2014-08-11 Rx Conf Call

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  • Melva Peters (Chair and Scribe)
  • Scott Robertson
  • John Hatem
  • Julia
  • Jean Duteau


WGM Agenda & Planning

  • Review Scott's survey - only 4 responses so far
    • Wednesday - good planned attendance
    • Thursday - limited attendance
Action: Scott to send email reminder
Action:  add to agenda for next week

Content in Ballot (John)

  • Medication Order - there is no link
Action:  John will send pharmacy content and then send Don Lloyd an email with all of the identified issues with the links

ISO eRx Requirements

  • defer discussion to next week
Action:  Add to agenda for Aug 18 meeting

List Serve Discussion

Sending orders to pharmacies - Rob Savage - August 6, 2014

  • HL7 v2 is used in the inpatient setting and NCPDP SCRIPT e-prescribing standards are used in the ambulatory care setting and a measure of meaningful use. They both could be ordered for vaccinations, depending upon the location of the prescriber and the immunizer. For example the patient’s PCP could order an immunization not carried in his office to be administered by a community pharmacy and would send the NCPDP standard to the patient’s community pharmacy.
Action:  John to respond to Rob to confirm if he received the answer he needed

Question from Mike Henderson - August 8, 2014

  • As John, Scott, and I discussed and clarified briefly at the HL7 May 2014 Working Group Meeting in Phoenix, the National Drug File (NDF), while being retained by VA, will no longer include open source drug interaction information after the release of Version 2.1 of the MOCHA (Medication Order Checking Health Application) module of the Pharmacy package of VA's VistA EHR.
  • Once MOCHA 2.1 is rolled out (for which a date hasn't yet been announced), users of VistA, and of other open source EHRs that depend on NDF, will need to rely on some other means of getting DDI information. The reference architecture in MOCHA involves the use of SOAP-formatted communications transmitted via (I believe, and am seeking clarification) Websphere, to communicate with First Databank. Implementers outside VA can choose to follow this course or to proceed in an alternate direction, but would benefit from whatever guidance may be available from the relevant standards communities -- HL7, IHE, and others as appropriate.
  • Can any of you tell me whether an HL7 implementation guide or IHE profile has been developed that standardizes the format in which DDI and similar types of information (such as patient education) are to be serialized for transmission? I'll be much obliged for any pointers you can offer, and am willing -- bandwidth permitting, as always -- to participate in the development or review of such documents if they exist or are anticipated.
    • For Pharmacy, this has not been developed - may have been developed for Clinical Decision Support
Action: Melva to respond to Mike Henderson that has not been developed.  Could consider a project if appropriate resources available to do the work. Invite to quarter in Chicago - COMPLETE

MedicationDispense.status and MedicationDispense.Dispense.status - August 6, 2014

  • what are these two status - question from Julia
    • need to update the documentation in the DSTU changes for FHIR to describe appropriately
Action:  Jean will add to the FHIR DSTU updates
Action:  Melva to respond to question on List - COMPLETE
  • ICH - dosing information question - July 10, 2014
    • ICH continues its work to implement the ISO/HL7 ICSR 27953 specification and we need to revisit the appropriate answer for the following item in order to remain consistent with pharmacy best practices for electronic order/prescription and dispensing records. In the case of 30mg t.i.d, which data entry is preferable A, B or is there another option (based upon existing specifications/best practices) that ICH should consider?
      • A:
        • Dose (number): 30
        • Dose (unit): mg
        • Number of Units in the Interval : 0.33
        • Definition of the Time Interval Unit: day
      • B:
        • Dose (number): 30
        • Dose (unit): mg
        • Number of Units in the Interval: 8
        • Definition of the Time Interval Unit: hours
    • this has not been answered - need A or B seem to be correct - 3 times per day is not the same as every 8 hours
Action:  Scott to draft a response for review on the August 11th teleconference

FHIR DSTU Updates and Resources

  • Medication Administration - question from Grahame - July 21, 2014
Action:  Jean will add wording changes to list for DSTU changes
  • Dates extended
    • The newly proposed timelines are as follows:
      • Oct. 15 - all resource and profile proposals approved by FMG.
        • We've recently extended our conference calls by a half hour to ensure we aren't the roadblock on getting this done
        • A PSS covering FHIR development work is a pre-requisite for resource and profile proposals, so that obviously needs to be done too.
        • To allow time for FMG review and updates, WGs should aim to get their proposals submitted no later than Sept. 29th
      • Dec. 5th - content ready for January "Draft for Comment" ballot
        • l content intended for inclusion in the 2nd FHIR DSTU must be present in at least straw-man form. (If it's not in this ballot, it won't make the DSTU ballot unless you're *really* convincing.)
        • It's ok if this content isn't gold-plated, but the higher the quality level, the more useful the feedback you'll get.
        • We'll have WG's flag content that is still "drafty" so reviewers can be informed about where they want to devote their attention
      • Dec. 12th to Jan 12th - ballot is open
      • Mar. 30, 2015 - Deadline for final "gold" content for DSTU ballot
        • This means FHIR QA guidelines have been met ([1])
        • Major items from the DFC ballot have been addressed
        • WG believes their content is suitable for production use
        • -Mid-Apr. 2015 - Ballot opens (after a QA review of content)
        • New content that doesn't meet QA criteria may be flagged as "draft" in the DSTU ballot or removed after discussion with the FMG
      • July 1 - Target for reconciliation to be complete and changes applied
      • July 31 - Target for publication
Action item: Jean will create a list of resources that should be included in the DSTU.
Action item: Group will add these comments to our FHIR DSTU work.
Action:  Melva to follow-up about FHIR Profile Webinar with Lloyd and raise issue with issue

PHER/Pharmacy Harmonization

  • will include this work in the DSTU changes
Action:  Jean will include these changes in DSTU changes
Action:  John to provide list to Jean

Pharmacy Template Project

  • Mood Code Discussion - will be included
  • John and Melva to continue the work

Next meeting - 2014-08-18 at 1600hr Eastern - Melva to chair