Patient Administration
Technical Committee Meeting Minutes
HL7 Plenary Meeting
September 27th – October 1st 2004
Atlanta, GA
Co-Chairs:
For more information on the Patient Administration Technical Committee, please contact one of the co-chairs listed below:
Gregg SeppalaDepartment of Veteran Affairs
Phone:
/ Klaus Veil
HL7 Australia
PO Box 857, Avalon 2107
Australia
Phone: +61 412 746 457
Jean Ferraro
McKessonInformation Solutions
19 Doral Lane
Bay Shore, NY 11706
Phone: (631)-968-4057
Facilitator:
Norman Daoust
Daoust Associates
Phone: (617) 732-9045
/ International Liaison:
Irma Jongeneel – de Haas
HL7 Netherlands/McKesson
1
Attendance
Patient Administration (PA) Technical Committee Working Group Meeting
Atlanta, GA
Date: September 27 – October 1st, 2004
(Please X attendance and note any updates)
Name / Affiliation / E-mail Address / HL7 MbrY/N? / M
Q3 / M
Q4 / T
Q1 / T
Q2 / TQ3 / TQ4 / WQ1 / WQ2 / WQ3 / WQ4 / THQ1 / THQ2 / THQ3 / THQ4 / FQ1 / FQ2
Gregg Seppala / VA / / Y / Y / Y / CQ / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y
Jean Ferraro / McKesson / / Y / Y / Y / CQ / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y
Klaus Veil / HL7 Australia / / Y / Y / Y / Y / Y / Y / Y / Y / Y
Norman Daoust / Daoust Assoc. /
Ilene Yost / Siemans / / Y / Y / Y / CQ / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y
Jeanne Greet / Siemans / / Y / Y / Y / CQ / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y
Irma Jongeneel de Haas / HL7 NL and McKesson / / Y / Y / Y / CQ / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y
John Firl / McKesson /
Richard Ohlmann / McKesson / / Y / Y / Y / CQ / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y
Allie Grassie / HL7 Canada / / Y
Barry Guinn / Epic Systems / / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y
Dale Nelson / Zed Logic / / Y
Ken Rubin / VA /
Louise Brown / HL7 Canada /
Susan Lepping / Siemens / / Y / Y
Freida Hall / Oracle / / Y / Y / Y / Y
Michael van Campen / GordonPoint Infomatics / / Y / Y
Helen Drijfhout / HL7 NL /
Beat Hegghi / HL7-CH / / Y
Sheila Franks / DDPA
Pete Rotney / VA /
Greg Thomas / Kaiser /
Joann Larson / Kaiser /
Rene Spronk / HL7 NL /
Rhonda Sato / Kaiser / / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y
Isabel Frean / HL7 Australia / / Y / Y / Y
Valerie Kirk / Oracle / / Y / Y
Kathleen Connor / Fox Systems / / Y
Jack Varga / DOD/TMA / / Y / Y
Sandy Hoang / Oracle / / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y / Y
Frank Plueg / HL7 NL / / Y / Y / Y
Joe Estrada / Kaiser / / Y / Y / Y
Nancy Orvis / DOD Health / / Y / Y
John Churin / Oracle / / Y / Y / Y / Y
Michelle Williams / CSC/NCHS / / Y
Bob Davis / NAHDO / / Y
Nancy McQuillen / CA DHS / / Y / Y
Rita Valtamore / WA DOH / / Y
Mead Walker / Y
1
Monday, September 27th PM
3rd Quarter
1:45 – 3:00 PM
Handouts:
1)Detailed Agenda
2)PA Mission and Charter
3)PA Decision Making Practices
Welcome/Introductions
Kickoff
Review Agendas
Review Mission/charter and Decision Making Practices (DMP)
We agreed that changes are required to the PA mission/charter statement as it is exists since the scope is too broad and not geared specifically to the recipient of healthcare services. The PA TC members will review the PA mission/charter suggest changes prior to the January 2005 meeting.
The PA TC reviewed the revised Personnel Management mission/scope that is to be proposed at the TSC this evening. Minor changes were made for clarification purposes.
The DMP was distributed as adopted in May 2004 for review.
Ballot 8 V3 report
We would have needed 18 affirmative votes to pass the ballot. Approval was not required since this was a draft for comment only. If this was an actual ballot – it would not have passed.
Actual totals:
14 Affirm
13 Neg
8 Abstain
5 No vote
Break 3:00 – 3:30
4th Quarter
3:30 – 5:00 PM
Joint with FM
Guarantor and Coverage
For review from San Antonio:
- Addr and telcom should be added at the GuarantorRole and a note added that this is the addr (where to mail the statement) and telcom (where to call regarding the statement) regarding the specific bill or statement.
Summary of discussion:
This has been updated but the CMETs were not balloted this last ballot cycle.
- The addr and telcom attributes will be removed from the GuarantorPerson and GuarantorOrganization. There is further works required work to ripple these changes forward into the FM DMIM for this. Michael needs to determine the scope of this.
Summary of discussion:
Michael agreed to ripple this change through the FM DMIM and any RMIMs that require the updates.
Address any ballot comments relating to Guarantor and Coveragefrom Ballot 8
- [Ref: ballot comment #6] Person with multiple insurances – how is this specified? There is no way to do this. The cardinality needs to be changed between the entity choice and covered party. How do we specify coordination of benefits? This still is a problem. Do we need a participation for the Role of patient (A_Coverage CMET)? How do we sequence roles – this is the problem. Sequence number needs to be added or should we create another version of the CMET that is specific to this requirement. How is it related back to the person that you started with? Context control exists in act relationships – we need to express a constraint that this must be the same person. .
Summary of discussion:
FM will create new A_Coverage CMET without entity classes under covered party – just the roles.
PA will remove R_CoveredParty from Patient R-MIMs and replace with a Participation from Patient to A_Coverage with a cardinality of 0..*. A constraint will note that the coveredPartyChoice in the CMET is the same entity as the entityChoiceSubject in the Patient R-MIM. This a substantive change to the patient messages for PA. This would be new content after DSTU.
Where would sponsor be represented in this? This is additional content and needs further discussion. This was added to the future list titled 200409 FutureQue.xls.
- [Ref: ballot comment #18] Trigger events for query/notification for insurance policies
Use Case:
Patient A insured by company B at this point in time – This is not an issue since there is an eligibility query (QUCR_TE200101)
Use Case:
Change of coverage – how do you message that there is an addition of one coverage and termination of insurance? There is currently no message for revise of insurance. This requirement was not defined to date for FM – referred to FM TC for discussion Q2 on Tuesday.
New work:
- Discuss possibility for a CMET that would deal with adding a guarantor. PA to replace the guarantor role in PA DMIMs with a CMET from AB.
We have this CMET in our DMIM. We can use the message to define the guarantor relationship if that exists. If we need the guarantor to be recorded as a person - we need to create the guarantor as a person first.
- Define the additional data elements that would be required or desired to fully identify or locate the guarantor in order to model correctly. These may possibly be a similar relationship as the PID/GT1 V2.
PA needs to discuss the requirements first and pass to FM. This was added to the future list titled 200409 FutureQue.xls.
Presentation about Aged & community care requirements
Isabella Frean did overview of aged and community care messaging use cases. See attachment titled Aged & community care requirements - domain location v0.3.pdf. There are storyboards created for these to date. The next step is for her to find a sponsor that is interested in pursuing these requirements and to present as proposals for new work to the various committees. It seems that most of the PA requirements already have defined triggers that would support the messaging of this information.
Tuesday September 28th
1st Quarter
9:00 – 10:30
V3 Work
Registries
Joint with CQ and PM – hosted by CQ
Refer to CQ minutes from Q1 Tuesday 9/28 for official minutes recorded for the joint meeting.
Jean Spohn did background of registry project
Intent was to establish a working project. 2 conference calls per month 1:00 PM EDT on Wednesdays. Louise Brown to act as interim project manager. Leon (?) to act as scribe for conference calls.
Project Deliverables:
- Agreement of terms/definitions
- Agreement on starter list of registries (patient/person/prov etc)
- Validate the business model against registry types
- Is there a pattern, deviations from generic model, changes to model required etc…
- Cost/benefit analysis of generic registry development
- Evaluation of MFMI infrastructure and dynamic model that exists
- HL7 publishing format/structure
The goal of the Registry Messaging Patterns and Behavior project is to enhance HL7 v3 support for registries, for example, persons, patients, practitioners, organizations, and service delivery locations.
MFMI proposal – definition of registryActCode –
REG represents the act of maintaining information about the registration of its addociated registered subject. The subject can be either an Act or a Role and includes subject payloads such as lab exam definitions, drug protocol definitions, prescriptions - person, patients, practitioners, and equipment.
Usage notes:
This class is intended for use where the subject is reasonably static and there is interest in tracking the registration events.
There will be another joint meeting scheduled for Orlando – CQ will host.
Break 10:30 – 11:00
2nd Quarter
11:00 – 12:30
Registries
Committee discussion and work resulting from joint with PM and CQ
There are no work items that we can do to update the person registry as outcome from the Q1 joint session. There needs to be further definition from the project team.
Review of PA V3 Ballot 8 Person comments
Review negative ballot comments from ballot 8
Neg-Mi
Ballot item #12 - Merge/Unmerge must be replaced by Link/Unlink whereever the both must exist. Merge by definition does not allow for an unmerge.
The committee found this to be non-persuasive. Motion was made and seconded to vote this as non-persuasive.
Vote
For7
Against0
Abstain0
The committee does not believe that this is a valid negative comment. The trigger description will be changed to the original text agreed to in San Antonio.
Description
The Subsume Person Patient Record trigger event signals a merge of records for a patient that was incorrectly assigned two different identifiers.
Ballot item #13 - Merge does not allow for Unmerge
This unmerge is actually defined as a cancel merge – not an unmerge. Trigger A34 was deprecated in V2.3.1 and is not a valid trigger to reference.
The committee found this to be non-persuasive. Motion was made and seconded to vote this as non-persuasive.
Vote
For7
Against0
Abstain0
Ballot item #10 playingPrevailingPerson is on the wrong side of the relation and should be 0..* instead of 0..1
The committee agrees that this is incorrect. The model that is used in the ballot is the incorrect version. Gregg will correct for the next ballot with the correct version. The model, HMD and MTs will be replaced with the correct versions.
The committee found this to be persuasive. Motion was made and seconded to vote this as persuasive.
Vote
For8
Against0
Abstain0
Ballot item #9 PrevailingPersonIDs and SubsumedPersonIDs seem to miss the ID attribute (now only have a classCode)
The committee agrees that this is incorrect. The model that is used in the ballot is the incorrect version. Gregg will correct for the next ballot with the correct version. The model, HMD and MTs will be replaced with the correct versions.
The committee found this to be persuasive. Motion was made and seconded to vote this as persuasive.
Vote
For8
Against0
Abstain0
Ballot item #8 Scoper for the Prevailing and Subsumed patient role is currently 1..1. This should be 0…1
Although the model that is used in the ballot is the incorrect version, the balloter’s comment still stands. The committee believes that this is non-persuasive since this is consistent with the new patient model. The scoping organization is mandatory.
The committee found this to be non-persuasive. Motion was made and seconded to vote this as non-persuasive.
Vote
For6
Against1
Abstain1
Ballot item #6 Persons with multiple insurances or historic listings of insurances are not supported. Relationship in New Patient PRPA_RM201101 between EntityChoiceSubject and CMET R_CoveredParty is 0..1. PA will remove R_CoveredParty from Patient R-MIMs and replace with a Participation from Patient to A_Coverage with a cardinality of 0..*. A constraint note in the PA RMIM will state that the coveredPartyChoice in the CMET is the same entity as the entityChoiceSubject in the Patient R-MIM. This a substantive change to the patient messages for PA. This would be new content after DSTU.
The committee finds this persuasive. Motion was made and seconded to vote this as persuasive.
Vote
For7
Against0
Abstain1
Suggest
Ballot item #5 Please provide trigger events and messages etc for Link & unlink and/or merge & unmerge - they are necessary to complete the Person topic.
The committee finds this persuasive and the intent was to include subsume and reverse subsume in the ballot. Motion was made and seconded to vote this as persuasive.
Vote
For7
Against0
Abstain1
Tuesday, September 28th PM
3rd Quarter
1:30 – 3:00
V3 Work
Encounters
Review of PA V3 Ballot 8 Encounter comments
Neg-Mj
Ballot item #4 The Class name "Person" which appears in the RMIM description (2.4.1 subheading "Person") and HMD diagram is morphed to "identifiedPerson" (with a lowercase first letter to distinguish it from "IdentifiedPerson") which was not described in the RMIM description in the ExcelView and TableView. The name "Person" is now greyed out in the TableView. Moving onto to the SchemaView, the name Person reappears and I cannot find "identifiedPerson" anywhere.
Refer to MnM
Motion made and seconded to refer this to MnM.
Vote
For10
Against0
Abstain0
Neg-Mi
Ballot item #3Patient.confidentialityCode cardinality. For act it's 0..*, for Patient it's 0..1. They should both be 0..*
The committee agrees that this should be defined as 0..* and as a SET. This will be a RIM harmonization proposal to change the data type from CE to SET. This is ballot related so it will need to be addressed as 2nd or 4th Friday following the working group meeting – (October 15 or 29th).
This will be an action item for Norman.
This change needs to rippeled into PA DMIMs and RMIMs, HMDs, MTs and documentation - Gregg.
The committee finds this persuasive. Motion was made and seconded to vote this as persuasive.
Vote
For8
Against0
Abstain2
Ballot item #3 Role Name of the focal class is not descriptive enough. Suggest to rename to PatientLink.
The committee is not sure that this needs to be changed. The formal name for SUBY is missing in the RIM repository. We will raise this as an issue at the MnM Facilitators' Round Table on Thursday. Motion was made and seconded to leave this as it appears – not persuasive.
Vote
For9
Against0
Abstain2
Suggest
Ballot item #5- "or other preparations" is too vague, e.g. could be interpreted as getting special equipment which is not a preAdmitTestInd.
Suggested wording
preAdmitTestInd - indicates whether tests or procedures were scheduled in a preadmission encounter prior to this scheduled admission. The actual appointment(s) for the pre-admit tests can be related to this scheduled encounter with the reason act relationship (see below).
The committee discussed the wording of this as it appears in the PA ambulatory encounter appointment walkthru. The committee opted to adopt the wording of the attribute from the RIM to replace the first sentence above. Similar wording changes need to be done throughout the other encounter types.
Motion made to approve the wording to replace the first sentence with the RIM definition and change other wording as indicated in the ballot spreadsheet. Motion was made and seconded to change this. Persuasive with modification.
Vote
For8
Against0
Abstain2
Break 3:00 – 3:30
4th Quarter
3:30 – 5:00
V3 Work
The remaining ballot issues are related to update mode and we opted to wait until after the update mode discussion and decisions have occurred on Wednesday in MnM.
Accepted Definitions for Encounter Types
The current RIM definitions are not very robust. Gregg had crafted Introductions for each topic that further clarifies the type. The committee decided that we should review the current ballot definitions and decide whether these are acceptable or need to be clarified further. We worked through the various encounter types and have created new definitions. See attachment EncounterDefinitions.xls
Wednesday, September 29th AM
1st Quarter
9:00 – 10:30
and
2nd Quarter
10:45 – 12:30
Add attribute level documentation – there was interest in the V3 training class to assist in mapping V2 to V3 attributes at the RMIM level. We have various versions of mappings that we could start with.
Irma has some mappings that se will forward as a starting point. See attachment titled Mapping V3-V2.doc.
We believe that Microsoft and Oracle also might have some that could be used for this.
Others might have mappings that we can use to map at the RMIM level
V2.6 Ballot Resolution
PA – 57 in ballot pool
51 voted
20 Affirm
31 negative
need 2/3 majority – we did not pass committee ballot
McKesson ballot issues
McKesson Ballot Item #2
Section 3.4.13.2 Wording should be changed to remove language about allergies.
The committee agrees and the wording was corrected in the ballot. McKesson has withdrawn the negative.
McKesson Ballot Item #3
The ARV segment needs a unique identifier associated with the segment. CQ has added language clarifying the action code/unique id requirement for segments in 2.6. It's now clear that if you don't have an explicit unique identifier, then you need to identify a unique identifier in the anchoring segment. Since the ARV seems to be anchored on either the PID or PV1, there are a number of identifiers in the segment that can serve as anchors. One possibility is to include a field in the ARV, with a CX data type which actually caries the related identifier for the ARV segment. That in conjunction with the ARV-3 code could uniquely identify the ARV.
This has been found non-persuasive. We want to keep the segment positional to the anchoring segment.
McKesson has withdrawn the negative.
Motion made and seconded to find this non-persuasive
Vote
For6
Against0
Abstain2
McKesson Ballot Item #4 - The segment should be repeating.
The committee agrees that this should be repeating. The chapter needs to be corrected to reflect the ARV segment as a repeating segment in the message structures. The assumption was for this to be repeating and is unique based on the restriction value ARV-3.
McKesson has withdrawn the negative based on the proposed corrections to the message structures.
McKesson Ballot Item #8 ARV segment should be repeating. This will result in changing the message structures that had the ARV segment added in both PID and PV1 groupings.
The committee aggress that this should be repeating and is already based on the restriction value ARV-3.
McKesson has withdrawn the negative based on the proposed changes to the chapter.
McKesson Ballot Item #10 Sequence 4 & 5 should be repeating
The committee agree that these fields should be repeating
McKesson has withdrawn the negative based on the corrections to the chapter
McKesson Ballot Item #16 Notes item PV2:50 as optional - PV2:50 should be conditional
The committee finds this non-persuasive due to the fact that the date is explained as When this field is valued, the field PV2-45 - Advance Directive Code is required so that the conditionality is on PV2-45 not on PV2-50.