2016-04-25 Rx Conf Call

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  • Marla Albitz (Chair)
  • Melva Peters (Scribe)
  • Michelle Miller
  • Daniel Zhang

Agenda for WGM

  • Asked for agenda items to be sent to the list


  • Order Sets/Protocol - discussion needs more clarity - being discussed in Work Flow meetings
  • Composite orders - discussion needs more clarity - being discussed in Work Flow meetings
    • how are multiple orders represented and are linked or grouped together
  • Medication resource - changes to this may need to come back to Pharmacy
    • still need to understand the requirements

FHIR Discussion Items

FHIR tracker items to cover this week, April 25

Action:  Melva to look at the example codes from the Tracker
Action:  Melva to invite Elliot to the call next week for the discussion
  • 9300/8603 - Value Set of AdditionalInstructions - can use Snomed CT 419492006 - Additional dosage instructions (qualifier value) as an exemplar value set - MedicationOrder, MedicationDispense and increase cardinality to 0..*
    • Motion by Melva - seconded by Michelle to add Snomed CT 419492006 - Additional dosage instructions (qualifier value) as an exemplar value set - MedicationOrder, MedicationDispense and increase cardinality to 0..* - 3/0/0 Carried
Action:  Melva to update GForge for both tracker items and assign to Michelle - complete
  • 9545 If MedicationStatement status is required, the status valueset should include "unknown"
Action: Melva Invite requestor to join a call to discuss further or join a quarter in Montreal
  • 9301 Add Verifier on MedicationAdministration and MedicationDispense
    • for some types of medications may need a second person to verifier
    • Michelle and Daniel to look at their systems to determine if this is handled in their systems
    • Discuss on next call or in Montreal
  • 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
    • Discussion with Lloyd - may want to handle the more simple use cases but not try to manage the more complex conditions
      • Be guided by what the implementers are doing today
      • Could use text as part of AdditionalInstructions
    • Implementers - Michelle and Daniel will investigate and help to guide the decision
      • Not supported as codeable concept in Epic - use in free text sig
      • In Cerner - there may be a way to build an attribute to support - not sure if this is fully codified
      • Not persuasive - if want to codify - this should be an extension -
        • moved by Michelle - seconded by Daniel - that this is not part of core and no changes should be made. Parameters can be represented as free text - 3/0/0 Carried
Action:  Melva to update in Gforge - complete

Open FHIR tracker items covered April 18

  • Tracker Item 5990/7742 - Wrong VS expansion
    • could bind to Snomed CT
Action:  Melva to propose an exemplar value set for method

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

  • 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 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

  • 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.

Template Work

  • Kai to let Pharmacy know when ready for review

Other business

Next meeting

  • Monday, May 2, 2016
    • Agenda