2014-11-24 Rx Conf Call

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  • Melva Peters (Chair)
  • Jean Duteau
  • Marla Albitz (Scribe)
  • Scott Robertson
  • Stephen Chu
  • John Hatem
  • Hugh Glover
  • Julie Glover
  • José Costa Teixeira
  • Matthew Graham


Discussion of FHIR Timelines

  • confusion on the timelines for the content for the upcoming ballots
  • there was discussion on the TSC call this morning
  • may need to have placeholders for new content
  • CCDA profiles for medication related content are not due until the May 2015 ballot cycle
  • Use case - medication regimen - managing a pill box
    • prescribed and over the counter medication
    • creation of the schedule for management of medications
    • could be a profile on medication administration
    • there is a PSS being created in Mobile Health to define this including use cases

Master File Profiles

  • 11/24/2014: Discussion occurred about the lack of WG group bandwidth for the FHIR Rx needs.
  • Motion was made by John and Hugh to delay master file profile work until the next DSTU.
  • Seconded by Marla Albitz
  • Voted to approve - 9:0:0

Proposed DSTU changes

  • 11/24/2014: Jean led group through a discussion about an option to combine the Medication Administration and Medication Statement. The idea is the create optionality for elements and express the two use cases through the constraints imposed at the profile level.
    • Group discussed aspects of this issue such as, if properties of a resource are the same should they be combined? Is there any risk to leave as is for now?
    • Group decided to leave the two concepts as separate resource and not combine into one resource at this time. May revisit when resources are re-evaluated.
  • Reviewed additional items - team agreed conclusions made for each DSTU item that Jean reviewed.
    • Group agreed we need to add examples and rationale for multiple dosage instructions.
Action: Scott will provide examples of complex dosage examples. 
Action: The group will add to Scott's examples
Action: Jean will send spreadsheet to group for individual review for next meeting's discussion.
  • Commenter requested a way to convey more than one reason for the prescription to be written. Group felt that this was outside the 80/20 rule. Decision: to leave as an extension.

FHIR Status

  • No update on 11/24: discussion of tasks

CDA Template work with Melva

  • John is working on the CDA Template work with Melva. Next step is to take this to put it into the FHIR tool that will then allow profiles to be created.
  • Update 10/27/14: John has started the profile creation work. John would like to work with Melva on the first profile. John suggests that we start with the Medication Dispense profile. Will proceed with profile work until we run into an issue. When we do we address issues with the StructuredDocs workgroup.
  • Update Nov 10, 2014 - 10% through the work - John working on CCDA Medication Dispense profile - had a call with Melva and Lloyd and will have a followup call
  • Update 11/24/2014 - 30% through work - not update for the group

List serve traffic

No Updates on 11/24

Pharmacy Resources

Rates of administration for medicines

  • Long thread on description for rates of administration for medicines – e.g. for dopamine to keep urine output at a particular level. Various sub-threads have emerged, including a syntax for free text (!) and critically where a free text dosage instructions should be put in the CDA.
  • Various folk are not able to join the CDA call on Thursday, but we feel that the correct pattern would be to use the component act relationship on the MedicationOrder SBADMRQO class to clone a second SBADMRQO class that carries the Dosage Instructions information.
  • The text attribute of that class can correctly carry the text of the Dosage Instructions. This is how the Dose Syntax Implementation Guidance for V3 describes this should be done too.
ACTION COMPLETED: Hugh/Julie will post something about this to the List. 
  • Update - The result of the Thursday meeting is not known.
  • Response from Brett: A few folks agreed to finalize a design offline and present to SDWG on October 30th. The initial draft is very similar to what Julie proposed.
Action: Melva to see if this was discussed on SDWG - don't know what the outcome was

Pharmacy on-line tutorial

11/24 no updates

  • Should we put that together – and if we do, would that help with issues from CDA, mobile health etc.
  • Suggest this is based on the V3 principles (particularly as FHIR still a moving target)
  • Who has time and resources to do this? Is it something that could be developed during two quarters at a WGM?
ACTION: Add to WGM Agenda for San Antonio.

Action: Develop PSS for a tutorial project. Determine scope and breathe of possible artifact developed.
  • Suggest that we should put the outline for a course together in advance of the WGM (many of us have training that we have done that we can blend together to give a good outline).


Discussion of Jose's v2.9 issue

  • Jose explained the project

File:811 Final.pdf

  • Will give the group a chance to review for the next meeting in two weeks.
  • Scott will review the document and provide a review to the Rx work group.
  • will cover this topic as an agenda item for the next meeting.
Action item: Add this item to the next agenda

Next meeting - December 8, 2014 at 1600hr Eastern