June 1, 2026

I) Review Decision regarding the document used to discharge a patient from a hospital i.e. ToS = Discharge

Remove 'Note'

Exclude Hospital from Setting

General support for removing Note and excluding Hospital from Setting field.

Action: Marc to investigate Manitoba use of "ED Discharge Note" when they admit someone to hospital. Question:can they write a "transfer note"? Or an "ED Consult Note" and the system recognizes it as an equivalent to a discharge note? Action completion: In Manitoba emergency department, they do a consult by filling out a template document and then do an ED discharge by clicking a button, and it adds the word “Discharge” to the title.

Note: Choosing Admission and Discharge documents to be only for admission and discharges from whole facilities, not units ensures that the document type will include what is expected by the reader (a summary of a whole hospital stay or whole evaluation before admission), no semantic overlap with the patient going in and out of a ward. It also allows for markers of hospital encounters when there isn't other encounter information.

Concept Creation Guide for ToS = Discharge

	Preferred	Allowable	Roll Up Term	Summary
Kind of Document	Note	Note	Note	Note
Type of Service	Discharge Summary	Discharge Summary	Discharge Summary	Discharge Summary
Subject Matter Domain	Suppressed	Any	Suppressed	May
Role	Suppressed	Suppressed	Suppressed	Never
Setting	Suppressed	Any facility that requires an admission and discharge. Excluding Hospitals and units within the hospital, such as: ICU, Emergency Dept, Observation unit, Pharmacy, Recovery Room	Suppressed	May - if needed for regulation or accreditation of the facility.
LOINC	18842-5	Many	18842-5	18842-5
Display Guideline	Remove 'Note'	Remove 'Note'	Remove 'Note'	Remove 'Note'
Note	By definition of Discharge, the setting is a hospital	Only use SMD if one discipline/SMD cared for the patient during the hospitalization, but this is not required.

II) Review decision regarding documenting a consultation being requested ie. ToS = Consultation

a) Remove 'Note'

b) Exclude Medical Students, Attending, Physician, Fellow etc.... from Role

General agreement.

Concept Creation Guide for ToS = Consultation

	Preferred	Preferred	Allowable	Roll Up Term	Summary
Kind of Document	Note	Note	Note	Note	Note
Type of Service	Consultation Note	Consultation Note	Consultation Note	Consultation Note	Consultation Note
Subject Matter Domain	Any	Any	Any	Suppressed	Must
Role	Suppressed	Restricted to Any except physician roles such as Medical Student, Attending, Physician, Fellow, Resident	Restricted to Any except physician roles such as Medical Student, Attending, Physician, Fellow, Resident	Suppressed	May - if non-physician
Setting	Suppressed	Suppressed	Any	Suppressed	May- if necessary
LOINC	May available	Some	Some	11488-4
Display Guideline	Remove 'Note' from name	Remove 'Note' from name	Remove 'Note' from name	Remove 'Note' from name	Remove 'Note' from name
Note	Role of physician is most likely so not specified	This option is for authors like NPs or PA's	Specifying the setting does not change the expected content of the document. Therefore, it is not supported by ontology principles

III) Review documentation of an Admission to hospital i.e. ToS = Admission for inclusion in Ontology

a) Specify all SMD

b) Do not specify Setting = Hospital or parts of hospital

Note that patients can be admitted directly to the ICU or to the neonatal intensive care unit. In this case, the document is classified by the training of the author, so this would be a Critical care medicine or Neonatal medicine document. Action: Check the difference between Neonatal and Perinatal with Isabelle.

In the case of needing to escalate care of someone who's already admitted we often say "Admission to ICU", and the ICU team writes an Admission note. We would prefer admission notes to be specific to admission to a hospital. The committee felt that it was reasonable to ask hospitals to change their workflow, calling an escalation of care to the ICU a Critical Care transfer note. This strict use of the Admission document type, ensures semantic clarity with no overlap.

c) Do not specify Role

Concept Creation Guide for ToS = Admission Evaluation

	Preferred	Allowable	Roll Up Term	Summary
Kind of Document	Note	Note	Note	Note
Type of Service	Admission Evaluation	Admission Evaluation	Admission Evaluation	Admission Evaluation
Subject Matter Domain	Any	Any	Suppressed	Must
Role	Suppressed	Restricted to Any except physician roles such as Medical Student, Attending, Physician, Fellow, Resident	Suppressed	May - if non-physician
Setting	Suppressed	Any facility that requires an admission and discharge. Excluding Hospitals and units within the hospital, such as: ICU, Emergency Dept, Observation unit, Pharmacy, Recovery Room	Suppressed	May - if needed for regulation or accreditation of the facility.
LOINC	Many	Many	11488-4
Display Guideline	Remove 'Evaluation Note'	Remove 'Evaluation Note'	Remove 'Evaluation Note'	Remove 'Evaluation Note'
Note	By definition of Admission, the setting is a hospital	Only use SMD if one discipline/SMD cared for the patient during the hospitalization, but this is not required.

IV) Review SMD for inclusion in Ontology

a ) List of modified LOINC SMD display names

b) Divided names

c) Generalized RCPS names

d) Semantic Overlap for two names

e) Requested RCPSC names

f) CFPC specialties