilyMemberHistory

  • GF#8782 NoKnown[X] for FamilyMemberHistory (Danielle Friend) -- non-substantive
  • GF#8781 FamilyMemberHistory Should be Patient, not Relative Centric (Danielle Friend) -- non-substantive
  • GF#9028 Use SCT values rather than V3 for family history relationship (Jay Lyle) -- Deferred

List

  • GF#8784 Proposed History Resource (Danielle Friend) -- Withdrawn

Condition/Observation

  • GF#11026 Relationship between Condition and Observation - 2016-09 core #45 (Jay Lyle) -- Waiting For Input

FHIR tracker items

  • 9028 Mapping of SNOMED codes to V3 codes for family relations. ( example binding);
    • Found SNOMED codes for most of them, but some were not found.
    • VA desires to use SNOMED, but it is not a hard requirement. Michelle remarks that it is an example binding and if the VA wants to use the SNOMED, then they could use it. SNOMED could add the V3 values to SNOMED. Clinical genomics require certain values on the relationships such as natural father of fetus.
    • Motion to defer the request until SNOMED has harmonized their value set. Request at SNOMED will be placed by Jay.
    • Move Jay second Danielle: Vote 6 in favor, 0 abstentions, 0 against
  • 8782 Danielle ( EPIC) Often “no known history” of patients. How do I express this?
    • This is resolved when the value set was updated with an extra SNOMED code: “no current problems or disability”. Similarity with conditions. Have to add a note on the conditions, because the value set is shared.
    • Move Danielle, second Marten: Vote 6 in favor, 0 abstentions, 0 against
  • 8781 “no known problems” On the patient level.
    • Lloyd suggests to use list. List empty reason
    • Move Danielle, second Marten: Vote 6 in favor, 0 abstentions, 0 against
  • 10508 Gap in the entry . It mentions events and conditions, but it does not cover this topic anymore and only mentions conditions. Comment is deferred.
  • 8784 Requirement to have a broader usage of family history.
    • Discussion postponed.
  • 12798 flag resource should allow a Condition reference as subject on a non-patient condition. It is related to the “Alerts” in NL. But the issue is withdrawn because the use case is not completely clear.
  • 13201 Discussion on outcome of clinical status ( inactive, resolved or remission. ) and Abated. Why do we need abatement? This discussion is postponed until we have clinicians to explain the use case of abatement.
  • 11026. Distinction between conditions and observations. The boundary is rather subjective, but there is explanation in the wiki. These resources will not be merged. They should however be of similar construction. This is a broad topic and Jay should provide more explanation. Waiting for input from Jay.



Patient Care Monday Q4c

Chair:
Scribe:


Attendees



Minutes




Patient Care Monday Q5: Placeholder for extra meeting if necessary

Present:



Minutes:



Patient Care WGM, Tuesday, May 9, 2017


Patient Care Tuesday Q1

Chair:
Scribe:


Attendees

Agenda

  • Podiatry EHR SFM PSS
  • Skin model update
  • CLIM project

Minutes

  • Podiatry EHR SFM PSS
    • PC will consider offline
    • Resulting discussion of SFM/DAM/DCM process. Draft:
      • 1. Clinical use cases
      • 2. DAM
      • 3. EHR System Functional Model profiling (decomposition/elaboration of DAM cases)
      • 4. DCM
      • 5. implementable specification
    • Further discussion in CIMI/CIC meeting Wednesday
  • Skin model
    • SOLOR modeling of skin assessment concepts
      • Further discussions on CIMI Skin project, probably Friday mornings ET.
    • Semantics of CIMI assertion & evaluation patterns (a.k.a. Condition & Observation)
      • To the extent this discussion informs FHIR, it goes through PC (and loop in OO)
    • Fall ballot:Vitals & labs
    • Project ownership; transition to CIMI
      • To do: confirm current PSS closure criteria. Close and re-start to address broader scope, possible change of sponsor.




Patient Care Tuesday Q2a

Chair: Michelle Miller
Scribe: Michael Tan


Attendees

[1]


Minutes

  • GF#11021 Increase cardinality of substance and make certainty relation to substance not reaction - 2016-09 core #40 (Jay Lyle) - need to discuss jointly with BR&R (formally known as RCRIM)
  • GF11021 Allergy : Certainty can change overtime. The substance is preferably stored in code, because this is where Clinical Decision Support would be looking at. Resolution to remove reaction and instead replace with a reference to adverse reaction. Options^:
    • Keep reaction embedded in Allergy
    • Slim down the reaction ( move substance out of the resource).
    • Reference to observation
    • Make adverse reaction a separate resource
    • Make adverse event a separate resource.
  • Difference between adverse reaction and event is that an adverse reaction is strongly related to the patient ( disposition for a medicine). An event is more related to a context, such as falling out of bed. Possibly an event is an overarching event, where adverse reaction to a drug is a component of the adverse event. The event is also meant for reporting purposes. The event is the action of giving medication to a patient, while a reaction is the outcome.
  • Consider that when the event occurs you might not know whether it really is an allergy. You may suspect that it is an allergy, but it could be caused by other reasons such as empty stomach.
  • Jay withdraws his request to refer to observation. (gf 11023).
  • GF#11023 Why isn't AllergyIntolerance.reaction an Observation? - 2016-09 core #42 (Jay Lyle) - withdrew
  • Can you have reference to a backbone element? And query it?
  • Current EHR systems usually record the adverse events in a separate system.
  • For creating a new resource ( adverse reaction) you have to prove why adverse event is inadequate. Adverse event is owned by BRR ( formerly RCRIM).
  • Need to test this out in Clinicians for FHIR.
  • Allergy & Intolerance is usually used for patient safety reasons. In that case you should keep the resource simple.
  • GF 12623 care plan activity status.
    • Value set: not started, scheduled, in progress, on hold…..
    • Missing abandoned. There is cancelled. What are the characteristics? Who abandoned, after start of before start? There is an element called statusreason where you can express a reason why it is cancelled. Do we need a hierarchy ( ended, with abandoned and cancelled. Discussion will be continued.

Patient Care Tuesday Q2b

Chair:
Scribe:


Attendees



Minutes


Patient Care Tuesday Q3a

Chair:
Scribe:


Attendees

[2]


Minutes
CarePlan/Goal

  • GF#11359 Why only one medication in an activity? And the value set is problematic (but example) - 2016-09 core #517 (Robert McClure) -- Not Persuasive / No Change
  • GF#11355 CarePlan category value set is out of date or wrong - 2016-09 core #513 (Robert McClure) -- Not Persuasive / No Change
  • GF#10622 QA 4a: Consider whether Goal.category should be bound to codes from an external code system (Michelle Miller) -- Not Persuasive / No Change, but need to revisit

Communication

  • GF#13306 Communication Extension: reasonNotPerformed is redundant (Eric Haas) -- Persuasive

Patient Care Tuesday Q3b

Chair:
Scribe:


Attendees



Minutes




Patient Care Tuesday Q4

Chair: Jay Lyle
Scribe: Michael Tan


Attendees [3]

Agenda

  • Negation ballot comments
  • Negation analysis; possible tactics for policy
  • GF#12633 Split Procedure into Procedure and ProcedureStatement (Lloyd McKenzie) -- agreement for PC to do the analysis
  • GF#13201 Condition Xpath constraint con-4 is not correct (Ardon Toonstra) -- Persuasive with Mod


Minutes

  • Nr, ? Comment ballot: Should use CDA examples. Disposition: Persuasive.
    • Richard Move; Rob Second. Vote : 21 in favor, 1 abstain, 0 against
  • Organize better table or remove it. Disposition to include definitions of columns in the text and explain and in the key.
    • Richard Move; Rob Second. Vote : 22 in favor, 1 abstain, 0 against
  • Does not know what the table means
    • Susan Move; Rob Second. Vote : 21 in favor, 1 abstain, 0 against
  • Nr. 26, 27, 69 numbers and headings
    • Susan Move; Rob Second. Vote : 23 in favor, 1 abstain, 0 against
  • Nr 30, and 70 definitions all seem persuasive. Motion to make the definition:
    • Galen move Second Susan: Vote : 23 in favor, 1 abstain, 0 against
  • Nr. 36 will provide explanation:
    • Galen move Second Claude: Vote : 24 in favor, 0 abstain, 0 against
  • Nr. 32, 33 and 37 and 39 will be rewritten:
    • Additional editors volunteering to provide text.
  • Galen move Second Susan: Vote : 25 in favor, 0 abstain, 0 against
    • Nr.46 there are no standard formats: will be refrased. There are formats, but none are standard.
    • Galen move Second Claude: Vote : 25 in favor, 0 abstain, 0 against
  • Nr. 47 question answered. Need to talk to Lisa.
  • Nr. 51 the classes in the appendices will be aligned. Persuasive
    • Rob move Second Galen: Vote : 25 in favor, 0 abstain, 0 against
  • Nr. 60 the document is not a DAM. No requirements: There are requirements; Not persuasive. It does contain requirements.
    • Galen move Second Claude: Vote : 25 in favor, 0 abstain, 0 against
  • Nr. 63 needs an better example. The given example is also not valid. Susan provides a better example.
    • Richard move, second Susan; Vote : 21 in favor, 0 abstain, 0 against
  • Nr. 71 will include principles:
    • Galen move, second Susan; Vote : 21 in favor, 0 abstain, 0 against
  • Nr. 83 Prohibition: Don’t do something: Not persuasive but will add more clarification.
    • Galen move, second Richard; Vote : 20 in favor, 1 abstain, 0 against

FHIR Procedure resource

  • Up till now procedure capture procedures information as history, but there is also a need to capture data for management purposes. These are 2 different needs and scenario;s.
    • Options:
      • 2 different resources
      • 1 resource with an extra flag.
    • These would be similar to medication administration and medication statement. I.e. procedure versus procedure statement.
    • The should be alignment with other resources. PC would apply the same policy towards procedure and procedure statements.
    • Also need to analyse how the different resources would look like before a decision is made. Need to look which attributes goes into which resource.
    • Also need to look into GF issues that have comments related to the split.
    • Vendors ( Cerner, EPIC) need to check
    • Lloyd: Motion PC need to make a initiative to make an analysis to make 2 separate resources, Michelle Second: Vote 20 in favor, 0 abstain, 0 against.
  • GF 13201: Condition : status: should we have a rule that abatement ( Boolean= false) and status not contradicting the Boolean. What is the use case for abatement? This can be reflected by status. Motion to remove the Boolean. But the remaining fields of abatement are still there. They should be in line with status. Stan Huff has not seen any system capturing abatement. Michelle moves a motion, second Galen.
    • Vote 20 in favor, 0 abstain, 0 against


Patient Care WGM, Wednesday, May 10, 2017


Patient Care Wednesday Q1

Chair:
Scribe:


Attendees



Minutes




Patient Care Wednesday Q2a

Chair:
Scribe:


Attendees



Minutes

Patient Care Wednesday Q2b

Chair:
Scribe:


Attendees



Minutes




Patient Care Wednesday Q3a

Chair:
Scribe:


Attendees



Minutes
a

Patient Care Wednesday Q3b

Chair:
Scribe:


Attendees



Minutes




Patient Care Wednesday Q4

Chair:
Scribe:


Attendees

Agenda

  1. Drug substance list
    1. approach
    2. preliminary results
    3. Key issues
      1. Defining cross-reactive classes
      2. Routes, salts, and other details; e.g., salycilates
      3. Vaccines & biologics
      4. Identifier selection
  2. IDMP: model & possible impact on identifier selection

Minutes



Patient Care WGM, Thursday, May 11, 2017


Patient Care Thursday Q1a

Chair:
Scribe:


Attendees



Minutes

Patient Care Thursday Q1b

Chair:
Scribe:


Attendees



Minutes




Patient Care Thursday Q2

Joint with SDWG and Template WG

Chair:
Scribe:


Attendees



Minutes




Patient Care Thursday Lunch: Co-Chairs Meeting

Chair:
Scribe:


Attendees



Minutes





Patient Care Thursday Q3a

Chair:
Scribe:


Attendees



Minutes

Patient Care Thursday Q3b

Chair:
Scribe:


Attendees



Minutes

Patient Care Thursday Q3c

Chair:
Scribe:


Attendees



Minutes




Patient Care Thursday Q4

Chair:
Scribe:


Attendees



Minutes





Patient Care WGM, Friday, May 12, 2017

Clinician-on-FHIR


Patient Care Friday Q1

Chair:
Scribe:


Attendees



Minutes




Patient Care Friday Q2

Chair:
Scribe:


Attendees



Minutes




Patient Care Friday Q3

Chair:
Scribe:


Attendees



Minutes




Patient Care Friday Q4

Chair:
Scribe:


Attendees



Minutes





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