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Agenda


QuarterRoomSizeAgendaHostingChair/Scribe 
(Attending)
Invitation Status
Mon Q1
 Plenary Not Applicable  
Mon Q2

Plenary
Not Applicable
Mon Lunch Annapolis FHIR Committers FHIR-I Michelle  
Mon Q3a
 Mega Report OutEHRNot Applicable
(Laura/Emma) 
Accepted: PC
Mon Q3b Guest Room 317 10

V2 Chapter 11 & 12 (Ask Amit to let OO know)

PSS for coordinated DAM (allergy/immunization)

PC Jay/Michael T
Mon Q4Constellation CD 

PC/OO FHIR Trackers

    • GF#17576 - Observation.comment cardinality (vs Observation note)
    • ValueAttachment vs Media
    • Guidance for interpretation of an observation using Codes, Coding, Components, Precondition or Panels.
    • Plus on the workflow side a question on tweaking whether to tweek the definition of event status - unknown definition
    • GF#17359 Task and Procedure resources completely overlap - need clarifying descriptions (in person)
OONot Applicable (Michelle attend)Accepted: PC
Tues Q1 Constellation CD40

CIMI

PC Jay/Laura 

Accepted: LHS, CIMI, EC

Tues Q2Columbia40

Clinical Notes in FHIR (continuation from Jan 2018)
* Update on the Connectathon
* Update from Argonaut 

Evelyn Gallego - Introduction to CMS Electronic Medical Documentation Interoperability (EMDI) Initiative EMDI Pilots (5 minutes)

PC Michelle/Emma SD 
TuesQ3Constellation E30

FHIR Admin + FHIR Trackers 

Follow-up / old business

  • GF#17359 Task and Procedure resources completely overlap - need clarifying descriptions (this is the PC tracker for Procedure)
    • GF#19109 Task and Procedure need clarifying boundary descriptions (this is the OO tracker for Task) – resolved in Mon Q4 during joint OO/PC
  • GF#16190 - prior motion (to find tracker persuasive) was defeated, but gForge requires a second motion (to find tracker not persuasive) in order to have a successful vote

CommunicationRequest

  • GF#17902 Description for Communication resource may need to be updated 
  • GF#13936 CommunicationRequest - intent value set

Goal-related trackers

  • GF#17755 Add support for conveying whether the goal is a one-time goal or an on-going goal 2018-Sep Core STU
  • GF#17756 Consider whether Goal.status should be split into 2 elements 2018-Sep Core STU
PC Michelle/Michelle Accepted: FHIR-I
Tues Q4a Constellation AB50

Negation

Core binding strength issues (harmonization across realms and standard families)

Other vocab topics (e.g. Clinical Status Value Set )

Gaps in Care

CQI requested Procedure/QDM discussion (if time)

PC Jay/Emma 

Accepted: Pharm, SD, CQI, CIMI, CG, Vocab, OO

Tues Q4b   "Podiatry Functional Profile" Joint Meeting (EHR WG hosting): Attachments, CIMI, CQI, O&O, Patient Care, Pharmacy  EHR  PC did not respond
Wed Q1 Columbia 30

FHIR Trackers - allergy and condition

Condition

  • GF#18833 Remove clinicalStatus requirement constraint - STU #31 2018-Sep Core STU (in person - Corey Spears)
  • GF#18832 Add more clarity to Condition.category - STU #30 2018-Sep Core STU

Allergy

  • GF#18819 Placeholder. There are some types that may be in issue - STU #17 2018-Sep Core STU
  • GF#18831 Remove clinicalStatus requirement constraint - STU #29  2018-Sep Core STU (in person - Corey Spears)


PC Michelle/Michelle Declined: OO 
Wed Q2a Executive Boardroom 

Joint with PA 

  • Care Team (LHS)
  • Resource VerificationResult (PA please provide overview)
PA Not Applicable 
(Michelle/Emma)
Accepted: PC
Wed Q2b Chesapeake B  

Blood Products, tissue and biological product (update needed)

V2-To-FHIR

OO  OO, II, CG, BR&R 
Wed Lunch 
 

Clinicians on FHIR Lunch (Russ will reserve room)

Invite David Hay - Stephen will send invite


Laura/Stephen/GeorgeN/A
Wed Q3a Guest Room 317 

OO owned FHIR resource review

GF#15726 add unit and total cost to ServiceRequest (joint with FM/OO/PC)

OO Not Applicable 
(Michelle/Jay)
PC
CDS, CQI, FHIR-I 
Wed Q3b 
 Common Clinical Registry Framework CIC Not Applicable
(Laura) 
N/A 
Wed Q4 Baltimore30 

FHIR Trackers FamilyMemberHistory

  • GF#18848 ValueSet for BirthSex (i.e.Clinical Sex) should be XX|XY|other (e.g. XXY, XYY) rather than gender (male/female) - STU #193 2018-Sep Core STU
  • GF#18849 BirthSex may be more appropriately modelled under Observation - STU #194 2018-Sep Core STU
  • GF#18850 FamilyMemberHistory.gender should be mapped to AdminitrativeGender valueset, not BirthSex valueset - STU #195 2018-Sep Core STU
  • GF#18855 What's reason for age of family member - STU #204 2018-Sep Core STU
  • GF#18856 What's reason for deceasedDate of family member - STU #205 2018-Sep Core STU
  • GF#18857 Revamp FamilyMemberHistory.condition - STU #206 2018-Sep Core STU
  • GF#18858 Change to be condition-centric - STU #207  2018-Sep Core STU 
PCMichelle/Michelle N/A 
Thurs Q1a Constellation E35 

CarePlan report out 

https://imeet.webex.com/join/laura.heermann

  • Care Plan -
    • Dental Interoperability Investigative Project - jointly between the ADA and HL7 - related to Care Planning
    • CDA
      • HL7 C-CDA 2.1 Care Plan Document Template - Lisa Nelson
      • HL7 CDA R2 Personal Advanced Care Plan Document - Lisa Nelson
      • CDA 2.1
      • Collaborative Review of CDA Management Group Pilot Template Review.
      • Pharmacy Templates CDA IG
      • Nutrition Template update
      • gender identity
      • primary diagnosis
      • differential diagnosis
      • assessments
      • presentation section
      • CDA implementationathon
    • Essential Information for Children with Special Healthcare Needs (Mike Padula)
    • Others
      • NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro
      • ELIDS
      • Nutrition
    • Patient Care Care Plan 2.0 Project
      • Model/FHIR Harmonization - Laura Heermann/Emma Jones
      • Gaps in Care

PC Laura/Stephen/Michael T

Accepted: Pharm, LHS, SD

Thurs Q1b 
 Common Topics (Stephen will ask Eric/Rob what this is and PC rep needed)OO Not Applicable
(Rob H) 

CDS, Templates  PC did not respond

Thurs Q2 Baltimore25

Template update
Updates on CCDA to FHIR
Update on use of StructuredDefinition to represent CDA Templates

Stewardship of clinical content (Need hearty representation from SDWG)

Clinical Status (Need hearty representation from SDWG)

GF#14874 Condition statuses

PC 

Stephen/Laura

(Michelle attend)

Accepted:  SD, Templates

Thurs Q2

EHR - Hot Topic Reducing Clinician Burden
Emma?/ Laura?
Thurs Lunch Frederick10 

Co-Chair Admin (plan next WGM agenda) 

DMP Review - slight changes made

Final V2 ballot comments

PC Michelle/Michelle N/A 
Thurs Q3a 
 Clinical Statement (currently in maint state and does not require further discussion until PC is notified)CS Not Applicable 

OO
Declined: PC

Thurs Q3b Constellation E35

FHIR Trackers (AdverseEvent)

  • PC proposes a new FHIR resource - Adverse Reaction that is referenced by AdverseEvent and AllergyIntolerance
  • GF#18854 SuspectedEntity doesn't work for "certain" - STU #203 2018-Sep Core STU
  • GF#18853 The short description is significantly different in meaning to the Definition. - STU #202 2018-Sep Core STU

  • GF#18852 AdverseEvent.resultingCondition - inadequate and inappropriate for documenting adverse reactions associated with AdverseEvent incidents - STU #201 2018-Sep Core STU

  • GF#17397 Add ameliorating actions in AdverseEvent

  • GF#17238 Add attribute to capture future strategies/recommendations 

  • GF#17237 Request to add attribute for actions or circumstances that prevented harm 

  • GF#16092 Add contributing factors to AdverseEvent

  • GF#16038 Add interventions required  in AdverseEvent

  • GF#16037 Add attribute to capture likelihood of recurrence

  • GF#16028 Add who detected the adverse event

  • GF#15573 AdverseEvent.category may need to be expanded

  • GF#13698 AdverseEvent.suspectedEntity.instance should allow CodeableConcept
  • GF#11021 Increase cardinality of substance and make certainty relation to substance not reaction - 2016-09 core #40
PC Michelle/Michelle Accepted: BRR 
Thurs Q4 Constellation C 

CareTeam DAM Ballot comments

IHE Care Team Managment Profile Proposal- EJ

LHSNot Applicable 
(Michelle/Emma/Laura attend)
Accepted: PC 
Friday   Clinicians on FHIR (Russ will reserve room)    


Minutes

Mon Lunch


FHIR Committer discussion about a tooling change from SVN to Git.

Get Started with FHIR on GitHub

Using TortoiseGit with FHIR

Mon Q3a: with EHR

Mon Q3b

Mon Q4: OO/PC Joint Meeting

OO hosted the quarter with PC joining

GF#17576 Observation.comment cardinality

GF#17359 Task and Procedure resources completely overlap - need clarifying descriptions (this is the PC tracker for Procedure) – will vote when PC is hosting
GF#19109 Task and Procedure need clarifying boundary descriptions (this is the OO tracker for Task) – resolved since OO was hosting

Tues Q1: CIMI Wound demonstration project

Received many different comments.  There were comments it was difficult to read.  Other comments fell into:

Detailed notes re: the reconciliation of each ballot item included in the ballot docs.  

To do:  need to take the process part of CIMI ballot process to the CIC/CIIC discussion.  

#28

Motion made: Mark this item as non-persuasive with MOD.  To work with the sponsoring WG and the relevant steering divisions to publish ballots according to the HL7 publishing calendar in a publicly visible calendar to accommodate community and WG reviews with response times to accommodate updates and changes in the ballot documents prior to publishing for ballot.  This will keep in mind the type of ballot being pursued - acknowledging the point and purpose of "for comment" ballots to get broad review of innovative thinking.  

 

In addition - to the second point of the comment - This was an experiment asking for feedback which was not clear to the readers.  Going forward we will be clear on what is consistent with the last balloted version of CIMI and what are new concepts and beyond the last balloted version CIMI.    

 

Motion by LKHL

2nd by MK

Abstains = 0, oppose = 0, approve 25. 


#63

Discussion: Persuasive with mod:  Thank you for your comment – will take this into consideration for future publications. 

 

Motion made by LKHL

2nd by RE

Abstains = 0, oppose = 0, approve 25. 

 

#61

Persuasive with mod – it depends on the context.  Requirements may be implicit in some assests in some  cases In others they may need to be modeled.

 

Ran of time –  will take this to PC and/or CIMI calls for completion of all the other ballot comments.  

Tues Q2: PC+ SD clinical notes

Chair:  Michelle Miller
Scribe:  Michelle Miller

Clinical Notes - Presentation slides from Brett, who led Connectathon Clinical Notes track this past weekend

The recent focus (including Connectathon) was the introduction of DiagnosticReport when Lab Reports, Radiology Reports, and Cardiology Reports were added to the scope.

David Hay asked if a custom operation was considered?  He used the example of a HAPI server writing a DiagnosticReport, which doesn't, by default, mean that it will be accessible as a DocumentReference.  Similarly, if a DocumentReference is written, then ontology would need to be used to infer it is also a DiagnosticReport.

Why not replace DiagnosticReport.presentedForm (Attachment) with a Reference(DocumentReference)?  DocumentReference doesn't add any additional value that Attachment doesn't have.

Next Steps / Decisions

  1. Create an international profile for clinical notes (which may not use the LOINCs that US / Argonaut used)

  2. Log Trackers to clearly acknowledge in the specification that the boundaries are not clear (between DiagnosticReport and DocumentReference) in the sense that there is overlapping content that could be in either resource (e.g. "the green area" in the Venn diagram in the ppt linked)
    1. DiagnosticReport (GF#19249) boundaries -- OO
    2. DocumentReference (GF#19250) boundaries -- SD 
    3. Clinical Safety Checklist (GF#19251) -- FHIR-I
  3. When adding guidance in the spec about clinical notes, whether ALL servers need to be expose Binary as both DocumentReference and DiagnosticReport will be optional in base spec and IGs can make required as needed
  4. Custom operation to query both resources
  5. Log trackers for OO to consider increasing cardinality of both DiagnosticReport.code (procedures done, such as head and neck) and DiagnositicReport.category (such as interventional radiology and radiology) - include link to PPT with LOINC parts
    1. DiagnosticReport.category - GF#19252
    2. DiagnosticReport.code for procedure - GF#19253 

Regarding January Connectathon, we would like to have more clients since past Connectathons have had servers only

Evelyn Gallego - Introduction to CMS Electronic of Medical Documentation Interoperability (EMDI) Initiative

Consultant Pharmacists using consult notes embedded with SNOMED codes for exchange of MRR (medication regimen review - federal requirement by CMS) exchange with physicians monthly to meet CMS federal requirements. NCPDP formed a task group under work group 14 to write a guidance document using the consult note for this purpose.  Information can be found on the NCPDP collaborative website dms.ncpdp.org under WG 14.

Tues Q3: FHIR

FHIR Ballot Prep (source of truth)

Priorities:

Follow-up / tracker issues

CommunicationRequest - Victor asked his question in Tues Q2 instead

Goal-related tracker

 

Tues Q4a: Vocabulary. Negation, Condition Status, harmonization, binding strength

Gaps in Care - Overview provided

CQI requested procedure/QDM discussion

Negation

No Known

GF#17946 Confusion regarding 'status' and 'outcome' metadata elements of "Procedure" resource In Person Floyd 

Tues Q4b 

Wed Q1

Chair:  Michelle Miller
Scribe:  Michelle Miller

Condition

Allergy

Wed Q2a

PA/PC joint quarter, with PA hosting

GF#18825 Add a reference to Observation for Appointment.indication. - STU #23

GF#18828 (duplicate of GF#18825)

GF#18829 Make element naming and modeling more consistent for Appointment/Encounter reason - STU #27

LHS CareTeam DAM is being balloted.

PC needs to document requirements for CarePlan reviews before we meet with PA next to see if there are gaps in VerificationResult.

Wed Q2b

Wed Q3a

OO hosted quarter, with PC joining

GF#18838 Add support for instructional material - no vote (need more information from Emma) - discussion ranged from having CommunicationRequest.basedOn reference the ServiceRequest; using CommunicationRequest.payload.content (since that can be a string, Attachment, or Reference to any)

GF#15726 add unit and total cost to ServiceRequest

 

Wed Q3b

OO meeting: blood Products, tissue and biological product (update needed)

There appears to be not much progress on this topic

To follow up with OO in future

Wed Q4

FamilyMemberHistory

Thurs Q1a

Todd Cooper moved that PC be primary sponsor of Dental Interoperability Investigative Project for January. Jim McClay seconds. Motion carries 23-0-0

Mike Padula reported on Children with special needs. We have use cases modeled in CDA and FHIR. They address several topics including contingency plans. There is a grant request from HHS: tech solutions for care coordination for children with special needs. This may affect scope to support parental participation.

Shelly Spiro reported on Pharmacist care plan. The guide balloted (for comment) in September has been widely adopted. Adoption has been wide in the Community pharmacy enhanced network. Innovation center has publicized nationwide. Shelly had examples of content, but these cannot be shared publicly at this time. The specification has not been published; the team plans to address comments from last year and reballot in May 2019 as DSTU.

Structure Documents requested to address Provenance in Q2.

ELIDS report. Informative document on information requirements balloted; moving toward balloting an IG.

Margaret Ditloff reported on Nutrition. Guide is published, looking for implementers. Need to update dietetics terminology updates.

CDA Management group

Working on changing implementationathons to support ability to identify topics or questions for implementers to address.

Working on scheduling implementationathons simultaneously with FHIR connectathon

Planning joint meeting with Commonwell meeting in April

A project to enhance and harmonize CDA. Prior iteration focused on allergy & concern in CCDA; keeping clinical scope but expanding to include all CDA, viz., International Patient Summary. [and FHIR?]

Question: how do we (SD, PC) work together?

Objectives seem to be a) improve CDA, b) provide mapping & transformation guidance (non-normative but advocated by workgroups), and c) work out how to coordinate this kind of thing.

PC expressed concern over time constraints. We will discuss how PC may be able to accommodate this effort.

Public Health

National healthcare survey template has Primary diagnosis. It’s a problem observation with Code: principle diagnosis (LOINC). Question: use priority preference template instead of code? High normal delayed priority. We don’t think so. But Principle is a billing value after the fact. Instead ask LOINC what’s the right code. Change the code and reballot. (Whether this can be a revised template or a future one remains to be seen.)

Differential diagnosis also based on Problem Observation Code = diagnosis. Qualifier typeOfDiag=differential diagnosis. Actually a modifier.

These are working issues rather than status. We’ll schedule time on a call to discuss in more detail.

Need guidance on Gender: another topic for the call

Assessments. : another topic for the call

Care plan DAM 2.0.

Working out scope, e.g., how to represent allergies relationships to Orders., gaps in care, self care, advance directives, care team, reconciliation, health concern, harmonization FHIM FHIR CCDA, and other topics. See page in Confluence.

Meetings Wednesday pm.


Additional notes from GD

Agenda

Into

Patient care has been working with Care plan dam. Patient care and learning health system. Ballot reconciliation beginning. – Will carry forward Tuesday evening. 

Template update

Summary: This is being pushed to 2019, it will be placed on the list for San Antonio. Brett will send a link to documentation when available


Updates on CCDA to FHIR

Summary: Existing work is documentation on documents types for transform. FHIR documentation on what US Core profiles can be used. This material has not been recently updated. The Divinci project will be concentrating on CDA to FHIR and updates are expected over the next few months. Divinci group will be working on mapping CDA to FHIR.  Historical project information can be found on Structured Document Wiki – Lisa Nelson to provide link. 


Update on use of StructuredDefinition to represent CDA Templates

Stewardship of clinical content (Need hearty representation from SDWG)

Clinical Status (Need hearty representation from SDWG)

GF#14874 Condition statuses

Provenance (added to agenda)

Summary: Provenance appears as potential US regulatory criteria. Government wants industry to define, industry wants government to define, stalemate. This session was treated as discussion/discovery with input on vendor’s current implementation, ONC’s general need, and existing specification. Discussed use cases covering authors, assemblers, scoping options. Document specific data and data specific information.  Outcome: An informational guidance document will be generated to cover CDA/FHIR. Assumption, it will be balloted.  Timeline and owners to be determined. Proposed Principle Structured Document and Co-sponsor FHIRI. Brett will inform on final decisions. 

Discussion Bullets

Thurs Q1b

No response from OO regarding topic of interest to PC.

OO and PC already have multiple joint meetings throughout the WGM week discussing multiple topics of common interest

There is no need to continue this separate meeting stream in future

Thurs Q2

Joint session with SD, PC & templates

Thurs Lunch 

Chair:  Michelle Miller
Scribe:  Michelle Miller

v2 ballot reconciliation - votes captured in the ballot reconciliation spreadsheet (Amit)

DMP - updates pertaining to Electronic Voting and announcements via EventMobi app.  PC wants to keep the existing deviations, within Chapter 5 (quorum variances) and Chapter 7 (electronic voting variances).  Discussion about quorum requirements for electronic voting.  Motion by Laura/Stephen:  quorum for electronic voting is 7 members, where at least 3 of which are co-chairs.  Vote:  8 approve - 0 against -0 abstain

Thurs Q3a

Thurs Q3b

Adverse Event

Chair:  Stephen Chu
Scribe:  Emma Jones

FHIR resource PC inherited from BR&R

Overview provided. 

Thurs Q4


FHIR Tracker Backlog

AdverseEvent

CarePlan

Goal

AllergyIntolerance

SD / SOAP Notes

CommunicationRequest / Communication

Condition

FamilyMemberHistory

ClinicalImpression

Procedure

8 Deferred ballot comments

1 Waiting for Input (ballot-related)