2014-04-28 Rx Conf Call

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  • Hugh Glover (Chair)
  • Brad Fonseca
  • Melva Peters (Scribe)
  • Wendy Huang
  • John Hatem
  • Julie James
  • Tom de Jong


Harmonization Request

Pharmacy Harmonization Proposal

  • Brad provided background on the proposed changes
    • model that should be referenced in the Harmonization proposal - Medication Order
    • Canadian requirement for a revision of a medication order - decision was to send the original order with all information with the changes and a reason code
      • 2 use cases - error correction and clinical modification
        • this attribute is not in Universal model so not sure how to add a concept domain
      • Canadian requirement - have added reason code as an attribute that is not in Universal. What is being requested is a concept domain that is Universal. No specific request that a change is made to the Universal model.
      • if this is taken to Harmonization meeting in Phoenix it must not be represented as approved by Pharmacy.


  • Attendees: Melva will attend; Hugh will try to dial in; John
Action:  Work on agenda in Phoenix

WGM Agenda

  • Review May 2014 Agenda
  • Based on availability/attendance of co-chairs, will only meeting Monday, Tuesday and Wednesday in Phoenix

List Serve Discussions

  • FHIR list serve questions - Tom has responded to one of the issues.
    • question related to an attribute to distinguish a medication order that is inpatient, outpatient or other medication
      • could use an extension to add an attribute
      • need to pull the requester into any further discussions
  • Immunization questions from Bonnie McAllister - File:Immunization Issues for Immunoglobulins 21414.docx
    • Include as a discussion in Phoenix
  • "Frequency" update requested. No discussion on today's call
Action:  Tom will add to Hot Topics page - there is an issue with the pages Tom added so he is following up with HQ
  • Name of "when given" attribute on Medication Administration resource - request to change name
    • Plan to submit a change request to change name - need to confirm what the plan to deal with this is
Action:  Tom to forward all outstanding email related to FHIR

Pharmacy's use of mood codes

  • Tom has made comments directly to Lisa and these have been incorporated into the documentation
  • For Structured Docs Brian Weiss is maintaining a blog CDAPRO with details of their guidance on use of CDA
  • Discussion then turned to nature and use of Medication Lists
    • Lisa pointed out that there will soon be a CCDA definition of a Medication list and now is a good time to get this correct
      • Lists may be for Physician to Physician communications others are for Physician to Patient or Patient to Physician
      • Its important to distinguish between actual as opposed to intent
    • There was agreement that lists only usefully exist in a context of use
    • This would be a good topic for discussion at the OOC
  • review of John's document
Action: John will clean up his document and share to the List


  • Will be discussed in Phoenix - John will participate

FHIR DSTU Question

  • I am looking for the correct resource to use that can capture something like "daily aspirin use" with possible values of: taking as recommended, taking but not as recommended (maybe the patient is taking half dose daily), not taking, unable to obtain, etc. I also need the date when that patient told the provider of their compliance in case we need to reconcile across multiple sources. This seems like it could fit in a couple different places -- such as an Observation, Questionnaire, MedicationStatement (or List) -- each with their own pros and cons. Which resource and attributes are recommended for this medication compliance information?
    • compliance question rather than a medication statement
    • could be done by putting an extension on medication statement - code for compliance and actual dose that could be taken.
Action:  Hugh to post a response asking for clarification on the use case and suggest that an extension on medication statement resource might work.

Request for review of ISO definitions


  • will review in Phoenix. Skype Julie in if possible


  • none

Next meeting - 2014-05-19 @ 1600 ET

  • Agenda
    • List serve discussion
    • Pharmacy use of Mood code etc.
    • Harmonization Request
    • Medication/Immunization FHIR Harmonization
    • Out of Cycle Meeting - Planning - Joint meeting and HL7 Pharmacy meeting
    • Pharmacy Template project/work
    • Pharmacy WGM Agenda
    • FHIR DSTU question - compliance
    • ISO definition review