Card Tech Minutes 2017.04.19-21

Wed, April 19, 2017 - Day 1

Consolidated CRC, Vol 1

10:30a - 12:00p

Introduction to the Supplement - This doesn't explicitly cover pediatric procedures, it only covers adult procedures. We will amend the wording to ensure that clinicians understand the scope of it's use. Antje added the references to Health Policy Statements (HPS) and other publications that were cited. She re-numbered the Open Items for clearer understanding of what was still left to be done. We also will add a glossary for the template. She copied the the content for Actors Requirements and Content Modules which will need to be transferred to the new Art Decor tool. In the Content Creator section the codes for report and procedure types was updated to include EPRC. Content Bindings need references for the containment structure. She placed an overview to give users the scope of how this is meant to be used in the clinical world. The three use cases remain unchanged, and give more details about how this could be applied. Some editing was done to remove duplication of descriptions. We will also place wording that this profile will supersede the previous versions. We'll spend a little bit of time to ensure that grammar and technical wording of the CDA is correct.

Documentation - Cardiology will be the first domain that will use Art Decor to produce the documentation of our profiles. Mary Jungers reminded us that the final content needs to be usable by end users, so we will need to balance the materials based in the template, and what resides in Art Decor, e.g. value sets. Discussions with Kai Hentmann will take place around May 2nd to help us define three mechanisms for publications: a PDF, a wiki, or a template within Art Decor. We'll use this a pilot for Art Decor CDA documents. If it doesn't work, we may need to consider another pathway. We may have a public comment period about the Art Decor publication process to have end users provide feedback on the new process. As a side note, the Art Decor is very helpful and does seem to streamline the work of the Domain.

Content Module - There is a new Parent template ID for this document, from 1.1 to 2.1. We are unsure if Data Element Requirements Mappings to CDA would be required for this profile. it is more conceptual, such as where the history for the section came from. This could be extended by the Registry Data Elements. On a high level, we could say these terms came from the HPS. IHE does not have a consistent approach to content modules. Optimally, this should be harmonized across Domains. In Art Decor, it is possible to list the Parent Templates, which may be too much detail for the average implementation. They are more interested in what actually works, not as much detail into the why something should work. Table 6.3.1 - Maps directly over to Art Decor, and include the cardinality and optionality. As a side note, Mary said that we would be responsible for testing the links manually. The template ID and the OIDs are linked within the document as well. Section 6.3.3, Section Content Modules will include a brief overview to help people understand the background behind each section. This should give people an understanding of the motivations for the build. If these are meant to be used by people with more expertise, we may remove the entry level documentation. Name Space entries might be maintained by each Domain. Cardiology is currently performing that function. two things that were removed were the constraints, and the examples. Art Decor allows for use to store the examples, which decreases the page count by 30-40%

Consolidated CRC - Vol 3 templates

1:00p - 3:00p

Chris Melo opened Volume 3 in the Art Decor tool. The identification of the document type is a LOINC code, pulled from the CRC template, that needs to be converted to a Value Set. We'll need to add the codes from EPRC-IE. The header was reviewed to possibly remove duplicate codes. Chris will contact Kai to see if he has recommendations for streamlining the template development. Several of the components were reviewed to establish their contributions to the newly named, Cardiac Procedure Note. There is the possibility of a tree view representation of the templates used to build the document that can be added to the document. Other aspects of Art Decor tool were discussed as Volume 3 was discussed. A value set was created called Cardiac Document Type. It is meant to be inclusive for diagnosis and well as therapeutic interventions. Further review of the details around the templates occurred, with minor changes made to improve the general efficiency. Some discussion occurred around the exact steps required for public comment using the Art Decor tool. No resolution was achieved, but further discussion will require feedback from Mary Jungers, to define the an effective way to document comments. We will also need to find a way to have non-Art Decor users feel comfortable navigating the tool for comments with little or no expertise. One point of discussion that emerged was: how do we develop a style guide around the capitalization of terms within templates. This varies between SNOMED and LOINC and others. No final decision was made, however we will create a policy for consistent development. Another point of discussion was around the timing of the encounter. The template listed a request to document down to the second for any encounter. This thought was that this is not practical for interactions that include office visits, which may not have that level of recorded detail.

Consolidated CRC - Vol 3 value sets

3:15p - 5:00p

We started with CRC value sets and we have the same concept represented via different code systems with semantics equivalence. A lengthy discussion ensued regarding duplicate listings. The possible solution may be to create value sets for each coding system that could make it easier for vendors to select the correct codes with fewer choices. Rebecca Baker reviewed the changes she suggested for the version 4.4 value set. Further comparisons of the codes between procedures will be reviewed and possibly consolidated. We begun the comparison of the during the meeting but this may take much more effort.

Thur, April 20, 2017 - Day 2

8:30a - 10:00a

The discussion of structured terminology and modeling vocabulary as a larger topic included Jimmy Tcheng MD as participant. He points out that making concrete recommendations such as RxNorm, in the US, as the first choice with SNOMED as a back up. Another solutions is to have a US national extension in Volume 4. Each nation could then have a choice to add and execute another national extension that is suitable for their frameworks. The decision is emphasizing RxNorm and SNOMED, and removing NDF-RT Drug classes, which is used primarily by the Veteran's Administra3ion, (VA) and will be phased out as the VA transitions to RxNorm. The challenge is to have the upkeep that is suitable for global implementation. Putting this discussion out for public comment might be helpful. One question that needs to be clarified is how the national extension could be handled within Art Decor. This might fall into the hands of each nation that adapts the profile as a Volume 4 and documented, however how this flows back into IHE Cardiology is still unclear. It may be brought to us, as a work item from the German implementation group, which we would import into Art Decor. It would very difficult to test the national extensions into the final text. The conclusion from the conversation is to leave one recommended table, RxNorm, and SNOMED with the option to add international extensions as needed. In a perfect world, the tool would also be able to handle the national extensions and allow for forked versioning.

Volume 3

The three use cases are still universal and valid per Jimmy's recommendations. The plan is to have the Public Comment version in Mary Junger's hands by May 5th.

10:30a - 5:00p

Breakout workgroups worked on value set evaluations and update.

Fri, April 21, 2017 - Day 3

8:30a - 9:00a

IHE Japan Update on JSC Standards and Activities

Takeshi Oozeki from Canon and IHE Japan Technical Committee gave a presentation regarding the Cath Report Contents Report with three sections. The first is patient demographic information, the second lists the catheterization and angio device panels. The third section lists procedure results. After physician comments the 400+ required data elements were too difficult to fill out in its entirety. Their solution will be to make many of the data elements optional. This will encourage physicians who have an interest in a research area will have the option to fill specific data fields. LOINC codes are used primarily, rather than SNOMED. Also smoking history has been a complex issue for inclusion in the Social History of the patient. IHE Cardiology uses the SNOMED codes for this information. Even between cardiac societies in the US do not have a harmonized approach to documenting this aspect of care.

IHE Japan CP for IVI addition to CRC

9:00a - 9:30a

Nakano Shinichi from Canon and IHE Japan Technical Committee presented a document for change proposal (CP). They are suggesting the expansion of the profile from device vendors to RIS vendors to allow for the wider adoption. The IVI examination is an optional part of the PCI procedure. This is highlighted in Section 3.2.x of the change document. They are listing all of the choices as optional. It was not clear which items were changed from the standard workflow. Changes will need to be made to the documentation. There may be additional complexity with the MPPS steps which indicate the currents status of the procedure. It was suggested for them to contact Kevin O'Donnell, as he is an expert on scheduled workflow. This may be an international extension.

Consolidated CRC

9:45a - 12:00p

Only two tabs of the spread sheet are left to compare before they are sent to Kai for upload. Rebecca Baker will do this off line and then present them to the group. While Nick Gawrit and Chris Melo work on the Results Observations section.

1:00p - 4:00p

Further work within the templates, planning for the June 2017 F2F meeting. Preliminary calendar invitations have been posted on the Google group.