HL7 January 2019 Working Group Meeting, FHIR Connectathon and C-CDA IAT: A Recap (Part II)

For the week following January 12th, a delegation from the Dynamic Health IT development team was on hand in San Antonio for the HL7 Working Group Meeting and FHIR Connectathon. Our team shared technical approaches and a vision for the future of FHIR, C-CDA and our industry at large. This is Part II of our recap of the week’s events.

While the Working Group Meeting (WGM) covered the entire week’s festivities, FHIR and C-CDA got the intensive treatment over the weekend of January 12th. While FHIR had its own discussion track at the WGM, in-depth technical discussions of interoperability at the document and data levels reigned over the weekend.

As in any technological meeting of minds, some of the discussion can become obscure. But it is just this level of detail that is pushing the maturity of the standards and is proving crucial to adoption.

Among other efforts over a busy weekend, our team discussed important use cases for the standards, reviewed USCDI data elements, shared our methodology for C-CDA to FHIR (not to be confused with C-CDA on FHIR) and went deep into the details of Clinical Notes. There were also, as always, a range of tracks offered to put developers through their paces.

In Part II, we summarize few more of these important flash points.

Provenance comes of age

DHIT team in a rare moment of down time.

Provenance is “data and metadata for who and when information was/is created, for the purposes for trust, traceability and identification.” And it’s been hot topic of conversation in some recent C-CDA events and this time was no different. To show that it’s arrived (and needs to be taken seriously) it has been included in the expanded USCDI.
If document-level meta-data can be verified and included as a matter of course, it will go along way to breaking down barriers of distrust between providers and systems.

Patient Summary vs. Encounter Summary

We discussed Encounter Summary documents at length in our previous post in which we reviewed some of the Carequality/CommonWell recommendations. Whereas an encounter summary is meant to be limited to a specific episode of care, patient summary documents contain a record of care over a period of time, including multiple encounters. 

But as debated at the IAT, how do we represent a problem list – should it show a snapshot in time, a net problem list or be in some way shifted to another document type or section to avoid any confusion? Most clinicians, at any given time, want condensed data that provides direct insight to the patients’ current state of being – so what happens to the history when a document is compiled?

Meds and Labs

Shades of meaning become increasingly important as standards are defined down to the last character.  While a ‘Medication, Administered’ should indicate that a clinician confirmed that the patient took the med, medication “complete” is another story.

There was a consensus for putting all lab results in the results section, while some associated procedures may be essential dual-entered in the procedures section.

Close quarters at Connectathons, while at times chaotic, have the virtue of providing sustained and meaningful interaction. Many questions that may get overlooked during a normal workday back at each of our respective offices get answered.

If the spirit of the event is “share and share alike,” then San Antonio was another roaring success. When it comes to interoperability, the learning and collaboration never stops.