SIGN IN AT http://bit.ly\HL7PC0518

Agenda 

QuarterRoomSizeAgendaHostingChair/Scribe 
(Attending)
Invitation Status
Mon Q1Saal 1, Maritim Plenary Not Applicable  
Mon Q2Salon 4, Eifel 20AdminPCJay/Emma N/A
Mon Q3Saal 2, Heumarkt  Mega Report OutEHRNot Applicable
(Laura/Emma) 
Accepted:  PC
Mon Q3 Salon 4, Eifel  20

Device Ballot Reconciliation

PC Jay/JayDeclined: FHIR-I
Mon Q4Saal 14, Köln  WorkflowFHIR-INot Applicable
(Michelle/Emma) 
Accepted: PC
Tues Q1 Saal 2, Heumarkt 40

CIMI

Status of skin & wound terminologies
CIMI current state model for adverse event
CIMI content onboarding process
CIMI publication status & implementable derivations

PC Jay/Laura 

Accepted: LHS, CIMI, EC 

Tues Q2 Salon 16, Königswinter 20 

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

PC Michelle/Emma Accepted:  SD 
Tues Q3 Saal 2, Heumarkt  20 

FHIR Admin + FHIR Trackers 

FHIR Tracker Backlog for discussion during May 2018 WGM

PC Michelle/Michelle Accepted:  FHIR-I
Tues Q3 Salon 16, Königswinter    HAI (FHIR and CDA) ballot reconciliation (Sarah)
SD Not Applicable 
(Emma)
N/A 
Tues Q4 Saal 2, Heumarkt  40Negation + AllergyIntolerance value set + Clinical Status Value SetPC Jay/Emma 

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

Wed Q1 Salon 15, Bonn  20

FHIR Trackers (Procedure)

FHIR Tracker Backlog for discussion during May 2018 WGM

PC Michelle/Michelle Accepted: OO 
Wed Q2 Salon 20, Fulda  Joint with PA PA Not Applicable 
(Michelle/Emma)
Accepted: PC
Wed Lunch Bistro La Galerie  Clinicians on FHIR update / plan for next WGM
Russ N/A
Wed Q3 Salon 19, Würzburg  

OO resources of interest to other workgroups
(Biologically Derived Product)

OO Not Applicable 
(Michelle/Jay)
Accepted: PC
Invited: CDS, Pharm, PA, CQI, FHIR-I 
Wed Q3  Saal 1 Maritim (table assigned) Common Clinical Registry Framework CIC Not Applicable
(Laura) 
N/A 
Wed Q4 Saal 2, Heumarkt 20 

FHIR Trackers 

FHIR Tracker Backlog for discussion during May 2018 WGM

PCMichelle/Michelle N/A 
Thurs Q1 Saal 2, Heumarkt  35 

CarePlan report out 

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

  • Update on Care Team Categories starter value set and Care Team member roles and responsibility value starter set- LHS (10 min)
  • Care Plan -
    • CDA
      • HL7 C-CDA 2.1 Care Plan Document Template - Lisa Nelson
      • HL7 CDA R2 Personal Advanced Care Plan Document - Lisa Nelson
      • IHE QRPH Early Hearing Detection and Intervention (EHDI) Plan of Care- Lisa Nelson
      • CDA 2.1
      • Collaborative Review of CDA Management Group Pilot Template Review.
      • Pharmacy Templates CDA IG
      • Nutrition Template update
    • Patient Care Care Plan Project
      • HL7 Care Plan Domain Analysis Model/FHIR Harmonization - Laura Heermann/Emma Jones
      • HL7 Care Coordination Services (CCS) functional model - LH/EJ
      • Essential Information for Children with Special Healthcare Needs (Mike Padula)
      • HL7 FHIR Care Plan Resource - LH/EJ
    • IHE PCC
      • Dynamic Care Planning Profile- EJ
        • Update: PlanDefinition/ActivityDefinition
      • Care Team Managment Profile - EJ
      • New: CDA Care Plan Summary Section - EJ
    • HL7 Clinical Oncology Treatment Plan and Summary - Jeff Brown/Gay Dolin
    • NCPDP/HL7 Pharmacist Care Plan - Shelly Spiro
    • Others
PC Laura/Emma 

Accepted: Pharm, LHS, SD

Thurs Q1 Salon 19, Würzburg Common Topics OO Not Applicable
(Rob H) 

Invited: CDS, Templates 
Accepted: PC

Thurs Q2 Saal 2, Heumarkt   25

Template update (Template co-chair/rep) 
Template versioning; 
Structured Doc/CDA update (SDWG co-chairs) 

*Topic CDA Templates as StructureDefinitions
Patient Care update: 
Allergy/Intolerance harmonization; template ownership 
Care Team (PC with LHS) 
Clinical Status Value-set - continued from Tues Q4 - Lisa attending for discussion
* C-CDA and FHIR
* Clinical Statement status vs Clinical Status - How to describe so that the differences are well understood

PC Laura/Emma 

Accepted: Templates, SD 

Thurs Lunch Saal 2, Heumarkt 10 Co-Chair Admin (plan next WGM agenda and PSS for Bidirectional Services eReferrals) PC Michelle/Michelle N/A 
Thurs Q3 Saal 14, Köln  Clinical Statement CS Not Applicable 

Invited:  OO
Declined: PC

Thurs Q3 Saal 2, Heumarkt 20 

FHIR Trackers (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#16027 Add date when AdverseEvent detected

  • GF#16092 Add contributing factors to AdverseEvent  

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

  • GF#13698 AdverseEvent.suspectedEntity.instance should allow CodeableConcept
  • GF#13302 Vocabulary issues with AdverseEvent
  • GF#11021 Increase cardinality of substance and make certainty relation to substance not reaction - 2016-09 core #40

Please add a 10-15 minute discussion re: the

Women’s Health Technology Coordinated Registry Network (CRN)  -

CRN_2018_HL7_Sep_WG_PSS 4-27-2018.docx

PC Michelle/Michelle Accepted: BRR 
Thurs Q4 Saal 14, Köln  CareTeam DAM LHSNot Applicable 
(Michelle/Emma/Laura)
Accepted: PC 


Minutes

Monday Q2 Admin Notes

Agenda review


1. Sign in sheet - Jay will set up the attendee list in google doc

2. Agenda review 

  1. Monday
    1. Q3 Mega Report out - PC Slides - Last update by Michael Padula. Michelle will update FHIR slide and send to Laura
    2. Q3 - Device recon - Jay chairing/scribing
  2. Tuesday
    1. Q1 CIMI agenda -
      1. Clinical groups asking for updates from CIMI? 
      2. Jay will follow-up with Susan. 
      3. Update on Wounds - Jay will follow-up with susan
    2. Q2 - Clinical Notes
    3. Q3 - CCDA score card - emma covering
    4. Q4 - Allergy substance need a vote. Clinical status - nesting for FHIR valueSet, SNOMED does not nest - hierarchy. FHIR I is attending to clarify. 
  3. Wednesday
    1. Q1 - FHIR trackers (Procedure)
    2. Q2 - PA agenda - need to request to add to their agenda - V2 change to chapter 3 (owned by PA) that effects chpt 11 (owned by PC). the change works for chapter 3 but does not work for chapter 11. Was sent to ballot for public comment. now have public comment. Amit need time to speak with publishing about it - after today Q3. Amit will discuss it at the meeting
    3. Lunch - CoF - 
      1. David Hay will demo ConMan. 
      2. Discussion about the use case and the process we will follow.
      3. Discuss clinical expertise at technical connecthathon. 
      4. Room will be preferable
    4. Q3 - 
      1. Biologically Derived product - Jay/Michelle. 
      2. Common Clinical Registry framework - meeting at a table in Saal 1 Maritim
    5. Q4 - fhir tracker
  4. Thursday
    1. Q1 - Care Plan Report out. Laura will pull the list forward
    2. Q1 - Common topics with OO
    3. Q2 - Template update. Clinical status continue (Lisa attending to discuss)
    4. Lunch - PC Admin
    5. Q3 - BR&R; trackers; CRN PSS will need to be voted on. PC wants to sign on as co-sponsor. However, if concerns, will be expressed by the both BR&R and PC. CIC is concerned that CCRF is not used. Laura will be involved (as PC rep) in ensuring the HL7 process and timeline is followed.  Jay: motion for PC to co-sponsor; Laura second; further discussion: motion is conditional for co-sponsorship based on the following reasons: 1) dates need to be corrected to be support plan to become normative (as per process) - can a profile be normative if the base resources are still in flux?  2) Need implementers if going normative 3)primary sponsor to be CIC  4) need to conform to CCRF. Vote: 0 oppose; 0 abstain; 7 for
      1. Further discussion will happen if folks attend on Thursday
    6. Q4 - LHS Care team - continue plans for the DAM

Monday Q3 Device IG

Monday Q4 FHIR I Workflow

 - Workflow overview

Definition pattern - actions that can occur

Request - planned, ordered, recommended (properties typically attributes that are generic)

Event - happening right now or have occurred.

Request patterns: FHIR I have reviewed the patterns and asked workgroups to validate if discrepancy are intentional. How in FHIR do you get something done. Simply having some way to get things done.

Third piece - created new resource - exampleScenario: makes visible to implementers workflow that have been defined (using plandefinition and activityDefinition).

 

Request pattern has an element "requestIntent" - implementers track orders in 2 ways

 -  the ones they have control over

 - orders that come from another system they don't have to track

The business rules are different between the two. When the orders you execute - will capture more details. When from other system, capture what you get from the patient.

should there be an element for "external" requestIntent?

 

Jose - Overview of workflow exampleScenario. Instantiation of plandefinition

 - formally define what your workflow process is using planDefinition

 - Describe how your workflow works

 - or use both

 

Toolkit is publicly available. Can point to the tool from the workflow page.


Tracker Items Discussed - 

15782 - Update definitions for codes in valueset-request-status


Tuesday Q1 PC with CIMI

CIMI

Status of skin & wound terminologies

CIMI current state model for adverse event

CIMI content onboarding process

CIMI publication status & implementable derivations

Tuesday Q2 - Clinical Notes in FHIR (continuation from Jan 2018)

* Update on the Connectathon
* Update from Argonaut 

 See Brett's slides

Notes in FHIR

Proceeded with documentReference

Connecthathon scenarios

See - Clinical Note Connecthathon track

Documentreference.class – category for the note – see tracker 17171

Need to query and get clinical notes back. If LOINC will define

Suggest a separate list of category and type with the differences between the two. Lots of ambiguity about this. Need to set a minimal bar.  

Diagnostic report – parking lot it for now. Need discussion about if it should be included in the list of “clinical notes”.

Point made that DocumentReference can point to anything.

Common Clinical notes Set

Discharge documentation – has one code for discharge document and another for hospital course. Use the most generic code as default.

Progress note – use provider-unspecified progress note as default      

Open issue – (MIME type and LOINC codes) how do you know what the server support?

Patient Care Questions

Continue this session next WGM. Will need this until USCDI is figured out.

Plan is to use this in US Core

Is this work worthy enough to go into FHIR core? see Tracker 14720 - see tracker 14720

PC will draft some verbiage. SD will vote on it.

Tuesday Q3 - FHIR Trackers

Chair / Scribe:  Michelle Miller
Attendance:  http://bit.ly\HL7PC0518

AllergyIntolerance

Condition

Procedure

Tuesday Q4 - Negation/AllergyIntolerance Value set/Clinical Status

Negation  Discussion

C-CDA document to FHIR document transformation.

AllergyIntolerance value set

Published results in VSAC

1 of 5 negatives withdrawn; outreach in process

Would like to maintain this valueset. Invite allergy contributions next maintenance round.

Motion: Emma moved to publish the allergy substance valueset pending

Second Rob Hausaum. No further discussion.

Vote: 1 oppose; 6 abstain; 22 for

Clinical Status Value Set for C-CDA problems

Background info:

Clinical status / Problem status

FHIR:

Active

Recurrence

Relapse

Well controlled

Poorly controlled

Inactive

Remission

Resolved

  1. Harmonization
    1. We want CCDA and FHIR to have the same values, right?
    2. FHIR list

                                                               i.      apply ‘controlled’ value changes

                                                             ii.      Is “code” datatype appropriate for a clinical element?

  1. Approach

                                                               i.      Semantic only (same terms & implicit semantics, possibly with a map)

                                                             ii.      Or lexical (same codes, system)

  1. Which one
  2. Document requirements so we can prevent flare-ups.
    1. wiki

 

 

Problem status template (and allergy status template) got un-deprecated. Currently both problem status and allergy status uses the problem status value set. The concepts being discussed are for problem status.

Discussion/Suggestions:

Motion: Emma Moved for the Clinical  Status concepts used for fhir condition.clinicalStatus to be used for C-CDA problem status.

Amendment (By Gay): CDA management group Agree to conceptually align the clinical status concepts as best as possible, working with Patient Care and SDWG

Vote: 0 oppose; 3 abstained; 28 for

Will need a collaboration work space (wiki page, confluence) to document requirements.

Wed Q1 FHIR Trackers

Chair / Scribe:  Michelle Miller
Attendance:  http://bit.ly\HL7PC0518

Procedure

IsModifier (all resources)

CareTeam

Wed Q4 - FHIR Trackers

Chair / Scribe:  Michelle Miller
Attendance:  http://bit.ly\HL7PC0518

All Resources

CarePlan

CommunicationRequest

Thursday Q1

Thursday Q2

Template update (Template co-chair/rep) 

Structured Doc/CDA update (SDWG co-chairs) 

CDA 2.1

Added a few attributes to the clinical statement

 

At the end of the standard is a spreadsheet like the HMD that highlights all the attributes that have been changed


Extensions were added it they were added to the SDWG CDA 2.0 extension page - http://wiki.hl7.org/index.php?title=CDA_R2_Extensions

Suggestion that Pharmacy classes should have been added. Should start a new extension page for 2.1

There are two schemas that are published. The new scheme to accommodate the new attributes.

ActParticipation type code was widened to include all the RIM actRelationship typecodes.

At the very end of the ballot. An informative component. Makes it easier to see what was in it.

Was there addition of relationship between classes? No new relationships were drawn.    

RIM harmonization version number changed from numeric to a string – had to reach into 1B for that change

Ballot status: closed all the negative. 2-3 months to get to publication

 

Allergy/Intolerance harmonization; Clinical Status Value-set

CDA Management group working on evolution process. Want to go back and look at templates that keep coming up as issues.

CDA MG will help identify gaps – value sets; guidance on transforms between CDA and FHIR; general clarity on data elements as an industry regardless of technologies. Goal is to start with problems and allergies.

New allergy intolerance value set – how it plugs in

Status (problem concern, problem status) same as allergy. Reaching out to PC, Pharm for medications. If PC supports this CDA management group and come back to patient to PC with PSS for co-sponsoring.

Mapping project happening between C-CDA and FHIR (Templates as StructureDefinitions)

Structure Definition – constraints on base model. Now have a CDA logical model where Grahame as expressed the R-MIM in FHIR CDA structure definition. This provides the ability to profile and describe how to constrain both CDA and FHIR. Will be nice for CDA template tool to reverse the process.

Initial prototyping has been done on this. Rick and Shawn working on this. Some gaps have been closed. There is still conceptual differences.

Have talked about this but have never realized a PSS to get this work done. Have to go to the CTO if this is for tooling – he has a tooling budget. It may not be about funding, but it is about money because two groups of tool smiths involved.

PSS need to capture

Can do PSS at any time unless heading for a standard then have to follow the dates.

SDWG took responsibility for the mapping because to the structure. However, the ownership of the vast majority of the templates are owned by Patient Care. As part of the CDA management group work is looking at following the fhir model and have work groups take ownership. Opportunity to take a more strategic approach. Patient care, Pharmacy, Financial management are the three groups to do a pilot with. CDA entry templates mapped to the FHIR resource with the associated work groups.

What plans does PC have ramping up to take control of this work? This is the first time PC is hearing about this.

CDA is intended to be a document you can read but has morphed into something different.

C-CDA is based on clinical care with the use of codes. Will need clinical expertise, terminology expertise.

What happens now? Does patient care get the ownerschip of C-CDA templates? What happens with the international aspect?

Work load will follow where it goes because of the domain expertise.

Is there a way to separate less tight coupling? The problem is binding vocabulary imposes the structure.

What is the task of HL7 international? To produce international standard. If in workgroups, whose job is to do the work. IPS – SDWG is the sponsor but not the owner. CDA management group question.

C-CDA on FHIR updates

Thurs Lunch - Co-chair Admin

Chair/Scribe:  Michelle

Attendance:  Lisa Nelson, Emma, Laura, Jay, Michelle, Abdul

PSS for Bidirectional Services eReferrals - Jay/Emma:  5-approve / 0 - against / 0 abstain

Review agenda for Sept 2018 WGM - Patient Care Agenda and Minutes

Lisa Nelson noted pilot project where CDA management group suggested domain groups have more control over the templates (both structure and value sets).  Pilot started with PC - problems/allergies, FM - payer/coverage/policy activity, Pharm - medication activity, CQI - overlapping templates with QRDA and PC.  Lisa took list of CDA entry templates and used existing maps from US Core and CCDA on FHIR to see which resources map to each entry templates.  Patient Care has A LOT of templates whereas other work groups only had a couple templates.

Thurs Q3 - BRR/PC

Chair / Scribe:  Michelle Miller
Attendance:  http://bit.ly\HL7PC0518

Recap last WGM.

There may be differences between clinical research and allergies/clinical use case.  In clinical research, the first occurrence is considered an incident or adverse event, but the first occurrence of an allergy reaction is not considered an adverse workflow.

Is the AdverseEvent the adverse workflow or the adverse manifestation?  AdverseEvent is when something undesirable happens and then track anything that may help determine causality.

Regulatory use cases:

  1. Associate drug to AdverseEvent
    1. Which stage of medication process?  AdverseEvent.category is 0..* because there can be multiple axes of categorization, so you could use category for "when" it was caught:  ordering vs dispensing vs administrating the medication. 
    2. To pinpoint the root cause was a barcode, a change request is recommended.
    3. Other root causes, which can vary by category
      1. Barcode or NDC issue
      2. Communication (illegible handwriting, unclear verbal message)
      3. Container labels or carton labeling confusing
      4. Container labels or carton labeling look alike
      5. Data entry error
      6. Device malfunction
      7. Human factors (e.g., knowledge deficit, product name was abbreviated on the computer listing)
      8. Instructions for use are confusing
      9. Name confusion (drug names look alike or sound alike)
      10. Other  (text/speech to text field)
      11. Packaging (product for oral use was packaged in a vial typically used for injections)
      12. Prescribing Information is confusing or inaccurate
      13. Product quality issue
      14. Products stored next to each other
      15. Wrong storage temperature
  2. Fetus has AdverseEvent when med was administered to parent/mother
    1. https://chat.fhir.org/#narrow/stream/4-implementers/topic/Mother.2FChild.20record
    2. http://build.fhir.org/observation-definitions.html#Observation.focus
  3. Link fetus infant report to parent report if parent also experience the adverse event
    1. Is this referencing another DocumentReference (the resource allows that) or referencing an AdverseEvent or some kind of a knowledge artifact saying they are linked together (Linkage allows you to link two AdverseEvent resources)? 
  4. Product, problem, or med error without a patient - medication didn't reach the patient
    1. Incorrect instructions on a medication dispense, but the patient caught it before taking the medication.  The subject is still the Patient, but the AdverseEvent.actuality = potential. 
    2. Possible change request:  Do we need to document an expected vs unexpected AdverseEvent?
      1. For example, an expected AdverseEvent might be giving non-compatible blood in an emergent situation when compatible blood is not immediately available.
    3. A defective bottle of medications (or stinky tray of food) where a specific patient is not identified yet.  Is this the Group of all patients (at risk) OR relax cardinality of subject to be optional OR is that not within scope of AdverseEvent?

Resolved GF#16027 Add date when AdverseEvent detected

To log new change requests: Click "Submit a Change" on the bottom of FHIR specification, which opens gForge. To get a gForge account, refer to http://wiki.hl7.org/index.php?title=FHIR_gForge_Tracker#Who_can_submit.3F