2017-06-05 Rx Conf Call

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  • Jean Duteau (Chair)
  • John Hatem (Scribe)
  • Michelle Miller
  • Nancy Westaway
  • Jose Costa Teixeira
  • Kent Bui

Agenda Items and notes

Compounded meds

  • Steve Emrik from USP
    • USP has monographs for compounded products/process - how to make the product
    • example Atenolol Example
    • add to future agenda for need to identify medications as compounded in FHIR Medication, necessary metadata, and possibly the directions for compounding
  • April 17 Update: there is not great support in Health IT space for sending/receiving information about compounded information
    • regulations coming out in the US - California to use USP monographs when compounding
    • What types of metadata would be useful?
    • perhaps a URI to the instructions for compounding
    • receiver: anyone who needed to compound
    • sender: not sure who would send
      • will be working on a code that could be included in RxNorm - URL would be a property of the USP code or RxNorm code
      • Open Medicine - has done some work on this
      • there are pieces of metadata that could be included
Action: Add a tracker item as a placeholder for changes to medication - complete #13295
  • May 1 Update.
    • California - not specifically requiring USP monographs. Sets 3 scientific prinicples that the monograph must achieve
    • what we need
      • to be able to point to the external monograph/recipe
        • this must be stated on the dispense (if applicable), may be present on the request
      • to be able to identify that the product is/will be/was compounded
        • this must be stated on the dispensed (if applicable), optional on the request
  • June 5 update.
    • Issue was discussed and motions were entered to address adding a method to document that a compounded medication had occurred and to support adding a method for documenting the preparation instructions via a URI. For details on the motion review resolution in tracker item 13295. Motion passed 4-0-1
    • The resolution also included folding in the Boolean for isBranded into this same proposal.

Tracker Items

FHIR Tracker

Medication Related (Group = A)

  • 13392 Enhance the Medication resource for alignment with the IDMP Authorized Medicinal Product model
  • 13295 Add support for compounded or magistral preparations
    • Addressed with motion on June 5th call, see tracker item for details.
  • 13149 Change medication.isBrand to medication.conceptType (or similar)
    • Jose to deprecate this item as a results of resolution on tracker item 1295
  • 12671 Consider adding "maintenance drug Indicator" on medication when discussing formulary.
  • 12396 Medication package and product
    • This item will be addressed as part of tracker item 13392.
  • 12395 Basis of Strength Substance
    • This item will be addressed as part of tracker item 13392.

Dosage Related (Group = B)

  • 13384 We need to be able to record the number of units of time that must pass between each time a drug is given/taken
    • Jean Duteau will reach out to Lloyd M to discuss about pushing this to FHIR-I.
  • 13383 We need to be able to specify that a dosage timing must be obeyed exactly
  • 13382 We need Dosage.text to be a CodeableConcept
  • 13381 We need a way to express <daysAdministeredAmount> and <daysNotAdministeredAmount> in Dosage
  • 13380 Possible new element in Dosage: calculationBasis
  • 13317 Allow Dosage to express a medication should start/stop relative to an event
  • 12791 Update dosage Instruction to include pre-condition and therapeutic target

Misc (Group = none)

  • 13449 add medicationRequest.intendedPerformer to the search parameters
  • Confirm what the tracker item is related to
Action:  Melva to create a tracker item - related to additional tracker item related to Header
  • 13044 Fix performer on MedicationAdministration - update description and add role back in with appropriate value set
    • waiting on changes from Workflow
  • 13043 Fix performer on MedicationDispense - update description and add role back in with appropriate value set
    • waiting on changes from Workflow
  • 12473 Status Review - consider splitting clinical status from verification status
  • 12332 Limitations on searches? - elements with type selection; chained searches
Action:  reach out to Scott to see if tracker 12332 can be withdrawn or referred to FHIR-I

FHIR Maturity

  • Medication, MedicationRequest and MedicationStatement = FMM 3
  • MedicationDispense and MedicationAdministration - FMM 2

Order Service Catalogue Project

  • To follow the Order Catalog work, use the following listserv: ordercatalog@lists.hl7.org
  • 5/1 - update from last weeks meeting. The group is continuing to evaluate the use of Composition (and more recently List) resource to address the catalog requirements. There are several changes needed to Composition to meet the requirements.
  • Update planned on Catalog work in Madrid WGM Tuesday Q2 at O&O
  • Meetings to be held week of May 22nd
  • 6/5 - John H to join calls this week and will report back week of June 12

International Chemotherapy Implementation FHIR IG

  • Chemotherapy IG Wiki Page
  • 5/1 - IG work is continuing. There are a few questions regarding Medication Request and Medication Administration and few new tracker items that have come out of these discussions.
  • Planned update on the work at Madrid WGM Wednesday Q2 in CDS
  • Meetings to be held week of May 22nd
  • 6/5 - John H to join calls this week and will report back week of June 12

Action Item List

  • Action item list - being updated by John - will provide an update week of June 12


Next meeting

  • Monday, June 12, 2017 at 1pm Eastern - NOTE, new time for weekly teleconference