2024 November 19: Meeting Summary for ONC Standards Group and USRPM Weekly Touchbase

Attendees

Quick recap

The team discussed the use of the sex parameter for clinical use, the necessity of adding a fixed code to an extension, and the challenges of testing and implementing the Uscdi standard. They also reviewed the design and functionality of the Usee data elements in Cda, the creation and management of value sets, and the use of standardized vocabularies in other orders. The team agreed to proceed with the current design, continue refining the value sets, and work with Eric to determine the best place to put guidance.

Next steps

Gay to provide clear guidance about how extensions work in FHIR and how the meaning is retained, and is the same as the meaning in the CDA representation.

Gay to present the QA of the US Core next week.

Al and Carmelo to review the clinical tests value set and provide feedback on codes that should be excluded.

Gay to make changes to the clinical tests value set based on feedback, preferably before going into ballot.

ASTP team to consider adding clarification in the CCG if needed regarding testing for SPCU in FHIR and CDA.

Gay to proceed with the original plan (bullet 2) for handling SPCU in FHIR without adding the LOINC code to the extension.

Summary

Sex Parameter for Clinical Use in FHIR US Core Discussion

In the meeting, the ASTP team discussed their internal discussions regarding the use of the sex parameter for clinical use.

They decided to reuse the existing design from Gender Harmony and provide guidance that the existing extension carries the same meaning as the LOINC code 99501-9 Sex Parameter for Clinical Use.

They agreed to work with Eric to determine the best place to put this guidance. The team also discussed the need for additional clarification and guidance, but ultimately decided to keep the Gender Harmony developed standard FHIR SPCU extension pre-design in place.

Adding Fixed Code to Extension

The discussion revolved around the necessity and implications of adding a fixed code to an extension. The participants debated whether this should be a standard practice, with some arguing for the use of standard terminology and others questioning the need for a code in this particular context.

The conversation also touched on the potential for inconsistency if different teams decide to implement something as an with or without standard termnology. The participants agreed that this issue was not specific to SPCU, but rather a general FHIR concern that needed to be addressed but is out of scope at this time as it is a Core FHIR issues.

USCDI Standard Testing of SPCU and Clarification

The team discussed the challenges of testing SPCU extension without a fixed code. They debated whether to make changes to the USCDI standard or to provide a clarification in the Certification Companion Guides (CCGs) Testing guidance.

The team also discussed the potential for confusion in interpreting the extension, with some arguing that the current system is clear and others suggesting that a fixed code is needed to check the value of the extension. 

The team agreed to consider the least impactful solution:  Reuse the Gender Harmony developed pre-existing design and provide guidance that existing extension carries the same meaning as 99501-9 Sex parameter for clinical use inherent in the elements of the extension itself.

USCDI Data Elements Design Review

The meeting focused on reviewing the design and functionality of the USCDI data elements in C-CDA.

The team discussed the C-CDA USCDI representation of:

• Clinical Notes
  • Emergency Department Note
  • Operative Note
• Immunizations
  • Lot Number
• Observations
  • Advance Directive Observation
  • Sex Parameter for Clinical Use
• Orders
  • Medication Order
  • Laboratory Order
  • Diagnositic Imaging Order
  • Clinical Test Order
  • Procedure Order

No major concerns or questions were raised about the design and all designs were approved to go into ballot. Please see some minor take-aways on the USCDI v5 Design Review Table