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HL7 TSC FMG Meeting Minutes 

Location: 
https://zoom.us/j/865863526 
(voice and screen)

Date: 2020-06-10
Time: 4:00 PM U.S. Eastern
Chair: DavidNote taker(s): Anne W.
Quorum = chair + 4yes/no
Co chairsxDavid HayxLloyd McKenzie
ex-officio
Wayne Kubick, CTO
MembersMembersMembersObservers/Guests
xHans BuitendijkxBrian PostlethwaitexPaul KnappxAnne W., scribe
xJosh MandelxJohn MoehrkexBrian PechxLorraine Constable
xGrahame Grieve



xBecky Gradl






xBrian Phinney






xAustin Kreisler






xDidi Davis






xJean Duteau






xDavid Hill






xSiama Rizvi






xLynn Laakso






xSean Mahoney








Agenda

Minutes

  • Roll Call
    • Numerous guests for projects
  • Agenda Check
    • MOTION to approve: Lorraine/Lloyd
  • Minutes from 2020-06-03 FMG Agenda/Minutes
  • Action items
    • Reviewed David's resource usage survey drafted here: http://clinfhir.com/survey.html. Will tidy up the list of resources. Should we capture the version or versions they support? Grahame can provide a list of resource names with aliases. John: Asking for the version might be noisy. Consent in STU 3 is different than STU 4, for example, but it might not be worth making it more complex. Lloyd: We could list them as separate resources. David: We could have a checkbox to check the version you're using. John: We could just ask them if it's okay to contact them for more detail and ask them to provide email if so. Could add checkboxes on the top so they can click the versions that they use, or differentiate on the individual resource. Capture name, organization, product, and email in text boxes, then the three version text boxes, plus "other." Grahame/Wayne could provide some text for the top of the page.
  • Review Items
    • HL7 Implementation Guide(s) for CDA® Release 2 & FHIR® Release 4: Healthcare Associated Infection Reports PSS
      • Old version of PSS: http://www.hl7.org/Special/committees/structure/projects.cfm?action=edit&ProjectNumber=1192
        • Austin here to represent. Is a scope update to an IG that covered both FHIR and CDA data. Principle scope will be  on the CDA side with COVID19 data elements. Lloyd asks why it's not happening on the FHIR side yet? Austin: The updates aren't covered yet for the FHIR side. Lloyd: Does the scope prohibit the FHIR side from including the changes? Austin: It's non-specific on the FHIR side right now. 
          • MOTION to approve: Lloyd/Paul
          • VOTE: All in favor
    • Nutrition Intake FHIR Resource Proposal
      • Becky Gradl and Lorraine here to represent the proposals and the PSS. 
      • These have been in draft in the build for several cycles now.
      • Observation was not sufficient to meet this need.
      • Lloyd notes fluid intake is typically captured as an observation. Becky: Parenteral nutrition has always been handled in pharmacy and captured by pharmacy resources. Enteral nutrition has been handled by dietitians. Lloyd: Should coordinate with OO for their guidance on what to use and overlap with observation.
        • MOTION to approve with suggested examination of resource boundaries: Hans/Lloyd
        • Lloyd notes they need to describe what the relationships are in resource relationships
        • VOTE: All in favor
    • Nutrition Product Resource Proposal
      • Group reviews
        • MOTION to approve: Lloyd/Hans
        • VOTE: All in favor
    • HL7 FHIR Implementation Guide (IG) for the Nutrition Care Process PSS
      • Lorraine describes the project. Will be coordinating with Patient Care. 
      • The original nutrition DAM was specific to nutrition orders. This expands to include the nutrition care process as a whole from the dietitian's perspective. Profiles are expected to be on existing resources.
      • This year the DAM will be updated, with IG created next year.
      • Lloyd: Seems primarily how to use existing resources. Might want to have references to the IG within the core spec.
        • MOTION to accept: Hans/Lorraine
        • VOTE: All in favor
    • PACIO Cognitive Status IG Proposal
      • Dave Hill here to represent
      • David suggests expanding eLTSS in the description 
      • Update timeline 
        • MOTION to approve: Paul/John
        • VOTE: All in favor
    • PACIO Functional Status IG Proposal
      • Dave describes
      • Expand eLTSS and IRF-PAI
      • Update timeline
        • MOTION to approve: Hans/Paul
        • VOTE: All in favor
  • Discussion Topics
    • Technical correction for CDS Hooks
      • Da Vinci has made a request that there be a frozen snapshot taken of the CDS Hooks spec, in particular hook definitions, so they can point to something in their specification that is frozen. We could and should broaden the discussion to the notion of policy around making snapshots, snapshot approval and snapshot management for any and all FHIR specifications. Question from Lynn is are we going to have a formal process that the TSC approves? John: Worried that we would allow a specification to have a normative pointer to something that doesn't exist. Lloyd: This is an STU spec that is based on CDS Hooks and we want to point to hook definitions that may or may not be balloted soon, but we need it to be a stable reference. Grahame: It makes perfect sense that they want a stable reference using a snapshot. Josh: It's the way that these things are published that causes confusion. People have trouble finding the right content. Grahame: We have the same problem with FHIR itself, but it seems manageable. The CDS Hooks side is not labeled as a continuous integration build, but it is. Lloyd: We need a process in FMG for everything that's in the FHIR family for people who want a snapshot. Grahame describes his snapshot process. CDS Hooks doesn't generate past versions on an ongoing basis - it only generates the current version. Discussion over FHIRPath and CQL. Need to get on top of this now that FHIRPath is normative. Lynn: What is the documentation and approval path? Grahame: One issue is formal publication and the other is publication of a snapshot. So far any committee can come to FMG and ask for a snapshot without authorization from TSC - it's a management process. Should have a minuted approval in FMG minutes for publishing a snapshot of "x". 
        • As a result of this discussion, there is general agreement that a CDS Hooks snapshot may be created for the purposes described
    • Gaps in care/DEQM ballot question
      • They are adding stuff to the scope of their IG. Do they need to do a new IG proposal? Or revise and resubmit their previous proposal?
      • They could send via email the new short and long descriptions for review and inclusion in the registry.
  • AOB (Any Other Business)
    • No call next week
  • Adjourned at 5:35 pm Eastern