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Chair and Scribe:  Floyd Eisenberg 

NOTE: This attendance applies if you are present at the related meeting/call, regardless if you have signed a different attendance for your WG. 


AttendeeAttendee's OrganizationAttendee's emailPresent
Abdullah RafiqiESAC

Chris PuglieseBrightree (PACIO Project)cpugliese@brightree.comyes
Paul DenningMitrepauld@mitre.orgyes
PJM Consultingpeter@pjmConsultingLlc.comyes
MD Partners

Shanna HartmanCMSShanna.Hartman@cms.hhs.govyes
The Joint CommissionYHu@jointcommission.orgyes


TopicAgenda item description - NOTE change to Wednesday mornings 10-11 AM ET (Next week Is US Federal Holiday, Veteran's Day - likely to be cancelled)Discussion
PACIO QuestionChris Pugliese from PACIO presented questions about using administrative resources to determine timing for when reassessment should be performed. 

Chris will share a link to the video from the last PACIO call and notes.

PACIO is thinking to use Episode of Care and Encounter.  Looking for feedback. The issue is the length of post-acute care settings - weeks, months, sometimes years. That has unique requirements based on CMS assessment requirements (OASIS and MDS). There are periods of time on which post-acute revenue cycle is based.  The OASIS must be completed every 60 days and MDS every 6 months for their respective settings.  There was no clear way to reference these periods using FHIR resources. Based on the assessments, the plan of care can change in addition to the revenue cycle component. When a claim is submitted or an audit occurs, the provider should be able to extract resources based on the period of time for which the agency/provider is billing - the "Reassessment time point".  The group is leaning toward the EpisodeOfCare to represent this concept. - note that EpisodeOfCare does not reference Encounter but Encounter does reference EpisodeOfCare.

In post-acute, the encounter has been used to represent the entirety of the admission because there was no other method to represent the concept in CCDA. The group (PACIO) is leaning to use the encounter to represent the entire admission. They are using Episode of Care since it is largely an administrative mechanism with many reference fields. Coverage, observation, documentReference, CarePlan, Goals, etc.

Should develop Zulip thread and speak to Patient Administration.

FHIR Clinical Reasoning Tracker Review

For Discussion:

  • FHIR-20725 - Add attribute in Measure to indicate how frequent results are released/published (e.g. every 3 years, etc.) (Finnie Flores)
  • FHIR-20723 - Request to add an attribute to indicate the level of reporting availability/disaggregation (e.g. international, national, etc.) (Finnie Flores)
  • FHIR-20722 - Request to add an attribute to indicate whether the results are calculated based on fiscal year, calendar year, school year, etc. (Finnie Flores)
  • FHIR-20726 - Request to add an attribute to capture calculation description (i.e. describes, in simple terms, how the indicator is calculated and also states the unit of analysis, if applicable). (Finnie Flores)

FHIR-20725 - some discussion if cardinality would be 0..1 or 0..*.  If measure can be calculated both quarterly and annually, for example.  Seems more complex to have 0..*.  Possibly related to reports (as opposed to the measure) and ability to ask for a report for a certain time period.

FHIR-20723 - need codes for representing the size of a political or administrative boundary.  Further discussion needed.  Could not find anything in DEQM.  Possibly DEQMReporterGroupExtension which references a Group, which perhaps can have a code for the size of the group?


Supporting Documents

Outline Reference

Supporting Document

Minute Approval

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