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Chair:  @Kathleen Connor

Scribe: @Joel Bales


Attendees


Name

Affiliation


Present

Name

Affiliation

John Moehrke , Co-Chair

By-Light


Alexander Mense, Co-Chair

HL7 Austria
x

Kathleen Connor , Co-Chair

VA (Book Zurman)

@Trish Williams, Co-ChairFlinders University

@Christopher Shawn, Co-ChairVAx
@Mike DavisVA

@David Staggs


VA (Electrosoft)

SRS

@Francisco JaureguiVA (Electrosoft)

@Joe LamyAegis



@Matt BlackmonSequoia

HL7 FHIR

@Dave SilverVA (Electrosoft)x
Kaiser

VA (Book Zurman)

@Ken SalyardsSAMHSA

@Peter VanLiesdonkPhillips

@Adam Wong adam.wong@hhs.govHHS

@Mohammad Jafari mohammad.jafari@bookzurman.comVA (Book Zurman)

@Ricky Sahu, @1up.health

1up Health

HL7x

x


Craig NewmanAltarum
xJoel BalesDoD/VA Interagency Program Office

Eric KettlerDoD/VA IPO
xCarlos PolkDoD/VA IPO

Gary DickinsonCentriHealth/UnitedHealth Group

Serafina Versaggi




Michael DonnellyEpic

Didi DavisSequoia

Matthew Rahn
x
Laura Bright

Agenda Topics

Agenda Item

Discussion

Decision Link(if not child)

Invariant from prior week

Share updates of new invariant - ask question about requiring that on device also

Inside FHIR profile is requirement of organization: who (author). Determined onBehalfof SHALL be present when Provenance.agent.who is a Practitioner. The same approach will be used for device. Brett Marquard will coordinate with Argonaut community for concurrence.  See link to Argonaut R4 Implementation Guide.

Argonaut R4 Implementation Guide CI Build (v3.1.0)

http://build.fhir.org/ig/argonautproject/R4/branches/master/StructureDefinition-us-core-provenance.html

Use Cases

Dig a deeper into the use cases we agreed to previously. (Section 2)

Existing use case works, Brett Marquard worked through a different use case to improve the guide. When a provider in their own local data store accepts the problem into their data store, they are accepting a new level of responsibility. When it is carried forward, then the person who accepts it into the EHR is then responsible for the content.

This depends on the type of data (some is inherently reconciled, and other data is not reconciled). For example, lab results don’t change authorship, but allergies do get reconciled (change authorship). Must specify that this is a special case for a limited number of items, which are currently reconciled.

Another example: if you accept a care plan, then accept ownership for the care plan. However, reconciliation is not required for care plans.

Other use cases are related to clinical information reconciliation process.

3 Implementation guidance

3.2: Authorship considerations. Group accepted the proposed language. Kathleen Connor suggested that legal expertise is needed. For now, we can’t do more than Best Practices unless HL7 publishes guidance.

3.3.1: C-CDA Best Practice – top three EHR vendors concurred with the proposed approach. Third bullet: “When generating a C-CDA document, if only a free text provide is available, the organization of the provider SHALL be present. If the organization of the free text provider is unknown, the source of information, or sender, SHALL be recorded as the organization.”  This requires input during the ballot.

3.4.1: FHIR-Specific Best Practices – “All systems that support the ONC USCDI SHALL be capability of providing a Provenance Resource that conforms to the Argonaut, or subsequent, US Core Profile. (May be controversial).

Gaps: Appendix – Advanced Provenance Efforts and 3.5: Resources for Advanced Implementers. Mr. Marquard will contact John Moehrke.

3.5 Resources for Advanced Information

Kathleen Connor will add information on these topics: 

EDA 1

Volume 2 Provenance (supporting Mike Davis)

Data Segmentation for Privacy (DS4P)

Lifecycle events

ONC Provenance Work was folded into Gary’s work (CDA R2 Provenance)

Use of Block Chain to store Provenance information. Federated Provenance information has value and was included in the ONC challenge.

Mike Davis: confirmed that links in 3.5 is a useful approach.

Mr. Marquard and Ms. Connor agreed that he will clean up existing content and submit to HL7 to meet the ballot deadline.  Then clean-up can continue through Aug 2.


Draft guide

Review a draft of the Basic Provenance Informative Guide and the latest Argonaut Provenance Profile.

Call ended

4:00 PM eastern time

https://fccdl.in/4D39Pm5KLK


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