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Agenda


QuarterRoomSizeAgendaHostingChair/Scribe  (Attending)Invitation StatusQuestions/Notes/Proposed Topics
Sun Q6L506
FHIR QA - Enhancement RequestsCIMI

Claude will send meeting room
Mon Q1

PlenaryN/A


Mon Q2

Plenary

N/A


Mon Lunch






Mon Q3Parlor 111410

PC Admin

PCMichelle/Michael Tan
Note:  If we need to free up a quarter, we could try doing admin during Mon lunch
Mon Q3M101
Mega Report OutEHRStephenAccepted: PC
Mon Q4a

FHIR Workflow

FHIR-IMichelleAccepted: PC
Mon Q4bParlor 111420

IPS

  • HL7 ballot comment review
  • Review IPS cross SDO initiative
    • IHE IPS Profile development
      • CEN
      • ISO
      • SNOMED
      • HL7
    • ISO IPS work
PCMichael Tan/Michael Padula/EmmaEHREHR as co-sponsor of PSS
Tues Q1Imperial Salon A40

CIMI

PC Jay/Emma

Accepted: CIMI, LHS, ED 


Tues Q2M10140

Joint with SD:

  • Provenance - ballot comment review/updates?
  • Clinical Status - ballot comment review/updates?
  • IPS update (5 min)
  • Clinical notes - ballot comment review/updates?
PC

Emma/Michael Tan

Attend: Stephen Chu/Michael Padula

Accepted: SD
Tues Q3M10430

FHIR Admin / trackers

GF#23061 Communication needs to explain the boundary between it and messaging

https://chat.fhir.org/#narrow/stream/179166-implementers/topic/Messaging.20vs.2E.20Communication

GF#22648 Is CommunicationRequest.payload intended for the sender or the recipient?

PC Michelle/Michelle

Accepted: FHIR-I

INM interest

DaVinci use case is interested in GF#23061
Tues Q4Imperial Salon A40

PC/Vocab

(Negation ballot - Vote on resolutions and close)

CPG-on-FHIR Project

  • Update on the CQF Recommendation Ballot
  • e.g. Opiate care plan (CDC); Chronic kidney disease, etc

Possible additions:

New  - AMA - Patient Referral - Seth Blumenthal

Elective Procedures GF 24014

Principle vs Primary Diagnosis

Principle vs Primary Procedures (22786 - Request "priority" element for procedure resource; 24014 - Inconsistent modeling - attributes in Claim and Encounter diagnoses and procedures)

Trackers:

  • withdrawn 20658 – Managing inter-related procedures using Event resource – FHIR-I tracker against the workflow pattern
  • US Core resolved 20527 - Request for Principal Procedure (to Structured Documents) – this is a US Core IG / SD tracker
PC Jay/Emma

Accepted: SD,Vocab,CIMI, CQI, OO

PA


Wed Q1L507

Joint with PA

  • PA artifacts and shared resources (Person, Practitioner, Encounter, etc)
PA Michelle/Michael Tan

Wed Q2L507

Joint with PA 

  • Care Team (LHS)
  • GF#11173 CarePlan needs support for reviews -
    • Resource VerificationResult (PA please provide overview)
  • GF#23843  Encounter should support a reference to CareTeam
  • Claude
    • GF#16147 Condition.category - can be used to specify granular type code? 2018-May Core - In Person Claude
    • GF#20483 Add Encounter.diagnoses elements to Condition In Person
    • GF#16148 Encounter.reason and Encounter.diagnosis (PA) In Person
PA Michelle/Michael Tan/Stephen/EmmaLHSSDWG (made aware of this quarter) - topic (Primary Diagnosis, Principle diagnosis, secondary diagnosis)
Wed LunchM10920Clinician-On-FHIR PCEmma/Stephen/Laura

Wed Q3a 

OO owned FHIR resource review.

  • Observation-Media
  • DocumentReference
  • DiagnosticReport-Composition
OO Jay/Michael Tan

CDS, SD, CQI, FHIR-I,

Accepted: PC 


Wed Q3b

US Core Cross Group Project Work formationSDEmma
Note: SDWG meeting about the new "US Core Cross Group formation" Suggest PC send representative to SD instead of Thurs Q2 - Rm 1107
Wed Q3cParlor 111420

FHIR QA - recommendations - Claude

FHIR Trackers

  • GF#22734 QA: Add Binding to ClinicalImpression.code 
  • GF#18859 Definition/description at odds with what clinical impression is - STU #208

2:30pm CDex Update - Viet (10 mins)

PCMichelle/Stephen
Claude - FHIR QA Work??
Wed Q4 Imperial Salon A30 

FHIR Tracker (AdverseEvent)

  • GF#22742 QA: AdverseEvent code systems need definitions for all codes
  • GF#22739 QA: AdverseEvent is missing entered-in-error status
  • GF#22108 AdverseEvent is missing status
  • 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#11021 Increase cardinality of substance and make certainty relation to substance not reaction - 2016-09 core #40
PCMichelle/StephenAccepted: BRR
Thurs Q1Imperial Salon A40

CarePlan report out (mega report out about all things care plan without diving into any details) (5 minutes allowed per topic below)  

  • Patient Care Care Plan DAM 2.0 Project - Laura Heermann, Stephen Chu, George Dixon, Emma Jones 
  • Essential Information for Children with Special Healthcare Needs - Mike Padula 
  • Care Plan 
    • NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro, Zabrina Gonzaga 
    • Nutrition - Becky Gradl 
    • Podiatry - Michael Brody, DPM 
    • Personal Advance Care Plan (update) - Lisa Nelson
  • Gravity Project - Lisa Nelson 
  • Care Team DAM (LHS) - Russ Leftwich
  • CCDA 
    • Care Team entries - Emma Jones 
    • Care Plan - Lisa Nelson
  • FHIR Enhancement Project (LHS) - Russ Leftwich 
  • FHIR Workflow
    • IHE DCP/DCTM: Care Team update while Care Planning- Emma Jones
    • FHIR Connectathon - Care Planning and Management Track working with Clinical Reasoning Track
      • Dave Carlson 
      • Jeff Danford/Emma Jones
PC Stephen/Emma

Accepted: SD, CBCC, Pharm, LHS, CIC, ED


Thurs Q2Imperial Salon A30

CDA deep dive

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

Collaborative Template Review Project (CDA Management)

Stewardship of clinical content (Need hearty representation from SDWG)

Clinical Status (Need hearty representation from SDWG)

Care Team - FHIR/CDA Alignment

                  - CareTeam.member/participant (status, role, function, skills, etc.)

PC 

Emma/Stephen

Accepted: SD

*New - Cross Work Group for US core work -  SDWG Hosting) Per SDWG - This will be a project meeting around the transition process - will not be discussing ''specific clinical topics"

Thurs LunchM10910 

Co-Chair and Editors admin

(plan next WGM agenda) 

PC Michelle/EmmaN/A Need to include dedicated quarter with SD among plans 
Thurs Q3M10435

PACIO Project - Dave Hill

Care Team

  • gForges ??
  • DAM ??

CTSA - an introduction topic

PC 

Emma/Stephen

Attend:  Russ


Care Team content with LHS - will update list during 9/10 call. Need to confirm if Claude will be available during this time. 
Thurs Q4 Imperial Salon A

CareTeam DAM Ballot Preparation

Claude's quality criteria

CareTeam CDA templates

LHS
Accepted: PC 
FridayM103, 104, 105

Clinician-on-FHIR

Care Plan (Team Member Discussions




Russ will request the room



Minutes

Mon Q1

Plenary

Mon Q2

Plenary

Mon Q3

Mon Q4a

Mon Q4b

Slide deck from Giorgio Cangioli and Rob Hausam:


IPS overview - 

FHIR Ballot

IPS initiative Coalition

Tues Q1

CIMI Projects Overview



Process - Interoperable App Development Process

Domain Analysis →Create Logical Models (CIMI)→Approve Models →Model Repository →Create FHIR Profiles (transform from logical model to FHIR)→Artifact repository (FHIR profiles)→create software

Tues Q2

Clinical Notes:

IPS:

Basic Provenance:

Clinical status

Tues Q3

Close the dental interoperability investigation project:  Todd/Lyndsey:  16 approve-0 negative-2 abstain

GF#23061 Communication needs to explain the boundary between it and messaging

Tues Q4

Negation Project - Jay Slides

Gender Harmonization PSS (Rob McClure)


CPG-on-FHIR - overview by Bryn Rhodes


New  - AMA - Patient Referral - Seth Blumenthal

Discussion/Questions

Will you make use of the existing document templates like CDA Referral notes?

ServiceRequest and C-CDA-on-FHIR are containers. Patient Care would be interested in collaborating in this work. The clinical content development will inform the containers. The existing work may not be adequate. 

Public Health B-SER IG - going to be published in a few weeks. Use case is different. Want to share information about this work with you. 

Don't currently need yet another referral project - HL7 do need clinical input into existing work. Suggestion that what is needed may need a white paper. 

Work is to include actual clinical data. Slide 5 has specific clinical content as an example of the type of content. One option is to see what's in FHIR and what has been done. 

Referral content - general content and also clinical specialty referrals which a typically based on specialty guidelines and protocols. Doing this will have certain degree of specificity. If there are specific work that has been published at the human readable level, will appreciate access to it. 

Patient care would like to get a PSS. Seth is made aware of next Patient Care CO-Chair call. 



  1. Elective Procedures GF 24064 - elective or non-elective procedure which was performed during the inpatient encounter

                                                   related to a tracker 22786 - Request "priority" element for procedure resource

3. Principle vs Primary Procedures (22786 - Request "priority" element for procedure resource; 24014 - Inconsistent modeling - attributes in Claim and Encounter diagnoses and procedures)

  1. These are OO questions. suggestion is to refer to OO because patient care can not change their valueset. 
  2. Suggest reviewing the request-priority value set. 
  3. FHIR-I owns the value set that OO (service request) is binding to
    1. Patient Care is the incorrect WG on the Committee
  4. Encounter resource uses the HL7 V3 Actpriority valueset. This valueset are machine state values. The FHIR-I valuesets are a subset of the HL7 ActPriority values. 

Principle vs Primary Diagnosis

Claim resource relationship to the clinical data

Discussion: 

Is there any guidance to the defintions? 

Second use of this is quality. Trying to get the two to line up is a problem. 

The problem may be for different context, these are used in the same spot in the resource. 

Another issue may be that QI-core is mapping principal to primary in FHIR. 


List used in Institutional


Used in Professional



ICD Qualifying Codes Used

Keep this quarter for next WGM. 

Wed Q1 - Q2

Joint with PA

GF#23843 Encounter should support a reference to CareTeam

Update on Patient Merge - Merge Operation

GF#23029 CareTeam.encounter should support cardinality 0..*

GF#20483 Add Encounter.diagnoses elements to Condition 


Wed Q3a

Joint with O&O

Wed Q3c

CDex - update - Viet and Bob D. 

DoD/Va had 32 negative votes. Had a total of 317 comments. 97 negatives. 

Many Va Votes requested in-person resolutions

Plan is to do the non-in person resolutions and will bring an update to PCWG. 

Ken Rubin will help coordinate the in-person resolutions on the Community project calls (CDex calls) 

Few comments are on the underline based resource. Please send Michele a message with the ones that impact the base resource. 

Plan is to get through all the comments - will create a group in gForge identifying the base FHIR clinical resource


FHIR QA - recommendations 

  1. Condition has severity but not criticality vs AllergyIntolerance has criticality but not severity – no change needed

  2. AllergyIntolerance refers to a ‘patient’ (Reference(Patient)) vs Condition refers to a ‘subject’ (Reference(Patient|Group)) – need a use case to better justify adding Group to AllergyIntolerance

  3. Condition provides two Event extensions: instantiatesCanonical, instantiatesUri – the extensions make sense if the protocol is about diagnosing the condition (not treating the condition).  Ask FHIR-I to clarify the extension by including an example specific to Condition.
  4. GF#24681 Rename AdverseEvent.date to occurrence
  5. Recommend renaming ‘detector’ to ‘asserter’ and ‘detected’ to assertedDate – consider logging change request (AdverseEvent has not been aligned with Event pattern yet)
  6. Consider renaming ‘outcome’ to ‘status’ or a more descriptive name. Name is confusing – referenced existing change requests related to adding a status.  
    1. GF#22739 QA: AdverseEvent is missing entered-in-error status
    2. GF#22108 AdverseEvent is missing status

Wed Q4 

Thurs Q1

Care Plan Report out

Additional Notes for the quarter - thanks Jay

Care Plan DAM 2.0 (update) - Stephen Chu, George Dixon


Pharmacy Care Plan

CDA and FHIR Pharmacy Care Plans passed ballot. 

Pharmacists have adopted the care plan

Information from initial Pilot Site - Community Care of NC. Trained 22 vendors. Currrently using the comment only balloted version of the care plan. 

Trying to put together a survey of the actual adoption is - large chain pharmacies have adopted it. Pharmacists are capturing clinical information. 

North GA work to transmit patient condition to the food bank to be aware of the types of diets the person should be with. 

Have connected with Cerner and Epic for care everywhere. 

Questions

Personal Advanced Care Plan - Lisa Nelson

Balloted in 2007 - published

Have been implemented and also sort an extension and went to ballot during this past cycle. 

SDWG and PC are co sponsors

Have started working in the context of the Gravity work. Still have activities that need to happen. Currently can't publish as an STU- will need another iteration. 

Petitioning the TSC to be able to go to normative. Vote taken

Lisa Nelson: Motion for PC to support the PACP project requesting TSC to address the issue for this project be able publish as an STU 2 following normative process. 

Scott Roberts: Second

Abstain: 3; Against: 0; For: 23


Gravity Project (update) - Lisa Nelson


Ask PCWG to take up sponsorship of their first PSS

Overview provided. 

One goal is to address how to add documentation (coded) around SDOH. 

Looking at collection of data in food insecurity, housing, transportation access

Progress in food insecurity so far

Looking across the cycle of care. 

Project aligns with many other HL7 projects. 

Goal is to leverage work that has already been done. 

Currently have 714 individuals participating in the project. Moving to build FHIR IG against the various domains. 

Timeline up to May 2020 for the first domain

Will do a new PSS if the scope gross across the initial 3 domains

Plan is to have versions of incremental prgress. 

Scope for the PSS is to work on the 3 domains one at a time

PC as primary sponsor or interested party (working with the Vocab work group)

Output is a FHIR IG

PC would like to take a look at the PSS - PSS is under the gravity project page

Will schedule a co-chair meeting on Sept 23 to vote on this PSS

C-CDA Care Team

Nutritional template in the C-CDA

Nutrition (update)

Contributing to the Gravity project

C-CDA Care Plan (updates)

Templates haven't changed

Care Team DAM

LHS Care Team DAM - Q4 today

Updates to FHIR careTeam resource - encounter removed

Previously stated in FHIR R4 - careTeam resource description updated in the current build. 

Care Coordination FHIR Track (overview) - Dave Carlson

Nursing Care Plans

Use of Task to support workflow

Integration of CQL in Clinical Reasoning

DaVinci Track

Payer coverage uses multiple care plans in bundles that are sent from payer to payer. 

Dental Interoperability Project (update provided by Stephen Chu)

Thurs Q2

Dental Summary Exchange Project


Plan - Short term - CDA templates extending C-CDA

Currently exploring FHIR aspects but not ready to do that work yet. 

DoD project

Have 3 vendors participating

Meetings Wed 2:30 - 3:30 pm

Hoping to ballot next fall. 

What involvement would PC like to have. 

Discussion: 

The intention is a patient transitional perspective - More longitudinal aspect - Dental history over a certain amount of time. 

US realm is the scope. 

Project site - under PIE work group

PSS have been approved by PIE and co-sponsor by SDWG

PC would like to be interested party

CDA Management Group overlooks the quality of the IG

Vote will be done at the Co-Chair call on the Sept 23, 2019 - 5 pm EST. PSS is here

This project is not related to the dental interoperability project but they are aware of the project. 

CDA DeepDive

Working on three year management project

Working with HL7 Affiliates on where in the world there are most implementations

Currently CDA documents have a bad rap about quality - doing some implementation work on how to deal with this. 

CDA R2.1 - Normative ballot is done and has been approved by HL7 for publication

CDA Management team will be educating folks about 2.1 - both versions will be published. CDA 2.0 will continue to be the based standards to go forward. 2.1 is backwards compatible with 2.0. Anything that currently validates will continue to validate. 

C-CDA on FHIR - Pattern is being used by FHIR documents. 

Collaborative Template review Project

PC - Problems and Allergy

FM

Medications

PC is the only group that have made progress. Changes have been made to align with FHIR work. 

Haven't made progress with transfer of stewardship of some of these value sets. Will need to continue to work together for now. 

After the companion guide work on open question around persistent IDs. What are the expectations on keeping persistent IDs so systems can know elements with same IDs may be the same. 

Problem concern and what it means to FHIR. FHIR does not have the notion of concern on the FHIR side. Need to continue to work with PC on carrying this over to the FHIR side. 

Discussion:

Disconnect between PC perception of health concern and SDWG notion of concern. 

Another area for progress may be with the transition to UTG. VSAC value sets have been moved to UTG. May provide the opportunity for patient care to review these value sets and provide updates/feedback. 

VSAC publication is updated June annually. HL7 remains the stewards but the authorship roles can be changed. 

Process for deprecating or adding values - OID is bound in the templates. If changes are in the scope of what is defined can erased and change the values. 

Big issue: UTG need to be able to document the need and rational for changing values in value set - need to require where value sets are being used so that changes to value sets doesn't break other IGs that uses the same value set. 

Care Team 

Care Team Member Function value set. Meant to describe roles on care teams. 

Suggestion to add examples to the VSAC description. 

In CDA this is the function code - usually on participation elements. Based CDA already binds values there. It can be extended. It's expressed in HL7 codes. Our function codes were expressed in SNOMED codes. Did a grouping value set but discovered overlap. There were 5 codes that overlapped. PCP is one one of the code. PCP - primary care physician. The problem now is in two spots

  1. Primary care provider has old and new code
  2. Primary care practitioner is an new code but there is no old code for it

Recommendation - back away from putting primary care physician to eliminate gap. Keep the SNOMED code for primary care provider. 

Harmonization group will not change the description to because it's bound to the notion and can not change notion because that changes meaning. Will need to a new code. 

Will remove SNOMED Primary Care Physician - prevent duplicate

Keep SNOMED Primary Care Provider

Suggestion is to take this discussion to SDWG Example Task force to get implementers input. 

Clinical Status

FHIR has clinical status (relates to condition of the patient) and Verification status (clinical workflow status)

Other resources has status that are not consistent across the FHIR resources. 

PC has been trying to get FHIR to sort out the differences between a workflow status and clinical status. This relates to outcome as well - outcome is a type of clinical status. 

This is a giant design flaw. So far the alignment seem to be with condition and allergy. Have not dealt with this across other resources. 

Claude Nanjo CIMI quality work can include this topic and gForge items will be created. Stephen will follow-up with Claude. 

Thurs Lunch 

Michelle drafted Sydney agenda and will send room requests & invitations.

We agreed with her draft.

SD question about PC stewardship of clinical content. We are getting the PSSs anyway; maintenance is an open question.

Thurs Q3

PACIO


Support use of CMS Data Element Library

PACIO goes beyond the DEL. 

Discussion

Thurs Q4

See LHS meeting notes.