2016-05-02 Rx Conf Call

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  • Melva Peters (Chair and Scribe)
  • Marla Albitz
  • Marisa Sanville (McKesson)
  • Michelle Miller (Cerner)
  • Lee Supreant (IBM)

Agenda for WGM

  • Review Agenda

May 2016 Pharmacy WGM Agenda

    • Lee will find time to join on Thursday


  • 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
  • MedicationStatement Status of OnHold - Rick Geimer
    • Tracker Item 9901 has been added - will discuss in Montreal
Action:  Need to add table to resources - See GForge 8010 - Updated to Deferred - complete
Action:  Assign resolved-changed required trackers - complete

FHIR Maturity

  • Please help set priorities for HL7's FHIR Standard for Trial Use 3, with a target release by end of 2016.
  • For resources you care about, we'd like you to indicate the FHIR Maturity Model (FMM) level you'd like to see them at when FHIR STU3 is published.
  • Due date: 5/5 @ 5:55p ET

Link to Survey

Action:  Add to the discussion in Montreal
Action:  Forward to Daniel

FHIR Discussion Items

FHIR Tracker items - May 2

New items

  • 9552/9298 Suggest additional values for reason-not-given
    • suggested value set is from Snomed CT but need to investigate if this is a full hierarchy
    • Proposed resolution for Medication Administration
      • Example value set could be the union of the following Snomed CT hiearchies: 406149000 (Medication Refused (situation) + 371900001 Medication Not Administered (situation) + 242990004 (Non Administration of necessary drug or medicine (event).
      • There are other codes available in SCT, but they aren't full hierarchies so this set is likely good enough to be exemplar
      • Also change the name of the codeable concept to "reason-not-given" (value set)
      • Look at description on Resource content page for wasnotGiven and update if necessary - discussion that it is clearer leaving as it is - no change will be made
    • Moved by Marla - seconded by Marissa - to change the example union of the following Snomed CT hiearchies: 406149000 (Medication Refused (situation) + 371900001 Medication Not Administered (situation) + 242990004 (Non Administration of necessary drug or medicine (event) and no change be made to the name of the value set - Carried 4/0/0
Action:  Update Gforge - complete
  • 8840 - ReasonNotTaken - MedicationStatement
    • consider if value set from MedicationAdministration is appropriate
    • some of these may be appropriate if the statement is inferred from a Medication Administration
Action:  Include in discussion in Montreal
  • 9297 - MedicationAdministration - Practitioner
    • Currently MedicationAdministration supports a reference to the person who administered the medication - can be a practitioner, patient or related person. The name of the attribute is "practitioner". Suggest we change to "Administerer" or something similar instead of "Practitioner"
      • Consider changing name to "Performer"
    • Motion to change the name of the element to Performer- Michelle - Marla - 4/0/0 - Carried
Action:  Melva to change Gforge - complete
  • 8834/8833/8435 - Fix exemplar value set for Medication CodeableConcept for Medication, MedicationAdminstration, MedicationStatement, MedicationDispense and MedicationOrder (MedicationOrder.medication)
    • Union of SCT 410942007 (Drug or medicament) (substance)) and SCT 373873005 (Pharmaceutical/biologic product (product))
    • Motion: Moved by Michelle - seconded by Marla to Fix exemplar value set for Medication to be Union of SCT 410942007 (Drug or medicament) (substance)) and SCT 373873005 (Pharmaceutical/biologic product (product)) and add to MedicationAdminstration, MedicationStatement, MedicationDispense and MedicationOrder - 4/0/0 Carried
Action:  Update Gforge
  • 8115/8018 - MedicationAsNeededReason binding for MedicationOrder, MedicationStatement, and MedicationDispense
    • SCT 404684003 (Clinical Finding (finding))
    • Motion to add SCT 404684003 (Clinical Finding (finding)) - Moved by Marla - Seconded by Michelle - 4/0/0 Carried
Action:  Update gForge
  • 8011 - exemplar value set for ReasonforUse - Medication order, Medication Statement
    • has this been applied? It looks like it is fixed in Current Build and may have been done as part of splitting this out (instead of choice) - need to update Gforge
Action:  Update Gforge to Applied or link to duplicate

FHIR tracker items - April 25

  • 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 - complete - no response
  • 9301 Add Verifier on MedicationAdministration and MedicationDispense
    • for some types of medications may need a second person to verifier
    • Michelle and Daniel and Marissa to look at their systems to determine if this is handled in their systems
    • Discuss on next call or in Montreal

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 9, 2016 - in Montreal - Safe Travels!