2016-06-27 Rx Conf Call

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  • John Hatem (Chair)

ListServ / Zulip Discussions

  • Topic: Multiple route of administration on a single order
    • Comments received from Lee - in a protocol where a medication could be given orally or Intravenous
    • can use multiple dosage instructions
    • multiple dosage instructions - Lee assumed it is "and" - how do we handle "or"? -
      • timing could be used to indicate when each of the medications are to be administered
    • Consider GF 10066 - Should route and site be inside dosage instruction line as part of this discussion
Action:  determine what additional guidance should be included to distinguish and/or or what we support - Melva - call with Lloyd scheduled June 27
Action:  Ask Lloyd - if and/or is supported anywhere else - how is it being done - Melva  - call with Lloyd scheduled June 27
  • MedicationAdministration dosage.text
    • GF #10216 - Will be reviewed for June 27 meeting
Action:  Melva to update and propose change for next week - for discussion July 11

FHIR Maturity

  • Getting our resources to Level 2 and 3
  • Have identified several vendors that are using some of our resources which collective use all of our resources. Need to determine specifics of who and what, as well as, what documentation would be required to prove level.
  • Response from Lloyd: For level 2, the requirement is that in some sort of real or test environment, at least 3 independently developed systems have shared the resource covering at least 80% of the data elements. You can capture the name of the connectathon or just a date and a list of the system vendors if it was done outside of connectathon (e.g. through Argonaut)
  • Additional information provided by Michelle that can aid in collecting FMM evidence
  • Email has been sent to Pharmacy List asking implementers to provide information
Action:  Add FDB news release
Action:  Daniel to provide Epic information

FHIR Discussion Items

June 27 items

  • GF 10123 - Exemplar value set for Medication Hierarchy - on all resource -
    • currently some of the new biologicals are not in the hierarchies proposed as the exemplar value set
    • Propose to include Snomed CT Hierarchy 106181007 Immunologic Substance (substance) as a 3rd hierarchy on all resources for MedicationCodeableConcept
  • GF 10084 - MedicationDispense.dispenser should allow Organization
    • Propose that we add attribute to MedicationDispense - "dispensedAt" with a reference to an Organization resource
  • GF items related to Examples
    • GF 9032 - Add examples based on CR 8697 - change to timing data type
      • examples are added in draft material
    • GF 8475 - Single ingredient dispensed as multiple products
      • examples are added in draft material
    • GF 8108 - Add example for Medication resource to reflect "little pink pill" (i.e. unknown medication)
      • examples are added in draft material
    • GF 7741 - 2015May core #1032 - Fix example.
      • examples are added in draft material
    • GF 7740 - 2015May core #1031 - Fix example.
      • examples are added in draft material
    • Propose that 9032, 8475, 8108, 7741 and 7740 are approved - examples will be ready for review in Current Build in the next couple of weeks

Outstanding June 20 items

  • 10141 - Categories - long discussion of proposed changes
    • Discussion of the term for #4 "community prescription" rather than "prescription"
    • Discussion of whether this is part of the 80%
    • Brought forward for previous discussion
      • Understand Lusia Li requirements and enter tracker item (if Lusia Li attends this session)
        • Home Medications
        • How to query for home medications?
      • If we add a category (to both MedicationStatement and MedicationOrder), then at minimum, we'd need 4 categories:
        • Inpatient (what is administered during the inpatient visit, which does NOT include discharge medications)
        • Outpatient (what is administered during the outpatient visit, e.g. ED visit or Oncology visits)
        • OTC/Hx (e.g. a subset of Med Statements that are modifiable because they don’t represent “real” orders in the system, but rather patient statements)
        • Prescription (e.g. “real” prescription orders, often filled by a retail pharmacy and is administered outside of the context of an encounter, often at home)
      • We did discuss category being applicable within both MedicationStatement and MedicationOrder.
      • The question about how to represent “knowledge of externally stored orders” wasn’t explicitly discussed that I recall, but warrants clarification – as our system implemented those as MedicationStatements, which are a mix of explicit medication compliance/use statements as well as implicit compliance of both over-the-counter medications as well as knowledge of externally stored orders (from patient statement about another provider who prescribed the med). A ‘patient statement’ (regarding OTC meds or prescriptions from other providers/external orders) is implicitly communicating compliance/use = was taken – otherwise, the patient wouldn’t have made the statement at all.
 Action:  Daniel will check if the inpatient encounter id is associated with discharge medications (written at the end of the inpatient encounter) - Response from Daniel - I verified that discharge meds were placed in the inpatient encounter in Epic. It won’t be feasible to tell if a med order is inpatient vs. outpatient based off the encounter type.
Action:  Define terms and definitions for MedicationStatement and MedicationOrder for review and voting on next weeks call.
Action:  Melva to work on categories and definition and bring back for discussion next week - deferred to July 11

Outstanding June 13 items

  • 10125 - International Realm Pharmacy extensions Profile
    • Each resource is supposed to have a core profiles
Action:  review the pharmacy-extensions-spreadsheet.xml to determine which should be moved to core - MedicationOrder and Medication Dispense

June 6 Items

  • 8783 - Medication order status
    • Epic is withdrawing the gForge issue due to the recent addition of MedicationOrder.eventHistory.
 Action:  Marla to follow up with Lloyd to check if workflow will impact this (e.g. removal of MedicationOrder.eventHistory) - will be discussed with Lloyd on June 27

Renaming MedicationOrder to MedicationRequest Discussion

  • 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 - to be discussed June 27

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.
  • Jun 13 discussion - meetings are continuing

Other business

Next meeting

  • Monday, July 11, 2016
  • Meeting on July 4 is cancelled due to US Holiday
  • Agenda