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Thursday, October 3, 2013

IHE PCC Profile Proposals for 2014-2015 Cycle

IHE Patient Care Coordination discussed two profiles for our next cycle, both of which I hope will go forward.  The first of these is to support reconciliation of goals, care plans and care teams.  This is pretty much a no brainer.  Yes, these things definitely need to be able to be reconciled, and we've already established some pretty good patterns in the IHE Reconcilliation Profile (RECON) when we addressed problems, medications and allergies.

The next profile is even more fun to consider, and fortunately for me, the original name of it was right, even though I disagreed quite strongly with the approach.  The idea was that there should be a profile that enabled a provider to give a patient a useful view of the information used in a recent encounter.  The full proposal name slips my mind at the moment (I overloaded on classwork last night), but the first two words were Patient and View.  And View is really the key word here.  It is a virtual representation or projection of a total collection of information onto some other space.

We talked about the patient view, and I think that's a fine first place to approach this.  One of the reasons for addressing this as a view, rather than a new form of CDA document is that as a patient, I want to see exactly what the doctor sees, as is done with Open Notes.  So, I'm not interested in a restricted set of data.  I want the whole thing.  However, I also see the point that there aught to be a way to mark (tag, add metadata) to content in a document that enables end-users to filter and make better use of information.

Some of the metadata that might be needed:

  • Was this information verified this visit.
  • Was this information otherwise updated this visit (e.g., change in medications).
  • Was this information added this visit.
  • Was any information removed during this visit.

All of the above has to do with so-called control-acts in HL7 Version 3 (which aren't directly supported in HL7 CDA -- but there may be a way to address that).

There are also ways to identify cases where:

  • There's no information to be presented (other than the fact that there's no information).
  • These are positive findings.
  • These are the negative findings.
These have to do with various ways to say NO, YES, and UNKNOWN.  Tri-state values on responses to key questions or observations that could be made during review of systems or physical examinations or other values.

Then there are differences that might have to do with interpretations:
  • This is within normal limits
  • This is outside of normal limits
  • This is something to be really worried about.
I find myself both satisfied and amused that I'm using Tuesday night homework in putting together my analysis for today's feedback on this profile proposal.

These are the only two profile proposals that IHE PCC has. We are also still waiting with baited breath on the outcome of discussions next Thursday at the HL7 SDWG call on CCDA Release 2.0 template versioning, and what's needed to handle that, and whether it must all go half-way back to the drawing board or not in our harmonization efforts.  I really do hope they adopt the solution I proposed.  IHE has been coordinating a great deal with Templates on how to version artifacts, I'm hoping that SDWG will take the same approach.

Next week we'll be in Oakbrook to further define and refine these proposals.  There may also be some work from DAF to look at, but ITI has first crack at that.


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