Patient Care Minutes

Jan. 2008 San Antonio

Monday, Jan. 14th 9.00 am – 5.00 pm

Quarter / Topic / Responsible
Q1 9:00 – 10:30 am / Planning / William Chair
Q2 11:00 - 12:30 pm / Care Plan / Work as a committee
Q3 1:45 - 3:00 pm / Finalize Allergies / Allergies: ensure that comments have been reviewed and what comments need to be addressed. / Larry Chair
Q4 3:30 - 5:00 pm / Joint with O&O and PC / Assessment Scales / O&O

Q1 – Planning

Name / Email / Q1 / Q2 / Q3 / Q4
William Goossen / / X
Linda Mook / / X
David Rowed / / X
Karen Nocera / / X
Farhan Ahmad / / X
Susan Matney / / X

Susan Matney announced that when her Patient Care co-chair term expires in May 2008 she will not run again for the position, as she is pursuing her PhD, but expects to remain in her current role at Siemens and to return to HL7 involvement.

Susan reviewed material from the Nursing Management Minimum Data Set Survey. This is data that is collected for nursing management activities. (What is the patient population? What are the service delivery areas? etc.) A great deal of work has been done to make the data set computable but not yet implementable. See Susan Matney for data element details.

William posited that this material can be used in population-based use cases, including the aggregation of messages with the removal of individual patient detail. This prospective project will be reviewed with stakeholders, including Community Based Collaborative Care. CDISC (clinical trials), CDC (immunization registry), cancer registry, and similar registries for other clinical care groups, are also likely to have relevant use cases.

Summary of current open action items:

  1. Assessment Scales (William)
  2. Allergy comments need to be addressed.
  3. Vocab stuff with Ted Klein (Geri)
  4. CIC plan with E.H.R
  5. Francois Menerot CEN call
  6. Care Plan storyboard and model compare (Susan/John)
  7. Problem storyboard and start of modeling
  8. Aggregate use cases

Discussion of May 2008 planning concerns

  1. Expect to use same agenda structure, incl. Monday Q1 planning quarter.
  2. Planning for ballot
  3. A publishing facilitator is needed. Talk with Helen Stevens.
  4. Review the ballot schedule and establish project plan for each (assessment scales, care plan)
  5. Talk with SIG’s and see if Wednesday works for them for a group meeting. Is another timeslot better? Or a teleconference after the May meeting?
  6. CIC will still require at least 2 quarters. Need to discuss process with Don Mon regarding PC tasks/deliverables and the related flow of domain information from CIC to modeling responsibilities in the technical committee
  7. Clinical statement will require 1-2 joint quarters

Q2 Care Plan Minutes

Attending:

Name / Email
Susan Matney /
Larry McKnight /
William Goossen /
Kay Avant /
John Kufuor-Boakye /
  1. Identify care plan source materials to review
  2. CEN 13940
  3. Care Provision model
  4. Use case document
  5. CCD – plan of care definition
  6. Nursing Process – JAMIA paper
  7. Care planning lit review.
  8. Reviewed model
  9. Concern Tracking
  10. Obs = Pneumonia in event mood
  11. Subconcern = risk for hypoxia, mood = risk

Action items:

  1. Define a mechanism for binding concerns in care plans
  2. Risks are defined in the mood of “Risk” (not event)
  3. Define how order sets are linked.
  4. Susan – complete the storyboard (utilizing sub-concern) and work with committee to document and map back to model – review on Tuesday.
  5. Review and revise the Care Provision Guidance document for:
  6. Problem
  7. Care Planning
  8. Order list
  9. Work list
  10. Allergy list
  11. Define how mechanism works for statement collector and care record.
  12. Terminology binding – especially “Risk For” solve +/-, +/+, -/- issues.

Q3 Allergies Meeting 1/14/08 Monday

Larry McKnight Chair

Attending:

Name / Email
Susan Matney /
Larry McKnight /
William Goossen /
Kay Avant /
John Kufuor-Boakye /

Plan Resolve Ballot Issues:

  1. Tooling issues have been addressed.
  2. Final review of ballot
  3. AllergyIntoleranceConcern (REPC_RM000324UV) “Participant2” should be “Author”
  4. Clone names have been changed correctly
  5. Validated that all comments identified are reflected in the current Jan. 2008 ballot.

Action Items:

  1. Need to give official notification to Don Lloyd that all ballot changes were reviewed and accepted and is now ready for DSTU. We also need to notify him that we have no publication facilitator to do the job.
  2. DSTU comment collector – Larry pointed out that we need a location to monitor comments given for DSTU. MaryAnn sent the URL a few months ago but William stated that it is not working correctly.
  3. Susan to contact Don that DSTU comment collector login is not functioning using Firefox or internet explorer.
  4. DSTU comment link needs to be distributed to the listserv and patient care is collecting comments.
  5. We will schedule meeting time to review the comments collected on the DSTU in Vancouver on Tuesday.
  6. Care Provision Explanation and Guidance needs to be revised.
  7. Susan ask Dan for source.
  8. Proposal is to pull the document off the Ballot site for right now.
  9. Susan email Don to have it taken off the site and state it is under revision.
  10. Motion – William motioned that we accept ongoing work up through May in Phoenix. Kay Avant seconded. All in favor.

Q4 – Joint with O&O – resolved common observation ballot comments.

Tuesday, Jan. 15th9:00 - 5:00 pm

Quarter / Topic / Responsible
Q1 9:00 – 10:30 am / CEN discussion on Contsys / Compare the care planning and workflow between care provision and CEN. / Susan Chair
Q2 11:00 - 12:30 pm / Problems Model / Larry Chair
Q3 1:45 - 3:00 pm / Assessment Scales / Assessment Scales / Susan Chair
Q4 3:30 - 5:00 pm / Care Plan
Review models that have not gone to DSTU / William Chair

Q1 1/15/08 Tuesday Walk through Contsys Model

Susan Matney: Chair

Attending:

Name / Email
Susan Matney /
Larry McKnight /
William Goossen /
Gunnar
John Kufuor-Boakye /
Andrew Perry /
Yvonne Pynacher Horelyh / Yvonne

1. Where is Contsys currently being used.

Action Items:

  1. Need to align Contsys with the care provision model in the context of care planning.
  2. Pick on a smaller area to start.
  3. First map terms
  4. Concern vs. health issue,
  5. Contact vs. encounter,
  6. Care plan and care plan content
  7. Contact
  8. Period of care, episode
  9. Use definitions.
  10. Create glossary of shared concepts – highlighting concept differences.
  11. Review HISA mappings – ask Mark Schafferman
  12. How:
  13. Concept clarification (Kay)
  14. Map on word/concept definition
  15. Combinatorial analysis (William/Gunnar)
  16. Intentional and extensional analysis
  17. Create as a project for the TSC for this collaborative work.

Q2 Health Condition List 1/15/08 Tuesday

Larry McKnight: Chair

Attending:

Name / Email
Susan Matney /
Larry McKnight /
William Goossen /
Tom Oniki /
John Kufuor-Boakye /
Kay Avant /
Andrew Perry /
Ian Townend /
Rik Smithies /
David Rowed /
Andrew Hinchly /
  1. Items to review
  2. ISO 18104 – Nursing Diagnosis Model
  3. ISO 13940 – Continuity of Care
  4. ISO 22789 – Conceptual framework for findings and problems in terminologies.
  5. CCD
  6. TermInfo
  7. Who is currently using problem models
  8. CanadaInfoway, VA, Mayo, University of Nebraska, CaBig
  9. Susan to check to see if there is a scope statement for this work.
  10. Currently have “Health Condition Topic” as the overarching item on the ballot.
  11. Possible people to assist
  12. Tom Oniki
  13. Kevin Coonan
  14. Gunther Schadow
  15. Jim Campbell
  16. David Rowed
  17. Bob Dolan
  18. Dan Russler
  19. Peter Elkin
  20. Larry McKnight
  21. John Kufuor-Boakye
  22. Susan Matney
  23. William Goossen
  24. Needs to go up on WIKI so use cases are reviewed.

Action Items:

  1. Initial analysis of model and background information
  2. Inform structured docs and O&O
  3. Email possible participants and notify of times.
  4. Notification of update to TSC
  5. Start WIKI page
  6. Collect model information
  7. Begin writing storyboards that highlight different use cases.
  8. Susan to start project plan.

Q3 Ballot Edit Review 1/15/08 Tuesday

Susan Matney: Chair

Attending:

Name / Email
Susan Matney /
Larry McKnight /
William Goossen /
John Kufuor-Boakye /
Ian Townend /
Tom Oniki /
Peter Swartz
Jim Campbell /

Action Items:

  1. Explanation and Guidance – remove for revision (Susan notify Don Lloyd)
  2. Care Structure Topics RMIMs – still need storyboards and activity diagrams for each section.
  3. Need to solicit examples
  4. Need hyperlink to common observation and back
  5. Care plan – still draft, not DSTU
  6. Care record query topic
  7. Investigate combining and creating on large query
  8. Jim Campbell will investigate if the query is giving DSS the data they need.
  9. “Condition tracking” in request needs to be changed to “Concern Tracking”
  10. Care Transfer Query Topic
  11. Not currently DSTU
  12. Don’t remove it – leave it unless further work is requested.
  13. Adverse drug events
  14. Not currently DSTU
  15. Needs to be stakeholders are asking for it.
  16. Care Composition Topic
  17. Need a clearly defined use case.
  18. Keep there for now. John will bring back Canada use case.
  19. Send email stating Patient Care would like DSTU comments by Sept. 2008.

Q4 ?? Karen Minutes?

Wednesday, Jan. 16th 9:00 - 5:00 pm(Susan taking tutorial in a.m.)

Quarter / Topic / Responsible
Q1 9:00 - 10:30 am / SIG projects: Community Based Collaborative Care and PHER / Max Walker – Community Based Health / William Chair
Q2 11:00 - 12:30 pm / Joint with EHR TC / Carley, Jason C. (HPTI) [
HDF Process / EHR
Q3 1:45 - 3:00 pm / Open / vMR update, planning. / Susan Chair
Q4 3:30 - 5:00 pm / Clinical SIGs – EC, Cardiology, Pediatric Data Standards SIG / National EMIS Information System –NEMSISSarah Ryan / Larry Chair

Q1 CBCC, PHER Report

Name / Email / Q1 / Q2 / Q3 / Q4
William Goossen / / X
Rob Savage / / X
Emily Honeycutt / / X
Anita Walden / / X
Rick Furr / / X
John Roberts / / X
Brian McCourt / / X
Lawrence McKnight / / X
Peter Kress / / X
Rita Altamore / / X
Michelle Williamson / / X
Kristi Eckerson / / X
John Kufuor-Boakye / / X
Kay Avant / / X
Gert Koelewijn / / X
Michael Martin / / X
Michael Tan / / X
Ken Rubin / X
Max Walker / / X
Linda Mook / / X
David Rowed / / X
Karen Nocera / / X
Susan Matney / / X

Wednesday Q1 Meeting Minutes

Community-based Collaborative Care

Peter Kress discussed current implementation concerns regarding the CCD (continuity of care document)

One of the components of community based collaborative health’s domain is a strong focus on long term care. In that focus they have been moving forward an agenda to achieve a base set of standards, and are at work on a 2nd generation of profiles that they expect to move into deployable standards. CCHIT processes continue over the next year. They have done a good deal of work on how to incorporate patient functional status content. This work has proceeded in the context of an IHE project, including a profile that incorporates functional status content in IHE. Now working in standards that incorporate regulated/required patient assessment data. The work uses a semantic content approach of combinant forms, original language, et al. to try to assure communication with the intent of the assessment. Uses semantic matches, Snowmed, and other terminologies, mapping to LOINC-coded questions and answers. LOINC does not encode answers but does have an approach for encoding this for such content. There is a concurrent project to have a minimum key data set for nursing home spaces. This can progress into what might be encoded in a use case for resident movement between long term care and acute care.

CCD has loose interpretations. Peter observes that there is a dialogue with 2 approaches to the CCD – one narrow, one more entrepreneurial. Peter is questioning Patient Care on how free we feel to discuss uses of CCD or CDA for accomplishing particular goals.

Peter characterizes the approaches as:

1. CCD initiatives include encoding a data set for continuity of care. CCD is a single document type of all the CDA doc types, including a Care Record Summary. A narrow approach would say that a CCD is not a discharge summary and specifically excludes it.

Can patient health monitoring summaries be in the CCD summary? Device monitoring with nurses’ comments/notes? Or do we need separate document types, with CCD encoded document standards that have been deployed to date?

2. A broader perspective comes not from the standards developers but from those who want to now leverage the working results: A care summary is anything that is less than the whole, up to and included any/all content for transferring care. Currently there is no work to move forward on a new document, so it seems time to adopt implementation of the CCD, even as document type refinements and tangents may proceed.

Peter asks, What are the Patient Care recommendations for Community Based Collaborative Care, as a group that is trying to promote adoption, not just ongoing development?

Larry asked if there are problems with deploying in terms of “CDA” instead of “CCD.”

Peter responded with concern that CDA implementation does not imply support of the CCD specifically. CDA is too open-ended, not specific enough, whereas CCD addresses a specific domain problem.

William advises that progressing in implementation will require iterative efforts as the standards continue to develop.

Peter invites further dialogue and input on the matter.

A current project by AHIMA is one that has implications regarding whether its outputs are going to be CCD. SD (HL7 Structured Documents) committee members consult on this project, and such conversations are happening now.

Patient Care deliverables are planned for DSTU 2009. TBD – whether CCD implementation decision affects that? Peter expects that typical harmonization efforts on Clinical Statement will meet those needs. However he does highlight that Patient Care needs to be aware of the approaches of assessment instruments and semantic content, an approach that uses LOINC encoding of assessment information but links LOINC Q&A pairs to growing matches. This approach has been discussed by Tom White and is documented in the functional status section of the CCD.

William highlights that we need to understand why a particular implementation of CCD or clinical statement works, and why it does not.

Community based collaborative care will continue joint meetings at WGM’s on Wednesday’s Q1.

Max Walker, as project leader, presented an Overview on HSSP – Health Services Specification Project. See and its wiki page. Community Based Collaborative Care is providing use cases, particularly for the Human Services & Provider Directory.

MOTION: Move that Patient Care take on the Human Services Directory activity as a Project for purposes of ballot hosting.

Moved by: Max Walker

Seconded by: Rita Altamore

DISCUSSION: How much ballot preparation will the project committee do? Ken Rubin describes that the work pace currently involves 6-8 months from task conception to ballot preparedness. The project works with fixed touchpoints and quality gates to assure ballot preparedness. William suggests committee level ballot preceding membership ballot is most appropriate. Membership ballot requires complete use cases, publishing db preparation, and models ready for publication. Ken added that models are not prepared unless there are gaps in existing models; the project primarily focuses on deploying existing standards content. Expects that all work will be DSTU.

Larry suggests that this project be “grandfathered” as an existing project without being subject to new committee leadership and structures.

William asks whether once there is a ballot, can we expect dedicated work time during WGM’s to resolve ballot issues? Ken reports Yes.

For: 17

Against: 0

Abstain: 4

Motion carried.

PHER projects update

CDC Project Overview by Michelle Williamson, Vital Records Birth and Death Registration Project.

Using flat file formats in CHS, states obtain information via proprietary systems; there are disparate interface requirements, issues of timeliness, duplicate data entry, accuracy, et al.

Development of a domain analysis model for this project has been launched. See Michelle’s Powerpoint documentation on the Project Scope Statement. The domain analysis seeks to identify workflows, likely supporting messages, et al. The project has support of the PHER SIG, and seeks Patient Care involvement as another project sponsor.

The intent is to leverage the E.H.R. to facilitate capturing of relevant data at point of care or point of contact.

Open question: should domain analysis models (DAM’s) be balloted (informative) material? The assumption of this project is Yes.

PHER projects in progress

-Vital Records (emphasizes involvement of the VSSC – Vital Statistics Standards Committee)

-Tuberculosis

-Immunization

-Cardiology – Coronary Care

Hot topic: What group(s) do DAM’s live in?

William highlighted that Patient Care ballot material includes well-described DAM material, though that material is not specifically balloted.

General feedback to the discussion supports that informative ballot of DAM’s is reasonable.

Discussion: How to ensure that the informatives are adequately distributed for feedback? The Patient Care list is one avenue. Patient Care is primarily focused on modeling and messaging, assuming that the SIGs are capturing the clinical domain expertise. Domain artifacts such as storyboards, activity diagrams, and glossary must be clear; distribution must include domain leaders outside the HL7 WGM.

Work to date has been US-realm specific, but now with growing international interest in the project, that will not be a limitation.

It is suggested that CIC guidance be sought on the question of the DAM process.

Larry suggests that harmonization of domain overlap can be managed by being very specific in the touchpoints of each given project. Approach the aggregate topics as clusters of use cases. This may trigger new RMIM development.

Recommended action item: Maintain 1 quarter/week at WGM’s for work in progress (in addition to the SIG update quarter that is typically Wed’s Q1). The SIG/TC co-chairs will resolve this schedule for the May meeting and beyond.

PHER and Community-based Collaborative Care SIGs are both interested in the current Patient Care project for aggregation/population studies. In May and future meetings, Wed Q1 will include not only a SIG update, but also a PC update on this project, opening for greater collaboration.

Motion: Move that Patient Care Technical Committee becomes one of the sponsoring groups for the Vital Records Birth and Death Registration Project, and that this project is linked to the action items of the aggregation of data from atomic health records of Patient Care. (William)