PCC TC Face to Face February 17-21, 2020 Minutes

February 18, 2020 F2F Meeting Day 1

Attendees:

• Present
  • Keith Boone
  • Andrea Fourquet, eHealthsign
  • Lori Fourquet
  • Vassil Peytchev, Epic
  • Steve Moore
  • Michael Clifton, Epic
• On phone
  • Mike Nusbaum
  • Bob Hausam
  • Holly Miller
  • Emma Jones, Allscripts
  • Thierry Dart, ANS

IPS (volume 2 review, Andrea Fourquet)

• FHIR section
  • Removing : observation imaging, observation pregnancy, observation pregnancy outcome
  • Device : https://build.fhir.org/ig/HL7/fhir-ips/StructureDefinition-Device-observer-uv-ips.html
    • Need clarification of participant role
  • Allergy and Intolerance
    • Structure do not seem to support the diagnosis
    • Severity value set does not include 'moderate'
  • Functional status
    • Entry functionalAssessment is a ClinicalImpression resource
  • Plan of Care
    • There is no strcture definition for Care Plan
  • Condition category code

360XL (volume 1 review, Vassil Peytchev)

• The 360 Closed Loop Transfer from Acute Care to Skilled Nursing Facility (360XL) profile builds upon the 360X profile for closed loop referrals. This supplement uses some of the existing transactions of the 360X profile and adds some new ones in order to adress use-case specific requirements for the transitionof care from an acute care facility to a long term skilled nursing facility.
• Actors : better to reuse the actors (Transfer initiator and Transfer recipient)
  • Actor grouping ?
  • Important to distinguish interfacility transfer and transfer
• Workflow
  • There are multiple facilities who can receive the requests.
  • Each facility has to accept or decline the transfer of the patient.
  • The patient or care givers make the final choice, and has to confirm his choice to a facility and to cancel to the others.
• Work to be done : review of the actors and transactions diagram

Business and CP work

• CPs session, PCC CPs Spreadsheet
  • CP-PCC-0285 (new CP, RIPT): assigned to Andrea: update NEMSIS mapping
  • CP-PCC-0284 (new CP, PCS): assigned to Andrea: update NEMSIS mapping
  • CP-PCC-0283 (Vassil): work in progress
  • CP-PCC-0282 (Vassil): work in progress
  • CP-PCC-0281 (Vassil): balloted, Michael to incorporate 2/18/20
  • CP-PCC-0280 (Lori): balloted, not incorporated
  • Combing in one CP : CP-PCC-0277, CP-PCC-0276
    • After a discussion with John, QEDm needs to have a vocabulary support. What is a international value set for QEDm ? To support national extension, we may use the search parameters. This topic will be discussed in the jont meeting (valueset binding in international profile and national extension)

ACDC (Comments review, Keith Boone)

• Open issues and questions
  • Seek feedback on the need to be able to update the results of an assessment -> how we address security and privacy.
  • QRPH SDC adresses the definition of forms
• Comments review
• Shall we need to embed the questionnaire into the questionnaire response ?

Joint meeting (ITI, PCC, QRPH)

February 19, 2020 F2F Meeting Day 2

Attendees:

• Present
  • Keith Boone
  • Andrea Fourquet, eHealthsign
  • Lori Fourquet
  • Vassil Peytchev, Epic
  • Michael Clifton, Epic
  • Amit Popit, Epic
• On phone
  • Mike Nusbaum
  • Bob Hausam
  • John Donnelly
  • Emma Jones, Allscripts
  • Dr. Nemanja Milenkovic, ANS
  • Dr. Holly Miller
  • Dr. Thierry Dart, ANS

IPS

• Review of plans for the profile
  • Pregnancy
    • specialist - suggestion to use performer on the observation for paractitionerRole
    • pregnancy - outcomes - missing value for still born
    • pregnancy metric does not seem to be supported - ability to capture gravidi and Parity. Discussion of how this is represented in CDA by Keith. Context is the IHE profiles capturing information about pregnancy. used for reporting information about pregnancy. Work done in 2009. These would be all observations in FHIR.
    • In IPS, would go in the pregnancy history section in the composition as another observation . Pregnancy outcome is a history of prior pregnancy. See http://build.fhir.org/ig/HL7/fhir-ips/StructureDefinition-Observation-pregnancy-outcome-uv-ips.html

Can't extend the valueset because it's required binding

• • • Suggestion
      • 1) add additional entries because it's open slicing with out making changes to IPS as all.
      • 2) If something is missing from existing slices and propose a change if a few elements are missing. Have a few weeks to do this.
      • Rob suggest providing a list of what should be added to the slice.

ACDC

• Review of the following
  • 3.X3.4 - Interacrive Diagram - Launch assessment
  • 3.X3.5.1 - Security Audi Considerations
  • Epic support the EHR Launch pathway, what kind of audit should be done when a FHIR SMART app? - suggested should follow -ITI Appendix Z
  • Vassil suggest a Launch event. Per Keith will discuss with ITI folks.
  • Review of the ATNA table of things that can go in the audit.

• Assessment request, requestor, patient should be included in the launch audit.

• • Discussion about entered-in-error - Status specified by the FHIR base spec.
  • The sending system will define if the questionnaire response is "amended" or "entered-in-error"
  • Transaction numbers assigned as requested by Keith - Keith will provide the transaction names to Michael
  • Update of X.4.2.1.2 Use Case #1 Process Flow.
  • Discussion about the search parameters.
  • Update to the ACDC Profile page reviewed - ACDC Profile page
    • Reviewed work to date.

360XLT

• Review of Vol 1
  • Actor Transaction

• Content from the initiator to the recipient only. No content is sent to the initiator from the recipient.
• Question from yesterday
  • How does the RIPT profile differ from 360XLT?
  • Is it common to use ambulances to transport patients to nursing homes?
    • It may not be common - different local policies determine different things.
    • Suggestion to include RIPT in the cross profile consideration.
    • Actors in the 360XL differs in that RIPT transaction is a query. Whereas 360XLT actors send.
    • Per Keith - if the grouping requirements determine when both actors are implemented this would be the expected behavior.

February 20, 2020 F2F Meeting Day 3

Attendees:

• Present
  • Keith Boone
  • Andrea Fourquet, eHealthsign
  • Lori Fourquet
  • Vassil Peytchev, Epic
  • Michael Clifton, Epic
• On phone
  • Mike Nusbaum
  • Bob Hausam
  • John Donnelly
  • Emma Jones, Allscripts
  • Thierry Dart, ANS

IPS (volume 2 review, Andrea Fourquet)

• Open issues :
  • Duplicated valueset on Allergies and Intolerance section
  • Some Snomed CT codes have been inactivated, where are they maintained ?
  • Pregnancy status currently being updated to value set ? (History of pregnancy section)
  • OID management : keep the actual OID until HL7 will update the new OIDs of the sections. HL7 is responsible of OID management for IPS.
  • HL7 doesn't support a time stamp for outcome date
• Need to keep a good connection between HL7 and IHE
• No vote for IPS

ACDC (Comments review, Keith Boone)

• Transaction and diagram tables have been updated
  • [PCC-71], [PCC-72], [PCC-73]
• Open issues
  • have been updated
  • Should there an error in input, or selection of assessment instrument?
• Volume 1
  • Changes talked yesterday have been updated
  • Need to update the workflow described in volume 1
• Security chapter has been updated
• Capability statement has been updated
• Volume 3 has not been changed (only the title !)
• Voting session
  • Motion to move the ACDC profile to trial implementation
  • Quorum has been established (Andrea Fourquet, John Donnelly, Lori Fourquet, Michael Clifton, Bob Hausam, Thierry Dart)
  • No discussion, no oppose, no abstention , all in favour

IPS (volume 2 review, Andrea Fourquet)

• Discussion to add an option to indicate if the IPS is complete (Derek)
  • Suggestion of Keith to address this option in public comments, Suggestion of Andrea to add this option in a open issue
  • For the publication
    • Publish an update of the Volume 1
    • Incorporate this option as an open issue
• Workflow is not include in this profile

360XL (volume 1 review, Vassil Peytchev)

• Actors definition
  • Name are the same as 360X
• Content module: still work to be done
• Transport options: XDR, XDM
• Security consideration are the same as the 360X
• Next steps
  • The expectation is to work on Volume 2 and 3 after this week (ready for public comment in may)
  • Volume 1 will be reviewed during the next PCC T-CONF (voting)
• Voting session
  • Motion to accept the changes made in volume 1 and continue to work on volume 2 and 3
  • Quorum : Emma Jones, Michael Clifton, Lori Miller, Lori Fourquet, Thierry Dart
  • No discussion, no abstain, no oppose, all in favour

Next PCC Bi-Weekly Calls: Friday 28th February 2020

• Voting session for IPS (Volume 2 and 3) and X360L (Volume 1)
• PCC Bi-Weekly Calls agenda and minutes