2020-07-09 Meeting notes

Status Updates

• Upcoming Vacations (OOO)

  • Linda: July 24 - August 8

  • Robert: July 15 - 2

  • We are more mature on BPM+ work than the questionnaire and we will split the calls for Monday to focus on questions and questionnaires (cancel large group meeting) and Thursday will focus on any additional questions we have when the group comes together

  • Group: Consensus

Explaining Value to the Field

• Keith:

  • Steve Brown says we need to make the case for why doing the BPM+ is important in the first place

• Robert:

  • What we're trying to do is clearly and concisely express clinical knowledge/ reduce costs/improve well-being

  • If we can agree that this will help us improve the value for the veteran, then the question is: what languages might one use to express clinical knowledge?

  • Historically we've used narrative text, spatial representation, traditional way of expressing clinical knowledge but the problem is that we're looking for domain appropriateness (looks at certain characteristics that you want or don’t want to have as part of your language)

• Keith:

  • Using the literal concept of domain appropriateness would not suffice for the type of detail Steve Brown is looking for. It's almost too "technical"

  • Let's round robin and see what the rest of the group thinks:

  • Linda: Doesn't think we have to use the professional terminology, but she would enjoy taking a stab at completely rewriting it for a different audience

  • Andrew: Yes the concept makes sense, but terminology should be accessible. We are trying to help providers in giving care

  • Penni: Understands it but is not familiar what how it was phrased

• Keith

  • Steve is concerned about the "Why?"

• Robert:

  • This work will remove the errors that are commonly found in clinical practice guidelines, e.g. same word being used with multiple implications

• Keith:

  • Robert and Linda work together to develop about 10 slides to break down terminology into simple English. This will get to the core of the "Why" question, e.g. explaining why Cerner, clinical reminders, etc., are not sufficient

  • We want to show the characteristics of the appropriate solutions

  • The first stage is for Robert and Linda try to spend some time on that, and we will get some strategic communication support at some point so their work will be an input to that comms strategy, and then Steve Brown will be pulled in to give counsel on how to present the language.

• Linda:

  • Robert to write down his perspective and Linda will work on it

• Robert

  • Probably pull slides that he uses in his class to explain these things for Linda
    
    

Questionnaires

• Keith:

  • We need to be able to represent the questions that are needed to get input back into the process

• Linda

  • [Screen-sharing what she has done in CMMN - it’s the flow of questions from the formal CDC questionnaire]

  • Keith: Wants to make sure that Penni has the equivalents for what to do in SNOMED. If Linda keeps working on it as text, then Penni can take that and work with aligning it in SNOMED

  • Linda: Gave the XML to Andrew; will send latest versions to Andrew in case anything has changed

• Robert:

  • He needs to go take another look at HL7 response before he can make any comments

• Keith:

  • Will show an alternative to the group to get group's thoughts. Logica Health has a different efforts related to COVID which is FHIR implementation work and they've been working on this implementation guide. Obvious overlaps: demographics, exposure, history etc.  However, they're using a structure definition resource as opposed to a questionnaire

  • E.g. For underlying cardiovascular issue present, theirs is 2,215 lines, whereas the questionnaire for "Does the patient have an underlying cardiovascular disease present?" will be about 10 lines

  • They should be using the observation resource not the condition resource; it's super complicated especially for the implementer and is not the right approach