2016-12-12 Rx Conf Call

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  • Melva Peters (Chair)
  • John Hatem
  • Yunwei Wang
  • Scott Robertson
  • Jose Costa Texeira
  • Ken Sinn

ListServ Discussions


  • MedicationStatement
    • related to "do not do" - as in patient not to be given a certain medication
    • may come out of Negation project from Patient Care
    • a number of items included in this Zulip chat
      • patient not to be given medication
        • not likely a medicationStatement - is this a negative order?
        • has not come up for Cerner - may infer something like this from an allergy
      • doctor recommends that GP prescribes drug ABC
Action:  Melva to reach out to Philip to post tracker item

FHIR Tracker Items

TR#12409 - MedicationDispense.substitution cardinality

  • Proposed change:
    • clean up definition for backbone element from "Deals with substitution of one medicine for another" to ?
    • discussed changing the substitution element to include:
      • add comment at Substitution - "If nothing is specified, substitution was not done." Cardinality remains 0..1
      • wasSubstituted - boolean 1..1 - will not include as a modifier - this element does not change the meaning of the MedicationDispense
      • type - CodeableConcept 0..1
      • reason - CodeableConcept 0..*
      • responsibleParty 0..* - reference(Practitioner)
  • December 12:
    • discussion of whether comment is needed
    • Motion: John moved to make the change as documented above - Yunwei seconded - 4-0-1 (abstain) - Carried
Action:  Melva to make changes

TR 12340 - Guidance for Substance abuse

  • Michelle Miller introduced on 11/10/16 call.
  • should MedicationStatement be used to document substance abuse
  • although, substance abuse tracking forms usually have more than can be documented in MedStatement. e.g., desire to quit
  • John:
    • classic clipboard at visit, are you taking these meds - each is a MedicationStatement
    • other "active products" - tobacco, alcohol, abusable substances - are handled as observations
  • but, if the clipboard asked "do you use illegal substances" ... need support Y/N/no response. This seems to be a MedicationStatement (need to support negation and no answer)
  • broader consideration: how to support MedicationStatement negation - is it MedicationStatment.notTaken ?
    • similar to assertions of Condition Absence (see Condition resource ...
    • Note this is in a Zulip chat as "Substance Abuse"
  • November 14: Tracker item has been added - need to spend more time on this
    • observation could be used that would support Question/Answer as well for negative statement of use - Questionnaire
    • create an example
Action:  develop some wording about when medicationStatement vs social history could be used as well as create examples (positive and negated) - Melva

Harmonization of Statement with Event

  • 11/10/16 brief discussion on mapping MedicationStatement to Workflow Event
  • Nov 14, 2016: No discussion
  • November 21, 2016: brief discussion - will continue on next call
  • November 28, 2016: see spreadsheet
  • December 5, 2016: no updates
  • December 8, 2016: see updates to spreadsheet and Gforge
    • Status
      • Logical model includes "preparation" - will not add to MedicationStatement
      • No changes to our statuses
  • December 12, 2016:
    • notDone - maps to notTaken
    • notDoneReason - maps to notTakenReason
    • definition - reference to Definition - LM believes this is an extension and not part of core
    • basedOn - add in Reference - same as in MedicationOrder
      • will include wording/comment
    • performer backbone element
      • not part of the core for Pharmacy - would be an extension
    • partOf -
      • proposal to add -
Action: John to create a draft for the wording
    • derivedFrom - update description for derivedFrom to make it clear when you would use this vs basedOn
      • keep this element
Action:  email List to get input from implementers before we agree on this change
    • Motion as follows: moved by John - seconded by Yunwei - 4-0-1 Carried
      • notDone - will not add
      • notDoneReason - will not add
      • definition - will not add
      • basedOn - add
      • Performer - backbone element - will not add


  • requests common search parameters across resources. One of the requests is for date across medication resources - but the medication resources do not have any common date related search parameters. I would suggest that there should be a 'date' on each of them.
    • MedicationRequest datewritten rename to date
    • MedicationAdministration effective-time - add date with same definition
    • MedicationDispense - whenhandedover rename to date
    • MedicationStatement - add date = MedicationStatement.dateAsserted
    • Some ideas:
      • 1 - I would have thought that when comparing MedicationStatements with MedicationAdministrations and other medication resources, the date of interest was the the 'date of medication use', not the 'date of assertion'. So MedicationStatement's search date should be based on effective.
      • 2 - This would be an opportunity to align the names of MedicationAdministration.effectiveTime[x] and MedicationStatement.effective[x].
      • 3 - The information that can be held by the combined data elements effectiveDateTime and effectivePeriod can also be held by two different data elements date and duration. That design would give a common date data element for searching without adding an extra data element just for searching.
      • Discussed 11/21 call, a common search parameters across resources.
 Action: John to ask Grahame (or someone on FMG) to join our call to discuss this with us.

TR#12011 - MedicationStatement - entered in error status

  • concern about the use of the status - of the record and the use of the medication
    • entered in error - is about the record itself
    • perhaps needs a second status to separate out the use of the medication from the record itself - recordStatus vs medicationUseStatus
    • there could be some additional statuses for the record - under review; suspicious
    • historical context - carried over from V3 models
    • PatientCare has split their statuses - clinical status vs verification status - on allergy and conditions
    • need to raise this up to FHIR Infrastructure - to see if there is a pattern that should be used across resources
    • consider updating our definition of the concept for status.
    • Motion: Persuasive with Mod - Update the definition of the status for all resources for what entered in error means - John/Tom - 5-0-0 Carried
Action:  need to create a new tracker item

TR#12175 - special authorization for ordering a drug

Action: reach out to Vince to get more information - concrete examples

TR#12347 - Adjust Medication.package.container value set to SNOMED CT Physical object hierarchy


Action: Melva to followup with tracker item author to ask which valueset she is proposing to use for container - complete

TR#12388 Add MAR Entry to valueset medication-request-category

TR #12379 Add values to medicationRequest.stage (Encoded, AdministrationRequest)

TR#12362 Track current number of Dose Administrations

TR#12238 How to say exact timing is up to party executing the schedule?

TR#10389 Add guidance about whether to choose medication codeableConcept or reference to medication if need to include lot number or batch

TR#7830 2015May core #1152 - Add RXD

FHIR Workflow Meetings Status

FHIR Maturity

  • Current Maturity status
    • spreadsheet has been submitted - MedicationOrder, MedicationStatement and Medication - MM2
    • review of MedicationStatement Maturity
    • no further need for the resources to get them to MM2
  • Update on MedicationDispense implementations

Order Service Catalogue PSS

  • Update on project meetings


Next meeting

  • Thursday, December 15, 2016 at 4pm Eastern