PCC TC Face to Face November 15-16-2017

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PCC Technical Meeting Face to Face November 15-16, 2017


Wednesday, November 15, 2017

Introduction/Agenda Review/Sponsor Announcements by Jeremiah Myers, IHE Secretariat

New HIMSS Manager Lauren Groden introduced

New IHE members Kala-ACOG, Michel Clifton-Epic

February F2F meeting will be at the Univ of Oslo Feb 12-16, 2018

Public Comment April 30-4th at Oakbrook

Final Text F2F meting July 16-20, 2018

IHE USA is requesting interested parties in writing blogs for HIMSS 2018


Emergency Transport to Facility:

Present: Andrea Fourquet (EHealth Sign), Lori Fourquet (EHealth Sign), Thom Kuhn (ACP), Michael Clifton (Epic), Amit Popit (Epic), Emma Jones (Allscripts), Kayla (ACOG), Denise Downing (AORN), Gila Pyke (Cognaissance)

Phone: Tone Southerland (IQVIA), Thierry Dart (ASIP Sante)


The problem: No proper transfer of information from an ambulance to a hospital A few of the mapping to NEMSIS are correct There are data detail concepts missing from the IHE profile. Need more data elements in each section Technical approach: Content profile- CDA summary document No new actors. Content creator and consumer are the existing actors for the profile. No new transactions. Andrea will have 2 new approaches. The biggest challenge to getting ems data is identifying the patient properly. The goal of the profile isn’t to take the human communication out of the equation but to simplify that communication and assist them in transferring the data from the ET to the facility. New transaction added: FHIR update/create

Question for Joint Meeting that come from this profile discussion – how do we identify a pt using FHIR without exchanging a document? PDQm will include demographics, use PIXm for not wanting to be exposed to demographics just one identifier

Discussion around this profile will have a new transaction FHIR update/create named "Send EMS Transport Data", should this be a QEDm transaction, no the content is different

ETS/ITS - ITS is the same as ETS, but ITS doesn’t send scene data, this profile will deprecate the two existing PCC profiles ETS/ITS

People are signing up at CAT for ETS those individuals were asked to do RIP

HL7 document maps to EMS that is created for the hospital EMS Pt Care Report v2-origin started with creating a new CDA level 3 document and took all the NEMSIS content and created templates, currently there are no immunization content and international information (i.e., insurance isn’t necessary for international purposes), HL7 took the NEMSIS value sets and normalize them with LOINC and ICD-9 codes

ZOLL has been demonstrating this at CAT with EPIC

Risks of the Profile - confusion for implementations, CDA side cleaning up the work and harmonizing with HL7 work, non-international work want to profile it here, if it is international in nature go to HL7 to update

Email Jay Lile or ask Dr Myers about the history of the NEMSIS HL7 Standard – NEMSIS - the goal of this profile is to use FHIR and NEMSIS to map content to, but NEMSIS is US based, so it doesn’t take into account international considerations, so make this content needs to be international

Use Case is focused on the handoff from the ambulance to the HC facility and the exchange of the content, there will be a FHIR and CDA option for transmitting data and the underlining data standard HL7 EMS Pt Care Report Level 3, NEMSIS defined the data content and sponsored the CDA standard, the value sets are in VSAC (NLM)

Goal make it international


CDA Document Summary Section

Present: Thom Kuhn (ACP), Micheal Clifton (Epic), Amit Popit (Epic), Emma Jones (Allscripts), Denise Downing (AORN), Gila Pyke (Cognaissance)

Phone: Tone Southerland (IQVIA), Thierry Dart (ASIP Sante), Dr. Miller (HCO), Daniel Venton (Allscripts), Neelima (VA)


Problem – complaints from users (providers) the documents (CDA) they are receiving from other providers are too long need a concise summary Discussed existing standards available - IHE Document Section Summary (text), C-CDA 2.1 Notes Section (structured enteries) and sending PHI in the summary document and the document sitting in a repository, by creating this are we making the system generate a summary and stating the document was generated because someone queried because the document will become part of the pts medical record, this should only be a user generated summary

Next Group of Use Cases is about Care Plan – there are linkages to the different sections within the CP, HL7 only gives examples of style sheets, but ONC is requiring a style sheet to be sent but the receiver should be able to view the content the way they want the information, displayed a better layout of the data showing the linkages of a concern, goal, interventions for one concern, systems can display or incorporate the data, the difference is the sender sends the summary or the receiver dynamically transform the data into a style sheet and displays the summary section

Discussion about making the profile into two+ profiles focusing one profile on provider>provider and then provider>system where the system generates the summary section

Third Group of Use Cases - pulling and displaying structured content in the document into the Summary Section, there is fundamental issues with the HL7 standard because of deprecated problem sections that is being addressed

When writing the profile it will determine if the profile should be two profiles, currently there are no new actors, different transactions and options


FHIR PlanDefinition for Care Planning

Present: Thom Kuhn (ACP), Michael Clifton (Epic), Amit Popit (Epic), Chris Melo (Philips), Rafealle Gairdano (Arsenal Italy), Emma Jones (Allscripts), Denise Downing (AORN), Gila Pyke (Cognaissance)

Phone: Thierry Dart (ASIP Sante), Neelima (VA), Jeff Danford (Allscripts)


Dynamic CP profile was the created due to HL7 work, then in HL7 they started working on Care Coordination DAM Extend the DCP profile by providing the ability to use Activity definitions will create an activity (i.e., medication) which will create the plan, it will use a FHIR workflow to create the plan FHIR Workflow Management – activity definition is a library for the plan definition, you put in the activity definitions as a predefined activity definition that is stored in a library

Rafealle – working on XDW, but not in ITI this cycle, their focus is to use FHIR to manage workflows, similar to this profile, but using general definitions, Task Resources

Question to the committee – is do we do the general workflow definition work with the specific (Care Plan) definition work? Mauro and Rafealla can offer guidance to this profile as SMEs

In January 2018 - Plan Definition turning into actionable orders will be tested at HL7 Hack-a-Thon which can be used to write IHE PCC volume 2


CP Maintenance

PCC TC rejected CP 266, with the proposal for the submitters to complete their next HL7 ballot and return with a new CP when the standard has passed ballot. Reviewed CP statuses/CP process. Began cleanup of CP folders.


Joint Meeting

Two (2) FHIR Profiles – Emergency Transport to Facility – exchange of scene information from an emergency scene to a hospital, currently scene information, transfer information, and intervention are only available to hospitals on paper when the patient arrives, this profile will close that gap, EMS data can also be used for Quality Care Measures and QRPH is taking on this work which may contribute to the needed content in this profile so we will keep an eye on this work in QRPH (Trauma, STEMI, Stroke, etc…)

Plan Definition for Care Planning – care planning is very difficult to create care plan, profiling the FHIR activity definition and Plan Definition Resources used by order sets or protocols, Extend the DCP profile by providing the ability to use


CDA Profile -

CDA Document “Executive” Summary Section - that looks at several problems - CDA documents often contains large amounts of information that makes it difficult to identify pertinent information in an efficient way for the providers. This profile will provide a mechanism to provide a concise synopsis about the document that the author needs to communicate to the reader

Thursday, November 16, 2017

FHIR PlanDefinition for Care Planning

Present: Thom Kuhn (ACP), Michael Clifton (Epic), Chris Melo (Philips), Rafealle Giordano (Arsenal Italy), Emma Jones (Allscripts), Denise Downing (AORN), Gila Pyke (Cognaissance)

Phone: Neelima (VA), Jeff Danford (Allscripts), Dr. Miller (HCO)


Reviewed changes to Detailed Proposals-Arsenal Italy is defining general workflows and Task Resources, this profile will consult with Arsenal Italy who is doing implementations

T-cons - do a Doodle poll for a biweekly meetings


CDA Document Summary Section

Present: Thom Kuhn (ACP), Michael Clifton (Epic), Chris Melo (Philips), Rafealle Goirdano (Arsenal Italy), Emma Jones (Allscripts), Denise Downing (AORN), Gila Pyke (Cognaissance)

Phone: Neelima (VA), Dr. Miller (HCO), Dan Venton (Allscripts)


Updated the Detailed Proposal – grouped the Use Cases differently, two groups - Group A and Group B

Technical approach create one profile, New Summary section will be optional and the profile will explore conformances (shall, should and may)

T-cons – do a Doodle poll for scheduling T-cons meeting every other week – Friday’s are better than Thursday, Friday morning or Monday


Emergency Transfer to Facility

Present: Thom Kuhn (ACP), Michael Clifton (Epic), Chris Melo (Philips), Rafealle Giordano (Arsenal Italy), Amit Popit (Epic), Chris Carr (HIMSS)

Phone: Neelima (VA), Tone Southerland (IQVIA), Dr. Miller (HCO)


Displayed the completed Detailed Proposal template, need a new Actor for FHIR, change the Actors name of the Actor FHIR Responder, perform a gap analysis between NEMSIS and FHIR

Co-chairs will reach out to Greg Mears (Zoll) to encourage them to become members. Cost is low, but the IP concerns are important. Bring Chris/IHE International in to help if that doesn’t work. Also reach out to NEMSIS Barring that, IHE PCC Co-chairs have the discretion to invite them as a guest to provide advice but not to author or vote. If other vendors try to take advantage of this loophole, Co-chairs have the power to say no.

T-cons - Biweekly meetings – Mondays or Wednesday prior to 12pm Eastern

Goal is to create one new profile and deprecate ETS/ITS, reach-out to users of ETS/ITS before we deprecate them

Change profile name to Ambulance Transfer to Facility (AFT)


Rating, Discussion and Voting

Ratings can be found here:ftp://ftp.ihe.net/Patient_Care_Coordination/yr14_2018-2019/Technical%20Committee/Detailed%20Proposals%202018_2019%20Cycle/2018-2019%20PCC%20TECH%20ProposalEvaluationMatrix%2020171006.xlsx

AFT - Tone motioned Emma seconded, No Objections, No Abstains

CDA Summary - Amit motioned, Neelima seconded, No Objections, 1 Abstains

FHIR PlanDefinition – Emma motioned, Neelima seconded, No Objections, 1 Abstain


Membership Discussion

Andrea is the provider side, but we need input from the technical side as an EMS system and those implementers may need to be an IHE member, there is an aspect of IP and patents with becoming a member

CDA and FHIR profile discussion - as a committee do we focus on the need or we wait until the need is brought up to us that the ecosystem wants to use a certain standard, as a committee it has been brought to PCC that developers only want to do FHIR, but CDA is what is currently out in the healthcare environment, to stay relevant and satisfy both needs PCC has chosen to develop some profiles with the CDA and FHIR perspectives


Meeting Adjourned