From Ioana Singureanu:
From a technical stand-point, it’s clear various aspects of Military Service and service history are relevant across several HL7 projects from US Core, ODH. Gravity, Da Vinci, etc. Thankfully, some work has already been done to establish consensus on requirements between VA and DoD. Other projects appear to be interested only in the most recent service item and status. However, it’s important that all the relevant extensions are consistent with each other and the extensive Veteran information required for VA eligibility, .
- multiple episodes, some of them include deployment
- Discharge status seems to be a common requirement: [ honorable, general, bad-conduct, other-than-honorable, dishonorable, honorable-absence-of-negative-report, honorable-for-va-purposes, dishonorable-for-va-purposes, uncharacterized, unknown ]
- FHIM - now Federated Health Information Model: https://fhims.org/content/420A62FD03B6_root.html
- Veteran as USUniformedServicesPerson
- ZMH segment - one occurrence per episode - mapped to VistA EHR data elements (an internal VA representation)
- coded details about deployment and risk factors
- ODH: https://build.fhir.org/ig/HL7/us-odh/
- Desire to decrease burden of data collection and use by increasing consistency when appropriate
- requirements analysis across IGs ?
- self-reported vss vs validated information?
- Ioana proposed a requirement for pulling together all stakeholders to collaborate on a comprehensive approach to all of the aspects referenced above. The response from Patient Administration is that their resources are more self-reportedfor patient identification. Military Service does not allow self-reported information without validation for billing purposes. Could be a workflow from self-reported to request to VA for validation processing then if validated, data are enriched with additional information from the VA, e.g., hazardous exposures, treatment. Biological gender and gender orientation represent some aspects that are not currently addressed by other Workgroups. Once reported information is known, it becomes evidence to identify types of exposures, risk factors, and billing-related uses. The information also affects social determinants of health. Multiple projects care about this information and consistent representation is required. E.g., define validation use case, public health use case, administration/billing use cases.
- Genny discussed Occupational Data for Health (ODH) that includes some data about military experience (including civilian exposure and also civilian time in a combat zone information for contractors).
- Mary Kay: There is an over-arching need to have this kind of information available for other projects (e.g., DaVinci, Gravity, etc.). Eligibility for certain programs requires evaluation of such criteria.
- Peter Muir: There may be another use case to determine access to clinical information based on current military status (i.e., authorization policy) - This concept may be a future scope consideration.
Recommendation: Consider a new project with scope to harmonize representation of military status. Balloting may occur through other projects, but this project would consolidate and define the method for representing military status. Other Workgroups need to be involved (Patient Administration, Financial Administration, Patient Care, etc.)
Ioana will work on a PSS-lite to propose to this workgroup.
Floyd and Jean will review with TSC the concept of this Cross Workgroup Project Workgroup acting as a convener for this Military Service definition project and potentially other projects with similar needs for convening.