2016-08-01 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

• John Hatem (Chair)
• Marla Albitz (Scribe)
• Jose Teixeira
• Ken Sinn
• Scott Robertson
• Yunwei Wang

ListServ / Zulip Discussions

• List Serve Postings
• Zulip ...
  • Discussed "Question regarding the FHIR Module categories" email thread
  • How to express "every Monday, Wednesday and Friday" for medication
    • conclusion: this would be expressed as an extension. Suggesting sender to enter a change request to consider as being part of 80% rule.

 Action item: John to respond to email originator per above bullet

FHIR Maturity

Completed Action:  Add FDB news release
Completed Action:  Daniel to provide Epic information
Completed Action:  Marla to send email to FMG

• Per Lloyd/FMG - Need to fill out the follow spreadsheet per our connecthon and implementation evidence in email from Marla
• spreadsheet to update: https://docs.google.com/spreadsheets/d/18HfXF7mUCUV7jACCG0oejFp6D-ibtvbmcgywNhn76lw/edit
• Updated spreadsheet on the call. Medication and MedicationOrder are now reflected a FMM level of 2.

QA of Pharmacy FHIR STU3

• Working groups are responsible for QAing their own content in FHIR STU3
• Need to develop a plan and timeline for QAing of Rx content

Action: Marla to ask FMG for the QA spreadsheet for the STU3 QA results.

• QA Assignments made on call (QA deadline/freeze is Aug 10th):
  • Marla: v2 mappings across all resources
  • John: RIM mappings across all resources, Medication Module, MedicationAdministration
  • Scott: MedicationOrder
  • Melva: Examples
  • Ken: MedicationDispense
  • Yunwei: Vocabulary, check the search parameters for each resource

 Action: Marla to reach out Jenny S. at Cerner to ask if she is willing to QA MedicationStatement

 Action: Identify QA for Medication resource

FHIR Discussion Items DEFERRED

• SEE SPREADSHEET OF OUTSTANDING CHANGE REQUESTS 2016-01-25 IN DROPBOX

FHIR Medication Module page DEFERRED

• [1]
• new, general introduction, page. added for all FHIR "areas"
• we need to review/edit

CDS Request DEFERRED

• Background
  • The CDS Work Group as part of reconciling ballot comments for the CQF-on-FHIR Ballot has created a resource in FHIR that can be used to describe "templates" for intent resources like MedicationOrder, ProcedureRequest, etc. The resource is called ActivityDefinition (https://hl7-fhir.github.io/activitydefinition.html).
  • As part of specifying the template for a MedicationOrder, we need to be able to specify the dosageInstruction and dispenseRequest elements. Rather than copying the element from the MedicationOrder resource definition, we are planning on defining a DosageInstruction and a DispenseRequest type that we could reference, rather than duplicating the maintenance of those elements.
  • Do you have any questions or concerns with this approach? The initial step is just to define the data types based on the MedicationOrder structure and will not involve any changes to the MedicationOrder resource.
  • Pharmacy WG has some concerns about the fact that CDS may be creating
• July 18 Update
  • more info see CDS Pharmacy FHIR request
  • suggestion that a datatype may be an option but that it will not be done it time for the freeze for STU3 - would need special permission to put a substantive change in to the release
  • continue to discuss on our teleconferences and possibly include time on the agenda for Baltimore

Action:  Scott to start a wiki page on this topic, CDS Pharmacy FHIR request

Outstanding June 13 items DEFERRED

• 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

Outstanding June 6 Items DEFERRED

• 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)

• • July 25 Update - Yunwei noted that recent FHIR Workflow discussions use Provenance rather than eventHistory. There was also an email from Lloyd (july 19) stating "The recommendation from workflow is to use references to Provenance rather than an in-resource structure". Too late to change for ballot. will need to address in reconciliation.

Renaming MedicationOrder to MedicationRequest Discussion DEFERRED

• Email received July 4, 2016 from Lloyd
  • The FHIR Workflow task force has been working for almost the past year to come up with guidelines to improve the consistency of how workflow (the process of requesting something to happen and then reporting the results of that request) are handled across all FHIR resources. Its scope encompasses clinical, administrative and financial resources. We've had relatively broad participation in the bi-weekly calls and very broad participation in the face-to-face sessions at HL7 WGMs.
  • While the project is still testing the recommendations using a variety of use-cases, we are sufficiently confident in the stability of the recommendations, that we voted last week to request all impacted work groups to apply the relevant changes to their resources for inclusion as part of the upcoming STU 3 ballot.
  • We recognize that the timelines for making this occur are tight. In the event that a work group cannot make the changes requested, we invite them to, at minimum, provide an implementation note highlighting the intention to adjust each affected resource to align with the workflow pattern and to include a hyperlink to the "workflow.html" page. (This page doesn't exist yet, but it will.)
  • We also recognize that not all of these recommendations will fall into the 80% for all resources. Work groups are asked to do the following for each recommendation:
    • Apply the recommendation from the FHIR workflow task force as part of core
    • Create extensions to support those data elements that are relevant but not commonly used by the domain
    • Indicate that they feel the recommendation should not apply to their resource by posting an email to the fhirworkflow list server indicating why they believe a given recommendation is inappropriate for a given resource.
    • ((The list of resources believed to be impacted by the FHIR Workflow recommendations are provided in the attached spreadsheet. Most of the listed resources are categorized as either a "request" - a resource that indicates a specific intention for something to occur; or an "event" - a resource that represents a specific occurrence that could have been done in response to a request. A few event resources are marked with a question-mark as it's not clear whether they are requested or not. It's possible that one or more resources in the spreadsheet that were not categorized should in fact be listed as a "request" or an "event". Feel free to apply the workflow recommendations to uncategorized resources if you feel they should apply.
  • In addition to these categorizations, the workflow project calls for the Order and OrderResponse resources to be removed. They are superseded by Task. As well, the scope of ProcessRequest and ProcessResponse should be revised to leverage Task for the purpose of requesting the current state of a resource and for soliciting a state change.
  • The recommendations are as follows:
    • Request
    • Add a note in the introduction section that the resource is a "request" resource from a FHIR workflow perspective, including a hyperlink to workflow.html#request.
    • Rename the resource to [xxx]Request instead of [xxx]Order (request resources are used for plans, recommendations and proposals, not just orders
    • Ensure all of the data elements present in the "request" pattern document (attached) are present in the resource, keeping consistency with the naming where possible and adapting definitions to reflect domain-specifics
    • Ensure the status element for the resource has a terminology that aligns with the "request" states as well. (Note that all statuses related to fulfillment progress are now handled by Task.)
  • Event
    • Add a note in the introduction section that the resource is an "event" resource from a FHIR workflow perspective, including a hyperlink to workflow.html#event.
    • Ensure all of the data elements present in the "request" pattern document (attached) are present in the resource, keeping consistency with the naming where possible and adapting definitions to reflect domain-specifics
    • Ensure the status element for the resource has a terminology that aligns with the "request" states as well. (Note that all statuses related to fulfillment progress are now handled by Task.)
• 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
  • Discussion - July 11 Meeting
    • John described the change proposed - we can alias resource to include MedicationOrder
    • Moved by John - seconded by Marla to add note to introduction section to Medication Order Add a note in the introduction section that the resource is a "request" resource from a FHIR workflow perspective, including a hyperlink to workflow.html#request. and to add an implementation note highlighting the intention to adjust each affected resource to align with the workflow pattern and to include a hyperlink to the "workflow.html" page. - 7/0/0 Carried

Action: Melva to update Gforge - complete

• • • Moved by John - seconded by Marla to add note to introduction section to Medication Dispense, MedicationAdministration, MedicationStatement - Add a note in the introduction section that the resource is a "request" resource from a FHIR workflow perspective, including a hyperlink to workflow.html#request. and to add an implementation note highlighting the intention to adjust each affected resource to align with the workflow pattern and to include a hyperlink to the "workflow.html" page. 7/0/0 Carried

Action: Melva to update Gforge - complete

FHIR Workflow Meetings Status

• 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

Next meeting

• Monday, August 8, 2016
• Agenda