PCCPlan Minutes 2017 10 16

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PCC Planning Minutes 10/16/2017 All Profile Proposals and evaluation matrix can be found at the FTP site: ftp://ftp.ihe.net/Patient_Care_Coordination/yr14_2018-2019/Planning%20Committee/Profile%20Proposals/

Time (US Central DST) Agenda Item Notes
Monday, October 16th ]
9:30 – 10:30 Emergency Transport to Facility

Present: Amit Popit, Chris Melo, Thom Kuhn, Thierry Dart, Denise Downing, Andrea Fourquet, Lori Fourquet, Taima Gomez

Phone: Holly Miller MD, Gila Pyke, George Dixon, Daniel Venton, Tone Southerland


1. Keep ETS/ITS

2. Deprecate ETS/ITS

3. Update ETS and deprecate ITS

RIPT how the information is exchanged by ETS Talked with Larry Garber about this profile, not creating a CDA document you could use RIPT ETS is content not workflow profile

To Do:

• Update the Use Case,

• define the true interoperability problem,

• state what the current state and future state of exchange for the EMS data

• Need to define within the workflow when the data can be accessed, at the point of getting the pt or prior to getting the pt?

• Do a visual

10:30 – 11:00 Break
11:00 – 12:00 CDA Document Summary Section Present: Amit Popit, Chris Melo, Thom Kuhn, Thierry Dart, Denise Downing, Andrea Fourquet, Taima Gomez

Phone: Holly Miller MD, Tone Southerland, Gila Pyke, George Dixon, Daniel Venton, John Donnelly, Elena Vio

Problem CDA documents are cumbersome for providers to read, not a true way to capture concise information

2 Use Cases

1. Synopsis Section – text section the provider can use to state what sections the referral provider should read, can be auto generated by a system or can be done by an individual who typed or dictated it

2. Care Plan Nesting Summarization – provides an easy way of how care plan components are linked, an easy way to help display what the goals are interventions that need to be done, current meds, current problems are, the viewer can still go to each individual section to get more detail Reviewed the Cardiology Document Summary Section, CDA Section Level Template Lots of discussion about Use Case #2 (Care Plan Nesting), what is the problem and how would this be generated, are we going backwards, the summary isn’t a referral statement, but the sender can tailor that this is a care plan summary about how care plan components are linked and nested

Is Use Case #2 a CP to Dynamic CP’ing?

Big Problem – why is a document generated?

Current CDA content profiles don't capture concise summary information about the document content needed to be communicated.

Providing the entire clinical history can be overwhelming and lead to complications related to information overload.

Sender will determine what is critical in CDA document when sending. Proposal is for a new optional CDA summary section on the head of document.

Amit: Necessary information should be pulled from CDA documents and populated in a readable format for provider.

The purpose of the summary is to clarify the reason a patient saw a doctor when the document was created.

Suggest to add section of active medication in CDA document to prevent negative medication interactions.

Providing an easy view of how care plan components are linked and nested.

Need to define whether a system or a person will be reading the linkage of the generated document.

Amit: Break into two work items. One could be fixing profiles surrounding care plans. Second could be the new section of the CDA document.

12:00 – 12:30 Emergency Transport to Facility Part of the problem is how the patient history and medication are retrieved and incorporated into the ePCR (electronic patient care record), if a patient's information is available to be imported from an EHR is out of scope for this profile. ETS and ITS is currently in narrative form, and now outdated.

Prehospital interventions and patient assessments would be available to the hospital/ emergency room system electronically when the patient arrives. This informs medical decision making during the hospital treatment and potentially saves lives.

12:30 – 1:30 Lunch
1:30 – 2:30 FHIR PlanDefinition for Care Planning Present: Amit Popit, Chris Melo, Thierry Dart, Denise Downing, Mauro Zanardino, Thom Kuhn, Raffeale Giordano

Phone: Holly Miller MD, Gila Pyke, George Dixon, Daniel Venton, Elena Vio, Jeff Sanford

Care Plan profile using FHIR workflow resources why you should use a Care Plan, why use FHIR? FHIR is a good structure for documenting what was done

Currently it is looking like XDW workflow document, can attach any type of document (i.e., FHIR order, CP Resource, etc.) to a XDW document

Incorporate the evidence-based protocols in a library and the clinician can go to the library to develop the order set

Workflow objects that are designed to generate the Care Plan, use the workflow elements and assemble at the library that can generate the Care Plan, building on the FHIR resource which can generate the order sets from the templates selected

Guidance for Care Plan development, content profile for developing a CP Resource and how you populate it

Should this profile be tailored to a specific disease process? No, it should be generic, the basic Care Plan Resource doesn’t give you enough guidance, this profile will give you the guidance for the content to include the clinical interventions, activities in the Care Plan, the Plan Resource does include actions and the order they need to be performed, you could have the planned action to generate the order and document what has been performed and what needs to be next, a plan definition

If it is generating the Order Set does the profile belong in ITI?

How to create activities within the FHIR Resource based on the profiles activity patterns

How to apply orders, protocols, or guidelines, introducing evidence-based care, is this decision support ITI has a profile that is based on mobile technology that could solve this problem, but need to look at the Use Cases content based workflow

If the profile’s need is to orgistrate the Care Plan then it should be in PCC, without activity definition you can’t orchestrate, but what is the expected output, it is a definition it is not stating there are a specific activity that is being executed, as IHE PCC do we want to provide the details about how to implement it- don’t think so, but provide the definitions for building it not the execution of the.

How does this profile overlap with HL7 work with CDA Hook and DS, HL7 Hook is guidance specific to the pt and gives back recommendations, CDA Hook can be incorporated into this profile to create and call-out specific comparison of data

2:30 – 3:00 ITI Proposal for XDWm ITI Room (joint with ITI)
3:00 – 3:30 Break
3:30 – 4:00 Wrap up FHIR PlanDefinition for Care Planning Present: Amit Popit, Thierry Dart, Denise Downing, Thom Kuhn

Phone: Gila Pyke, George Dixon, Daniel Venton, Emma Jones, Tone Southerland

Cleaned up the problem definition.

1. Current CDA content profile do not capture a concise synopsis about the document that the author needs to communicate.

2. Some CDA documents contain elements with linkages to other elements that is often not represented in a way that effectively portrays the clinical picture. CDA documents often contain large amounts of info that makes it difficult to identify pertinent information in an efficient way.

3. FHIR may provide a solution but there is not enough guidance in HL7 workflow resources. This profile will provide guidance on the use of FHIR planDefinition resource to create carePlan activities.

4:00 – 5:00 Finalize Board Report and Board Updates
5:00 Adjourn