Attendance

2023 Jan WGM Patient Care Attendance

HL7 Antitrust Policy

Each Work Group/Committee is required to include the following statement at the top of the minutes for each meeting: 

Professional Associations, such as HL7, which bring together competing entities are subject to Few scrutiny under applicable antitrust laws. HL7 recognizes that the antitrust laws were enacted to promote fairness in competition and, as such, supports laws against monopoly and restraints of trade and their enforcement. Each individual participating in HL7 meetings and conferences, regardless of venue, is responsible for knowing the contents of and adhering to the HL7 Antitrust Policy as stated in §05.01 of the Governance and Operations Manual (GOM).

Quarter - Time Zones Conversions

Agenda

Minutes

Monday Q1 - Admin Quarter

Review of WGM Agenda

CCS - Next steps

Discussion: 

What are next steps options for it:

1. Take it back to ballot
2. Absorb it into other work like the CP DAM
3. Get rid of it

ACTIONS: Ken Rubin will follow-up with SOA and let PC know what SOA would like to do with CCS. 

Reaffirmation V3 

• Michael submitted project proposal to withdraw it. Next step is for Lynn to bring it forward to TSC

Review of Mission and Charter

• Co-chairs will re-read and will vote during the Thurs admin call this week

BPM - Ken Rubin

• BPM- assessing pathways and the process
• Clinicians on FHIR agenda
• Use case around diabetes management

Mon Q2 - CDex / FHIR Tracker

Eric shared 

• Completed 2022 Sept ballot reconciliation, Jan 2023 connectathon. 
• Ready to publish within the next month.  Vote to publish during the next call (FHIR call on Thurs, Feb 2).  Eric will send communication about review period and call scheduled on Feb 2.
• CDex Attachments using LOINC Attachments is intended to be compatible with X12 transactions
• Mapped data elements to X12 segments
• CDex not named in the rule - comments from DaVinci and HL7 pending.
• Rule is about electronic transmission of attachments
• Bob may do KT on the rule sometime later
• Connectathon focus is on testing (requesting and submitting attachments for claims and prior auth.  New Questionnaire and QuestionnaireResponse in CDex attachments)
• Reviewed what's new (see PPT linked)
• Adding Questionnaire to CDex - includes merging with DTR guide (automate retrieval and QuestionnaireResponses)
• Purpose of Use Value Set Hierarchy (see PPT linked). At registration, it is more generic purpose of use, but this is more dynamic at time of ask (when client queries server)
• Pending/TO DO includes QA, grammar/technical corrections, credits page.  Eric will create a page for people to add their name to the credits page.
• Migration of CDex Vocab to UTG
  • Purpose of Use codes - HL7.FHIR.US.DAVINCI-CDEX\CDex Purpose of Use Value Set - FHIR v4.0.1
  • Work Queue codes - HL7.FHIR.US.DAVINCI-CDEX\CDex Work Queue Value Set - FHIR v4.0.1
• Emma asked about coordination with DS4P due to purpose of use used for context of use
  • HL7.FHIR.UV.SECURITY-LABEL-DS4P\Security Label DS4P Home Page - FHIR v4.0.1
  • Security-labels - FHIR v4.3.0 (hl7.org) says

Context: Requests (e.g. Read, Query, message triggers) - would describe the context of the request using purposeOfUse and compartment/clearance

FHIR-32901 - Getting issue details... STATUS

Mon Lunch - FHIR Committers

Feb 24 - Freeze deadline for R5

2 weeks of QA

Mon Q3 - FHIR Trackers

FHIR-32901 - Getting issue details... STATUS

Tues Q1 - CIMI/PC

Q1 Patient Care / CIMI

• Joint session with CIMI. Main topic is PSS: 2154
• Analyzing the IG. Too many profiles and extensions. It is growing exponentially. > 6000 IG.
• There 50 profiles on observation only.
• 80/20 rule does not apply anymore. Many extensions are the same, only naming differently.
• A lot of duplication. Aim to merge profiles.
• CIMI wants to slow down the growth of profiles and provide an extension registry.
• It must be a voluntary process, because you can force the users.
• Part of the solution is providing tooling.
• Now focus on US realm, but the PSS aim is eventually universal.
• Other countries having a different approach, where more legislation is used to enforce certification and the use of  some IG or profiles.
• Look into OpenEHR where they have a super Profile.
• Russ Leftwich has been to South East Asia ( Indonesia, Singapore). Their approach is completely different.
• Who does CIMI engage within HL7 : FHIR-i, FMG, CIC)? Approach of the clinical groups first, because they sponsor the IG's.
• There is also an issue with governance.
• What is the viewpoint of ONC? You need the right people in the project. These organisations are not that far. They are still engulfed in the implementation and not thinking about the governance
• Patient care agrees that this is a good initiative and will encourage the project.
• An IG is created as new LAB profiles;
• Allows subtypes, data types and different value sets.
• See the following page.https://build.fhir.org/ig/HL7/cimi-labs/profiles.html
• Wish to promote to universal realm. Most of these profiles makes use of SNOMED
• Could be an issue when promoting to universal realm.
• Update on LOINC SNOMED collaboration by Stan Huff.
  • Avoid duplication between SNOMED and LOINC.
  • Create a LOINC extension in SNOMED to express the LOINC concepts.
  • Necessity of creating a computable ontology in the LOINC concept.
  • LOINC parts will have SNOMED codes.
  • The 6 axis of LOINC work well with observations, but that is only a part of the observations.
  • Also assesments scales with scores do not work well with LOINC.
  • First step is a trial with 20.000 observations.
  • Susan Matney will assist in setting this project.
• New agreement between SNOMED and LOINC.
• Originally one code to express a string for observations.
• But this strategy did not work. Instead make LOINC available for everyone.
• Proposed solution:
• Brainstorming of coding that would be dependant on the context on which it is used. It would require less codes.
• Condition modelling.
• The FHIR resource has different participants in the FHIR resource of Condition.
• Does CIMI require more participations?
• Stan will look into this matter.
• Extra complication is the ergonomics. There has been many discussions whether the attributes are related to an observation and the condition should be seperate. Many systems do not want a seperate step and resource.

Tues Q2 - BRR/PC

FHIR-38592 - Getting issue details... STATUS This tracker is a duplicate of applied issue FHIR-38318 but its status did not update properly to "Applied" in Jira

FHIR-39420 - Getting issue details... STATUS

FHIR-39419 - Getting issue details... STATUS

FHIR-39410 - Getting issue details... STATUS

FHIR-39409 - Getting issue details... STATUS

FHIR-39408 - Getting issue details... STATUS

FHIR-39406 - Getting issue details... STATUS

FHIR-38823 - Getting issue details... STATUS

FHIR-38822 - Getting issue details... STATUS

FHIR-38812 - Getting issue details... STATUS

FHIR-38811 - Getting issue details... STATUS

Tues Q3 - US Realm

Tues Q4 - Vocab/PC

Gravity update (Corey)

International Patient Summary (IPS) (Rob H, John D'amore)

IPS project update

• Current version - https://build.fhir.org/ig/HL7/fhir-ips/
• Published version - https://hl7.org/fhir/uv/ips
• Published in November 2022
• Newly added resources
• Added $summary operation
• Evaluated MustSupport
• Terminology updates - even if not a SNOMED affiliate
• Canada hosts projecthathons for their national adaption of IPS

IPS And PS-CA

• 2021 Canada began work with IPS and its various jurisdictions to produce a Pan-Canadian Patient Summary (PS-CA)
• Learnings include jurisdictions aligned on basic use cases but ecosystem very diverse
• Difference clinical charting practices including some elements in IPS marked as MS were not captured in clinical workflows; privacy policies in some jurisdiction impacting data that is allowed to be captures/received
• Still hearing from implementer community

How to get involved:

• Birds of a feather for IPS
• chat.fhir.org IPS stream and weekly IPS calls
• If you're a country that's a GDHP member next connecthathon (TBD) - contact John D'amore
• Upcoming projecthathon in Canada

See IPS links to standards - https://international-patient-summary.net/ips-links-to-standards-and-specifications/

International Patient Access (IPA) (slides) (spec) (Isaac V.)

• Overview of the difference between IPA and IPS
• About to publish STU1
  • Has been approved by PCWG
  • IG QA completed
• 2023 Tactical Steps
  • MustSupport pilot - allows implementation guides to be more specific about computable definition of MustSupport
    • Being explicit about what requirements are placed on what actors - defining the actors and expectations on the client and the server actors. 
    • Asking Argonaut for continued support
    • STU update in Sept 2023
• Strategic Steps to support adoption
  • Public support by relevant multi-national apps (e.g. patient access to their data, broader use of patient apps such as popular multi-national patient apps
  • Pursue working with CGP of defining a variance process similar to what is done for US Core - inclusion of a review process. 
  • Quality checks included use of the comparison parameter against other guides - this is build into the IG publisher - to compare two different IGs to compare differences on elements of the same resource. 
  • HL7 influence towards jurisdiction adoption - looking for help on how to advance IPA around the world. 
  • Leaders in HL7 Community to evangelize IPA
  • As various jurisdiction do their jurisdictional profiles, do a structure map with IPA similar to V2 to FHIR structure map - this will provide a relative comparison with IPA. This will provide a difference between jurisdictional profiles and IPA
  • Comparison between US Core and IPA was done and has been published.
  • HL7 Question: From a National baseline perspective, will the ability to compare jusrisdictional guides to IPA be used as a base line?

Wednesday Q1 - OO/PC

OO meeting minutes:  2023-01-16-20 WGM - Orders & Observations

FHIR-19362 - Getting issue details... STATUS - will revisit Wed Q4 with PC/OO/SD

2023-01-09 OO - Specimen - Orders & Observations - in 3 dimensions (x/y/z)

FHIR-38633 - Getting issue details... STATUS

How to present pertinent negatives?  Continue discussion on Feb 2, 2023 in PC FHIR conference call.

• FDA logged JIRA for Observation, Condition, Allergy, and FMH – how to say whether or not it is present or absent.
  • Allergy has clinical verification (said present and then clinician disagrees).
  • Observation uses value.
  • Be consistent where business cases are similar vs not.
  • Patient doesn't have condition + FMH 

Device Association - Device Association - Orders & Observations

• In R4, Device has a subject, which makes sense for implantable, but for a device like wheelchair, it doesn't need a subject
• Proposed a new resource called AssociationMultistake holder - AMA; CMS
• Goal is to protect PHI.  Don't want PHI when querying Device and getting back Device history for multiple patients.

Wednesday Q3 - PA/PC

PA minutes:  2023 January WGM (Las Vegas) - Agenda - Patient Administration

FHIR-39466 - Getting issue details... STATUS

Wednesday Q4 - IPA; CGP - USCDI update

Physical Activity Project Overview (Laurie Whitsel)

• PAA - HL7 WG Meetings - January 2023.pptx
• Physical activity alliance - move with us
• mission is to increase physical activity across the US population
• 18 board organizations members
• ONC; CMS; AHRQ; White House engagements
• Its time to move campaign - Assessment 
• Currently working on IG
  • Core Measures for assessment
    • Muscle strengthening
    • Aerobic physical activity
• Has completed 2 Connecthathons with plan to go to ballots in May
• USCDI - level 2
• upcoming meeting with NCQA
• Accommodating self reported data as well as device data
• Self reported data will be included - Lloyd is working on it

HSS - Enhancing FHIR for Person-centric View (Ken Lord)

Business Driver - importance of environmental factors on health outcomes (60%) of modifiable health outcomes can be attributed to SDoH

The need - educational, housing, occupations, food insecurity and other HSS domains the individual is represented as a person, family, or house hold. 

Currently in FHIR - for services such as food programs, temporary and permanent housing, educationsl programs to help the person achiev their goals and to provide services, the person should be represented as a patient. 

Upcoming Project Scope Statement Proposal - PSS-2153 - Getting issue details... STATUS

• TSC received the proposal today then workgroups will get a chance to review it. 

Discussion:

• the word "patient" shows up. Patient resource is normative. suggest providing a way to clarify. sometimes "subject of care" is sometimes used. 
• the request is not to change patient
• Need to determine the scope of patient - and how is this different
• Want to drive this by usecases
• This is a great topic - research literature is available in this space
• When looking at building workflows always looking at the patient role - there is person in view of testing these systems. 
• PSS proposal will be posted and looking at 

Incorrect reference direction Procedure -> DiagnosticReport (topic from OO Q1 - Hans)

Notes taken in the Jira ticket - see comments on FHIR-19362 - Getting issue details... STATUS

HL7 Terminology in the CDA Publication

Logical model for CDA - need some way to pull in the older version

Bound to the V3 null flavor that need to be fixed. 

Looking for feedback from Vocab. 

onBehalfOf not appropriate for Practitioner

Reviewed this JIRA and voted on resolution (Michelle)

Jira FHIR-32507 - Getting issue details... STATUS

Thursday Q1 - All things CarePlan

MCC (EMI Advisors - Gay Dolin) Update

• Recent for comment only ballot, plan STU ballot Sept 2023
• Profiles derived from US Core 6.0.0
• Plan Connecthathon Track May 2023
• MCC eCare Plan Apps
• Care Coordination system vendors need to participate in this work. 
• Value set approach similar to what Gravity is doing. Vocab WG need to be involved. 
• Plan on using the care plan Weds calls for ballot reconciliation. 

Pharmacy Care Plan production presentation (Shelly Spiro)

POLST

• CDA IG published Sept 2022

PACIO - ADI - Corey Spears

Discussion:

• Is the Condition resource adequate for "In case of X" perform the planned interventions in an ADI?
• The Condition resource could be used if the status elements support it. 
• If not using Condition resource, what should be used?
• Suggestion to add an appropriate status code - e.g. potential
• Condition Resource scope now includes situational scope where the statuses have been revised
• USCDI Level 4 now includes an ADI data class - US Core will start working on how to model this. Need to work together. PACIO was instrumental in getting this data class added. Corey has been discussing with Eric Haas on working together. 
• As as an ADI document the intervention part are observations. When brought into a CarePlan, it becomes a service request. 
• The current scope between observation and condition - condition are things that have risen to a level of concern. 
• Need a code for a conditional state that provides a switch to the level of concern. 
• The patient's concerns don't always end up on the problem list
• CarePlan.addresses could be used as a code
• Idea of a contained condition. If the condition is contained in the CarePlan, it will not land on the problem list - it doesn't exist on its own outside of the carePlan. 
• Aligning with this, many carePlans sit outside of the EHR. 
• What other attribute on a condition will be needed? If no other, may as well use clinical concept.
• Suggestions include Flag resource; Procedure; Goal 
• Goal Resource has this text: Goal does not include the legal Advance Directives, which should be represented with the Consent resource with Consent.category = Advance Directive or a request resource with the intent = directive. Legal Advance Directives may specify clinical goals that can be represented as a Goal resource as well. Informally, advance directives could be represented as a Goal resource regardless of whether it was included in the legal Consent, such as "I want to die at home."
• Referring to Advance Directive as end of life but they can be contingency plans (e.g used by children with special needs)

PACIO - Personal Functioning Engagement - Dave Hill

Discussion:

• HL7 has expressed concerns about the process being followed and to make sure to engage Vocabulary WG. 

CardX - SMBP use case - Bruce Bray

• CardX - new CodeX Accelerator
• Cardiovascular Data exchange Cardiovascular
• Currentl CardX Community building: Providers, etc
• Initial Use Case: HTN Management/Self Measured Blood Pressure (SMBP)
• Project proposal by May WGM, Connecthathon in Sept
• Initial phase - SMBP
• Next phases - Guideline based hypertension management
• Additional Use case topics per community input
• mCARD - core cardiovascular data element

Discussion:

• Add patients to the community list
• Scope of the project - have vendors doing HTN management using an App. Would like to get the data from the patient into the EHRs. 

Upcoming JIRA  - remove the CarePlan.activity.detail element.

Please provide input by Feb 3rd

FHIR-39101 - Getting issue details... STATUS

CarePlan DAM Update - Laura and Jay

Thursday Q2 - SDWG; CMG

C-CDA Companion Guide  - Overview (Gay Dolin)

Dashboard - https://jira.hl7.org/secure/Dashboard.jspa?selectPageId=12105

Model is to role things in on a new cycle anually

US Core CarePlan.text discussion (Brett and Gay)

• Will convene a group to work on the requirements for the Assessment and Plan USCDI data class

CCDA to FHIR Mapping (Jay)

• On going work - CSG project

US Core and SDWG

• Plan on spending the 2nd hour of the SDWG thursday calls on USCDI design for C-CDA companion guide and Companion Guide reconciliations

CMG - CDA Product update

CDA MG checklist: CDA Publication Request Checklist

SDWG (Gay) is working with CDM to develop a new checklist that is applicable to the new StructureDefinition publication of C-CDA

May WGM: Will plan for this quarter and reassess need for the quarter (bases on topics) during agenda planning. 

Thurs Lunch

2023 May Patient Care WGM Agenda and Minutes - Patient Care - Confluence (hl7.org)

PSS-2153 - Getting issue details... STATUS

Motion to approve the revised mission and charter from the last co-chair meeting.

Emma Jones / Jay Lyle : 7 for -0 against -4 abstain

Michael Padula Discussion about logging a change request to PA to update RelatedPerson scope/boundaries to acknowledge that a parent IS a caregiver for their child, but a parent IS within scope of RelatedPerson.  Is the better/real differentiator that a Practitioner cares for multiple non-related Patients and/or working on behalf of an organization?

Information about a person that is involved in a patient's health or the care for a patient, but who is not the target of healthcare, nor has a formal responsibility in the care process.

and

The person/animal operates on behalf of the care delivery organization over multiple patients (Practitioner)