Attendance

Quarter Times

Agenda

Minutes

Monday Q4

FHIR IG - Maternal Health Mortality & Morbidity PSS - Dave deRoode

https://jira.hl7.org/browse/PSS-1802

https://jira.hl7.org/browse/PSS-1802?jql=text%20~%20%22maternal%22

• Hope is to socialize and engage interest
• Showed to PHWG today - they wanted to know other WG interest
• Longitudinal Maternal Health Record

• Includes SDOH IG
• Linkage between the mother and newborn and getting the information to NIH for research purposes
• BR&R is also interested in this work due to the NIH
• Patient Care - ACTION to inform Dr. Padula of this PSS for interest from a Child Health perspective.
• Discussion include MedMorph and the Registry Reporting IG
• CodeX - not sure how this IG fits in with CodeX (an accelerator)
• Discussion on Zulip on Estmated Due Date - calculation. Is it included in this work? Action: Michele will add a comment to the JIRA with link to the Zulip chat.
• Next steps - will evangelize and contact PC for formal interest.

CDEX - Eric Haas

• Will withdraw FHIR 30497 from the block vote.
• DaVinci Cdex project weekly calls where the disposition is discussed.
• Negatives reviewed - FHIR 29683, 31887, 30497
• Motion to approve the Block Vote: Eric Moved; Jay Lyle Second
  • No comment or questions
  • 0 Against; 11 Abstain; 11 For
• Update of the project - CDEX was ballotted last cycle. Hope to wrap this time around in the next month. Have other trackers with changes that need to be applied. May have one more block vote.  Hope to publish in the next month or so. 

Br&R  and PC Topics

• PC have been focusing on getting PC resources ready for normalization. 
• BR&R have been working on similar
  • Project -Adverse event for Transfusion and Vaccinations - FDA work have gotten regular updates but have not been driving resource development. This work is using R4. 
  • CDIS mapping
• Blood Products have come up a bit in PC discussions relating to procedures. Question to BR&R to elaborate on the current work and the clinical documentation related to this work. 
• FHIR Implementation Guide for Transfusion and Vaccination Adverse Event Reporting
• ACTION: Michele will reach out to Jean DeTeau on his work-to-date
• Jean's work is more towards the FDA side (ICSR)
• Vulcan Work - follow Jean's work.
  • He took the whole ICR and mapped it to FHIR. Trying to bring together things that are similar and see if there is an overlap. Its not the intended to start another adverse event project. 
  • Bringing together each of the projects of groups that are doing work on Adverse Events to provide a structural presentation of what their project is about. From these presentations with attempt to capture the linkages between the different project and groups for a landscape view. From there will ask how Vulcan can help, working to a bigger objective of tying things together. 
  • Some of the folks from PCWG are already part of the Vulcan Round Table event. 

CDISC mapping 

• Overview - Rebecca Baker
• Discussion- Trackers
  • FHIR - 23023
    • AdverseEvent - outcome, seriousness and resultingCondition need to align the values in the valuesets
    • Resolution refers to the prior tracker which updated the seriousness valuset to focus on serious and non-serious. 
    • Keep seriousness and outcome separated
    • FHIR-22994
    • "Outcome" is also used in the condition resource - context may be different but context may be similar
    • Did not create a profile on Adverse Event. 
    • AdverseEvent.outcome is an example binding
    • Severity got moved to the condition aspect 
    • ACTION: A tracker will be logged by Michele or Rebecca
    • Plans for R5 - Michele suggests adding a sentence for general guidance that the mappings are specific to R4 and will put out a new set of mappings for FHIR R5
  • Review of PCWG Adverse event backlog items
  • Will Rosenfeld - Submission to USCDI - Submitted by FDA - currently in USCDI Comment. May be in USCDI V3
    • Suggestion to provide comments and use cases
    • USCDI is considering another round of submission. Adverse event have been included by EPIC as part of their APIs. 

Group agreement to keep this quarter for the next WGM. 

Tuesday Q4

There are many versions of Discharge Disposition value sets out there in V2, CDA, FHIR, PHIN VADS, LOINC. It would be nice to have one, or fewer. In addition one source has IP limitations (NUBC UB-04 FL7 patient status). HTA has established an MOU with NUBC for HL7 use. 

This value set belongs to Patient Administration.

CCDA terminology update team needs a process for resolving this sort of issue.

Team may use this value set as a test instance to propose a solution in UTG & manage building consensus.

Value set alignment: item covered above.

Common substances for allergy records

CCDA update team has taken the large set of drug classes in previous versions and made it smaller, and converted substance class codes to product class codes in 2.16.840.1.113883.10.20.22.4.7.

Will also provide guidance for recording terms not in this value set in the CCDA guide.

Will ask Patient Care to identify things that might not belong in there, e.g., "anticonvulsants."

Open question: selection of Product is intended to facilitate drug check on product orders. PC attendees agreed that substance is more semantically appropriate for an intolerance, but that product might be worth it, if it's really easier to query "is this product a descendant of this class of products" than "does this product contain a substance in that class of substances."

Lisa will arrange a call to include Rob H, Rob M, Russ L, Jay L, Patricia C, and any member of Vocab, PC, SD, & CQI.

CDex, SDoH updates: possibly Thursday.

Signs/Symptoms: on OO Wednesday

Thursday Q2

Allergic Intolerance Substance ValueSet

• Discussion (Robert McClure, Jay Lyle):
  • Will need to plan how to deal with this matter with the various SMEs - Lisa, Rob H, Robert M, Jay, Russ
    • Engaged in the conversation of how to identify the substances, ingredients, drug classes - need to resolve what this kind of valueset needs are as well as the why. Have to make this decision plus the clinical implications (Russ concerns)
    • This ties into the work done by PC
    • Align with what C-CDA needs are - then will update the C-CDA valueset
    • CCDA valueset project - has a timeline. Then need to align with other projects and alignment with implementers expectations
    • Question: Why is it driven by implementers expectations (allow implementers to do what they currently do) and not clinical expectations?
      • The template may be updated to allow that ability to share something that is not in the valueset (e.g. "other")
      • Other option is to not allow deviation from the concepts
      • The conversation is to happening now
    • Michael Tan - Does this only effect the US Realm? Rob - This conversation should affect any realm
      • Unicom project in Europe is happening - speed up the introduction of IDMP
      • This should also be part of the conversation - need to be aware of IDMP. This was an inherent part of the work jay did. 
  • Suggestion to set up a few calls to flesh out the scope - clinical, political, technical landscape
  • ACTION: Rob McClure will start an email conversation on this topic. Include your email address in the chat if you would like to be included in the conversation. 
    • Short term decision - what do do with the CCDA list
    • Long term decision on what to do about the list in general
    • Lisa - got stuck because the right people were not present for the US Realm CCDA update. would prefer to not have the meeting until we have the framework. 
      • Primary use case and goal: Need a framework for guiding goals with includes linkages to RxNorm orderable products that is easy for implementers to implement
      • Historical information need to be considered
      • Stephen agree with needing a framework. Concerns with RxNorm due to the internationality implications that Michael Tan brought up. 
      • Jay - need to have the discussion with the right people in the room. 
      • Michael Tan - just want to expose what Europe is working on
      • Stephen - Can adapt the framework to cater for the RIM and technology specific approach. 
      • Lisa propose having the pre-meeting discussion via email to include co chairs of PC, Vocab, LHS (Russ), CQI, SD
      • Have agreed to create an example (via Example-Task-Force) for C-CDA when something is not in the valueset. 

CDA Roadmap (Linda Michelson)

• CDA alignment processes with the FHIR processes. This includes
  • The PSS process - assignment of 3 letter acronyms for setting up the processes - aligns with Github, JIRA
  • Announcements and posting on the CDA Management Zulip channel. 
  • Following the work on CDA Logical model that will enable publishing CDA IGs. This uses the FHIR web publishing
  • IAT Implementationathon coming up at the end of July
  • See CDA Management Group Confluence Page 

CDA Collaborative Template Review update (Giorgio Cangioli, Lisa Nelson,)

• Discussion: jay made a request for updates
• Lisa and Georgio discussed -  pilot and main findings
  • PC - problems and allergies - results were very positive with solid analysis that looked at the design considerations comparing the IPS design and CCDA design
    • Brought the right skills together
  • FM - Payer templates
    • Some results but the appropriate SMEs were swamped with DaVinci work
  • Pharmacy - Medication templates
    • Limited results from the CDA community. Nothing much happened
  • Produced a great design, the appetite for making major changes resulted in identifying that better designs are needed.
  • The external force is needed to make this happen. Better tooling is needed.
  • Until we get where the tooling and processes are improved as a design pattern and the will power to make this happen, we are not there.  
  • The work was published as a report and delivered two implentationathons ago. 
  • There was discussion about aligning the problem concern and sniffing it out of CCDA - has that happened?
    • This has not happened because there is no evidence of adoption. 
    • There have been some flushing out of verification status
    • Same with data provenance - observation provenance and concern provenance
    • Starting to understand there can be some benefit but have not played this out and better design guidance
  • Is this project still need more effort?
    • Lisa suggest giving it a proper finalization with a Confluence page of summarization that people can use as a resource. There is a confluence page - See here.
    • ACTION: Lisa to update the page. Will be featuring IPs at the next implementhanathon (July 28) and will use this page as a summary of the harmonize design. FHIR will benefit from this design. Lisa will work with Stephen on updating the page. 

PCWG would like to discuss the implications of Withdraw IGs for implementers 

• What does the concept of withdrawn mean?
  • Austin - withdrawing was a process for withdrawing normative standards that has been expanded
    • An expired IG was withdrawn; the project team has evaporated; the stake holders of this project is no longer present at HL7
    • Administrative change - the project is archived off. Product brief will be made available. nothing stops implementers from implementing it. Additional changes will need a new project. 
  • Stephen - raises a question about use case in Australia - standard is expired meaning it no longer supported and may not  be clinically safe to use. Does this apply here? 
  • Austin can not speak to the clinically safe. It will be marked as retired. Does not stop working for implementers that are using it. There will be not place to make comments against it. 
    • There is information on the HL7 Page - request for the link made by Lisa
    • Need to raise this as an issue for the folks doing co-chair training
  • Whoever responsibility is need to make this type of information available to the larger community
  • Amit Popat - Something was DSTU, there is no plan to move it forward as normative. If retired it, it stays in dormant position. Understanding is that HL7 does not make statement about clinical safety.
  • Jay - do we need to vote or need a motion
  • Action: HL7 have to do better documentation about the processes. Direction from Austin to look at the  HL7 Essentials Page (thanks Matt Elrod for the link)
  • Amit: Assumption co-chairs know and understand the rules. Essential page was put out to help co-chairs and the entire community. 
  • Austin - SD is plowing thru a series of these so may get more of this. 
  • Lisa - where does the list of expiring IGs from? Does PC get the list?
    • Emma - Patient Care get the list but the list is filtered on Sponsoring work groups. PC does their analysis and updates based on if they are sponsors. 
  • Would like continue this session next WGM
    • Austin: suggestion to invite CDA MG as well since topics discussed were mostly from them
    • Stephen: will invite CDA MG

Thursday Q3

• Gravity Project -SDOH Overview (Bob Dieterle)

  • Information about Gravity Project  - The Gravity Project
  • Gravity is a FHIR Accelerator. Has 1800 prticipants 
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  • Have a large number of sponsors
  • Working on twenty different domains
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  • All Domains will address health concerns/problems
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  • Implementation Guide is here https://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/
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  • Using Questionnaire/QuestionnaireResponse for survey instruments
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  • Orange lines are non-FHIR - using something other than FHIR
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  • Consent use case integrated in the workflow. 
  • Will be testing at the CMS Connecthathon in July 2021
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  • Have been working with the community on what things typically get exchanged. 
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  • Have considered individuals with limited technology use. 
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  • Discussion 
    • Slide 12 - ICD 10 submission - what was used from what Gravity recommended? Focus was on housing insecurity and food instability. Have agreed to include a subset in the Oct 2021 release of ICD 10. 
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    • ACTION: Access to the slides will be posted in the minutes
    • Unconfirmed health concerns will be identified. a small subset may become problems and get placed on the problem list. 
    • Suggestion to have this available across the care paradigm and not limited to just SDOH. Agreement that the idea was not meant for just SDOH. The reference implementation code is open source and is on GitHub. 
    • Timeline - Goals - PC Need to discuss an action plan. 
      • Process was to do all four of these for each domain
        • survey/assessment
        • healthconcern/problems
        • establishing goals
        • interventions
      • Working separately for adding the work around goals and interventions
      • intervention is very broad - all national programs, etc. Things that will assist a person with social needs
      • Need to work with PC on getting this figured out with consideration of this timeline. Lots of work needed by PC on goals.
      • SDOH have already done some work in this area on some of their domains. 

• FHIR Clinical Guidelines - Project Update (Bryn Rhodes)

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  • CPG-On-FHIR
  • Set in a broad framework that results in content IGs, Model IGs
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  • Concept knowledge Architecture with knowledge capabilities
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  • Care Plan specific artifacts were created
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  • Translates knowledge to execution
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  • Have a growing open source stack. Bryn will link this to the landing page with more documentation to describe. 
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  • Content IG is published
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  • ACTION: Bryn will share slides 
  • CDS Hooks track at connecthathon
  • MedMorph and public health reporting utilizing plan definition with quality measures to drive case reporting. 
  • There is an effort in CIC to launch all things registry - New project - CREDS
    
    • See CIC for registry efforts
  • Does Vulcan belong in this Ecosystem? Yes but Bryn is not currently work with vulcan. 

• PACIO Projects (Dave Hill)

  • Presentation
  • 2021-05-24 PACIO for WGM-2.pptx.zip
  • Various Use cases - around post acute care and managing the data
  • CMS Assessment and Data Element Library to standardize the assessment
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  • Functional and Cognitive status
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  • 16 different systems
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  • Re-Assessment time point is a new use case
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  • May 2021 connecthathon on ADI 
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  • Virginia - would like to test the patient request for correction in the ADI work flow. 

• Multiple Chronic Condition   - Joe Bormel

  • Recent Efforts:
    • a. 2 connectathons (Sept 2020, January 2021)
    • b. Implementation Guide on TriFolia
    • c. Adding 3 disease domain categories to IG: CVD, type 2 diabetes, chronic pain Value Sets FHIR profile gap analysis
  • Future Plans:
    • a. Completion of value set identification & FHIR gap analysis
    • b. Update of Implementation Guide to reflect that work
    • c. New funding! COVID 19 / Long Covid & caregiver data elements d. Targeting initial balloting?? in September 2023 (will include CKD, CVD, diabetes, pain & COVID)
    • Questions? Email Joe Bormel at jbormel@cognitivemedicine.com
    • The MCC eCare Plan materials can be found here Multiple Chronic Conditions (MCC) eCare Plan
  • Work with modeling goals with PCWG
  • Dynamic care plans is critical to ensure the elements are handled consistently.