PCCPlan Minutes 2013 10 09

Attendees: Laura Heermann Langford, Laura Bright, Charles Rica, Bruno Grossin, Denise Downing, Anne Diamond, Keith Boone

Call in Attendees: Emma Jones, George Cole, Dave Stumpf, Lisa Nelson,

Reconciliation of Interventions, Goals and Care Providers

• Emma Jones
• Discussion:

What do we mean by "intervention"? Need to define this in the detailed proposal.

Should we consider other things that need reconciliation? -

• • 1. Advance directives
  • 2. Providers and Pharmacy
  • 3. Family members and Contacts
  • 4. Patient preferences
  • 5. Coded Functional Status
  • 6. Medical Devices (would this go in the "intervention"?)
  • 7. Review of Systems
  • 8. Discharge Instructions (hospital) (would this go in the "intervention"?)
  • 9. Instructions Section (would this go in the "intervention"?)
  • 10. Discharge Diagnosis
  • 11. Hospital Discharge Results Summary
  • 12. Diet and Nutrition (would this go in the "intervention"?)
  • 13. Social History?

Some things have privacy and security risks.

Reconciling Vitals and Results as another profile is discouraged because results is done by other means and vitals are typically collected and utilized locally - this was discussed as part of the SMART project (Per George C.)

Patient Visit View Summary

• George Cole
  • Review of Profile Proposal
  • Discussion:
    • use of section headers, section titles to allow for different phrasing to be used for patients and providers
    • scoping - inclusion of rendering content? At this point encouraged to include for further discussion at the Technical committee.

Need to address classification that exists and can it be used to drive the display. What goes in the style code attribute of the CDA doc and these are the values. Make it more about what it does with the content in the CDA document. Need to make the classification broad - e.g.

• Section level content
• Item level text within a section
• Patient header data
• etc

Implementation as to what is seen with rules can that enables it to be rendered. For example, may include the address if it was updated recently.

Wording for the sections should be different for the patient. Suggest we should not profile any behavior that changes actual text within the document.

Section title is inside the document - there can be two levels to dealing with the title

• The organization of the material on the screen have the title.
• Section title and section code allows CDA document to do this type of organization.

Align with vol 1

• need to describe the capabilities we want to enable - purpose is patient friendly display

e.g. hide empty section, allow patient preferences for what they see.

• In the vol 1 - indicate what is already supported in CDA

In vol 2 simply describe what you do with the content to enable this capability.

For Detailed proposal

• More work needed on the request list - provide grouping
• Add a few different use case to illustrate hide or show sections
• Also more on the categorizations - may need to do a matrix of categories and functionality of what we want to happen (rows and columns)

• May want to work on a more extensive list - Keith have a list to share - other organizations may have some.

Identify how to classify narrative content to enable the functionality

Need to decide if the following is in Scope/Out of Scope

• How to render tables, lists (numbered and bolded), paragraphs, etc - should we want to include rendering of content. One issue is to classify columns of information in a table. These are technical committee questions.

Suggest keeping the scope as wide as possible for now and narrow down during the technical discussion.

This gets into the user experience capabilities - which is a differentiator from work being done by other groups

Harmonization of Lab Section

• This issue came up in a recent change proposal meeting. The Results Section in PCC Framework is not aligned with the Laboratory Committee definition. Discussion RT what needs to be done to harmonize/reconcile the difference. Team agreed the work needs to be discussed at the Technical Planning Committee meeting in November. There will be opportunity in November to have joint meetings with IHE Laboratory Committee. Laura Bright will create a Detailed Profile on this topic to facilitate discussion at the Technical Planning meetings.

Synoptic Reporting for Cancer Diagnoses

• There is active work happening in several areas of the world regarding this topic. It has not been brought to IHE by any of the teams actively working on it - but IHE recognizes the need for this to be included in the technical framework. A small group from PCC Tech will create a Detailed Proposal to facilitate discussion at the Technical Committee Planning meetings in November. Efforts to invite and coordinate with Lab and Radiology committees will also be done. It is anticipated Radiology will be meeting at the RSNA offices in November at the same time as the PCC Tech Planning meeting so this too should facilitate collaboration of the teams on this topic. This will likely be a white paper.

Data Aquistion Framework (DAF)

• PCC had a discussion regarding the level of team support available and of interest to the PCC community. It was agreed that if needed, PCC likely has the bandwidth to facilitate the project management of this topic. PCC recognizes the importance of the topic within the US and its applicability to other nations. Several members of the PCC team are and will continue to be highly involved in the project regardless. With the current bandwidth of PCC we agree to volunteer to manage the project through IHE process and facilitate high collaboration with the other interested workgroups - if that is what the other workgroups would like to do.

Voting on Profile Proposals

• Reconciliation of Interventions, Goals and Care Providers
  • Motion made by Laura Bright to accept the brief proposal and move the project on to the PCC Technical Planning Committee. 2nded by George Cole. No abstentions, No objections, 8 affirmatives. Project proposals passes to proceed to next step.

• Patient Visit View Summary
  • Motion made by Keith Boone to accept the brief proposal and move the project on to the PCC Technical Planning Committee. 2nded by Anne Diamond. No abstentions, No objections, 8 affirmatives. Project proposals passes to proceed to next step.

• Harmonization of Lab Section
  • Motion made by Keith Boone to move the project on to the PCC Technical Planning Committee. 2nded by Anne Diamond. No abstentions, No objections, 8 affirmatives. Project proposals passes to proceed to next step.

• Synoptic Reporting for Cancer Diagnoses
  • Motion made by Anne Diamond to move the project on to the PCC Technical Planning Committee. 2nded by Laura Bright. No abstentions, No objections, 6 affirmatives. Project proposals passes to proceed to next step.

• Data Aquistion Framework (DAF)

Deeper Dive on DAF and its scope

• Discussion led by Keith Boone
  • In-depth review of Proposal and identification of existing IHE profiles that apply in each part of the DAF.

Local Query

Structured Data	Document	Quality Measures
QED	XDS MetaData	QH
HL7 V3 Messages	XDS	HQMF R2
PIX/PDQ for patient demography	XCA	QRDA
	XCA	GAP
	MHD
	QRDA
	QRPH?

(suggestion made to also consider the OASIS Collaboration Profile)

• • Query Structured Layer
    • XDS Metadata
      • Documents -> MHD + FHIR
    • Structured Data
      • V2, V3 Patient Administration
      • PIX/PDQ/XCPD
      • QED V3 Care Record

• • QED + FHIR = Gap

---

API's conceptually missing....

     WSDL      XDS/XCA
     (SOAP)    QED
     REST  ->  MHD  ->  FHIR  ->  BB +

Imaging??

Transport

  WSDL/SOAP
  REST             HTTP
  V2 / MLLP / TCP
  XDM / SMTP

---

Authentication

Local = EVA Cross Enterprise = XVA or Federated = IVA

ATNA <- Node and Required User Auth

• • • Discussion resulted in the following proposals:
      • Write a White paper out of IHE
        • Include a description of the framework
        • Include references to profiles as appropriate.

• • • • Create Profile Proposals to address these needs
        • ????

T-Con Scheduling

Between now and the November face to face meetings.

• Reconciliation of Interventions, Goals and Care Providers
  • Tuesdays 11:00 CT for 1 hour, every week

• Patient Visit View Summary
  • Tuesdays 10:00 CT, on October 10/22 and 11/5

• Harmonization of Lab Section
  • No need for specific calls to be set up

• Synoptic Reporting for Cancer Diagnoses
  • Laura will reach out to Kevin O'Donnell for assistance
  • No need to set up specific calls for this.

• C-CDA Harmonization
  • Calls on hold until the templating/versioning discussion is completed at HL7

• Change Proposals
  • Timing for calls will be reevaluated at the November meeting
  • None needed between now and November meetings

• DAF
  • If this project goes forward with significant PCC involvement we suggest scheduling to accommodate Keith's schedule (possibly Friday mornings 0900 CT).

• Preparation for the Technical Planning meeting
  • Have Detailed Proposals to Laura B by November 5.
  • Slide deck to discuss the detailed proposal is optional. May just use the detailed proposal document for discussion at the November meetings.