2016-02-22 Rx Conf Call

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Attendees to be updated

  • Marla Albitz (Scribe)
  • John Hatem (Chair)
  • Michelle Miller
  • Jose Costa Teixeira


Medication Status - 'Entered in Error' CLOSED

  • Discuss as group
  • Was not able to identify "explanation" narrative as to why "entered in error" for medication resource is not supported.
  • in the meantime the QA errors are addressed temporarily since Michele has inserted a placeholder.
Completed Action:  Need to confirm whether "status" is needed on Medication - answer - we are not going to add status on medication but instead as guidance to leverage extension for this purpose.
  • Question posed to group on 2/22 call - Is 'Entered in Error' a valid status for a medication resource? No, this will be handled by an extension. Guidance will be provided. Michelle conveyed that this type of guidance can be listed under a "Best Practices" section.
 Action: Michelle will provide verbiage that will provide for example, how to convey active vs. inactive using an extension. Michelle will tie this change to a QA issue.

Verbiage provided by Michelle: “Medication does not have a status. If Medication was used to support a formulary use case, then an extension can be used to convey formulary statuses, such as active (e.g. the medication can be ordered) or inactive (e.g. the medication can be documented, but not ordered).”

Renaming MedicationOrder to MedicationRequest Discussion - DEFERRED

  • From January 25 meeting: Lloyd shared the proposal to rename all request type resources to <resource>_Request. Seeking consistent name for all resources and term that encompasses larger swath of types of requests. An element beneath the tag instance would state the particular request, such as 'order'. This impacts the current Pharmacy Medication Order FHIR resource.
 Completed Action: Rx WG to discuss to determine if we agree or not. - agreed (with no vote) to comply with change but not needed to be made yet, per Lloyd
  • Lloyd suggested that we hold off on making the change, if we decide to make the change. Wait for FHIR Infrastructure group to workout additional details before we make the changes. May have impact on how other data elements are name or included.
  • Discussion: If we agree to the change, we'll need to review the description and other content for our resource to ensure that it accurately reflects the usage. This type of change will mean changes for implementers and it may not be as intuitive for implementers.
    • No decision to be made today. Will consider on a future call
 Action: to followup with Lloyd to find out status and/or next steps

FHIR Workflow Meetings Status

Action item:  Scott - find / asked for / create(?) a 1-pager explanation of what the business need and proposed solution.
  • For statuses - what we have so far is correct - may need to remove "superseded" as a status - need to find a different way to represent a relationship between 2 orders
Action:  Melva to add change request to GForge

John provided update to workflow meeting activities: discussions have occurred about the status types. Today, the discussions focused the relationships between a request and a task. Not quite ready to test against the Rx use cases.

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

Ready for Review

  • 8778
    • options proposed by Chris and comments from Melva - see spreadsheet
  • 9334 - dose
  • 9295 - max dose per lifetime -
  • 8735 -example
  • 8730
  • 8603
  • 8016 - example
  • 8012
  • 7738 - example
  • 5925 - marked as applied by Michelle
  • Scott is working on the Terminology Items - proposed that we bring a full set of Tracker Items forward
  • Mapping to NCPDP - assigned to Tim and Scott - Tim has a draft - Scott to review and then will bring forward to the Pharmacy WG
  • Change 8016, 8735 and 7738 - moved by John, seconded by Scott - 6/0/0 - Carried
Action: Melva to update Gforge
  • 9344 - Change Quantity to "dose" in MedicationAdministration. Change MedicationOrder and MedicationDispense with MedicationStatement - change all 3 to be dose[x] - doseRange, doseQuantity and definition to "Amount of medication per dose". Moved by John - seconded by Tom - 6/0/0 - Carried
Action:  Melva to Update Gforge and assign
  • 9295 - max dose per lifetime - would need to represent "lifetime" in the denominator - continue the discussion
Action:  reach out to Lloyd/MnM - to determine how to represent
  • 8021 - marked as applied by Michelle
  • 9604 - marked as applied by Michelle

Other FHIR Items - Deferred

  • Build Error Items - Marla/Michelle/Rik
    • 9367
    • 9368
    • 9369
    • 9370
  • Tom will assist with items that have been assigned to John.
  • We are going to try to make the February 10th deadline if possible.
  • "packageitem" - need to determine how to handle - should be called "item" but that is ambiguous
Action:  Melva to send exemption to MnM and determine how to handle
  • RIM Mapping - John has forward to Tom for review.
Action:  Tom to review
  • Medication.product.ingredient - only remaining issue
Completed Action: remove the "to do" - Michelle
Completed Action: Consider status on Medication - 5827


  • Jose to draft the start of a PSS

[Draft PSS Posting http://lists.hl7.org/read/messages?id=288115#288115]

Action: Jose to send reminder to group to review PSS.

Joint Meeting with ISO/IHE Pharmacy DEFERRED

Action:  Melva to check on availability of meeting room in Montreal - in progress

Template Work DEFERRED

  • Kai to let Pharmacy know when ready for review
Action:  Melva to followup with Kai to get a status

NCCN template orders - DEFERRED

  • Lee Suprenant requested input on the ChemotherapyOrderTemplates work.
 Action: Lee will document the items that should be targeted for Pharmacy.
  • Lee requests time in the next call for further discussion or a separate call.
  • Lee completed categorization, needs next steps identified for the columns marked as "maybe".
  • On 2/8 - reviewed Lee's categorizations
 Completed Action: Lee to distribute updates to the group.
  • Lee plans to continue to join our calls as we work through the list.
  • John recommended we would through the list before Lee takes the list to the FHIR workgroup.

Other business

Next meeting

  • Monday, February 28, 2016

Both John and Marla are not attending HIMSS will be on call.