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October 2015 WGM Atlanta: Oct 4 to Oct 9

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Atlanta, WGM - October 2015 Patient Care WG Meeting Approved agenda:




Atlanta WGM - October 2015. Patient Care WG Meeting Meeting Minutes

  • Sunday, October 4 - International Council Meeting
- No PCWG meeting


Patient Care WGM, Monday, October 5, 2015


Monday Q1

  • Plenary Session
- No PCWG meeting



Monday Q2

  • Plenary Session
- No PCWG meeting



Patient Care Monday Q3

Joint meetings

Track (a) EHRWG
Track (b) FHIR/OO (this track extended into Q4 session)


Present:

  • Track A - See EHRWG attendance list - Elaine Ayre and Laura Heermann representing PCWG
  • Track B - See OO attendance list - Stephen Chu and Michael Tan representing PCWG


Minutes:

  • Track A - PCWG update slide deck:
WGM October 2015 Atlanta - Patient Care Update October 5, 2015


  • Track B - Meeting Note:
Topic: FHIR workflow issues
- There are inconsistencies in the current way that FHIR resources handle workflows.
~ FHIR resources that requires workflow management and related issues are captured in this document:
WGM October 2015 Atlanta - FHIR Workflow Issues and Workplan October 5, 2015
- Need to identify set of coherent, common patterns for handling workflows more consistently
- Look into leveraging existing industry workflow patterns
- Identify what infrastructure required to support workflow management in FHIR


- FHIR approach:
~ What kind of connectathon use cases need to be satisfied to deal with the workflow requirements
~ Develop the FHIR workflow solution to address the use cases, test in the connectathon until it is right (or close to right)
~ First to get something that is useful to be tested in connectathon
~ Once tested and improved to close to right, take to ballot
~ OO will coordinate the discussion – invite stakeholders to discuss, may spin off teams to work on domain specific problems and bring back proposals, solutions to the group
- This conversation needs to be carried forward after Monday Q4
~ FHIR to request a list to be set up and start a wiki page for this topic
~ Include interested WG to participate
~ Schedule call in 2 weeks to move things forward
~ To split off some taskforce to investigate the use of BPMN in workflow modelling
~ Get domain experts to contribute
~ Will work on designing RESTful patterns first to get understanding of what can be done in RESTful space (and the limitations) then take to services and asynchronous (messaging) spaces
~ After a set of patterns are identified, then work out which resource may be associated with a particular pattern, and which resources may need to be associated with more than one pattern
- Deliverables for next meeting:
~ Spreadsheet that compares resource contents in each category
~ Identify candidate connetathon use cases (interesting from “how will this work” as well as interesting to implementers), e.g. radiology image remote read; cross departmental use cases (admission, eligibility, orders, observations), medication order lifecycle, referral lifecycle, visit appointment; charge capture; protocol (dicision support, order set, composite order)
~ Primer on BPMN and related methodologies as they might apply to this problem space
~List of resource scopes



Patient Care Monday Q4

Present:
Elaine Ayres
Emma Jones
Bryan Schellar
David Pyke
George Cole
Larry McKnight
Iona Thraen



  • Minutes: Paris meeting approved
    • Move: Emma/David
    • Abstain: 1
    • Negative: 0
    • Approved: 5

Review of Agenda - Move: Emma/Larry; Abstain: 0; Negative: 0; Approved: 5

  • Tuesday
    • Health concern - Tues Q1
    • Meetings with FHIR
  • Wednesday
    • SOA on CCS
    • Child Care
    • Negation topic
    • Allergy and intolerance
  • Thursday
    • Care Plan
    • Clinical status with SDWG
    • Health Concern ballot Reconciliation
  • Friday
    • Clinician on FHIR

New Projects?

  • Maternal Health Proposal - Stephen Hasley wants to build a registry which may be beyond patient care scope for now.
  • Question about patient preferences/Patient goals - Lisa Nelson will discuss Wed Q1

Ongoing Projects

  • Care team domain analysis model
  • Care Plan EHR Functional Model
  • HSI RECON profile is in trial implementation




Patient Care Monday Q5 & Q6


  • Q5 - Co-chairs meeting
  • Q6 - DESD meeting


Present:
Elaine Ayre
Michael Tan
Russ Leftwich
Stephen Chu
Laura Heermann


Minutes:

  • Co-chairs meeting - See TSC and other presentations


  • DESD meeting - see DESD meeting minutes




Patient Care WGM, Tuesday, October 6, 2015


Patient Care Tuesday Q1

Present: Stephen Chu - chair, Jay Lyle - scribe, Michael Tan, David Pike, Iona Threan, Jason Goldwater, Tom Oniki, Christina Knotts, Margaret Dittloff, Laura Heermann, Nathan Davis, Emma Jones, David Tao, Larry McKnight, Danielle Friend, david Hay, Ewout Kramer, Michelle Miller, Susan Matney, Russell Leftwich.


Minutes:

  • DSTU FHIR2.1 has been published. Some of the PC resources are to be frozen. They have to have maturity level 5. The proposed resources from PCWG are allergies, condition., procedure. We have to decide on this list as PCWG.
  • PCWG will test some of these resources on the FHIR clinician connectathon ( care plan, condition, allergies and medication). It is suggested to decide either on Friday or on a call after the PCWG.
  • Our estimation now is that condition should be taken out of the proposed list.
  • The publication of DSTU 2.1 will focus on the workflow, messages.
  • FHIR Discussion Condition. Issue 5546 Input from Larry McKnight.
  • It is not really clear what is being represented:
  1. The actual physical process.
  2. A person can observe at a certain time. : I see X. This is a snapshot.
  3. Action on the concern.
  • Timing aspect is not clear. Lloyd's claim is that this could either be used to state a condition and follow action on the concern. Larry's view is that it is not sufficient, because 2 care providers could have different views leading to different resources. Example 2 different concerns on 1 intervention.
  • We suggest to create a seperate resource for concern.
  • How are concerns stored in EHR's. Most of care providers misuse problem lists while they are actually are concerns. In Larry's view you can select issues depending on the role for your concern list and discard issues.
  • Jay's questions Jim view on how to keep track on the evolution of the issue.
  • Why is the word "problem" not used in the discussion. This is historical. The naming has evolved from problem, condition to concern.
  • Emma: do we capture concerns? This is not clear in her implementation how to do that. According to Larry this is not done explicitly. A care provider put's it on a problem list and therefore define it as a concern. Emma confirms that the care provider can select or discard the conditions from the problem list.
  • David Pyke put forward Motion 1 :We identify a need for a seperate resource for health concern. We will sort out the different attributes between condition and concern.
  • The motion is amended: Need an anlysis of the distintion of data attributes in condition vs concern.
  • second Russ: Vote : 1 abstain , 1 oppose, 21 favor.
  • Iona add's that in the beginning of health concerns we were approaching concerns from the family point of view. Michael's view that input from the family was brought into the scope later on. Larry add's that it is actually the same.
  • Larry's Motion 2: clarify in the FHIR specification that this current resource of condition is to be used as a point in time observation of a condition.
  • David second: Vote : 8 abstained, 3 oppose, 11 in favor.



Patient Care Tuesday Q2

Present: Larry McKnight, Stephen Chu, Michael Tan, Jay Lyle, Dominick Brannon, Emma Jones, Yokinoh Konishi, Solomon Tabasaba, Masaake Hirai, David Tao, Larry McKnight, Susan Matney, Peter Park


Minutes:

Overview of Health concern project by Stephen

  • Concepts of health concern from clinical and technical perspective.
  • 3rd cycle of informative ballot

Overview of the Health concern DAM document by Michael Tan

Ballot Reconciliation

Textual and Grammatical changes

  • Move that Michael resolve all textual and grammatical changes
    • Block vote: Moved: David; Second: Larry; Abstain: 0; Opposed: 0; Approved: 11

Negative Major Items

  • Comment from Jay Lyle - Chapter 3, section 4,5,6. Jay has proposed a change to this area.
    • Discussion around the room.
    • Stephen Chu contributed these section because of the confusion of the differentiation between the clinical and technical perspective. The goal was for the DAM to provide a view point of "what" it means without saying "how" this should be implemented. The intent of these sections were to provide clarity on the different perspective.
    • Proposal to circulate Jay's proposed change, group will review the proposed change and the group decide if the change will be adopted and the comment disposition.
    • Larry moved we table this for now and circulate the jay's proposed change for review then do a conference call discussion of the proposed change. Will treat as a block change.

Moved: Larry Second: David Abstain: 0 Opposed: 0 Approved: 11

  • Remove conceryIdenfifier and Add concern expressor

Moved: Larry Second: David Abstain: 0 Opposed: 0 Approved: 11

  • reference to health concern section changed to health concern Act

Moved: Jay Second: David Abstain: 0 Opposed: 0 Approved: 11



Patient Care Tuesday Q-Lunch

Present:


Topic: Adverse Event vs Adverse Reaction
Minutes:



Patient Care Tuesday Q3

Present:



Minutes:




Patient Care Tuesday Q4

Present:



Minutes:



Patient Care WGM, Wednesday, October 7, 2015


Patient Care Wednesday Q1

Present:


Minutes:



Patient Care Wednesday Q2

Present:


Minutes:



Patient Care Wednesday Q3

Present:



Minutes:




Patient Care Wednesday Q4

Present:



Minutes:




Patient Care WGM, Thursday, October 8, 2015


Patient Care Thursday Q1

Present:


Minutes:



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

Present:


Minutes:



Patient Care Thursday Q-Lunch: PCWG Co-Chairs meeting

Present:


Minutes:



Patient Care Thursday Q3

Present:



Minutes:




Patient Care Thursday Q4

Present:



Minutes:




Patient Care WGM, Friday, October 9, 2015



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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