Minutes HL7 Patient Care WG Meeting in Phoenix, AZ, USA, 14-18 January 2013

Minutes HL7 Patient Care WG meeting in Phoenix, AZ, USA, 14-18 January 2013.

Monday Q1.

Present:

Stephen Chu, Nehta,

Jon Farmer, Thrasys, USA,

Kim Nolen, Pfizer, USA,

Iona Thraen VAMC / Apelon, USA

Christine Knotts First Databank, USA,

Michael van der Zel, Results4Care , NL, /

William Goossen, Results4Care, NL,

Michael Tan, Nictiz, Nictiz, NL

Susan Matney 3M, USA,

Enrique Meneses, Careflow solutions, USA,

Elaine Ayres, NIH, USA,

Stephen chairs and opens the meeting. The minutes of last WGM are accepted (no comments came in).

First item: Stephen puts a motion to appoint two interim co-chairs for PCWG in order to carry out part of the work. This will be accompanied with asking Ian Townend and Klaus Veil about how they see their position.

William has announced that he might step down.

Discussion on tasks and projects

0 against

0 abstains

10 in favor.

Due to absence of Klaus Veil, Ian Townend, Hugh Leslie, and Kevin Coonan, and the preparations to step down of William, PC faces that again there is insufficient leadership and decides to appoint 2 interim co-chairs and to prepare for their elections in May 2013.

Michael Tan volunteers as co-chair ad interim and will take up concern as topic.

William motion, Iona seconds.

0 against

1 abstain (Michael Tan).

9 in favor.

Congratulations to Michael from the whole team.

Other individuals are asked to express interest.

Stephen moves that we accept the minutes of last meeting.

William makes an exception for one Quarter that still needs to be added. Given that, the remainder of the minutes are moved for approval.

Motion William to accept the minutes Jon seconding.

0 abstain

0 against

10 in favor.

Question from tooling: how will patient care handle versioning of templates? This is a work item of templates, structured docs and PC. Kai Heitmann is representing the PC position in this, based on implementation work in care record messages in the Netherlands.

The agenda is talked through and the work plan is clear.

For May meeting, it can be more or less a copy from this, since both Allergy and Assessment scales need to reballot.

Q2 Monday.

Present:

Stephen Chu, Nehta, Australia

David Rowed, OpenEHR, Au

Thomson Kuhn, ACP, USA,

Rik Smithies, HL7 UK,

Jon Farmer, Thrasys, USA,

Iona Thraen VAMC / Apelon, USA

Christine Knotts First Databank, USA,

William Goossen, Results4Care, NL,

Michael Tan, Nictiz, Nictiz, NL

Susan Matney 3M, USA,

Enrique Meneses, Careflow solutions, USA,

Gordon Raup,

Adel Ghlamallah HL7 Canada,

Helen Drijfhout HL7 NL,

David Hay, Orion Healthcare (no mail provided)

Ewout Kramer, Furore the Netherlands,

Tom de Jong, HL7 NL

Hugh Glover, HL7 UK.

Peter Handler, Kaiser Permanente, US.

Joint with FIHR

Topic to be discussed: “Problem”

Ballot Reconciliation is currently taking place and Ewout Kramer presents the FHIR ballot results on this.

Ewout Kramer is presenting the Fihr problem model, and goes through several ballot comments.

Those parts for PC are addressed only this quarter. Workgroup members comments and Resolutions voted on include:

* Change the description: it is circular

* Change the cardinality of Supporting information to 0..*

* Change Location to 0..*

* Add a 0..1 reference from Problem to Encounter,

where the link means "encounter during which the problem was first asserted"

* Add a 0..1 attribute "asserter" which references the provider/agent/patient

* Rename dateFound to dateAsserted, because this date is relative to the asserter.

* Add a 1..1 attribute "subject" which references the patient

* We do not expect the search to calculate the onset date

from the onset age and let this turn up in the search results when search on date.

* We do not add treating provider nor applicable treatments to Problem.

This should be handled through concern tracking,

care planning and provision, which are resources yet to be defined.

* If a stage assessment is applicable, this is indeed done using an agreed upon

assessment scale, however it is unclear whether the commenter meant this. Since the

AssessmentScale resource does not yet exist, we will defer this discussion and accept Any

for now.

Add to ballot sheet:

* Age is questionable, you might well need a range of Age or even (in practice)

a text like "in their teens". => new ballot comment.

* Todo: discuss the applicability of assessing stages

He uses the Excel spreadsheet for the ballot reconciliation.

Diagrams will become proper UML models.

Williams moves to accept the comments, Rick Smithies seconds.

Vote

3 abstains

0 against

14 In favor

There is a discussion about the yes or no use a link of problem to encounter. There are different use cases. Decision made is to include a link, but allow to not use it.

Motion to include by Peter

2nd by David

Vote 1 abstain

0 against

18 in favor.

Onset.Can be data or age. Can system translate this to date? Do we need it, there are valid use cases. Can we do it this way, or are we mixing age and date up. The latter is not disputed.

Will be split up into date and age.

Ewout moves, William seconds

0 Abstain

0 Against

18 in favor

We do not ad treating provider nor applicable treatments to the problem.

Motion Rik and 2nd Ewout.

1 abstain

0 against

17 in favor

Motion carries

Assessment comment moved by Ewout and 2nd by Rik.

1 abstain

17 in favor

0 against

(1)PC agrees with the proposal that the Patient Administration Work Group will take the lead in developing the Encounter Resource for the FHIR project. Patient care to nominate leadership and representative persons to work with PA and FHIR on development of Encounter resource. The nominees will need to participate in the Encounter resource development conference calls (weekly) and provide inputs/comments where necessary. Who this will be, will be discussed later this week.

(2)Patient care will take primary responsibility in development of allergy/intolerance/adverse reaction and care plan resources and submit them to FHIR for balloting. These resources will be developed following completion of the DAM ballot for both topics.

Monday Q3

Stephens notes to be integrated here.

The ballot reconciliation is kept in the spreadsheet.

Monday Q4. Discussions in the O&O meeting.O&O hosting.

Please refer to the minutes of O&O for the details.

PC discussed the progress on Allergy, Careplan, some V2 pharmacy materials.

Tuesday 15 January

Q1 Patient Care

Present

• On the agenda of Q1 is reviewing the ballot outcome of Assessment Scales.
• Technically we have an overall positive result on the votes. We have a quorum and there were 28 positive votes. The threshold for a positive result is 24 votes.
• Question: which assessment scales are selected for the ballot? William explains that the ballot explains how an assessment scale is modeled and the scores mentioned are examples.
• Propriety scores are often now allowed to be published.
• Elaine would prefer to explain the difference between assessment and screening. The name of the topic will be changed to assessment/screening tools. Add some screening tools ( from malnutrition) to illustrate the possibility of this topic.
• William has no objection to add new examples of scales.
• To add a new scale you need an ID for the scale ( LOINC, SNOMED), not for the terminology used in the scale.
• The system logic is not part of the explanation of the ballot.
• The scales /screening are used in the clinical statement box, ( for example) with an organizer with various assessment scales.
• Five examples from mental care will be sent and added. Action Steve Daviss
• Second comment from Daniel is to reference LOINC appropriately. Action Susan Matney .
• Storyboards and diagrams are missing. The storyboard are placed elsewhere in the Care Provision material. We will link to these storyboard. Action Michael Tan
• The RMIM is using R1 and should use datatypes R2. Action Jean Duteau.
• Virginia comments that HMD information is missing. We do not know what VirginiaLorenzi means. Action William Goossen.
• Question on the cardinality of author and patient. The cardinality is currently set to zero to many. The cardinality should always be a minimum of 1 to many for subject and author. The model should be adjusted. Action Jean Duteau.
• Kevin is complaining on the German text. They are not typo’s but umlauts. They will be corrected. Action Michael Tan
• According to Kevin the use of ICD 10 in assessment scales is not clear. ICD 10 will be removed. Action Michael Tan
• Kevin suggests that only universal models should be mentioned in the ballot and that the German examples should only be mentioned in the German realm. We will keep International examples. Action Michael Tan
• Kevin objects to name Clinical Statement Pattern. It should be changed into Clinical Statement. Action Michael Tan
• Classcode with a capital letters should be changed to lower case. Action Michael Tan
• Wrong use of Derivationcode. Derivation expression the means to arrive at the total score. This text has to be changed. Action Michael Tan.
• Duplicates will be removed. Action Michael Tan.
• The Class, Mood where there is a match with observationEvent should be explained more better. Action Kevin Coonan.
• The RMIM is screwed up according to Kevin. We do not understand why. This comment is regarded as not persuasive.

Motion from Susan Matney to accept all the comments on the 5 spreadsheets of the ballot review.Second from Elaine. 0 against, 0 abstain, 9 in favor.

The changes to be made are not substantive, (only editing). We can regard the ballot as accepted.

Tuesday Q 2

Patient care reviewed the status of the different materials in the ballot and identified work for future WGMs and projects. See pictures

Patient Care – Joint with Anesthesia

Q2 1/15/2013

Present:

Ongoing work

D-MIM

R-MIMTransfer - ready

Query - ready

Care Record - ready

Clinical Statement – done

Allergy R-MIM, DAM (September) work in progress

Care Plan R-MIM, DAM (September) work in progress, in planning phase

Assessment Scale R-MIM All changes are non-substantive

Pressure Ulcer DAM will be published in the next couple weeks (Jay Lyle)

This work is under control.

To Do

1. Remove care statement - done
2. Remove old observation assessment scale (2007) - done
3. Observation Vital Signs R-MIM– work with anesthesia and devices
4. Needs updated
5. Harmonize with GAS and devices
6. Concern topic (will use ISO 13940 Contsys as the standard) get to NHS work through wikipedia
7. List
8. Tracking
9. Statement collector
10. Health Concern Topic (Michael Tan)
11. Statement collector
12. Concern
13. Concern Tracker
14. Clinical Document Topic – needs to be removed, in Sept. 2009 ballot material.
15. Canadian Work – discussed in 9/2010 and in 2011. Need to know the plan for these items. Removed from ballot and no longer working on. Canada has been encouraged to develop new project scope statements to work on the following items.
16. Professional services
17. Care Composition
18. Detailed Clinical Models
19. Vital Signs – new project scope statement.
20. Braden – William has formally requested permission to use.
21. Susan to check LOINC copyright for use within DCM.
22. Ballot edits
23. Remove “Ballot Clean-up for Jan. 2010”
24. “Notes to readers” will be number one and the first and second paragraph will be removed. Keep third, fourth and fifth paragraphs.
25. “Guidance for balloters” can be removed. Graphic “Care Provision Domain Relationships” needs to be updated.
26. Keep Acknowledgements
27. Changes from previous release: remove
28. Known issues and planned changes – keep.
29. Care Provision Section – keep. Revisit after contsys review.
30. Explanation and guidance topic – remove.
31. D-MIM storyboards – topic four, replace current graphics with the correct ones.

Tuesday Q 3

Present: William Goossen, Michael Tan, Jon Farmer Enrique Meneses and Peter Hendler.

William Goossen gave a short tutorial on Detailed Clinical Modeling, the status of them in HL7, the work of CIMI, the status of the ISO DTS 13972 on DCMs, existing tooling and projects in the Netherlands.

Tuesday Q4 Patient Care Review ballot DAM Allergies

Attendance sheet to be included here.

• Continuation of ballot reconciliation of the DAM for allergies.
• The notes and action of each comment on the ballot comment spreadsheet is written down in the overall ballot comment sheet of the DAM by Elaine Ayres.
• Rob McLure is in search of standards and value sets for allergies for the purpose of CCD and meaningful use. The current stage in Patient Care however is still analyzing the domain on conceptual level. You will not find any specific value sets at this stage.
• Jean Duteau does mention that the model of the DAM is still in line with the removed DSTU model of allergies from 2009.

Wednesday Q1 Joint with PHER, Emergency, CIC and CIBG.

Present:

William Goossen, Results4Care, NL, chair and scribe

Mark

Crystal Wolfe Abbott Nutrition

Jamie Cash Abbott Nutrition

Laura Heermann Intermountain

Russel Leftwich TN

Rebecca Wilgus DCRI

Dianne Reeves NCI

Anita Walden Duke

Ed Hammond Duke

Rob Savage PHER

Xxx deYoung Oasis

CIC. DIM to DAM work for EMS (Emergency Medical Services).

Cardiac Domain Analysis Model, working on multi modality modeling and other aspects. 250 data elements are going to be brought to ballot.

MAX tool for export and export content from EA to excel and other formats. Requirements are published, but not yet gaining much responses, so will be done again.

CIC is sponsoring this with tooling. It is in particular important for the requirements in spreadsheet put in EA.

Other work on the DAM is ongoing.

PSS for trauma registry CDA with progressive timeline.

Project for Schizofrenia.FDA project towards submissions.Meeting with RCRIM about the models.

Perhaps use a different modeling approach. FDA would like to see the DAMs to look consistent. Make them more consistent. Today Q4 and Thursday Q2 and Q3.

Would mindmapping be useful?

Discussion on the tools.

PHER update on the joint project with OASIS aiming at transforms between OASIS and HL7.

V2 and v3 version.

Questions are raised about how to interest vendors to implement it.

Testing and connectathons are very helpful too to attract a vendor.

Would cooperation with IHE and NIMSIS be helpful?

Rob moves the motion to accept the PSS for this as PC co-sponsoring this project.

Laura seconds 11 for, 0 against 0 abstentions.

Emergency Care DAM is close to ballot. There are some travel restrictions so not everybody can be here.

EHR Functional Profile is going to be updated. And a DAM will use that.

Mark Shafarman will send the PowerPoint he presented during the Q1 meeting.

Wednesday Q2 Joint with EHR.

During EHR updates were given on the care plan and allergy work of PC. For minutes see EHR WG.

Wednesday Q3. Work on ballot reconciliation on Allergy and Intolerance

Attendance sheet to be included here.

Wednesday Q4 Allergy and Intolerance discussion

Attendance sheet to be included here.

Thursday Q1 Care Plan

Attendance sheet to be included here.

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Thursday Q2 joint with SD and templates.

Attendance sheet to be included here.

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