2015-12-07 Rx Conf Call

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Attendees to be updated

  • Melva Peters (Chair)
  • Lee Supernate
  • John Hatem
  • Scott Robertson
  • Marla Albitz
  • Tim McNeil
  • Lauren Gallagher
  • Jose Texiera
  • Chris Nickerson
  • Daniel Zhang

FHIR Workflow Meetings Status

ACTION:  Scott - find / asked for / create(?) a 1-pager explanation of what the business need and proposed solution.
  • Update from Scott: Team meet 11/23, did not meet last week, will not be meeting next week - team has been working on identifying use cases.
  • Update from Scott: has been attending, but many meetings have been cancelled.

FHIR Ballot Discussion Items

    • A = Dosage Related
    • B = Terminology
    • C = Misc
    • D =
    • E = Examples
    • F = Multiple indications/reason for order
    • G = Status
    • H = Medication Related
    • I = Mappings

8778 – dosage based on body surface area

  • Update from John - response to John's question of what 'mustunderstand' means? - response: "mustUnderstand" is that if we do use an extension for this concept, then we would mark it as Must-Support (because a system not understanding the max dose properly would be extremely bad) and also as a Modifier Extension (because it changes the interpretation of the dose element).
  • December 7, 2015 Update
    • chemotherapy order templates - PDF format for chemotherapy schedule, regimen, etc
    • Trying to define a fhir server that could serve this data in a FHIR resource
    • These are not patient specific, but the content could be used to create an order for a patient
    • Templates themselves are closest to a care plan - includes a cycle a definition
    • Timeframe - needed by the end of March
Action: Maxdose - Chris and Lee to look at options on how to handle - discuss on next weeks call
Action:  Lee to put together some other requirements and submit a change request
Action:  Look at scheduling a quarter in Orlando to review the requirements

8442 – MedicationPrescription – clarify datewritten and prescriber – group discussed final decision noted in GForge item

 Completed Action item: Jose will take a look at this off-line (8442). Concerned about one-to-many relationship implied in solution. Will bring investigation conclusions back to group. Jose’s findings could impact 5827, 8276, 8378, 8526, 8783
  • Discussion of versioning resulted in a group understanding that this issue is an infrastructure issue, not Rx specific.
  • Also can be remedied with additional documentation
Action: Jose to create new change request to address the documentation work only and separate from the infrastructure issue.
  • 11/16 - When changes are applied, the original resource is not altered, the changes are incoproated into a clone of the original resource (with a relationship to the the original resource). From the FHIR resource perspective, these are separated resources. From the system perspective, there may only be a single "database entry" which is modified. Getting difficult to keep track of the constructs and proposed solution.
 Action item:  Jose will develop a resolution for consideration at the next call. Principly 8442, could impact 5827, 8276, 8378, 8526, 8783

Other FHIR Items

Action item: Marla to complete 7830 - consult with Mike Henderson
  • PSS for FHIR content
Action:  Melva has sent draft to list - please review and provide comments.  Can be approved in Orlando

Timing discussion

  • how to represent "to be taken 10 minutes before meal"
  • DSTU2 guidance still incorrect (verified during call)
  • handled by change request # 8697
    • adding new offset guidance to handle this.
    • targeted for DSTU 2.1
Action: Melva to confirm if changes to be made will support "take one tablet 3 times day, 30 minutes before meals.

5925 & 8021 (grouping A)

Action item: Tom to review spreadsheet John forwarded on 11/9 .  Tom volunteered on the 11/2 call to look at this.
Completed Action item: John will review spreadsheet to see which resource elements/attributes may be affected.
  • John started presenting his review/work on the call.
  • Will continue reviewing and vote (if applicable) on the next call.


  • No listserv items to discuss this week

ARB Project

  • ARB update
  • Link to meeting minutes: [1]
  • Update from John - did not meet the last two weeks, will meet again after Thanksgiving
  • Dec 8, 2015 - no update

Other business

Action Item: Marla to enter change request for RXA-25 v2 FHIR mapping issue.
Action Item: Marla Reach out to Mike Henderson and Jose about final touches to the v2-FHIR mappings (perhaps even outside of the FHIR resources)

Next meeting

  • Monday, Dec 14th - Need a chair for December 14th meeting since Melva will be unable to attend.