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Agenda


QuarterRoom SizeAgendaHostingChair/Scribe 
(Attending)
Invitation StatusQuestions/Notes/Proposed Topics
Mon Q1Chula Vista Boardroom 10 

PC Admin

  • approve minutes from Sept 2018 WGM - Patient Care Agenda and Minutes
    • Approve all minutes, except Thurs Q2 (need to talk to Stephen and Laura):  Michael/Emma:  6-0-1 
  • review agenda for the week
  • Anesthesia intra-procedure DAM PSS request
PC Michelle/Emma


Mon Q2Regency Ballroom East 1/2 

Provenance

PCJay/EmmaAccepted: SD


Mon Lunch






Mon Q3aRio Grande East

Clinical Notes in FHIR (continuation from Jan 2018)

SD/PC


NEW TIME
Mon Q3Regency Ballroom East 1/2 
Mega Report OutEHRNot Applicable
(Laura/Emma) 
Accepted: PC
Mon Q4Blanco 

FHIR Workflow

FHIR-IMichelle attendAccepted: PC
Tues Q1 Regency Ballroom East 1/2 40

CIMI

PC Jay/Laura 

EC

Accepted: LHS, CIMI


Tues Q3Rio Grande East 30

FHIR Admin / trackers

Ryan Howells Dave Hill - focus on FHIR-based post-acute care interoperability

2019-01 WGM FHIR Tracker Backlog

PC Michelle/Michelle Accepted: FHIR-I
Tues Q3bMaverick B 
EHR - Hot Topic Reducing Clinician BurdenEHREmma/ Laura/ Mike P
No invite was sent...not sure if this is planned for Thurs or Tues. They announced in the Mega report out they are meeting Thursday Q1 and Q2 on Clinician Burden
Tues Q3 and Q4 Mesquite

v2.9 reconciliation

V2 to FHIR

OO Vassil Peytchev (attending for Amit Popat)

 OO WGM Agenda


Tues Q4aRegency Ballroom East 1/2 40

PC/Vocab

Negation ballot

Documentation Templates and Payer Rules (DTR)  PSS

GF#17946 Confusion regarding 'status' and 'outcome' metadata elements of "Procedure" resource (In Person with Floyd Eisenberg / CQI)

Opiate care plan CDS

PC Jay/Emma 

CQI

Accepted: Vocab, CIMI, OO, SD


Tues Q4bMaverick B 
"Podiatry Functional Profile" Joint Meeting (EHR WG hosting): Attachments, CIMI, CQI, O&O, Patient Care, Pharmacy Head count does not include formally invited WGs EHR 

Declined:  PC

(PC did not accept and are not available) 



Wed Q1 Regency Ballroom East 330

FHIR Trackers

2019-01 WGM FHIR Tracker Backlog

PC Michelle/Michelle Accepted: OO 
Wed Q2a Directors 

Joint with PA 

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

Blood Products, tissue and biological product (update needed)

OO  Michael Padula

Wed Lunch Rio Grande West 30

Clinicians on FHIR Lunch (PC will reserve room)

Agenda

  • Discussion - Possible Use Cases
    • Child Health
    • Medication
    • Care Team
    • SDoH
PCLaura/GeorgeN/A
Wed Q3a Mesquite 

Observation-Media-DocumentReference/DiagnosticReport-Composition OO owned FHIR resource review

OO Not Applicable 
(Michelle/Jay)

CDS, SD, CQI, FHIR-I

Accepted: PC 


Wed Q3b Rio Grande Center 
Common Clinical Registry Framework CIC Not Applicable
(Laura) 
N/A 
Wed Q4 Regency Ballroom East 3 30 

FHIR Tracker (AdverseEvent)

2019-01 WGM FHIR Tracker Backlog

Boundaries with a new resource for Incident or Accident (PA tracker GF#14199)

PCMichelle/Michelle Accepted: BRR
Thurs Q1Rio Grande Center 40

CarePlan report out (mega report out about all things care plan without diving into any details)

  • Care Plan
    • CarePlan Type - Rob McClure
    • Dental Interoperability Investigative Project - Todd Cooper
    • CCDA - Lisa Nelson
    • Essential Information for Children with Special Healthcare Needs - Mike Padula
    • NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro, Sabrina Gonzaga
    • ELTSS- Reporter TBD, (Jonathan Coleman) Targeting a May STU ballot
    • Nutrition - Margaret Ditloff
    • Patient Care Care Plan 2.0 Project - Laura Heermann, Emma Jones, Jay Lyle
    • IHE DCP/DCTM: Care Team update while Care Planning- Emma Jones
    • FHIR Resources
PC Laura/Emma

Accepted:  LHS, Pharm, SD


Thurs Q2a Rio Grande Center 25

CDA deep dive

DaVinci PSS - eClinical Data Exchange

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 

Laura/Jay/Michael

(Michelle attend)

Accepted: SD


Thurs Lunch Rio Grande Center10 

Co-Chair Admin (plan next WGM agenda) 

Confluence info architecture

PC Michelle/Michelle N/A 
Thurs Q4 Rio Grande Center 

CareTeam DAM Ballot Preparation


LHSNot Applicable 
(Michelle/Emma/Laura attend)
Accepted: PC 

Care Team DAM ballot pres

CIMI with LHS Wed Q3


Friday Rio Grande West 
Clinicians on FHIR (Russ will reserve room) 




Minutes

Mon Q1

Chair:  Michelle Miller
Scribe:  Michelle Miller

Approved minutes from Sept 2018 WGM - Patient Care Agenda and Minutes

Approve all minutes, except Thurs Q2 (need to talk to Stephen and Laura):  Michael/Emma:  6-0-1 

Review agenda for the week

Regarding the Anesthesia intra-procedure DAM PSS request, Patient Care has a few questions:

Mon Q2

Chair: Jay Lyle

Scribe: Emma Jones

Provenance

Discussion  - Brett Marguard

Ask:

1) Do we need a new project

2) Is PC and SDWG the logical WG to co-sponsor?

3) Where is the logical home? 

Addl info - 21st century Cures Act and USCDI  proposed expansion process lists Provenance along with narrative. 

Addl info - DoD has a project. 

October 2018 WGM - Joint with PC and SDWG

Need to understand how provenance is functionally produced or originate the provenance information.

C-CDA IAT - 

one-hop back may lose the notion that patient generated the data if originated from the patient. 

IAT, the WHO is not only the who handed it to you should include the who created. Suggest including the who and the when. 

the "one-hop" prior should include "at least" - if not carrying the entire provenance

Suggest taking a look at David Hay's blog on provenance. it also includes clarification of the verification resource is complementary to FHIR. 

Distinction between author and performer - noting that author is a loaded term. 

May need to get into the 'what' to determine the role and activity related to the provenance. 

Question from the VA was if there is more than one link in the provenance chain, would be interesting to know what is the weakest link. 

Notion of weakest link implies a judgement call - suggest provenance is captured in an objective way 

Prior provenance efforts -

Discussion should be on systems functional behavior of capturing provenance information - why is EHR work group not the home?

Security WG - Provenance core model is predominantly derived from W3C Prov.

Does EHRWG provides guidance on "How" systems should capture and deal with provenance? Need something that says - use this. 

The challenge is when the work requires expert resources on what to do. HL7 is having a challenge of getting the right community together. 

Data Provenance IG vision need

Additional things to add

Is patient care and SDWG the logical WG to be considered for co-sponsor? Patient Care is interested. So is SDWG. CBCP (formally CBCC) would like to be interested party. 

Motion for Patient care would like to be involved in the project procedural and analysis development of the requirements and use case discussions

Moved: Brett/Second: Chris Hall

No further discussion

43 for; 0 against; 0 abstain

Project is planning on going to security as primary sponsor. John M does not think security should be the primary. Suggest EHR-FM 

Suggest the EHR-WG should be involved as interested - to ensure that the functional requirements are captured correctly. 

Others think it should be owned by security - security owns the FHIR resource

Concern with separating the work out - CDA Mgmt group is currently trying to figure out the ownership of some templates that was designed by one work group but doesn't seem to be working functionally. 

Seem to have a chicken and egg situation - there are multiple different ways of looking at provenance. Need to consider all the use cases and define provenance. Then from there, determine the end goal for the project. When this is done then the participants can be identified. 

Question is about governance - what work group should be the sponsor? what work group that has some level of authority and would like to exert. Have not heard from EHR-WG leadership in this meeting. Suggest talking to them about their interest in participating. 

Currently have 2 options - The way currently being approached or suggest using Standards as a service process. 

Plan on having discussion with CBCP and EHR-WG

Suggest bringing this up with Gemini as a possible IHE project

Conversion of Hl7 messages or CDA documents to FHIR resources - capturing provenance of that - is it part of the use cases?

 - Yes, but not a primary use case. 

Clinical Status - Moved to thursday Q2

Ownership of Clinical Content - Moved to Thursday Q2

 - collaboration between PC and SDWG. 



Mon Q3

Mon Q4

FHIR - I workflow

Overview of workflow patterns provided by Lloyd. Example Scenario resource is meant to organize the workflow 

Currently no active change requests on the event pattern - currently at maturity 3

R5 - will try to enforce the workflow mappings. Will move the example resource forward. 

Examples to cover the context of use 

 -  examples like diagnosticRequest and serviceRequest is helpful for the community to see how this happens in the real world. Talked about desire of creating examples based on templates. 

Workflow calls information is located here


Questions

What is the maturity level for workflow patterns?

Message header resource has an event type code that has no valueset. Will there be a normative valueset? Have not had a request from the community for one.

Imaging study resource represents DICOM imaging studies that can be created at several points in time with or without procedure. Question from the imaging workgroup is if imaging should follow the event pattern. This is a discussion for the II members to be convinced why this will make sense. 

Anyone looking to forward systems protocols - FHIR-I have a sense of what needs to be done but want to work with someone who is actually wanting to do this. 

OO is the owner of the Task Resource - can one of the WorkFlow calls can be used to talk about task resource? FHIR-I can make that work. 

Connecthathon Planning for May 2019 - Is there an effort to get a task based testing done? Have not had a request from the last 2 connecthathon. If anyone is interested in this will be happy to see that happen. 

Is messaging part of workflow? It is part of the infrastructure methodology. See List of patterns here.


Tues Q1

Joint with CIMI, EC, 

Agenda –

Skin and Wound

Pain Assessment

Process to get in the project Queue

Update on Care Team


 Notes:

Tues Q3

Normative implications

Resources targeted for normative (FMM=N) in R5 

Increase FMM level as noted below

Note:  to clean up QA reporting, we need to do RIM mappings.  Lloyd said he might be able to help with RIM mappings once JIRA is up.

Draft Resources (currently, FMM=0)

Any implementation guides?

The expectation is that the Patient Care WG will begin helping implementers via IG publications once resources are normative

What is timeframe to get resources at the new levels?

One sentence for R5

Ryan Howells - focus on FHIR-based post-acute care interoperability

Tues Q4a

Chair: Jay Lyle

Scribe: Emma Jones


Negation ballot

Reviewed comments Number 19, 20, (83 - Floyd E. moved to adopt the proposal to be persuasive to change the wording. May T second: 28 for - 12 abstained - 2 against)

Documentation Templates and Payer Rules (DTR)  PSS

GF#17946 Confusion regarding 'status' and 'outcome' metadata elements of "Procedure" resource (In Person with Floyd Eisenberg / CQI)]

Opiate care plan CDS

Tues Q4b

Wed Q1

Chair:  Michelle Miller

Scribe:  Michelle Miller

CarePlan

Goal

AllergyIntolerance

FamilyMemberHistory

Wed Q2a

PA hosted quarter

GF#16148 Encounter.reason and Encounter.diagnosis - defer to joint conference call on Jan 30 at 3pm Eastern
GF#14199 Open up Task.context to reference other resources
GF#15177 Does CareTeamCategory: Episode need to be linked to another Category for context? - 2018-Jan VHD #8
GF#13601 Common "patient" searchparam has non-patient target
GF#17304 Encounter needs a outcome element

Touched on VerificationResult being used for CarePlan reviews

Wed Q2b

Wed Lunch 

Wed Q3a

Wed Q3b

Wed Q4 



Chair:  Michelle Miller


Scribe:  Michelle Miller



Boundaries with a new resource for Incident or Accident (PA tracker GF#14199)


AdverseEvent Resolved

Discussed, but no vote:. 

Thurs Q1

Care Plan 

Thurs Q2

DaVinci PSS - eClinical Data Exchange (Viet Nguyen, Bob Dieterle)

CDA deep dive

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)

Keep same time for the next WGM. PC will request the room

Thurs Lunch 

calendar for May 2019 reviewed and updated

rooms for May 2019 requested . http://www.hl7.org/Events/MeetingPrep/reports/ViewWG.cfm . 

review of WG documents done - SWOT needs updating, will do at next co-chair call

conference calls to be set up-


Thurs Q4


Friday Q1 

January 2019 Clinicians on FHIR SDH

Presentation: 

Discussion:  Clinicians on FHIR’s best option for Care Plan 2.0 DAM is to draft an SDH white Paper.

Summary:

Factors:

Care Plan Resource

Questionnaire Response Resource