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Difference between revisions of "September 2016 WGM Baltimore: Sep 18 to Sep 23"

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Line 463: Line 463:
  
 
Present:
 
Present:
−
 
+
* Chair: Jay Lyle
 +
* Scribe: Emma Jones
  
 
<BR>
 
<BR>
 
Minutes:
 
Minutes:
  
 +
'''Overview'''
 +
* Purpose
 +
* Principles
 +
* Requirements -
 +
** Ask: confirm requirements
 +
** Ask: ways to make product useful for design teams
 +
** New Ask: query requirements
 +
 +
'''Discussion Points'''
 +
 +
* Rob: need to look at positive assertion vs something that is negated. Should it be represented the same way the positive statement is represented (i.g go on the problem list?)
 +
** Clinical way to indicate
 +
*** List of negated cases that have been collected.
 +
*** NPO - is a positive assertion of an observation
 +
*** Not NPO (observation)
 +
*** No peanuts - is an assertion
 +
*Imperatives Vs preference
 +
** Family member pedigree - maternal aunt does not have breast cancer
 +
** Need to be able to query and see what the query looks like.
 +
 +
** Is there eating restrictions on the paitent - this is an inference. All the observations and information is data. To draw conclusion about what to do with the patient is inference. A lot of what we're doing is to whip the raw data into inference. We need to be working on robust query to be able to make the inference.
 +
 +
** Does your grandmother have breast cancer - question answer format
 +
** Grandmother does not have BC - is a statement
 +
 +
*** This is 2 different way to represent the same information but how to do it is different.
 +
*** Specific implies the general - acute MI implies MI.
 +
*** What type of query to run on the data -
 +
*** For example, ACOG pregnancy form has a lot of pertinent negatives
 +
 +
*** Diabetic yes/no
 +
**** Diabetes on the patient problem
 +
**** Is there a means of deriving that the patient is diabetic
 +
 +
** Here are 3 ways of looking for diabetes that are not direct  - will have different patterns. All 3 ways may be used depending on the vendor.
 +
 +
** Absence of information - is commonly documented for rad findings. Reading normal: No xxx …
 +
 +
*** This is assertion. Although the thing is not there, we are asserting that it's not there. Therefore end up with assertion of the presence of the thing being asserted.
 +
 +
** Is the goal to try to come up with a way or the ways to do this? Suggest there is a preferable way to do this. SNOMED  - created a model of inferences have to say presence of absence. V3 tells negation in the structure as well as negation in the flag. V3 was too broadly scoped. Term Info went with making positive insertion and not use the negation flag. CDA uses negation indicator but doesn't tell whether the negation is on the entire act or on the value in the act.
 +
 +
** Go forward plan:
 +
*** groups can look at the inputs (list of exapmles) and see if something is not there
 +
*** Recommend doing it any other way. Look at the patterns and determine if there is a way to do it differently.
 +
*** Query for negated items - how will it be found?
 +
 +
** Consent added to the list.
 +
 +
** Will get confusing if merging the idea of what is recorded with what is queried.
 +
 +
** Most observations are negative so may need to have codes for it.
 +
 +
** All discussed have been positive assertions
  
  

Revision as of 22:33, 20 September 2016


Baltimore, WGM - September 2016 Patient Care WG Meeting Approved agenda:

Note - All PCWG members: Due to Plenary Sessions and joint meetings with other WGs, the PCWG Administrative and House Keeping meeting quarter has been moved to Sunday Q4. Please join this meeting as there are important agenda items that need to be discussed and approved by PCWG members. Thank you




Baltimore Plenary and WGM - September 2016. Patient Care WG Meeting Meeting Minutes

  • Sunday, September 18 - International Council Meeting
- No PCWG meeting


Patient Care WGM, Monday, May 19, 2016


Monday Q1

  • Plenary Session
- No PCWG meeting



Monday Q2

  • Plenary Session
- No PCWG meeting



Patient Care Monday Q3

Present:

  • Jones, Emma (Allscripts)
  • Lyle, Jay (Ockham Information Services LLC)
  • Mandel, Josh (Boston Children's Hospital)
  • McKnight, Larry (Cerner Corporation)
  • Miller, Michelle (Cerner Corporation) -- chair/scribe
  • Shekleton, Kevin (Cerner Corporation)
  • Tan, Michael (NICTIZ Nat.ICT.Inst.Healthc.Netherlands)


Minutes (joint with FHIR-I):

PC agenda includes gForges related to Condition.category and scope of Condition

-- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10091 QA: switch category value set to SNOMED

-- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10404 ask for balloter feedback on data type and binding strength of category

-- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10611 add more codes to value set for problem and concern

-- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11156 add more codes to value set for problem and issue

-- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10614 which category to use when it's a condition due to a procedure in the past

-- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10662 medical history

-- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10090 QA: include concern in scope

-- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11211 support for required binding strength of Conditon.category

-- http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10544 Add condition extension(s) to represent a role in context of Condition.encounter (e.g. Primary/Sequence Admit Discharge etc.)

Discussion, but no vote....

Condition.category 0...* CodeableConcept with extensible binding to value set with codes:

  1. Chief Compliant -- in context of encounter
  2. Symptom -- review of systems or HPI - very close to "S"ubjective of SOAP
  3. Past Medical History - includes conditions as a result of procedures
  4. Assessment Problem from "A"ssessment and "P"lan (of SOAP) -- includes diagnosis
  5. Problem on Problem List -- if homeless or financial barriers or lack of transportation are being managed, then it could be a problem; clinician expresses concern about social history; can be patient-stated concerns (doesn't need to be on a clinician's problem list) such that asserter will differentiate between them -- could include risks / fears as well.
  6. Discharge Diagnosis -- in context of encounter
  7. Billing Diagnosis- in context of encounter, In US, would have ICD-x (one problem has 0..* billing diagnosis codes)


or

Condition.category 0…1 CodeableConcept with extensible binding to value set with codes:

  1. Billing Diagnosis - In US, ICD-x, in context of encounter
  2. Problem - In US, SNOMED, on the "problem list" and managed over time by provider - includes pregnancy
  3. Other Concern -


Other discussion topics:

  • Category is like the C-CDA Problem Type, but hard to define codes to be mutually exclusive
  • Use Observation for exam findings
  • Use FamilyMemberHistory
  • Use Questionnaire/Observation if captured as part of Social History



Patient Care Monday Q4

Present:FHIR WG, OO WG



Minutes:

Reviewed the following GForge Ballot comments

  • Resource: DiagnosticRequest
    • "Stage" is a poor name #11190 [1]
  • Revamp scope and direction of workflow module #11492 [2]
  • Additions to Definition Pattern #11466 [3]


Patient Care Monday Q5: Placeholder for extra meeting if necessary

Present:



Minutes:




Patient Care WGM, Tuesday, May 20, 2016


Patient Care Tuesday Q1 FHIR/PCWG/ECWG/CIMI

Agenda

  • SDC update from CIC (~ 15 min) - CIC not present
  • CIMI - Skin Care model meeting


Present:
Attendees:

Last Name First Name Organization
Emma Jones Allscripts
Laura Heerman Intermountain
Stan Huff Intermountain
Nona Hall
Steve Hufnagel
Robert Tray Nall
Jay Lyle
Harold Solorfa
Linda Bird
Patrick Langford
Bryn Lewis
Rien Werther
Susan Matney
Russ Leftwich
Larry McNight
Inger H. S. Khateeb
Dan Soule
Jim McClay
Brian Scheller
Margaret Dittloff
Michael Tan
Richard Esmond
Andrew McCaffrey
Shafa al-Showk
John Kilbourne
Steve Emrick
Marie Swall
David Pyke
Dan Morford
Richard Kavanagh
Simon Knee
Sadamu Takasaka
Masaaki Hirai
Yukiuoli Koniski
Kurt Allen


Minutes:

  • PSS from CIMI with request for patient care to be co-sponsor
  • Jay presenting - PC CIMI POC
    • Scope tightened to exclude drugs, devices, conditions.
    • Limited to physiologic assessment
    • Using the assessment pattern - question and answer. Skin color is an example.
    • Added in ability to assert things like wounds and lesions.
    • Need to be able to associate the asserted thing with the assessment.
    • Patterns align with SNOMED CT concepts models but is not the same as SNOMED CT.
    • Model as a physical examination observation
    • CIMI demonstrated what they are trying to achieve as far as the modeling.


  • Pressure ulcer advisory changes - CIMI has done a gap analysis identify changes
    • In the last year some of this has changed - instead of pressure ulcer, it's now pressure injury
    • ONC has a version that was developed as part of a grant - not based on a modeling paradigm.
  • CCDA wound observation is not correct - working with CMS on fixing it.


  • Suggestion that data set and data elements for DEEDS to be used to create CIMI models.
  • Clinical LOINC codes can be used to transform into the modeling if the pattern is known. Need a process to use especially if already has a defined code system.


Stephen Hoffnagel - PSS - Investigative Study "Information Model Integration"

  • Currently doing a pilot.
  • Extend an invitation to Patient Care to participate
  • Has slides - will send to PC list serv (has not come thru as yet)
  • Overview presented
    • Foundation of a Learning Healthcare System is accurate, computable, data starting with the integration of CIMI, FHIM, DAF, etc.
    • FHIM value is used very little
    • Objectives
      • Accept various models and provide a suite of clinical models
    • requesting the involvement of patient care - they are working with Susan and Jay already
    • Involvement include assisting with prototype of the project
    • Participate in meetings
    • Follow the work they are doing
    • See if the pilots are of interest to patient care
    • Govt agency wants to use the CIMI modeling, CCDA docu, FHIR
    • Need to involve patient care in some way for the clinical pieces
    • Susan document is the PSS for the work with the govt agency.
    • Jay is aware and will bring more info to Patient care.




Patient Care Tuesday Q2

Present:

  • Michell Miller ( chair)
  • Michael Tan ( scribe)
  • Viet Nguyen
  • Dennis Patterson
  • Rik Smithies
  • John Donnelly
  • Craig Parker
  • Rashedul Hasan
  • Jim McClay
  • M'Lynda Owens
  • Larry McKnight
  • Tim Blake
  • David Tao
  • Dan Soule
  • Joshua Mandel
  • David Pyke
  • Simon Knee
  • Geoff Low


Minutes:
Voted on resolution to gForges (from Mon Q3)

Condition.category 0…* CodeableConcept with example binding to FHIR-defined value set with codes:

  1. Encounter Diagnosis – point in time diagnosis (e.g. physician, nurse) in context of encounter
  2. Problem List Item – an item on a problem list which can be managed over time; which can be expressed by either a practitioner (e.g. physician, nurse), patient, or related person

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11117 Update search type for the "abatement-info" search parameter. - 2016-09 core #271
Resolved: Rename abatement-info to abatement-string and change type to a string

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11158 Condition.abatement from 0..1 to 0..* - 2016-09 core #312
Resolved (Not Persuasive):
abatementString can be used to convey edge use cases like 2-4 months in 1985 (when date is not known)
abatementPeriod can be used to convey specific dates in 1985 (e.g. 1/1/1985 through 4/1/2985)
Resource history/versioning can be used to track multiple abatement periods

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=11212 BodySite should be a reference to the resource instead of a just a codeable concept - 2016-09 core #366
Resolved (Not Persuasive): Related to http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10735 An extension (http://hl7.org/fhir/extension-body-site-instance.html) can be used, where needed.


Patient Care delegate to SOA meeting (Laura and Emma)

Publication of CCS update provided by Laura Heerman

  • Laura provided update on where in the process the publication request is
  • Ken Rubin/cc Diana will proof read after Laura sends to Ken (diana.proud-madruga@va.gov )

CCS OMG submission Update provided by Ken Rubin

  • OMG met last week
  • Submitters wants to extend the dates - Mediscape is requesting to open the gates to allow new submitters. Open for submitters until 12/31/2016. Working with the State of New York to become submitters
  • Old submission is thrown out
  • New submission date is march 2017.
  • Technical updates -
    • Assessing how much they want to base the spec on FHIR
    • Expect patient care to provide resources around care plans
      • Encourages Patient care to be part of the submission team and drive the submission
      • Next steps - continue to have a joint meeting. Target Thurs Q1 for SOA to join PC care plan report out meeting.
      • HL7 Participate as supportive with periodic attendance at OMG. HL7 has a member vote in OMG matters. 2 times a year to go to meeting.

Scheduling service:

  • Couldn't get any interest in the past
  • Relates to CC - timing right
  • Convene a group involved in the project
  • Has a rough draft PSS - will do the heavy lifting. PA agreed to be the primary owner - SOA, PHIR, PC are co-sponsors. No specific ask of PC
  • Relationship with FHIR - in the process of figuring out what adaptation is needed. Very interested in scheduling using FHIR. FHIR will be vetting the new process. PA folks know it is something new.
  • Does PC have enough interest to be listed as co-sponsors? Will take to the WG for voting. Can indicate level of involvement - quarterly involvement
  • Meetings Scheduling - currently meeting Thursday at noon EST. Planning STU Jan 2018
  • Next steps: SOA is working on new PSS
  • Patient care has expressed interest in the Scheduling service.



Patient Care Tuesday Q3

PC hosting CQI and CDS (not present)

Present:

  • Laura Heerman Langford (Chair)
  • Emma Jones
  • Juliet Rubini
  • Anne Smith
  • Leslie Kelly Hall
  • Chana West
  • Linda Michaelson
  • Paul Denning
  • Marc Hadley
  • Bryn Rhodes
  • Angelique Cortez
  • Jamie Parker
  • Stan Rankins
  • Robert Koyes Telligen
  • Kanwarpreet Setti
  • Viet Nguyen
  • Larry McKnight
  • Walter Surez
  • Michael Tan
  • Chris Millet
  • Seth Blumenthal
  • Michelle Miller
  • Margaret Dittloff
  • Sheryl Taylor
  • Muhammed Asian
  • Martin Rosner
  • Robin Williams
  • Shafa Al-Showk
  • Johanna Goderts
  • Oskar Thurman
  • Alex Connor
  • Patty Craig
  • Mary Visceglia
  • Lee Surpregnant
  • John Hutem


Minutes: Agenda

CCDA harmonization with QRDA and CQI

How to engage clinicians across workgroups on topics

  • Julia suggests a monthly call for clinicians to participate
    • Used to provide a unified clinical voice
    • Proposal to increase communication by consolidating meetings around common content
    • Viet suggests finding the clinicians that are on the various work groups and poll if or when we should have a regular meeting
    • Reasonable request to have a meeting to discuss the CIMI modeling of FHIR concepts
    • Co-chairs will need to coordinate this.
    • Need to decide who will be the facilitator, need agenda items, call info.
      • Goal is an intentional approach of merging various data model into a stack that can be used.
    • CQI and CDS has been balloting the same content for some time. A means of maximizing effectiveness with

What is QDM?

  • QDM used for all HHS quality measures
  • National deployed model
  • Question asked if consumer vocab is used for goals - response: used both for provider and patient goals.

Clinicians-on-FHIR

  • Hosted by PC but involves many other workgroup
  • Not focus on the interoperability part
  • Look at value set and cardinality





Patient Care Tuesday Q4

Joint meeting - PCWG, OO, FHIR, Vocab, Clinical Genomics - CIMI, Struc Docs. Topic: Negation, others

Agenda

  • Survey of draft document
  • Review of principles & open issues
  • Review of pattern description
    • including open questions for deficits, goals
    • including proposal for "query" chapter of requirements
  • How to make patterns useful


Present:

  • Chair: Jay Lyle
  • Scribe: Emma Jones


Minutes:

Overview

  • Purpose
  • Principles
  • Requirements -
    • Ask: confirm requirements
    • Ask: ways to make product useful for design teams
    • New Ask: query requirements

Discussion Points

  • Rob: need to look at positive assertion vs something that is negated. Should it be represented the same way the positive statement is represented (i.g go on the problem list?)
    • Clinical way to indicate
      • List of negated cases that have been collected.
      • NPO - is a positive assertion of an observation
      • Not NPO (observation)
      • No peanuts - is an assertion
  • Imperatives Vs preference
    • Family member pedigree - maternal aunt does not have breast cancer
    • Need to be able to query and see what the query looks like.
    • Is there eating restrictions on the paitent - this is an inference. All the observations and information is data. To draw conclusion about what to do with the patient is inference. A lot of what we're doing is to whip the raw data into inference. We need to be working on robust query to be able to make the inference.
    • Does your grandmother have breast cancer - question answer format
    • Grandmother does not have BC - is a statement
      • This is 2 different way to represent the same information but how to do it is different.
      • Specific implies the general - acute MI implies MI.
      • What type of query to run on the data -
      • For example, ACOG pregnancy form has a lot of pertinent negatives
      • Diabetic yes/no
        • Diabetes on the patient problem
        • Is there a means of deriving that the patient is diabetic
    • Here are 3 ways of looking for diabetes that are not direct - will have different patterns. All 3 ways may be used depending on the vendor.
    • Absence of information - is commonly documented for rad findings. Reading normal: No xxx …
      • This is assertion. Although the thing is not there, we are asserting that it's not there. Therefore end up with assertion of the presence of the thing being asserted.
    • Is the goal to try to come up with a way or the ways to do this? Suggest there is a preferable way to do this. SNOMED - created a model of inferences have to say presence of absence. V3 tells negation in the structure as well as negation in the flag. V3 was too broadly scoped. Term Info went with making positive insertion and not use the negation flag. CDA uses negation indicator but doesn't tell whether the negation is on the entire act or on the value in the act.
    • Go forward plan:
      • groups can look at the inputs (list of exapmles) and see if something is not there
      • Recommend doing it any other way. Look at the patterns and determine if there is a way to do it differently.
      • Query for negated items - how will it be found?
    • Consent added to the list.
    • Will get confusing if merging the idea of what is recorded with what is queried.
    • Most observations are negative so may need to have codes for it.
    • All discussed have been positive assertions



Patient Care WGM, Wednesday, May 21, 2016


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, May 22, 2016


Patient Care Thursday Q1

Present:


Minutes:



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

Agenda

  • CDA updates
  • Clinical status & act

Present:


Minutes:



Patient Care Thursday Q3

Present:



Minutes:




Patient Care Thursday Q4

Present:



Minutes:




Patient Care WGM, Friday, May 23, 2016


Patient Care Friday Q0: PCWG Co-Chairs meeting

NOTE: co-chairs to determine whether this will be moved to Thursday Q-Lunch

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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