2017-06-12 Rx Conf Call

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  • John Hatem (Chair)
  • Scott Robertson (Scribe)
  • Michelle Miller
  • Nancy Westaway
  • Yunwei Wang
  • Jose
  • Eric

Agenda Items and notes

Tracker Items

FHIR Tracker

June 12 - IDPM will be deferred for today

Medication Related (Group = A)

  • 13392 Enhance the Medication resource for alignment with the IDMP Authorized Medicinal Product model
    • 12396 Medication package and product
    • 12395 Basis of Strength Substance
  • 12671 Consider adding "maintenance drug Indicator" on medication when discussing formulary.

Dosage Related (Group = B)

  • 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
    • Jose clarified question. To add query parameter for performer in order to retrieve orders for that performer. similar to intended dispenser
    • Motion to add query for intendedPerformer (Jose/Eric) 6-0-0 motion passes
Action: Scott will update tracker item
Action: <someone> to add Search parameter
  • 13044 Fix performer on MedicationAdministration - update description and add role back in with appropriate value set
    • waiting on changes from Workflow
    • Logical model for workflow has Performer (0..*) with roles from SNOMED
    • John - we were asked to constrain that role list but we decided at the time not to include role. Now we want to have it and need it to work with the definition in workflow.
    • Michelle - if role is a static aspect of the performer, then we don't need it (it's available in the specific resource describing that person). We need role if it related to the specific event and may not be consistent across related events.
    • extensive discussion ... does this include performer/verifier? That was previously advised (by FHIR) to be done with provenance. This may result in a "stack" of provenance events related to the order (ordered by, verified by, modified by, ...). This isn't how most systems are designed ... would be extensions(?) ... at least it would work. Event history (links to provenance) doesn't link to the most recent status ... would have to track through the provenance find the most recent state.
    • 6/12 we have not reach the end of this discussion (but we are at the end of the call)
      • John - the specific tracker can be addressed by adding role to medicationRequest, but this may not address the intent.
  • 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
    • may be answered to FHIR Search page [1] chained parameters.
    • no further discussion needed. No further action by Pharmacy, no vote needed
Action:  Scott will review FHIR Search page to see if question is answered.  If not, will refer to FHIR-I.

Order Service Catalogue Project

  • To follow the Order Catalog work, use the following listserv: ordercatalog@lists.hl7.org
  • context:
    • under Orders.
    • Catalogue vs Formulary. Catalog is a superset of Formulary, includes orderable items beyond medications. Significant overlap may necessitate
    • Jose and John involved
  • Update from John Hatem & Jose
    • one or two new resources coming out of this work
    • Jose is very involved. Composition is preferred. Adding metadata support for catalog entries.

International Chemotherapy Implementation FHIR IG

  • Chemotherapy IG Wiki Page
  • Update from John Hatem
    • NCCN and other European input
    • to support broad requirements. Specific implementation would constrain as needed
    • expect to participate in San Diego connectathon

CIMI Pharmacy Model Update

  • Update from John Hatem
    • Claude Nanjo working on presentation to Pharmacy to explain CIMI application to pharmacy resources

Action Item List

  • Action item list - update from John Hatem
    • generally a short list
    • John working on updating list with items from recent discussions (WGM and calls). Some are already addressed. When updating complete will bring it to a Pharmacy call


  • Eric: coordinate a call PC OO and Pharmacy related to Blood Products/Transfusion/Tissue products. Michelle - in addition to the conference call, there is the joint session available at the Sept WGM. John - also consider enteral feeding. Jose - boundary between medications, blood products, devices, etc ... make sure there is sufficient overlap so that similar processes are used across all scenarios. John H - need good definitions - sometimes a med and device are ordered separately, sometimes they are "one thing".
Action Item: Eric will coordinate a call between PC, OO and Pharmacy prior to Sept WGM

Next meeting

  • Monday, June 19, 2017 at 1pm Eastern - NOTE, new time for weekly teleconference