2016-04-11 Rx Conf Call

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Attendees to be updated

  • Scott Robertson (Chair)
  • Melva Peters (Scribe)
  • Ken Veisat - McKesson
  • Andrew Ross - McKesson
  • Lee Suprenant - IBM
  • May Terry - Flatiron Health
  • Daniel Lanphear - McKesson
  • Jose Costa Texeira
  • Michelle Miller
  • Marla Albitz
  • John Hatem

NCCN template orders - on a agenda for APRIL 11, 2016

  • 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
  • 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.
  • 3/7 - continued to work through the list to determine what group should deal with each item (row).
  • Discussion from April 11:
    • 2 spreadsheets were shared with the Pharmacy WG list
      • catalogue of top issues
      • Regimen mapping to FHIR - mapping of data model to MedicationOrder resource
    • some of the topics are being discussed on the workflow calls
    • Pharmacy Related Topics
    • Divided Doses
      • currently do not handle this
      • believe this to be an extension
      • could include this a text in the text element or possibly the additionalInstructions
    • will use an extension - on <dosequantity> to include a <modifierextension>
    • Model the maxamount per period and/or introduce ratio instead of quantity


  • None

FHIR Discussion Items DEFERRED


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

FHIR tracker items to cover this week, April 11

  • Tracker Item 9603 - Medication dosage rate shouldn't have range option
  • Tracker Item 5990/7742 - Wrong VS expansion
  • Tracker 9302
    • Include parameters in dosing - "if x happens, decrease dose by y"
    • Discussion of how to handle - there may be some overlap with the discussion going on in the workflow discussions
    • Will need to include conditional dosing choice in our MedicationOrder resource - could reference an observation resource or diagnosticReport resource or Procedure resource to the DosageInstruction
      • may not be able to use this because these are actual events that exist but the parameters will point to conditions that do not exist
Action:  Discuss with Lloyd or Grahame to determine how best to handle this - Melva
  • Tracker 9142 - Medication.product.form - clarify definition
    • Update documentation for product.form to be clear that when you use in each of the resources that it refers to the MedicationOrder product.form = ordered form, MedicationDispense.product.form = dispensed form, MedicationAdministration.product.form = administered form
    • Moved by Melva - seconded by Michelle to update the wording based on the details of the change request - 6/0/0 - Carried
Action: Melva to update the change request in Gforge and assign to Michelle - complete - Michelle completed build update 4/8/2016

FHIR tracker items from last week, followup/update action items

  • Tracker 9763 - increase cardinality of reason on MedicationStatement
    • have increased the cardinality on MedicationOrder to 0..*
      • had to change to two attributes with a comment on how to use
      • MedicationOrder - suggested that the comment should be added on the reasonReference back to the reasonCode
      • MedicationOrder - add a comment to say that the two can be used together
    • change MedicationStatement to reflect the changes in MedicationOrder for reason
    • moved by Scott - seconded by Michelle to change MedicationStatement and to update the comments in MedicationOrder - 4/0/0 - Carried
Action:  Melva to update Gforge and assign to Michelle - complete - Michelle completed build update 4/8/2016
  • Tracker 7560 - need to confirm if this was done
Action:  Contact Grahame to see if this was done and if it is Pharmacy WG - complete
  • Tracker 8476 - Clarification on medicationOrder.dispense.medication vs medicationDispense.medication
    • Discussion of whether we need the Dispense.medication - could be an extension
      • Include in the agenda for next week and determine what to do - either remove or add a comment on how to use
    • recommendation that we remove medicationOrder.dispense.medication
Action:  John to reach out to Lloyd or Grahame to confirm if this is an issue
  • Tracker 9296 - Consider new statuses (Proposed, Draft, Under Review) for MedicationOrder and MedicationAdministration.
    • discussion of the granularity - have draft already and Proposed is part of workflow discussion
    • suggest that we leave as is for now
Action: post a question to the list serve to seek information - John will start the discussion for the question - discussion ongoing
  • Tracker 8489 - Medication related indicators - maintenance dose, over the counter
    • Leave as "Considered for Future Use" and discuss when we look at formulary requirements
  • Tracker 8778 - BSA Related dosing
    • discussion of adding the ability to support a maxDosePerAdministration
    • we believe that we should add this element
    • Moved by John and seconded by Scott to add maxdosePerAdministration as a simpleQuantity to medicationOrder - 4/0/0 Carried
    • also will re-sequence the attributes
Action: Confirm if 8778 is assigned to Michele - complete
Action:  Followup with Lee on the modelling to confirm - Complete
Action: Michelle to update build - Michelle completed build update 4/8/2016
  • Tracker 9286 and 5827 - Review the need for status on a Medication Resource.
    • Setup a discussion with Lloyd re: modelling for these items before we make a decision
  • Tracker 8783 - Medication Order Status resolution - review the 2 questions in the tracker item.
    • Consider along with 9296
  • Tracker 8378 and 8276 - consider adding the reason for all statuses changes on MedicationPrescription.

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 DEFERRED

  • Status - there were no workflow meetings week of March 14th.
  • Discussion of Pharmacy Workflow Mockup (John)
    • Pharmacy has been providing input into the workflow meeting discussions. One suggestion is that Pharmacy create a Pharmacy specific workflow case similar to the one that is being created for lab. This work has not started yet, but John will start working on this in April.


  • Defer further discussions until April conference calls.

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

  • discussion of the timing for this project - Jose raised concerns that this is a priority but Pharmacy is trying to focus on FHIR changes requests for the next few weeks
  • Jose has proposed to take to other work groups for input - Pharmacy indicated that he should not shop around the PSS until he finds a WG to take on this project
  • the project needs more work before it can been submitted for approval

Joint Meeting with ISO/IHE Pharmacy DEFERRED

  • Room is available courtesy of Canada Health Infoway - waiting for a response from Michael Tan

Template Work DEFERRED

  • Kai to let Pharmacy know when ready for review

Other business

Next meeting

  • Monday, April 18, 2016
    • Agenda
      • Formulary Project Scope Statement - primary topic