ToC+CIM+Vocab+WG+F2F+Meeting+Minutes+2011-07-07

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ToC CIM Vocab WG Meeting Minutes

 * Date:** 07-07-2011
 * Time:** 1:00-2:00pm EDT
 * Dial-in:** 1-408-600-3600 | **Passcode:** 661 213 377

Attendance
Robin Barnes, Amy Berk, Tom Boal, Amy Brantley, Ernest Grove, Allen Hobbs, Lindsey Hoggle, Lester Keepper, Rich Kernan, John King, Ed Larsen, Russell Leftwich, Arien Malec, Vassil Peytchev, Adrienne Pugh, Sandy Stuart, Steven Wagner, Luann Whittenburg, Bob Yencha

Action Items

 * **#** || **Date Initiated** || **Action** || **Owner** || **Status** || **Date Closed** ||
 * 1 || 07-07-2011 || Provide high level examples in each section of the CIM Detailed Report || Holly Miller, Russell Leftwich || Open ||  ||
 * 2 || 07-07-2011 || Incorporate changes and edits to CIM Detailed Report || Meredith Lewis, Holly Miller, Russell Leftwich || Open ||  ||
 * 3 || 07-07-2011 || Review and publish revised CIM Detailed Report || Meredith Lewis, Holly Miller, Russell Leftwich || Open ||  ||
 * 4 || 07-07-2011 || Continue to add comments to discussion board through CIM Detailed Report document || All || Open ||  ||

Agenda Items

 * 1) Discuss CIM Detailed Report comments

Meeting Notes

 * CIM Detailed Report Comments** (Reviewed by Holly Miller)

My suggestion was that for the medication list, each entry has a date discontinued, if null it is active, if today's date it is discontinued. This can then be displayed by the receiving system as discontinued meds if today >= date discontinued. No known should also include "not asked" and for allergies, no known food allergies, no known medication allergies, etc. Does "reason for referral" resolve this? In an ambulatory encounter the admitting diagnosis is typically the chief complaint. It is on the active problem list (in a virtual sense) until resolved to the discharge diagnosis, which then is added to the active problem list. e.g., chest pain on admission, resolved to acute myocardial infarction. In an inpatient admission the problem list might actually change over the course of time; in ambulatory it is likely just the status at the end of the encounter. The difference in "prescribed diet" and "reported diet" was dealt with in care plan, but not captured in this document.
 * Review of data groupings comment** (Russell Leftwich)


 * Responses:**
 * Russell Leftwich:** Review of data grouping is trying to find language around groupings
 * Holly Miller:** I concur
 * Arien Malec:** I concur
 * Vassil Peytchev:** If discontinued why include in list? Also physician don’t enter discontinue date. This is an information model be sure the clinically relevant categories are well defined.
 * Holly Miller:** The purpose is to call attention to the PCP letting them know that the specialist discontinued the medication. We have definitions around medications patients are taking, should be taking and medications that are active in patient body after discontinued.
 * Holly Miller:** We should leave display to software design.
 * Arien Malec:** The exposure is important clinically and noted for the purpose of automation. Knowing what is discontinued in the encounter is useful as long as it’s documented.

Need a data types section -- very confused by the difference between VALUE SET and CE (unless VALUE SET  is what I'm calling List of Foo). Would suggest example content for each section having the first element of the medication list is Active Medication List is.... confusing, particularly as its typed CHAR (18). I have no idea what this is supposed to be. Suggest stealing as much as possible from NCPDP. This section needs to be clear what attributes apply to the list vs. list elements. Would suggest breaking the table into two, where one of the attributes of the List is typed "List of Medication Items" or some such Dose can't be an integer (e.g., "1/2 tablet" "1 drop", "thin coating") unless there's some crazy ontology for unit dosing that I'm missing. The instructions are highly confusing (conflates dose and unit dose). Please note that the drug code may (often does) include unit dose and formulation. Where do I put a text SIG? PIs: the fact that your example has more than 20 characters suggests the data type is wrong.
 * Review Active Medications List comment** (Arien Malec)


 * Responses:**
 * Arien Malec**: Medication History list
 * What medications is the patient currently taking
 * What medications is the patient exposed to
 * Document the medications that are discontinued in last encounter but might still be present in the body

Seasonal shouldn't be a separate list from environmental. At best, it's an attribute on environmental. Is the concern how to express allergies that are seasonal but aren't attributable to a specific substance?
 * Allergies and Intolerances -Environmental/Seasonal comment** (Arien Malec)


 * Responses:**
 * Arein Malec:** Reflect structure will not have discussion today around this topic can discuss offline

Again, really need to break this section up. Here's the cardinality as I see it: Allergy/Intolerance Attributes List of Allergies/Intolerances
 * Allergies and Intolerances comment** (Arien Malec)
 * A/I attributes
 * List of Reactions
 * Reaction Attributes


 * Responses:**
 * Arien Malec:** Possibly eliminate seasonal (How do you document seasonal allergy, make sure well documented we need comment at allergy level)
 * Arien Malec:** Reaction attribute should have a cause defined
 * Arien Malec:** Allergies take from NETHA modeling similar to CDA 3 levels
 * Vassil Peytchev:** Allergy Reaction Severity –maybe affecting the system design because some user see allergy regardless of how many reaction seen they want to see the strongest reaction as with allergy they look at overall level.
 * Arien Malec:** Environmental Allergy -maybe be different from actual reaction. NETHA model made decision to put severity at reaction level and put contraindication at reaction level- this is a clinical determination of the likely severity of a reaction
 * Russell Leftwich:** There is a difference between severity of episode and severity of condition

Admitting/Discharge Diagnoses: text is confusing. Should these be assigned for an ambulatory encounter? Would suggest either labeling this something more generic (e.g., "Episode of Care Diagnoses") or clearly specifying what happens to such diagnoses. Also need to clarify how this relates to the problem list.
 * Review of Data Groupings comment** (Arien Malec)


 * Responses:**
 * Holly Miller:** Encounter discharge for ambulatory
 * Arien Malec:** Suggest make generic and include as a “B” element
 * Holly Miller:** How is this different from active problem list? Issue came up at the time of discharge maybe a diagnosis to sign. Specialist will add diagnosis but will not it delete that is usually left to Primary Care Physician.
 * Arien Malec:** Did something change clinically? Billing set of issues is not what we’re capturing? Paper document makes new diagnosis explicit/out of scope
 * Vassil Peytchev:** In general trying to capture change is somewhat out of scope exchanges are to be used in specific content.
 * Holly Miller:** This is next steps
 * Holly Miller:** Remove distinguish discharge don’t need that category. Encounter diagnosis is irrelevant leave active problem list and continue to have discharge diagnosis category for input. Will have encounter diagnosis in EHR we are talking about TOC active problem lists.
 * Holly Miller:** Reason for referral may include diagnosis with the encounter (will be captured in active problem list)

Lists Physician to Physician, please clarify where other consult requests are covered: OT, PT, Speech, SW, Nutrition, etc.
 * Reason for consult request** (Lindsey Hoggle)


 * Responses:**
 * Lindsey Hoggle:** Check use case want to make sure ancillary care is included in document
 * Holly Miller:** at this point it is in Meaningful Use, this care is out of scope and will be included in next phase
 * Arien Malec:** The primary mission is to support MU agrees it should be generic – the reason for transition of care should be as generic as possible we should generalize the purpose. Can make clear the reason for consult is applicable
 * Rich Kernan:** There is underline tech chosen to cover the other caregivers

Next Meeting

 * Date:** 07-14-2011
 * Time:**1:00-2:00pm EDT

Reference Materials

 * 1) ToC CIM Detailed Report

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