Notes (quarters to continue)

• IPS/IPA 

Monday

Mon Q1 (Plenary)

Mon Q2 (Plenary)

Mon Q3 (PC Admin)

Reviewed WGM agenda.

Congratulated co-chairs, who were re-elected:  Laura Heerman Langford, Emma Jones, Michael Tan 

Eric Haas reviewed CDex - see attached PPT - https://confluence.hl7.org/download/attachments/161079370/2023%20Sept%20CDEX.pptx?api=v2

PBS Metrics

• 1105    PCWG Develop FHIR resources and profiles for the Next STU release.
  
  • Dave Hamill said he would close it
• 1111    Essential Information for Children with Special Health Care Needs
  
  • Michael Padula Padula will email Dave Hamill to close
• 1731    PACIO Project: Speech, Language, Swallowing, Cognitive Communication, and Hearing (SPLASCH) (PSS in Confluence)
  
  • Jay Lyle to email Dave Hill
• 1262    Definition of negation requirements for standards
  
  • Jay Lyle asked Dave Hamill to close
• 770    HL7 Child Health Neonatology Profile for EHR Systems, v 1.0
  
  • Michael Padula  will email Dave Hamill to close
• 1650    Ophthalmology Retina Module IG (PSS in Confluence)
  
  • Stephen Chu pinged Dave Hamill, who responded and included Anne and Lynn for help
• 1722    International Patient Access (Jira PSS-1808)
  
  • Ask Isaac Vetter in Mon Q4 for updates
• 924    HL7 Care Coordination Service (CCS)
  • Emma Jones ask SOA

Idle Ballots

1650 is being discussed as part of Project Insight email

Active ballots without reconciliation packages for > 2 cycles

Expired STU

Ask Emma Jones to add to co-chair call to discuss idle ballots and active ballots without reconciliation packages for > 2 cycles

Mon Q4 (IPS/IPA)

IPA Isaac Vetter EPIC ( International Patient Access).

• FHIR IG identify patient access to data with the use of FHIR.
• Publish the IG as a foundation that countries can use to access the patient data.
  • Focus on the most important data: minimal profiles.
  • Simple authorized access (based on SMART).
  • Connectathon has been organized.
    • Lead by Vassil Peytchev
      • Learning & Breakouts
      • Comparison with Australian Core
      • University of Washington: Has produced an IPS from IPA, by accessing the data through IPA,
      • IPS is the starting for a National Core Set.
      • There is a tool available to compare any National Core Set with the standard Core.
  • The IPA has reviewed all their 'must support" requirements, to determine what systems are expected to do.
  • Lot of countries are looking at FHIR, but there is little coordination between them. The IPA could be a base to compare the different core systems.

IPS

• Rob Hausam presented the status of IPS
• Introduction film from John D'Amore.
• IPS is  a summary, it's not context specific, target is continuity of care.  Purpose is Cross border exchange of information, but also local systems.
• Currently a lot of International momentum to implement IPS.
• Website for the IPS is : The International Patient Summary – key health data, worldwide (international-patient-summary.net)
• Here is the link to the IG.
• Connectathon for the IPS has taken place:
• There is a tool to produce a QR-code, with which you can scan the QR and pull up the IPS.
• No care provider wants to run through the IPS to verify if it is correct. It is better to let the patient review the IPS.
• Next steps: working toware 2.0 ballot.
• Work on vendor adoption ( Google, Microsoft etc….)
• Work on feedback from implementers:
  • Canada
  • Australia
  • Netherlands
  • US
• SNOMED has made the value set of IPS available for all countries.
• IPS is actually the "document" of the dataset. It inherits the constraints from IPA. It actually it implements the  IPA.
• Michelle is running through the Jira issues that could have impact on the IPS.  Are there any breaking changes.
  • Patterns
  • 'Reference to BodyStructure should be allowed in Condition. It has been changed in Observation and Condition should be similar, See issue in Jira. 39602.
  • FHIR-40516 - Getting issue details... STATUS
  • FHIR-40500 - Getting issue details... STATUS
  • FHIR-39630 - Getting issue details... STATUS
  • FHIR-39602 - Getting issue details... STATUS

Tuesday

Tues Q1 (FHIR Trackers)

Candidates

FHIR-28235 - Getting issue details... STATUS

FHIR-42693 - Getting issue details... STATUS

Seek input on JIRAs tagged with PC-R6-breaking-change

• FHIR-40516 - Getting issue details... STATUS
• FHIR-40500 - Getting issue details... STATUS
• FHIR-39630 - Getting issue details... STATUS
• FHIR-39602 - Getting issue details... STATUS
• FHIR-39513 - Getting issue details... STATUS
• FHIR-39288 - Getting issue details... STATUS

FamilyMemberHistory-genetics profile

Thoughts on what to do with our FamilyMemberHistory-genetics profile in FHIR Core? We discussed possibly moving it our Genomics Reporting IG, but it isn't a perfect fit. There is work going on to build a new FHIR IG based on (Phenopackets)[https://phenopacket-schema.readthedocs.io/en/latest/] which includes "pedigree" like features and could replace this.

Mike Padula has seen in in EHRs in two ways:

• Formal pedigree
• Simpler table (less comprehensive)

Genetics variants with each family members or more general (following diseases or phenotypes)

FMG

R6 release

• Based on feedback from the community, the FMG expects that all patient-related resources, as well as the resources that are needed to support those (e.g. Practitioner, Organization) will be defacto normative in the R6 release
• The default position is that other resources in the core spec will also be normative, though we may be able to carve out certain exceptions
• While this may make some work groups uncomfortable, the reality is that the implementer community has decreasing tolerance for breaking change and therefore we will have to get to a place where such changes will no longer be a factor.
  • The FMG will provide some design guidelines to help make resources that are normative less fragile if they haven't yet been well-exercised.
• Question 1: are there any resources you're responsible for you think *shouldn't* be normative in R6, and if so, why?
  • Linkage?  No known implementations - shouldn't go normative without implementation.
  • ClinicalImpression?  Abbie Watson implemented it for patient/self reported outcomes.  PEWG likes ClinicalImpression - shouldn't go normative without additional implementation (clinician's impression).
  • Flag?  Amit said Epic has implemented Flag
• NOTE: It will still be possible to add net new resources as STU in R6 (and net new resources will need to be STU for their first release or two).  Net new elements could also be STU, but whether that will be meaningful is unclear.  Work groups intending to do this in R6 should discuss it with the FMG
• The FMG will still be sending out a survey in the next month or so seeking feedback from implementers around their desired timeframe for R6

R6 interim ballots

• R6 is too large for most balloters to reasonably review the entire thing in the 30 days a typical ballot is open.  Also, given that we're looking to lock most things down as normative, there may be a need to get feedback from the community *before* we lock things down.  For that reason, we're planning to have "preview" for-comment ballots which will each be focused on specific pages and resources that work groups feel are ready to review
• We expect to have about 3 of these ballots, one each cycle starting in the January cycle (final content due Dec. 17)
• There are two categories for artifacts to review:
• We believe this content is stable and is unlikely to change much.  We're offering the resource/page for early review for the benefit of the ballot community so they can review content now and feel comfortable doing a much lighter review when the normative balloting starts.  For content offered up for review this way, work groups will be asked to closely track and list all changes that happen between the preview ballot version and the eventual normative ballot version.  These artifacts should only appear in one preview.
• The content is less stable and there are certain changes we want review on *before* the normative ballot.  In some cases, these artifacts may go through multiple ballots.
• We would like to spread our resources out over the waves (for the benefit of both work groups and balloters).  I.e. we don't want everything in wave 1 or wave 3 of 'preview'.  Work groups should decide which resources or pages they'd like to include in each cycle assuming 3 cycles.
• Question 2 : Which resources or pages do you plan to ballot in the Jan 2024 cycle?

Extensions review

• One of the objectives of moving the 'common' extensions into a separate IG was to allow us to iterate them more quickly.  It also allows us to ballot them as a distinct specification and therefore get a bit more review than they typically get as part of the FHIR core spec
• We plan to ballot the 'core' extensions in the January cycle.  Before that, we would like work groups to do the following:
• Review all of the extensions against resources you own and make sure they're scoped properly and defined the way you want them to be
• In general, extensions should NOT have a scope of 'Element'
• Ensure that terminologies and extensions are not marked as 'draft' unless they are not appropriate to be referenced in IGs or implemented
• Also look at the extensions listed here: https://fhir.org/guides/stats2/extension-summary-analysis.html
• You may not be able to influence the non-HL7 published ones, but can at least determine whether they should exist and evaluate whether a 'standard' extension is needed
• Reminder that for extensions to be marked as FMM3+, the extensions must be endorsed by the work groups responsible for the resource/data type extended
• Question 3: Any questions around extensions?

JIRA Management

• For both the 'preview' ballots as well as the eventual 'normative' ballot, we want content to be as up-to-date as possible.  That means that we want to keep the number of 'unresolved' and 'unapplied' changes low.  Work groups should try to adopt a "continuous review, continuous application" process to keep up-to-date.
• Keep an eye on the FHIR Core progress dashboard
• (Though you also need to monitor JIRA for all of your other specifications too - including ones you have no intention of re-publishing anytime soon.)
• Question 4: Any questions/issues around Jira management or expectations?

IGs

• Question 5: What new IGs and/or new IG ballots are you expecting in the next year?
  • SPHR - Standard Personal Health Record will ballot in Jan 2024 (double check if PC is a sponsor or interested party)
• Question 6: Thoughts on IG alignment across IGs and what, if anything, we can/should do to foster that?
  • IPS/IPA is a good start
  • SPHR - Export - networking/Argonaut SMEs recognized similar need 
  • Patient Navigation - Patient Characteristics
  • Need resources for IG authors - best practices to identify redundancy

Tues Q2 (AdverseEvent/BRR)

Rebecca Baker gave a Vulcan update - see attached PPT - Vulcan Adverse Events Update.pptx

JIRAs Discussed

• FHIR-38908 - Getting issue details... STATUS
• FHIR-22742 - Getting issue details... STATUS
• FHIR-39338 - Getting issue details... STATUS
• FHIR-34318 - Getting issue details... STATUS
• FHIR-26434 - Getting issue details... STATUS

Ran out of time

• FHIR-36009 - Getting issue details... STATUS
• FHIR-34200 - Getting issue details... STATUS
• FHIR-26436 - Getting issue details... STATUS
• FHIR-18852 - Getting issue details... STATUS
• FHIR-37746 - Getting issue details... STATUS
• FHIR-41402 - Getting issue details... STATUS

Tues Q3 (ADI - PE-hosted)

Tues Q4 (Vocab Joint)

Child Health

• Michael Tan presents the CHOICE project and explained the intention.
• The Implementation Guide has gone to ballot. The results of the ballot were 5 affirmative and 24 negatives.
• However 15 of the negatives were related to one issue.
• The team will deal with the outcome of the ballot in the coming period.
• Rob McLure had questions about the code systems. Rob is concerned that systems will not understand the extension and consider that the patients are born.   How to deal with systems that do not comply  and realize that the patient is not a baby, but a fetus?
• It is important to understand that the IG does not dictate how data is supposed to be stored in the EHR. It only gives guidelines about the exchange of data. That is what HL7 is about.
•  Question why not use the (birth) date  of patient to express a fetus. This was one of the option, that has been discussed by PA and PC, but in the end the decision was the patient with extension.

Pain scores

• SDWG  requested TOPIC: Revisit CDA-20320 about adding Pain Scores (or not) to Patient care
• According to Russ Pain as a vital sign has been proposed by pharmaceutical industry, but the issue is that iIt is not properly measurable.
• The issue has been submitted by Susan Matney. 
• The group is not in favor of adding the pain scores in the vital signs.
• Gay Dolin will enter a comment.

Wednesday

Wed Q1 (OO/PC)

OO minutes:  2023-09-11-15 WGM - Orders & Observations

• Family/Household Update/Discussion (https://chat.fhir.org/#narrow/stream/179280-fhir.2Finfrastructure-wg/topic/Representing.20Family.20in.20Group.20resource) CareTeam/Group
  • OO Families/Household JIRAs - Orders & Observations - Confluence (hl7.org)
  • No decision.
  • Reviewed pending [FHIR-41674] Need language that clearly defines boundaries between Group and Organization - Jira (hl7.org) for PA - which may get discussed Wed Q2 during PA/PC joint
  • Grahame is coming to OO Thurs Q2 to discuss
• How to handle multiple imaging studies with one Diagnostic Report. FHIR-19253 - voted to re-open this JIRA
• FHIR-32265 - How to store parameters related to focal devices when executing a procedure?  See comments in JIRA – Changed status from Published back to Resolved - Change Required, so the pink banner can be applied.
  • FHIR-42747 - Getting issue details... STATUS
• [FHIR-34194] Add businessEvent extension - Jira (hl7.org)
  • Agreement that ORC-1 concept needs to enabled through Task (possibly) in some way, e.g., how to request a cancelation of an existing service request.
  • Ask for PC input

WED Q1 EHR joint  with PC

• Abigail Watson: Presenting IPS.
• Setting up the Jira ticketing.
• Reviewing up the backlog on Jjira tickets about IPS.
• Michael Tan presenting CHOICE
• What can EHR functional model do to promote the implemenation of CHOICE.
• Michael was thinking of enforcing the guideline of CHOICE, because most countries regulations on reporting vital statistics. This would need guidelines how to report. In practice this is quite complex, because you have to take account of multiple situations like fetal demise.
• Social services and Social determination.
• SHIFT.
• Schools still have a lot to catch up with.
• Lincoln Weed: Problem Oriented Care: Meaning and Mechanism.
• The development is now in second phase.
• Creating problem lists. Explanation of the history of problem oriented  care.
• There seems to be coupling tools that can  group data together. But it is not clear what this tool is called and if it is used frequently.

Wed Q2 (PA/PC)

2023 September WGM (Phoenix) - Meeting Minutes - Patient Administration

• Birth and Child Model IG Review
  • One motion has been put forward to rephrase the word "born status" to "fetal delivery status".
  • Vote affirmative ( 17 in favor, 5 abstentions, 0 negative)
  • Michael will send the jira issues to patient administration. And they will adjust the model..
    
  • PA will take care of the issues.
• FHIR-41674 - Need language that clearly defines boundaries between Group and Organization 
• FHIR-38703 - Add core extension for preferred-pharmacy on Patient 
• [FHIR-41244] Clarify description of both Patient.multipleBirthInteger and Extension: Patient Multiple Birth Total (R5+)to include fetal losses - Jira (hl7.org)

Wed Q3 (FMG Joint)

See notes from Tues Q1 - same comments.

R6 will have normative resources (if not FMM = 0)

R6 interim ballots - smaller chunks

Breaking change is defined in Versions - FHIR v6.0.0-cibuild

Try to avoid normative resource with TU elements (doesn't really prevent breaking changes)

Requested FMG administer survey to know which resources have been implemented in production.

Profiles shouldn't have higher maturity than the base resource maturity.

Next Steps:

• FMG Zulip or email FMG co-chairs - Dec ballot resources + resources that we don't want to go normative

Wed Q4 (US Core)

CGP 13 September Q4 WGM Minutes: Review of the US Core and CCDA USCDI V4 Initial Design - CGP

Adjourned early (4pm Pacific)

Wed Q4 LHS

CardX presentation:

• This project focusses on blood pressure. This is about patient enablement.
• Vital sign profile.  Project team does not prefer a large profile.
• A question is where you position the conversion into FHIR.

 Cancer Mcode update

• Ballot has been completed. Some 30 issues identified.
• FHIR 41051 code sets for code sets. There are 3 value sets and we should choose one. But the chosen value set does not cover tumor. The is issue is not found persuasive. Voted affirmative.
• Mcode should not only cover solid body fluids. New codes have been added.
• QA of the IG does report issues which have been discussed with FMG.
• Vote to publish the IG voor Mcode; affirmative.

Clinical registry

• Implementation guide for automated generation for Clinical registry extraction.
• Data is extracted from source systems and via structured data stored in output registries.
• Connectathon delivered 35 tickets. Explanation by Dave Pyke about the issues.
• Vote to publish the IG for the registry.

CodeX accelator

• Codex is an accelator program to promote FHIR interoperability.
• Industry is implementing Codex
• Vendors are using clinical genomics to perform conversions.

Thursday

Thurs Q1 (Care Plan)

• Graham Grieve:
• Family involvement in the care processs. In Africa this is often the case.
• Currently not consistent in the HL7 standard.
• Family as a group / household / care team
• Related topics: goal, conditions, recorder, performer, social workers.
• This needs to be resolved still.
• Care Plan DAM:
• Shift in focus from planning process to care plan progress.
• MCC ( Multiple  Chronic Condition):
• 3 deliverables
• FHIR IG Changes.
• Ballot wit 38 affirmative and 2 negative votes. 32 actual comments
• Remark Graham: FHIR resource "related person" seems to be missing in US core.
• Most of the profiles are derived from US core.
• Action item: Gay Dolin suggested creating a foundational CarePlan IG that takes the common requirements from each of the other CarePlan IGs.
• PACIO 4 different sponsored projects;
• See slides above
• TOC is a new use case.
• Collaboration with LHS:
• In Q4 there will be a specific quarter on that topic.
• A handful Jira's submitted by LHS. These are not resolved yet and have a some impact. Will be dealt in the weekly FHIR calls.
• CDA-IG update:
• Alignment required. There is a specific Confluence page on this topic.
• Motion to approve publishing for personal advance IG. Lisa motion, Gay Dolin;
• Vote: abstention 5, against: 0 , affirmative. 35.
• Jira on Care Plan:
• JIRA: issue 29730: about  "on-behalve-of."
• Jira status : Issue 25267 : about "status" This son member level.
• How does this fit in the Care Plan or Care team? Necessity to maintain the care team.  ( snapshot?)
• Jira : Issue 28461: about case. A
• Current scope Care team relationship to subject: LHS wants to increase the cardinality 0..n. I.e. multiple patients as subject.
• Question for LHS: Is the  are team dependant on the subject? Or is it agnostic? Is there another way to express that?
• Other Jira issues:
• Apply performer order: (about reference.) There is an extension. This is no longer applicable to Care Plan.
• Motion : issue not  persuasive watson second.
• Vote : 4 abstentions: 0 against:  Affirmative. 25
• CHOICE: Presentation from Michael Tan about Child Health.

Thurs Q2 (SD/CDMG/PC)

Austin chaired with Jay dialed in.
We reviewed the CCDA/FHIR map project items of interest
1. discussed desire to minimize further divergence between C-CDA & US Core.
2. agreed to CCDA/Core coordinating principles
3. agreed to make suggestions for enhancing CCDA by end of September to support January ballot
4. shared metrics for possible investment in completing and maintaining mapping 

Thurs Lunch (PC Admin)

R6 Normative (No Breaking Changes) Exemption Candidates

• FMM = 0
  • ConditionDefinition - not a patient resource, so better chance for making an exemption case
  • Linkage
• FMM = 1
  • ClinicalImpression
  • Flag

Implementer community willingness to accept breaking changes.  FMG will survey implementers to get feedback.

What would it mean to WG if no breaking changes were allowed?

• Deprioritize JIRAs in backlog
  • things that could be addressed via extensions (new elements)
  • things that are non-substantive (tweaking example value sets, examples, textual clarifications)
• Prioritize JIRAs in backlog
  • change a binding strength
  • change a cardinality
  • impact an existing element

Dec R6 interim ballot (for Jan cycle)

• Allergy - including a note asking for feedback on FHIR-39513 - Getting issue details... STATUS
• Condition - include a note for feedback on breaking changes + resolving family + addressing the latent concerns
• Procedure - include a note for feedback on breaking changes + evaluate dosing related extensions + review how ServiceRequest handled parameters and do the same for Procedure
• CareTeam - ok knowing that extensions can be used + address onBehalfOf (adding additional targets is not considered a breaking change)
• CommunicationRequest
• AdverseEvent - need to iron out JIRAs related to status
• CarePlan - only JIRA remaining is related to reviews, which might not even impact CarePlan (e.g. Provenance, Observation)
• Goal - new targets for Reference and new elements (via extension) are not breaking changes + Family
• FamilyMemberHistory - just Family JIRA in backlog + may need to delete/remove the genetics profile in base spec (follow up with Genomics WG)
• ClinicalImpression - not well adopted, but Michelle Currie will be working on ClinicalImpression.
• Flag - potential breaking changes as part of the alignment with Event pattern
• Linkage - minimal adoption

mid-Dec is deadline for the January ballot content

Thurs Q3 (LHS-hosted Virtuous Cycle)

Sept 2023 WGM - Learning Health Systems Agenda - Learning Health Systems - Confluence (hl7.org)

FHIR-41583 - Getting issue details... STATUS

FHIR-41582 - Getting issue details... STATUS

Thurs Q4 (LHS-hosted CareTeam)