PCC TC Face to Face February 12-16-2018

Day 1 - IHE PCC Tech Committee Meeting F2F Oslo 2018-02-12

Participants:

• Tone Southerland (Quintiles)
• Emma Jones (Allscripts)
• Denise Downing (AORN)
• Thomson Kuhn (ACP)
• Andrea Fourquet (e-Healthsign, LLC)
• Gila Pyke (Cognaissance)
• Chris Melo (Philips)
• Raffaele Giordano (Arsenal.IT)

Emergency Transport to Facility

Attendees: Andrea Forquet, Lori Fourquet, Tone Southerland, Thom Kuhn, Emma Jones, Gila Pyke, Denise Downing

• Lori Fourquet joined us for the discussion
• John Moehrke joined us for part of the discussion
• Discussed the open issue of whether use of the FHIR document composition would satisfy both CDA and FHIR systems
• Not clear if metadata needs for XDS would be met
• Emergency vendors want to jump directly to FHIR
• John suggested we do CDA because it is easier to make normative, and also use FHIR composition/FHIR resources
• Open issue is closed: Will follow the same approach as in RIPT, i.e., Do both CDA and FHIR.
• Created new open issue, “How will this profile align with ongoing development in FHIR and HL7 working groups in relation to FHIR document composition, and any other developments that occur?”
• Reviewed Open Issues
  • see HL7 Pt Care WG Discussion about FHIR Composition – representing Notes in FHIR, how clinical notes represented in FHIR a lot of systems today that capture notes in structured and unstructured ways, HL7 how do I discover the Notes in CDA documents, document reference is the broad thing it can point at CDA document, image, FHIR observation, FHIR, during the meeting they discussed how to format clinical notes, but focus on using FHIR Document Reference for discovering Notes and talking about the GET, but need to have a Content Creator; how should a Clinical Note that isn’t all that structured and a FHIR Composition may be too much, Observation is too flexible, what’s the best way to define a Clinical Note – will close #1 as it is currently written use CDA or FHIR, will move to Close, but write a new Open Issue about CDA and FHIR Composition, how is this profile going to align with future FHIR development in FHIR HL7 WGs in relationship to FHIR Composition and any other FHIR development work
  • create new FHIR Resources for NEMSIS data, can we use NEEM backbone that all the gov divisions use (fire and rescue), certificate of med necessity had to have a new Resource, imagining & lab reports, if we identify gaps in mapping we present the need to the appropriate HL7 WG

Change Proposals

• The committee worked on updating and moving CPs into the new CP structure
• CP 266-02 – HL7 Ballot on this topic has been completed. Request to move the CP to completed.
• Stopped at CP 226
• Committee work – Do we have a process for how do we deprecate profiles – define the process,
• Action item identified: Discuss how to deprecate profiles. Find time on the agenda for this. Candidates: ITS, ETS, GAO

FHIR Plan Definition

Attendees: Raffaele Giordano, Tone Southerland, Thom Kuhn, Emma Jones, Gila Pyke, Denise Downing

Phone: Jeff Danford, Chris Melo

• This item is not creating a new profile, it is updating the Dynamic Care Planning (DCP) profile with this use case, a FHIR way to do dynamic care planning and templating all the updates are in “green” font, definitions have been updated and “Care Plan Guidance Service” definition is new, added new transactions and glossary terms and activity definitions, corresponds with the HL7 Care Coordination functional model,
• Goal is to have something implementable or that clinicians can use after the profile has been developed
• Background – part of clinicians workflow they use protocols or clinical practice guidelines (EBP) for Care Planning, templates for specific disease protocols and clinicians can modify them for each ind pt, select the order sets that can apply to a pt, each order is an activity definition, this profile has a collection of activity definitions organizes under the Plan Definition which then is assigned to a pts Care Plan, needed an Action to accept the Activity Request (e.g., Procedure Request), applying this to the current Care Planning Profile and the Care Plan Contributor will interact with the Care Planning Guidance Service, the Request Resources will be sent to the applicable systems (i.e., lab, EHR, eRx), in the future Decision Support can be added and physician referrals, updating the Care Plan can be accomplished within Dynamic Care Planning
• FHIR has an “apply” action that can be used to make the activity definitions into a procedure, a referral, a medication, device or a lab request or order as applicable based on the context in the activity definition, these would be created as a “task” and workflow piece is out-of-scope for the profile
• Jeff showed a visual of how the profile could work, clinFHIR.com
• Actor definitions were discussed Care Plan Service and Care Plan Guidance Service, discussion about the name of the Care Plan Guidance Service and will put it in as an Open Issue, need to add to Open Issue an explanation about what “as initiator” means if not already present in vol 2
• Reason Content Contributor is paired with Care Plan Service is because it needs to share resources that would be acted upon (i.e., RequestGroup Resources) and share (i.e., Push or Pull) the applicable content. or sent to systems, section X.1.1.5 needs some rewording

CDA Document Summary Section

Attendees: Raffaele Giordano, Thom Kuhn, Emma Jones, Gila Pyke, Denise Downing Phone: Dan Venton, Chris Melo

• Updated acronym of the profile and put a hyphen in it CDA-DSS
• Overview – content creator/consumer provides the ability to do the same thing, but can do other things based on how it is implemented
• This item is creating a new profile, with new options on Content Creator/Content Consumer
• Content Modules creating new IHE PCC sections, added to the IHE PCC list, need to make the Notes Summary Section a US vol 6, but can discuss this if it needs to be international, Care Plan Team Summary Section needs template ID
• User defined piece needs further definition, another area of work how to create views (how to slice/dice CDA views)
• Reviewed all the Use Cases, defining Care Team, right now in Care Team in HL7 there isn’t a lot of context, this Use Case will define who is the care provider for the pt in one region or another

Sponsor Updates

Tuesday evening meeting at one of the restaurants in the building, Jeremiah has left HIMSS and will no longer be the coordinator for PCC, Celina will take over PCC duties until a new coordinator is hired

Homework for Tonight

• Read the Plan Definition and CDA Summary documents and provided Emma with comments.

Day 2 - IHE PCC Tech Committee Meeting F2F Oslo 2018-02-13

CDA Document Summary Section (CDA-DSS)

Attendees: Raffaele Giordano, Thom Kuhn, Gila Pyke, Denise Downing, Emma Jones

Phone: Dan Venton, Chris Melo, George Dixon

Open Issue – how should C-CDA templates handle US Realm templates date/time, should it go into IHE vol 6 which is US Realm specific, discussion about doing an errata to HL7 to get this fixed, this affects Notes and Care Team templates to determine if it is restrictive to US Realm vol 6 if not will put it in the vol 1 content and point to the HL7 standard

The profile has received comments which have been addressed, all comments reconciled

Participants:

• Tone Southerland (Quintiles)
• Emma Jones (Allscripts)
• Denise Downing (AORN)
• Thomson Kuhn (ACP)
• Andrea Fourquet (e-Healthsign, LLC)
• Gila Pyke (Cognaissance)
• Chris Melo (Philips)
• Raffaele Giordano (Arsenal.IT)

Motion and Vote

• Motion: Move CDA-DSS Profile Volume 1 forward so Volume 2 can be started.
  • Motioned by Allscript and seconded by ACP.
  • Unanimously approved by 6 voting organizations

OB Discussion Attendees: Raffaele Giordano, Thom Kuhn, Gila Pyke, Denise Downing, Emma Jones

Proposal coming from the National Academy of Medicine, how to move the PCC OB profiles forward in this project

NAM doing a policy position in the US to move forward vendors, hosp systems to have more interoperable systems, doing a Whitepaper which is device centric at the time and has referenced PCD profiles, wiki page needs to have the profiles seen, looking at FHIR profiles,

Is this similar to the ONC-ISA, this is a draft document, attendees at the meeting were Kaiser, Mayo, VA, Cerner, this project will get a lot of press, part of the VA/Cerner contract language, the agreement will contain specific profile usage, timeline sooner the better for PCC to review/revise the draft Mike put together, the sample language to include in the draft paper needs to be done immediately for final publication, sample language to provide the sample language, need to bring in IHE leadership (Chris Carr, Joyce Seinsmeyer), once the agreement language is developed IHE has a lag time from contract to implementation so IHE has time to work on the suggested profiles to use, alignment of IHE profiles with CCDA with the profiles and other groups (i.e., Stan Huff) and common vocabularies and work done in VSAC should be done with the profiles, national realm extensions, this is US centric, this is a great opportunity for IHE, each hosp will take this agreement/contract language as a sample to use for other IHE profiles (cut/paste) , looking at doing this as a bucket layering (i.e., security, content, language, transport)

• All the IHE PCC profiles are up-to-date and incorporated in FHIR
• How a vendor or hospital to operationalize the use of the profile

Action Items:

• Dr. McCoy will send the draft
• Tone will review the document
• Denise to send Joyce an email about this project

ETF

Attendees: Raffaele Giordano, Thom Kuhn, Andrea Forquet, Lori Forquet, Tone Southerland, Emma Jones, Gila Pyke, Denise Downing

Phone: Elena Vio, Chris Melo

Issue that came up during the QRPH meeting - the FHIR actor name should be more simplified, that way it can be used for other profiles, looked at ITI FHIR actors that push activities, new name data sender and data consumer

Transaction names are good Data elements table reviewed, discussed that the data dictionary should be in vol 1 and the actual table should be in the appendix