2016-12-15 Rx Conf Call

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  • Melva Peters (Chair)
  • John Hatem
  • Jose Costa Texeira
  • Scott Robertson

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 12385-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
  • December 15: John gave a summary of outstanding issue
    • will discuss remainder on Monday
    • all approved changed have been applied


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


  • December 15 - IDMP - could look at using
    • Scott thinks NCPDP may have looked at using SNOMED-CT
    • could use a US centric value set if can't find anything else
Action:  Scott to look at what NCPDP used and if we can reference it
Action: Jose to look at IDMP and it's implementations

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

  • for medication-request-intent, need to add - instance-order
  • Motion to add Instance-order to medication-request-intent value set and to make intent a search parameter - John/Jose: 3-0-0 Carried
Action:  Melva to make the changes

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

  • covered off by TR#12388 - will not add for now
  • Motion to find this request not persuasive - Jose/John - 3-0-0 Carried

TR#7830 2015May core #1152 - Add RXD

Action:  Scott to confirm the mapping for Day Supply

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#12448 drop "eventHistory" from medicationRequest

  • EventHistory was updated based on discussion with Lloyd McKenzie to reference provenance
  • Motion: Find this request not persuasive - Jose/Scott - 3-0-0 Carried

TR#12440 Add PerformerType to MedicationRequest

TR12439 - Add "intendedPerformer" to medicationRequest

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

  • Monday, December 19, 2016 at 4pm Eastern