PCCTech Minutes 2018 07 16

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Monday, July 16, 2018

Review Agenda

Items to include at every F2F Meeting:

Patent Policy http://wiki.ihe.net/index.php/Patent_Disclosure_Process

Committee Secretary Reminds Committee Participants of Policy The domain committee Secretary is responsible for reminding committee members of the patent disclosure policy in writing (via email) and orally at face-to-face meetings (using the presentation slides provided below) at key milestones throughout the development process of Technical Framework documents, including:  When a call is issued for new Profile Proposals  When draft Profile Proposals are being selected for Supplement Development  When Supplements are being prepared for publication for Public Comment  When Supplements are being prepared for publication for Trial Implementation  When Supplements are being advanced to Final Text for incorporation into Technical Framework volumes The duty to disclose applies both to Profiles under development and to those already published. In the case of new Profiles, the mandated timing for disclosure is prior to their publication for Public Comment. Committee members are responsible for promptly disclosing patent claims relating to already published Profiles whenever they become aware of such claims.


“Discussions of pricing, product release and other plans, market allocations, specific competitors, suppliers, customers and any other topic that would lessen competition among manufacturers must be avoided. Customers may discuss such matters with their own vendor in confidence. More detailed rules can be found in the DICOM procedures. “

Change Proposal & Resolution Discussion

Outstanding CPS:

1. CP-211 – has been integrated, but not in all IHE PCC profiles

2. CP-267 – needing LOINC code for Oxygen Saturation, Lori needs to complete the LOINC submission form and send it to Chris Carr once complete

3. CP- 268-271 - Raffaele will talk with Mauro about the resolution for the CPs

4. CP-260 & 261, 254, 239– Outstanding, CPs assigned to Steve Moore

5. CP-230 – wasn’t assigned to anyone, assignment made to Steve Moore

6. CP – 229 – Emma’s CP – Update RECON FHIR , needs discussion at the Joint Meeting

7. CP-249 – GAO – in the Deprecation Process,

There are several CPs that need to be integrated into the profiles, those are noted on the “CP Profile Status” tab on the CP Process Spreadsheet https://docs.google.com/spreadsheets/d/1kUNTaDr8ePjhWdT5L-FkCVnEeINj0RRij63S9A9LArs/edit#gid=0

CDA-DSS Summary Section

Present: Steve Moore, Raffaele Giordano, Chris Melo, Thom Kuhn, Dr Thierry Dart, Emma Jones, Gila Pyke, Denise Downing, Andrea Fourquet

Phone: George Dixon, Daniel Venton, John Donnelly

Reviewed all Medium and High comments, combined all comments into one spreadsheet for review


• Made low priority changes to the document already, i.e., minimal to minimum

• rendering summary sections from at least one to –be capable of rendering summary sections

• Changed the 3Y.1 to PCC-1 TF2.3.1.1

• X.2.2 did not clearly explain about the Summary Section View Option and due to this comment edited Summary Section Option section of the profile which discussed Content Creator

• Decided to leave the question open about if the summary section will get added to the CDA document, for this profile it does not apply to all documents across the organization the decision is left up to the implementer – can include the question in the Joint Meeting, but for this profile will include this question in the Open Issue section of the profile – IHE needs to solve the issue of grouped Actors

• Customizability – raising the bar that the HCO user can customize the view onsite, but it does raise testability issues, Steve will give Emma a revised statement to satisfy this comment

• Changes in status and updates – wanting to make sure the data placed in the summary section is consistent with the data in the CDA document, a system generated section would be presented in the same manner in the summary section so there isn’t a chance for the sections to have different content, if it is a user generated system there is a chance for the user writing a summary for the content to be different, but the summary is stating what the issue is in a narrative form for the receiver of the summary section to review back to the CDA Summary section, can you do linkage from the summary section down to the definitive data section, issue is with maintaining the linkages, discussed testing of narrative content in the Summary Section and the content in the CDA document

• Receiving consumer of the CDA document can set the business rules to see CDA data items that wasn’t known to the system, this profile is not changing the CDA capability

• X.6 – could do a better job of describing content in this section, Steve

• Vol 3 – Content Modules – we do not have a volume 3, volume 2 is transactions, in the past volume 2 use to have content so PCC developed volume 3 for this content and PCC wasn’t going to have transactions, but now we do and we do not have volume 3 content – adding this to the F2F Joint Meeting

• Rendering Only – Active/Planned Medication Summary Section for the profile Use Case is looking at meds the pt is taking and going to be taking, look at status of moodCode, Active and Planned Meds, as a consumer do they have to look to see if the information is present before rendering a med section, why as the consumer do you have to do this? if the consumer only wants to render the Active med and the section already exists in the document, but if you wanted to dynamically create this section you would want the consumer to look for this in the document – Steve will reword this section and send to Emma

• X CDA Document Summary Section Profile (Section) - Added more clarification to what the profile can do – added content that the profile can also contain specific template sections for providing summary sections, one or more summary sections allows a narrative summary section that may not contain data from content in other sections, but doesn’t have to, the Notes section can have narrative or structured entries,

• X.4.1 – Concepts – reworded the section to add the term “rendered” instead of “generated”

• X. Corrections to previously Reported Treatments or Diagnosis - reviewed concepts – “incorrectly reported data” and edited wording to this section

• Reviewed “Notes” and that this profile is using the “Notes” template

• Negation – is there any requirements on the Actors when creating a summary that has a code check negation, should be able to apply negation indicator when interpreting the discrete data elements wording was added to this section

• The profile doesn’t provide any guidance for format of text, this is based on implementation business rule guided

• Out of Scope for this profile is what to do if there isn’t a Care Team to take care of this pt., how to display this to the user is out of scope

PlanDefinition for Care Planning (DCP)

Present: Steve Moore, Raffaele Giordano, Chris Melo, Thom Kuhn, Dr Thierry Dart, Emma Jones, Gila Pyke, Denise Downing

Phone: George Dixon, Daniel Venton, John Donnelly, Jeff Danford

Reviewed Comments submitted, only received comments from 2 reviewers


• Actor Grouping – 3 Actors CP Guidance Service,

• Several comments retracted due to misunderstanding of text in the profile

• Figure X. – doesn’t understand how it is connected to the Clinical Use Case, Use Cases don’t contain technical information, but the diagrams should show the transactions, comment stated the text did not talk about FHIR planDefinition, a planDefinition defines several activity definitions, why is the arrow going to Update PlanDefinition when this is not displayed properly in the figure, figure is confusing, updated figure

• Care Plan Definition Service should be the term used throughout the profile

• Several comments need to discuss how the FHIR Subscription Resource is done in vol.2 of the profile, will discuss tomorrow with additional committee members and SME

• Will need to define how the Request Resource will be able to map to Care Plan Activity

Paramedicine Care Summary (PCS)

Present: Raffaele Giordano, Chris Melo, Dr Thierry Dart, Emma Jones, John Moerkhe, Gila Pyke, Denise Downing

Phone: No Committee Members


• Condensed ED Summary for a report if the HCO wanted it part of the report, QA & Trauma data elements will be present in the appendix, make an ED Summary option that would include meds, hx, scene times, style sheet XML format can be formatted for the user, so don’t need to send data that is not useful for the end-user, but if you don’t send data that the end-user wants they can’t see it, want to keep that in mind when profiling the structured data, don’t want to overburden the end-user with not needed data, but you have the case that if it’s not sent they can’t use the data, will continue with 3 options – ED Summary, Trauma Data & QA Data

• Need to discuss content for vol 2 & vol 3

• Move the Billing section to volume 4, remove from volume 3 and leave the LOINC codes as is

• Discussed that the profile will have 3 options – ED(clinician) Summary, QA Section and Trauma Section, need to have the CDA and FHIR documents

• Will move the Trauma data set to volume 4 because the trauma data, transport mode, and trauma center criteria for transport to is US centric

• Will do a table to compare all 3 options (Clinical, QA, Trauma) to compare all 3 data elements so we can see what data elements overlap

• Dr. Mears comments were discussed and resolution noted on the Comment spreadsheet

Tasks To Do:

1. Receive answers from Dr. Mears about his comments, discuss his answers with the committee tomorrow

2. Discuss some open issues with John and Steve in the room

3. Review CDA Referrals from Cindy

4. Talk with Steve Moore tonight

5. Extensions for CDA for EMS procedures

6. Do the 3 Option table

7. Structured Definitions (did Forge and Trifolia, Forge worked well and Trifolia wasn’t anywhere near what it should be)