Web viewAppointment and Scheduling : Argonaut and another project PA & SOA ... Since the word "disconnectedness" portrays a negative connotation,

Monday Q2

HL7 Patient Administration Meeting Minutes

Location: Marriot Auditorium,

Potsdam Conference Room

Date: 2017-05-08Time: Monday Q2

Facilitator Brian Postlethwaite Scribe Iryna Roy

Attendee Name AffiliationX Brian Postlethwaite Telstra Health, Australia

X Line Saele HL7 Norway

X Helen Dryfhout HL Netherlands

X Iryna Roy Gevity Consulting Inc.

Quorum Requirements Met (Chair +2 members): YesAgenda

Agenda Topics

Welcome/introductions

Approve agenda

Review PA Mission & Charter

Review Decision Making Practice]

Review 3-Year Work Plan]

Review SWOT Analysis

Supporting Documents

PA mission & charter

PA decision making practice

PA 3-year work plan

SWOT

Minutes

Minutes/Conclusions Reached:

Introductions

WG started with the approval of the agenda.

The group discussed the attendance for the week and potentially Wednesday Q4 may be cancelled due to

unavailability of resources (human resources, conflicts with other meetings). The group needs the FHIR

facilitator to close tracking items. This quarter will be monitored and adjusted during the week.

Thursday Q1 and Q4 will be merged. Q1 will cover wrap up activities: Approval of the next ballot, FHIR

Planning, etc. Thursday Q4 will be cancelled. Meeting Agenda is updated. Action Item: Line will notify the HL7

about the changes in the agenda.

Brian moved to approve the agenda. Second by Helen for agenda approval.

Vote (for against/abstain): 3/0/0. Motion Passes

The WG continued to review the mission and charter. TSC is requesting a charter to include what type of work

the group is doing. Line asks to keep it in mind when reviewing the charter. The group reviewed the mission

and charter and no changes were needed.

The WG reviewed the Decision Making Practices. No changes needed. Action: Fix link of DMP to most recent

document (v3 to v4). Line (action item stays)

The WG continued reviewing the SWOT. No changes needed. A new risk noted: Brian’s company may require

him to spend significant time with FM group to contribute to the development of FM resources for the national

project, which may realize the human resources threat, already recorded in SWOT.

The WG continued to review the 3 year work plan. Brian suggested adding the US Provider Directory project to

the plan. The project is added with the PSS Planning status. The statuses of all FHIR resources are reviewed

and updated in the plan. Patient, Practitioner and Organization (and possible Location) resources are going to

be normative in 2018-05.

Motion: A motion for was made by Brian to approve existing DMP, updated 3 years plan, Mission and Charter

all together. Seconded by Helen.

Vote: 3/0/0

Discussion: None

Motion Passes

The group continues reviewing the Google sheet with action items. Brian will talk to Michelle to add a tracker

item for 1605-6; Alex has an action item to create PSS for PA resources. Statuses for completed action items

are updated to “Done”. Updated action item for #9226 to be discussed with the Patient Care during the joined

meeting. A lot of action items are assigned to Alex. Line will follow up with Alex to review and update the status

of action item completion.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)

Action: Fix link of DMP to most recent document (v3 to v4). Line.

Action: Line to add the review of action items to the meeting agenda during the Q4 on Tuesday

Next Meeting/Preliminary Agenda Items

.

Monday Q3





Facilitator Line Saele Scribe Iryna Roy





X Christian Hay GS1

X Craig Newman CDC

X Tom de Jong HL7 Netherlands

X Lori Reed eHealth Sign

X Rene Spronk Ringholm

Quorum Requirements Met (Chair + 2 members): YesAgenda

Agenda Topics

1. Update from the FHIR Connectathon

2. Update on FHIR Projects

3. Tom: Gaps for Provider Registry project

4. OHD HL7 V2


Minutes


Introductions

Connectathon Update (Brian)

Patient Track is used as educational track for “beginners”. This is one of the tracks that is chosen for testing the

TestScripts by Touchstone software. It doesn’t seem to be any major issues with the Patient resource.

Action: Next Connectathon - new track for evaluating updates and creation of encounters potentially using the

Patch operations. Brian.

Projects Updates:

1) Brian: Project Statement is approved for the US Provider Registry project (centralized registry

for the US, where they talk how local registries can synchronize with the central repository).

Australia: Provider Directory secure messaging use. Maintenance of standard definition for

the directory so GPs can be able to find the content and send a secure messaging.

Connectathon at Australia May 26.

2) Tom: Netherlands have a project (Vzvz) related to the implementation of the Provider Registry

using the national Infrastructure. Number of sources related to the provider, every doctor

needs personalized card to access the Infrastructure to use it. The moment that happen the

Organization is listed as a card issuing authority. Organization and Providers contain duplicate

records (a Provider can be listed as an issuing authority for a card). The missing functionality

is to identify a provider using the name known by a patient. Vzvz has a list of providers and

names. The list will be combined using the common key between legal and formal name. A

goal is to maintain a common list of Organizations and Providers (deduplicate?). The list will

be maintained by each Organization. Centralized interface will be exposed to maintain data by

external applications. COTS product is used. The product supports RESTful interface (not

FHIR). The challenge is to map internal COTS Database model to the FHIR resources. The

mapping is done. There is a delta in the mapping to resolve. The plan is the project will reach

the Connectathon state this summer (or this year 2017).

3) Occupational Data for Health – Alex is away due to medical reasons, will further discuss when

available. Feedback for the proposed structure discussed.

Mapping Gaps between FHIR resource and COTS db, discussed for Project #2:

Tom presented the Data model for the Netherlands Provider Registry and mapping delta issues. Provider

Identification sharing was discussed. Tom: the issue is a limitation of only one name per Organization. Brian:

Organization name is no longer the only name placeholder. An alias is introduced with the cardinality 0...* to

keep other names. Tom: a type of a name would be desired to consider for future releases to distinguish a

name purpose. It may be used by 80 % of systems. It can be solved as an extension for now. Tom: if we have

a validity period, the Boolean may be preferred, in case of the validity date range is known. Brian: use

yesterday’s day for the expiry period, when unknown. It means already expired. Tom: might add an item to a

tracker for this issue. Still considering. Tom: Certificate? Brian: Australian extension for similar needs. Tom:

Geolocation for an Organization. Brian: Consider using a Location resource because it is really intended for

specifying a physical location. Tom: Logo for an Organization. Brian: Extension. Tom: should an interactionId

be mapped to a payload type? Brian: we have a mapping to the connection type (IFE, HL73, etc) for an

interactionId.”payloadType” maps to a payload identifier of a message. Check the value set, it is significantly

changed in the STU3. Tom: Endpoint direction (“send” or “receive” or “both”), is not in the resource. Brian:

There is no need to specify, the system would know.

Brian: Consider distribution of updates to other systems.

Occupational Health Data (PHER) HL7 V2:

Proposed structure for HL7 V2 for OHD is reviewed. Question: Move Occupation before Industry. Occupation

data type should be CWE. It can be different per country. A set of elements is proposed to be attached to PD1:

Usual Occupation; Usual Industry; Employment Status, Family Relationship, Usual job. Usual job may be

bounded to the Occupation and Industry. Usual – the longest that was taken over period of time. Effective date

is required in addition to the Recorded date. When it was known not when the system had it recorded. The PD1

segment is preferable because it is related to a patient. Item #14 does not have a data type. The whole concept

of usual job may be used multiple times to identify usual job of multiple family members. A suggestion is better

to create a separate segment for it. This will allow repetition and sync-up of Job information. It can be related to

a patient or to someone important to a patient.

Action: Alex will review and provide updates.

Meeting OutcomesActions (Include Owner, Action Item, and due date)

Action: Next Connectathon new track for evaluating updates and creation of encounters potentially using

the Patch operations. Brian.

Action: Alex. Occupational Health Data (PHER) HL7 V2 review and update according to the feedback.


.

Monday Q4


Location: Hyatt Regency San Antonio, Directors

Conference Room







X Rene Spronk Ringholm

X Juha Mykkanen HL7 Finland

X Michael Donnelly Epic

X Attila Farkas Canada Health Infoway

X Christiaan Knaap Furore

X Richard Kavanagh NHS Digital

Quorum Requirements Met (Chair + 2 members): YesAgenda

Agenda Topics

1. FHIR Scheduling


TrackersMinutes


Introductions

There is a project on Scheduling and PA resources are contributing to this project.

1. 8774 – Preferred bundle examples –

Needs to be done. No issues. Examples will be added. Already voted.

2. 12603 Define an operation to find a potential slot.

Locating slots that are appropriate for an appointment involves several steps. Proposed operations is

Appointment.$find that will do it. The draft is published by Epic system. Discussion: “resume-key” is not needed

in the proposed structure, because the “bundle” resource returned in a response contains the “next” link

reference. Instead of start-time/end-time, introduce a repeatable “period” structure with start-time and end-time

elements optional to be able to specify multiple time slots for searching in one operation. A “period” is optional

as well (0..*). The operation Outcome may contain an indication what period was searched. Additional

guidance needed around the visit-type element (Michael to take back to Cooper); “appointment-provider is an

actor? OperationOutcome should have clear indication on what was searched. Reasons: optimal search for a

user and a system (to minimize the number of searches). Should a search for a patient include the same

extensions as a patient search? Potentially to add a flag to indicate a perfect match vs. a match for less than all

search criteria. Patient (resource): patient is suggested to be a reference or resource data type. Reasoning: a

patient may not be found in the system. A patient does not need to be created as part of the find operation.

Only when appointment is decided to be created. “specialty” – suggested to use and add serviceCategory and

serviceType (same as healthcare service). This may result in no longer needing the visit-type element.

“indication” – review property if this should match an appointment resource (reference Condition | Procedure).

Output should be either bundle or single operation outcome. The bundle may contain operation outcome with

information or warning messages regarding the results processed (e.g. what period was searched, what

provider etc.)

Question (Helen): if there are multiple actors in a search requested, should the result include the response for

each? Answer: the behavior of a scheduling system isn’t prescribed. Discussion about possible outcomes of a

search. The possible match or match score requires the follow up. The item is still open. Participant type should

be considered. Preferred search elements may be specified.

Multiple appointments search considerations.

Additional details are in the tracker.

Action: Cooper to review the feedback and address. [email protected]

3. 6262 – Recurring appointment pattern.

Discussion: Epic system does not indicate recurring appointments but all appointments may be linked to one

episode of care. Australian system: service on wheels – may be recurring appointment use case. Community

services are a use case for recurring appointment. The group still does not have enough requirements.

Status: Deferred.

Moved by Michael Donnely/Second Line Saele

mailto:[email protected]

Discussion: None

Voting: 8/0/1

4. 9452 - Add/document a standard extension to Appointment which references the Encounter act. In

cases where an encounter contains/groups/is comprised of/fulfills multiple appointments. That's a fairly

typical use case if the encounter is e.g. an outpatient encounter with a hospital.

Discussion: Rene: to solve the problem by the standard extension that allows association of multiple

appointments to the same encounter.

Status: Persuasive.

Moved by Rene Spronk / Seconded by Michael Donnelly

Discussion: None

Voting: 6/0/2

5. 13195 (related to 13196) – Add a reference to an order (Procedure Request) as a new property.

Discussion: Rene requests an element to indicate a ProcedureRequest for an appointment. at the moment.

Other requests may be added in the future. Brian: proposed to defer the discussion to the joined session with

the Patient Care group. Michael: suggested to add now and PC may add other references in the future.

Property name is suggested BasedOn.

Additional details are in the tracker.

Moved by Rene Spronk / Seconded by Michael Donnelly

Discussion: None

Vote: 7/0/1



.

-------------------------Tuesday Q1

PA joined with FHIR-I

Tuesday Q1




Date: 2017-05-09Time: Tuesday Q1




X Helen Drijfhout HL Netherlands


X Simone Heekmann Gefyra

X Christian Hay GS1

X Marten Snuts Furore

X Jeff Danford Allscripts


X Andrew Torres Cerner

X Dennis Patterson Cerner

X Guillaume Rossignol Almerys

X Fahmi Boussetta Almerys

X Vadim Peretokin Furore

X Eric Haas Health eData Inc

Quorum Requirements Met (Chair +2 members): Yes

Agenda

Agenda Topics


FHIR-I updates

Tracker Items


MinutesIntroductions

The WG began by reviewing the email sent out by Lloyd McKenzie regarding FHIR deliverable dates and timelines.

Ewout representing the FMG reviewed where we are today. Timelines for R4 reviewed.

QA Rules:

- Feedback on existing rules due by the end of May 2017. - Candidate Rules will be published by FMG by the end of June 2017- Work group should plan to align by the end of November- Encourage to start sooner than later

Brian: QA rules question. RIM Mapping mandatory – will this go away?

Planned ballot timeline discussed.

Brian’s updates on PA activities:

Examples’ help is needed for PA group for the Encounter resource.

New Resource needs are discussed for joining Organizations. Brian: many organizations are associated through a business partnership. It will allow expressing various relations. A proposal will be submitted.

ChargeItem – linkage between Account and what was charged. A proposal is already submitted.

Other PSSs – Occupational Health Data (H7 V2) and impacting the FHIR data as well. What resources are impacted is unknown at this moment but it will be reflected in a new standard. PA group is considering the Occupational Health Data belong to a Patient and this is our scope.

Provider Directory PSS is going through FMG – Practitioner.Certification? may be impacted.

The group discussed the Normative ballot process. There will be more than one package: terminology and conformance package; patient resource package, etc. If one package fails to make a normative, the other one can still be accepted.

The group discussed the FMM rules for determining the maturity of resources.

Resources reviewed for possible Normative candidates:

- Organization possible Level 3 or 4? - Patient 5 (definitely)- Practitioner- PractitionerRole- RelatedPerson

- Location- Endpoint- HealthcareService (needs some additional work and implementation)

James identified that the Patient resource is used for veterinary use case. It made the resource to be approved to be Normative.

The group discussed that all of the resources that are used for Provider Directory can be Normative.

Encounter is lacking an implementation.

Appointment and Scheduling : Argonaut and another project PA & SOA – looking at clinical scheduling in details. The group reviewed the new $find operation in details yesterday.

Ewout: Martin, what was the issue with the Practitioner resource?

Martin expressed an interest to use a reference to PracticionerRole instead of Practitioner in other resources. This is related to a Workflow pattern implementation.

Brian: Wednesday Q2 this is where those questions will be discussed.

The group discussed how the packaging for a Normative ballot will look like? Is it by the subject? Such as all related to Patient resources? Brian: No, it will be decided what is mature enough to be packaged together. Ewout: the number of packages should be reasonable. Too many packages may create confusion in tracking ballot comments.

Any other concerns?

Brian: Human resource availability. It is not just Brian working on resources in PA.

Tooling issues are discussed. Excel worksheets may no longer be enough, a replacement should be considered.

Brian: trackers report. 48 items to go through.

Question: should the extension change the resource maturity? This question wasn’t raised before.

#13075 – Patient Notes refer to Patient Match operation.

Reference needs to be fixed.

Moved By Michael Donnely/Andrew TorresDiscussion: NoneVote: 13/0/2

#10042 – Add an example for an infant.

Action: An example will be created. Already moved and approved.

#12299 – Mapping to Breed/Strain

A change is coming from Hans Buitendijk.

Eric Haas will investigate an issue. PID -35 may convey both breed and strain. The mapping may be changed and explanation will be added. No voting yet needed.

#12594 - Patient match shouldn't require match-grade

The wording will be update to relax the requirement for the match grade extension always needed.

Moved By Michael Donnely/Line SaeleDiscussion: NoneVote: 13/0/2

#12454 – Patient.photo should be Media vs. Attachment.

Not persuasive. The group does not believe the change is necessary. A patient photo is a quick identification mechanism, no need for additional information.

Moved By Eric Haas/Andrew Torres Discussion: NoneVote: 12/0/2



.

Tuesday Q2











X Christian Hay GS1

X Ashley Duncan Furore





Agenda

Agenda Topics


ChargeItem resource overview

Tracker Items


MinutesIntroductionsSimone presented the ChargeItem resource business scope. The discussion is about what is the difference between ChargeItem and Service? Christian Hay is asking how the service and charge item are related. The discussion is about the relationship between those two concepts and ClaimItem. A ChargeItem will always be related to Account.

There is a general model in FHIR that is called CatalogueItem?

What is currently missing in a ChargeItem is a reference to a definition of that particular charge item. At some point we would want to create a ChargeItemDefition resource that would connect to CatalogueRecord and describe the definition of a particular ChargeItem resource.

ChargeItem only has one field for manual price overwrite. All other prices should be described in a catalogue record. Business rules may be attached to a catalogue item to clarify how and when it should be billed.

Simone collected business requirements from one of the vendors in Germany. Other vendors are welcome to submit requirements as well.

The group discusses various use cases for a definition of ChargeItem and where to link it: EpisodeOfCare or Encounter (Visit).

Element review:

occurenceTiming – a field that indicates how many hours (time unit)need to be charged.

Participant – Ok

The proposal is to review the resource with Patient Care and get their agreement on certain elements.

priceOverride - ok. Allows manual change of a record without impacting the catalogue, if needed.

Account – account to place a charge. Can be multiple accounts. Simone proposed to keep the cardinality of 0..* to keep the possibility of restricting it using national profiles vs the constratined cardinality can’t be extended.

Helen asked to consider relaxing the context of a ChargeItem to be able to refer to both EpisodeOfCare and Encounter. Brian asked to create tracking number

The presentation of ChargeItem resource is completed.

#13216 – Default filter for active patients.

The group continues discussing the Patient Search options. The issue is related to identification of an active patient, proper retrieval of records where a patient does not have a status.

Brian and Andrew are discussing the status option. Patient has a flag = active. The flag is optional. The search should use not active = false statement to get nulls and actives.

Appointment search option – the status has a set of values assigned for a status option.

MedicationRequest status is a set of codes as well.

Resolution: the group believes the issue is not scoped to a patient only and needs to be resolved on a higher level. The group would like to review requirements for the “default” filter. This is impacting all terminology systems where the value set exclude items “outside of the range”. The group agrees that the outcomes of the discussion should be updated in patient resource notes.

The tracker is updated to “waiting for input” and awaiting a response from Lloyd with additional requirements.

#12441 - Clinical Trial extension should be defined without reference to specific US registries.

The group discussed that the NCT element is US-specific and should not be included in the standard extension. Brian: question – would the doctor be interested to know if the patient is participating in a clinical study. Should this information be on a patient profile? Line asks a question, if a patient is part of a clinical trial and dr is querying information, the dr should know to query for ResearchSubject resource as well. The group decided: if the ResearchSubject will become a normalized status, then this extension will no longer be required. A suggestion is to consider including this resource into $everything response for Encounter and Patient resources.

Tracker status: Waiting for Input.



.

Tuesday Q3











X Christian Hay GS1






Agenda Topics


Joined session with SOA

Review of Scheduling Service

Tracker Items


Minutes

PA met with SOA in San Antonio. Exchanged information about what was done and what are the plans. The Scheduling Service work is primarily driven by Cooper (Epic), Argonaut is also involved. PA has an operation definition for finding the available appointments. Service Functional model?

The operation within a FHIR methodology

Document template that SOA was working on was presented. We will be reviewing it and will be using it as a template for the Implementation Guide. Service Functional model is a template purpose. SOA is a sponsor.

SOA reporting the work on Ordering Service (IHE, OMG), Care Coordination Service (IHE/HL7). SOA concerned that the overall monitoring is required to ensure that the work is compatible and it is not three different outcomes.

Brian presented the new operation template. The complete set of operations is not yet defined. What operation, what parameters, guidance for what is going inside the operation, expected outcomes. It is purely expressed as an operation definition. Another concept: define Terminology Service through the Capability Statement.

Scheduling Service operation definition is on Simplifier. Brian presents the operation definition document: https://simplifier.net/Scheduling/Appointment-find

Capability Statement: http://hl7.org/fhir/capabilitystatement.html

Brian covers elements of the newly defined operation for finding appointments.

Question: why to pass Patient at all to the finding service. Brian: for additional checking such as consent, preferences.

HP expressed an interest to contribute to the Scheduling service. Open source system to do national scheduling, HP produced a demo version to meet the tender requirements. The project never started, the HP has detailed requirements for the scheduling service.

Another use case: Scheduling of Medications. Brian: not at this point. But according to the scope administration of chemo as appointment is wihin the scope.

Other PA activity (interest for SOA): Provider Directory. Base resources are completed. (eHPD profile). The next step is waking beyond resources into the service space. How we can do change notifications? Filtering of notifications. Cross reference locations, practitioners. Single Provider list downloaded (like all providers, all locations, etc.) so there is no need to pull one by one.

Timeframe for Provider Directory service? STU4 timelines.

Action: Vincent will follow up with HP on documentation (requirements) for scheduling.

Brian: do we need a joined session in September?

http://hl7.org/fhir/capabilitystatement.html

https://simplifier.net/Scheduling/Appointment-find

SOA: Yes. Next time more detailed review.

Action: Schedule Q3 on Tuesday for the September meeting.

Tracker items:

#12299 Eric Haas provided updates in comments. Both species and breed are mapped to HL7 V2 PID-35.

Note: a breed is commonly specified in smaller species, this is why it is included in FHIR resource.

Moved by Eric Haas/Second Andrew TorresDiscussion: NoneVote: 9-0-2

#9711 – Vocabulary work is required to complete the tracker.#12319 - Broadening Value Set Encounter Reason Codes.

The group discussed the Event and Situation with explicit context branches applicability for appointment reasoning and extension of a current value set with these branches. The decision is to support the change. Persuasive.

Moved by Eric Haas/Second Ardon ToonstraDiscussion: NoneVote: 10-0-2

#12884 – Appointment.appointmentType to Appointment.type

The discussion is to enhance the description of an element? The group is not convinced that this is an issue. The name and description of an element will stay the same. Not Persuasive. Additional details are in the tracker.

Moved by Andrew Torres/Michael DonnellyDiscussion: NoneVote: 9-0-3


Brian/Line: Schedule Q3 on Tuesday for joined with SOA meeting.


.

Tuesday Q4





Facilitator Line Saele Scribe Iryna Roy






X Christian Hay GS1


X Melissa Mendivil US Realm

X Fahni Boussetta Almerys

X


Agenda Topics


1. Review Meeting Minutes

2. Updates from Steering Division

3. Harmonization proposals - no proposals

4. HL7 V2 work

5. Tracker


1.Minutes


San Antonio Meeting Minutes are reviewed. Action items are collected and recorded to the Google sheet.

Minutes approval: Moved by Helen/Second by Brian

Discussion: None

Vote:7/0/0

The WG continued with the draft agenda for September WGM 2017. From the last quarter, we understand that

we still will want a joint session with SOA and PA will host.

Action: Line to request rooms for next meeting.

Draft agenda is created and reviewed

Minutes approval: Moved by Brian/Second by Helen

Discussion: None

Vote: 8/0/0

Updates from Steering Division from Line: Line is working on a new group Structure and Semantic design. The

New name is Domain Foundation. DAM is updated with small details. O&O PSS that was approved. Patient

Administration name is challenged as well. The group is thinking about a new name.

No harmonization proposals yet.

HL7 V2 work: Melissa requested an update for the AL1.6. The AL1.6 – Allergy date. Suggested to move the

date to the IAM segment and verify that IAM segment is included into ADT message type.

Tracker Items

#12974 – birthPlace does not follow the standard naming convention and does not include prefix.

The group supports the suggestion. The name will be updated.

Moved by Brian/Second by Andrew Torres

Discussion: None

Vote: 8/0/0

#12441 – Research Subject.

Lloyd has provided additional information. The group has agreed to remove an extension with the US specific

element. The group has agreed to add a reference to the ResearchSubject resource.

Moved by Brian/Second by Helen

Discussion: None

Vote: 8/0/0

#9993 – Patient LinkType Negation

PA group discussed the negation of potential association between 2 records to indicate that they are not the

same patient (even though they look the same).seems reasonable. But would like further input on this, and

potentially investigate if that would make more sense in the Linkage resource.

For an unmerge operation, the system would remove patient.link entries and create negated linkage resource

to reduce a change of re-merging records. Additional details are in the tracker.

Input expected from Lloyd.

#13146 – Relationship type contains both roles and relationships. Request is to separate concepts if possible.

The group has discussed a change of cardinality of the relationship type, as well as separating codes. The

change options and implications will be further discussed.

Action item: Andrew Torres to check implication of changing the relationship from 0..1 to 0..*


Line to book a room for PA and PA joined meetings

Action item: Andrew Torres to check implication of changing the relationship from 0..1 to 0..* (13146)


.

Wednesday Q1 Patient AdministrationBrian is chairing, Helen scribe.

Attendees: Brian Postlethwaite (Telstra Health), Line Saele (HL7 Norway), Michael Donnelly (EPIC), Helen Drijfhout (HL7 NL), Christian Hay (GS1), Andrew Torres (Cerner), Richard Kavanagh (NHS Digital), Isabelle Gibaud (HL7 France).

Line: We have a problem with Q4 today, we want to do tracker items but Brian is not present. Drew Torres will be there, so we will keep the quarter as planned.

Tracker items

#13146 Resource joins via RelatedPerson.Discussion yesterday: Person is very limited in scope. Patient is used everywhere.

There is a desire to have a more general Resource for the relationship.

Brian would love to have a resource proposal for the general resource to resource relationship. It will have a 0..* relation to Any resource, with a relationship Type.There already is a Linkage resource, maybe this one could be used when the scope is extended.Brian: we need a relationship for things that are not the same thing, Linkage is just for linking records for the “same” item.

Attributes on the proposed Relationship resource:

Type (e.g. Familial relationship) Source Target RelationshipType (e.g. Father) Period

Yesterday we talked about the RelatedPerson, who has a relationship item with cardinality 0..1.Brain wanted to make that 0..*, but that would open the issue of choosing the relationship that applies in a specific context.

Brian: Back to reality, look at the current tracker item (13146).

Suggestion is to add another item next to relationship: role 0..*.This can be used for e.g. “Billing person”, “Legal guardian”.

Brian drafts some examples.

He shows a software application in which there is a relationship coding system, which includes all family relations and also codes for e.g. “Formal guardian”, “Carer”.

We now look at the resource definition of Patient.Contact.This also has an Organization item, 0..1.

There is a fundamental problem in FHIR that doesn’t let you model your relationships well.If this tracker item will be fixed by adding a .role item, there will still be a fundamental issue.Procedure request and diagnostic order are merged back again, also Medication request and …Lloyd suggests in the tracker item to use the CareTeam resource for expressing the role.

The RoleCode table on Personal Relationship roleType has some more codes in it that do not directly belong in a CareTeam, e.g. “State Agency”, “Insurance Company”.Drew and Michael wouldn’t use the CareTeam resource for that.

Concluding this for now, this needs more discussion. Brian updates the tracker item.

PA thinks we should be considering a new general relationship resource in FHIR. It would be similar to the Linkage resource, except not for the relationship with itself.

This is not voted on, action is waiting for further input.

Other issuesMichael brings on a wish to be able to use a hierarchy in the use of the Practitioner resource:

System one wants to use Practitioner in a more simple way, no PractitionerRole resource is needed.A second system wants to use this instance in a general regional directory system which has more information. Their resource would relate to the general Practitioner instance with an inheritance reference.Third: a local system would inherit the regional practitioner set, and add some other things like specialty, fax number. The question is if there can be an inheritance tree for the same resource.

You would only publish the practitioner information for which you are the truth of source.

Local content would override the information from the general directory system.

Brian: this would demonstrate the PractitionerRole concept.

Question: where do we change the Practitioner reference to a PractitionerRole reference?

Concerns which Brian had before: there will be changes in PractitionerRole, and that impacts the historical references to this resource. E.g. when a practitioner has no longer a specialty role like Neurosurgeon, what would the reference from CareTeam to Practitioner (Role) do?

Drew: there are temporary Care Teams, e.g. for an Encounter, and lifetime Care Teams like PCP. Sometimes they associate to a Practitioner, sometimes to the PractitionerRole.

A new approach would be using a contained PractitionerRole, which not suffers from changes to the actual resource.This makes it hard to search for with a parameter.

There are more places in which contained resources are actually used.

We do not come to a conclusion on this at the moment, just need to have further input and discussion.

#9226 Provide a way to rank procedures in the context of an encounter To designate the most significant procedure. This should also be applied to conditions.

There is a proposal, but there are circular references in that:Collapse all in diagnosis.role.

Procedures are not referenced on the encounter, the reference is the other way.

In the proposal there is a new item: rank 0..1 (int).This will do the ranking, within the role (billing, admitting, etc.). Question if there should be more clarification about the ranking, saying it is the ranking within the role.Question is if this covers the original change request.

Related tracker for Condition: 10544. This one is fixed and closed, by adding the new diagnosis item with role, procedure/condition and rank. This is in STU3.Conclusion is that the 9226 item also is solved by this resolution.Resolution: question answered, resolved.

Wednesday Q2 Patient AdministrationBrian is chairing, Helen scribe.

This is a joint session between PA and PC. We will talk about joined resources.

Attendees: Brian Postlethwaite (Telstra Health), Line Saele (HL7 Norway), Vadim Peretokin (Furore), Isabelle Gibaud (HL7 France), Helen Drijfhout (HL7 NL), Christian Hay (GS1), Emma Jones (Allscripts), Andrew Torres (Cerner), Michelle Miller (Cerner), May Terry (Flatiron Health), Russ Leftwich (Intersystems), Stefan Lang (HL7 Germany), Michael Donnelly (EPIC), Michael Tan (Nictiz), Chris Melo (Philips), Simone Heckmann (Gefyra).

Tracker items

#12509 CareTeam participant Michelle Miller explains: there is a lot of discussion about the role of a participant, how do you describe what the participant is responsible for. The current opinion is to extend the cardinality for role from 0..1 to 0..*. Also ideas are to add Responsibility and Specialty.

There will have to be good clarification about what is a role, and what is a responsibility.PC is focusing now on the value sets for these elements.Brian asks if it impacts CareTeam on e.g. Encounter.You can reference a PractitionerRole, which is a particular Person.There is some discussion about what is a CareTeam: are those actors? Or are the individual Persons the actors? If a role can be played by a CareTeam, it has to be an actor.

See also #13338, PC resolved this today: there is some clarification about CareTeam. It may be for a single patient, a group or an organization, e.g. an emergency response team.There can be transfers of team members over time, and of responsibilities.

PA was talking about RelatedPerson, who could be the billing contact. Some people in there are there for professional reasons, like “Billing person”. Lloyd suggested they should be part of the CareTeam resource, and not add a role to RelatedPerson. PC thinks this is not a CareTeam role, but a RelatedPerson role.Michael: it feels weird to have the person to which the bill is send in the CareTeam. Example: I have 2 siblings, one of them is living in the same street and part of the Care team. This one should be in the CareTeam. The other one is just a RelatedPerson.

Michelle: the RelatedPerson should carry the familiar relationship, the CareTeam should carry the care relationship.

Brian shows #13146, the request to add role to RelatedPerson.Michelle: There are roles that are not persistent in time and could be context specific, they should be on CareTeam rather than RelatedPerson.Michael Donnelly: there was also a request to extend the cardinality for relationship on RelatedPerson.Drew: prefers to create another resource instance for each relationship of the same person to a patient.Michelle thinks that a person could as well be the grandmother, as the legal guardian. In all contexts this RelatedPerson would have both roles.Drew agrees, and suggests to relax the cardinality on relationship and NOT add another item role. Role should be put in the CareTeam. Brian puts this resolution in item #13146.Michelle: the role could also be in other resources, that would not only be in CareTeam.

Brian goes back to the text we got today in Q1 about linkage of resources.

There we talked about an OrganizationAffiliation resource.Question to PC is whether they also have a need for a generic linkage resource.Michelle: this would also be useful for Practitioner linkage, as long as you are able to distinguish different network organization types.In STU3 there is a Linkage resource, but this has a restricted scope: “Identifies two or more records (resource instances) that are referring to the same real-world "occurrence".This resource is still a draft version (level 0).The discussion on this doesn’t affect the resolution of #13146.

The motion to relax the cardinality on relationship and to not add role is moved by Michelle, seconded by Michael Donnelly. Votes: 13-0-2.

ChargeItemSimone presents the draft proposal for ChargeItem. This is the result of an activity which can be send to the billing system. The ChargeItem would not contain the unit price, but could override the list price e.g. when there is a discount for a particular reason.Comments from Patient Care:Michelle: is there a relationship between charges? Simone: yes, ChargeItem can be a part of another ChargeItem. ChargeItems can be grouped. This is done with the partOf relationship.

May: has not seen this hierarchy relationship before. How does this relate to Claim?The Claim resource does not include ChargeItem at the moment, it has an “item”.

Brian: the context is modelled in a reference to the “context”, which can be an Encounter of an EpisodeOfCare. Specific information about the services is in “service”, this references to 0..* different services.Drew: Encounter should be in the list of services, it is not there at the moment.Simone: the rules for the billing code should not be in this resource, but in a Definition resource. We do not have that yet.

Discussion about negative amounts. What do you do when the charge has been entered in error?Simone: the ChargeItem has a status, which can be “Entered in error”.There is a quantity item on the ChargeItem, which may be different from the quantity in the service depending on regulation for the charge codes.May: that is fine. We would use HIPAA codes.

LHS Care Team DAMRuss Leftwich presents the Care Team DAM. This is about a Learning Health System, it is continuously improving process. The approach for the DAM was to reverse engineer the care team for a specific patient and look at all the care team participants. Participants could retire, or may have limited time engagements, or be there for only a specific period of time. So the care team for a patient will be dynamic over time.There also could be sub-teams.Many attributes still need to be defined, e.g. consent. Who has consent and how is that transferred, how is the communication.

We are keeping this joint quarter in the next WGM.

Russ: you might also invite the Learning Health System group.

Wednesday Q3 PA

Tracker Items

Line chairs, Helen scribe.

Attendees: Brian Postlethwaite, Line Saele, Helen Drijfhout, Peter Jordan, Christian Hay.

Brian spoke with Lloyd about the Patient Active stuff. He is supporting it.So this would need some clarification and then this can be voted on.

#11368 coveragePeriod -> period - 2016-09 core #526

The requested change on the Account resource has already been applied in STU3, it is even published.There is a wording issue in the active period, it still refers to “coveragePeriod”.

Action for Brian to file a new tracker item to change the text.

# 11367 Change description of Coverage - 2016-09 core #525Brian: This will be put on the joint session with FM, Q2 on Thursday.

#13345 Organization, Location include alias elements and extensions The Organization resource has received an alias item in STU3, before that there was a standard alias extension on Organization and Location. This can be removed.

The datatype is string, 0..* cardinality, same as the extension.

Motion to remove the extensions made by Brian, seconded by Helen, accepted with 4-0-0.

#13264 Organization, Location, and Practitioner need support for Merge/Link/Unmerge Needs more discussion.

#13235 add endpoint to groupBrian thinks we need more information on this. Practitioner already has an e-mail address, also Care Team will get an Contact Point. Is it then still needed in Group?

#10762 Wrong system used in practitioner example fileThis is part of QA changes. The examples will be updated.

#13074 QA: Valueset warnings cleanup for Encounter and ChargeItem (draft) The QA warning is about update casing.This seems to be already applied as part of QA.

Motion to accept the change made by Brian, seconded by Helen, accepted with 4-0-0.

#13020 Encounter Length is Quantity search, not NumberLength of the Encounter has been changed from positive integer to duration, so the Search example doesn’t fit anymore.

Motion made by Brian to update the search parameter for length from number to quantity. This datatype is compatible to duration. Seconded by Helen, accepted 4-0-0.

#12888 Add "Alternate Home" to EncounterDischargeDisposition value setIn Canada there is a need for a concept like “discharged to home, but not the patients own home”.This sounds reasonable.Helen remarks that the proposed code is “ALTDISHM”, why the “DIS” in this code? Brian agrees there is no need for this. All the codes are for Discharge Disposition.Suggestion to make this “alt-home”.

Motion to accept the change made by Brian, seconded by Peter, accepted with 4-0-0.

#12722 Replace organization type Insurance Company with PayerDiscussion about deprecating Insurance Company: there are several countries, like The Netherlands and Norway, in which still insurance companies are paying for the hospital services. We are quite happy with adding Payer, but not with dropping “Ins”.

The valueset is an Example, so this will likely will be overruled locally.

Motion to add the concept Payer as indicated made by Brian, seconded by Helen, accepted with 4-0-0.

#12854 Remove/anonymize ical mappings from Appointment resource definitionThe present examples have Brains name and e-mail in it. Suggestion to remove that.

Brian moves to anonymize the examples. Peter seconds. Accepted with 4-0-0.

#13066 QA: Location.mode should not be an modifier Location.mode has a modifier on it, which according to Grahame is not appropriate.

Brian moves to remove the modifier as requested. Peter seconds. Accepted 4-0-0.

Wednesday Q4 PALine chairs, Helen scribe.

Attendees: Andrew Torres, Line Saele, Michael Donnelly, Helen Drijfhout

Tracker items

#12270 Add DICOM mappings for OrganizationThis item has no extra information provided. Line changes this to “wait for input” from Brad Generaux.

#10304 Organization Affiliation Will be discussed later.

#13264 Organization, Location, and Practitioner need support for Merge/Link/Unmerge We ask John Moehrke if he will be available tomorrow to discuss this.

#12920 Person definition/description needs workLloyd suggests a change of the definition text:

The resource needs to state in the first line of its definition that "Person is a linking resource used to convey shared demographics for one or more other Patient, Practitioner and/or RelatedPerson resources". A later sentence needs to say "Person instances are never directly referenced as actors (authors, subjects, performers, etc.) Individual actors are identified as either Patient, Practitioner or RelatedPerson, depending on the role of the individual when undertaking the action"

This looks reasonable.

Moved to accept the proposed change by Michael: the text will be updated as requested. Seconded by Drew, accepted 3-0-0.

#13033 8.3.3 De-normalized DataSuggestion to change the text of the Person resource:

The second sentence in the first paragraph states: This is intentional and highlights that the "disconnectedness" of the resources.Since the word "disconnectedness" portrays a negative connotation, you might consider using the words "loose coupling" instead. For instance: This is intentional and highlights the loose coupling of the resources.

Moved to accept the proposed change by Drew: the text will be updated as requested. Seconded by Michael, accepted 3-0-0.

#12726 Appointment needs a property for the actual arrival time. Drew: finds this not persuasive, because the Appointment is in the future. Arrival time can already be put in the Encounter with the Status history.

Drew moves to make this non-persuasive, Michael seconds, accepted 3-0-0.

#12739 Need a per-participant period for Appointment Cooper Thompson asks to add the period on the participant backbone item in the Appointment resource, because participants may be involved with the appointment for different periods in time.

After having some discussion of the options the motion is made by Michael to add period 0..1 to the participant. Drew seconds, accepted 3-0-0.

#12304 Add IHE PCD MEMLS data items to FHIR DSTU2 Location resourceMonroe Pattillo asks to align the Location resource with MEMLS profile from IHE.

Drew remarks that some of the extra attributes, like accuracy and speed, are attributes of the device which has been used, not of the Location itself. The Location is fixed and has GPS coordinates.

Drew moves to make this not-persuasive. Michael seconds. Accepted 3-0-0.

#9249 Manage the Provenance of Practitioner (and Other Resources) using an ExtensionThe suggestion is to use the Provenance resource.

There has been voted on this in January 2016, to refer this for future use. It would be tested in a connectathon by Brian, but there has not been a follow-up. We ask Brian for more information.

#12365 How should we represent an Endpoint.address for a v2 mllp connection? There is an example in the tracker item.We need an IP address and a port number. Michael types the example in the resolution.Michael moves to add the example, Drew seconds, accepted 3-0-0.

#11367 Change description of Coverage - 2016-09 core #525The Coverage resource is owned by FM, so we will not vote on this today.

#12364 Added 'Direct-project' to valueset-endpoint-connection-type Michael: This is about direct messages, not about the project “direct-project”, that doesn’t exist anymore. But looking at the wiki page for the Direct project (http://wiki.directproject.org/), he changes his mind and finds this persuasive. Drew seconds the motion. Accepted 3-0-0.

Line has just heard that Alex deLeon has been re-elected as a co-chair of PA!

http://wiki.directproject.org/

Thursday Q1

Thursday Q1




Date: 2017-05-11Time: Thursday Q1







X

X

X

X

X


AgendaAgenda Topics

1. Tracker Items

Minutes#9989 – Actor cardinality in a Slot resource.

The group discusses the business scenarios for booking multiple slots and multiple actors for a schedule. Brian explains the reasoning for the modeling of the current structure. The complexity can be either carried by the client or by a server that books an appointment. The current model supports the Outlook-style scheduling. Details of the discussion and thinking process are in the tracker comments.

Option 1: both actors defined on one slot

Option 2: having slot resources for each author

Both options introduce complexity related to searching of available slots/actors. The current scheduling project and proposed operations in this space will be working on resolution of these issues.

The issue stays as “Triaged”. The discussion over the phone to follow up

#12363 – Add _include Endpoint support for Provider Directory related resources.

Already completed. Added to all Provider Directory resources. Fixed as part of QA for STU3 and no need to vote.

#13366 – Clarification to be added to explain a difference between Endpoint and ContactPoint

The group agrees to add a clarification: Endpoints are used facilitate system to system communication vs ContactPoint that provides physical and official contact information. The details of the amendment are in the tracker.

Moved by Michael Donnelly/Second Andrew TorresDiscussion: NoneVote: 4-0-0

#13235 – Add Endpoint to a group resource.

The PA group discussed possible scenarios. The group resource does not have a scenario for a system Endpoint. The group believes the request is non persuasive. Additional details are in the tracker.

Moved by Andrew Torres /Second Michael DonnellyDiscussion: NoneVote: 4-0-0



.

Thursday Q2




Date: 2017-05-11Time: Thursday Q2


Attendee Name Affiliation

X Brian Postlethwaite Telstra Health, Australia

X Paul Knapp Knapp Consulting Inc




X Simone Heckmann Gefyra


X Attila Farkas CHI

X Marten Smiths Furore

X Ardon Toonstra Furore

Quorum Requirements Met (Chair +2 members): YesJoined Session with FM group – no joined meeting due to lack of FM group attendance.

AgendaAgenda Topics

1. ChargeItem2. Account3. Tracker Items

MinutesThe FM group didn’t have a representation. Paul was the only one attending. Decided to move the review of Account and ChargeItem resources to a PA call.

Agenda change: Tracker Items review is added.

#13155 – Waiting for Ardon, a requestor

#12685 – Linking of Accounts required.

Discussion about use cases for linking accounts. For example, an account that subsumes all the charges of a previous account (children reference a master). Simone will go back to a company requestor for more detailed information about types of possible account linkages. Andrew Torres will bring Cerner requirements as well. The discussion will continue during the next PA Call.

#13155 – Clarification required for Encounter.serviceProvider.

A group discussed various use cases to challenge the description. Details of the discussion and examples are attached to the tracker. Persuasive.

Moved by Ardon Toonstra/Second by Andrew Torres Discussion: NoneVote: 8-0-0


Action: Simone H. and Andrew Torres provide additional information for Account linkages.#12685

Action: Ardon to create examples for #13155


.

Thursday Q3 PABrian chairs, Helen scribe

Attendees: Brian Postlethwaite, Helen Drijfhout, Christian Hay, Andrew Torres, Simone Heckmann.

Topic: Wrap up and prepare for the next WGM.

Talking about what is possible to bring ChargeItem to a next level. Simone thinks there will be German vendors attending the WGM in Cologne, but not in the next 2 WGM’s in the US.

At the moment we are not approving a ballot.We are fine with the V2.9 ballot, we don’t have to vote on that at the moment.

Looking at the QA status of the FHIR resources.Drew will take an action item to see if Cerner could participate in an Encounter, ChargeItem and Claim connectathon.

Next months PA will concentrate on having all the existing PA FHIR resources upgraded to level 3+.

Focus on preparing for a connectathon with Encounter, ChargeItem, Account and Claim.

We currently have 16 triaged tracker items on FHIR resources, 4 waiting for input, 1 deferred.

Monitoring the progress on the FHIR directory content for the PSS.

FHIR Planning for the next months:

1. Progress all PA FHIR resources to at least level 3 FMM (need to check ChargeItem)2. Final review Patient in preparation for Normative3. Prepare Proposal for a sept connectathon on Encounter, Account, ChargeItem, and Claim4. Valueset reviews / harmonization5. Evaluate scopes for all resources to prepare for moving past FMM 36. OrganizationAffiliation resource development7. Scheduling Project progress (co-ordinating PA, SOA, Argonaut, ...)8. Directory Project progress (co-ordinating PA, ONC, US-Realm, US-Core, Australian projects, Canadian projects)9. FHIR Tracker issues10. Apply workflow patterns to the PA resources

3 Year Workplan: Line has updated this on Monday this week, this does not need changes now.

Timelines (from FMG / Lloyd):- Dec 2017 (Jan ballot) – for comment

- Apr 2018 (May ballot) – STU + normative- NOV 2018 – ready to publish

Resources that we would like to go normative:- Patient

It makes more sense to upgrade the Provider registry resources to level 5, to be able to push them together to normative later. This effects Organization, Location, Practitioner, PractitionerRole, Endpoint, HealthcareService.To achieve that these resources will have to be in the Connectathons in September and January.

Action for Brian to report our status to FMG.

Some examples are for single resources, some others are Bundles of related resources. Brian will try to create these Bundle examples.

Work Group Health: Line will update this after the meeting.

Simone will try to be on the calls. The current time is good for Europe (9:00 PM). Drew will be on the calls more often.

Motion to adjourn from Simone, seconded by Drew, passed 4-0-0.