2017-06-26 Rx Conf Call

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Attendees

  • Scott Robertson (Chair)
  • Bob Thompson
  • John Hatem (Scribe)
  • Michelle Miller
  • Nancy Westaway
  • Jean Duteau
  • Kent Bui
  • Eric Haas
  • Jose Costa Teixeira

Agenda Items and notes

Tracker Items

FHIR Tracker


Medication Related (Group = A)

  • None of these tracker items were discussed on June 26.
  • 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)

  • None of these tracker items were discussed on June 19.
  • 13383 We need to be able to specify that a dosage timing must be obeyed exactly
    • Discussed on June 26, 2017. Motion by JeanD that this item is Not Persuasive, seconded by MichelleM. Vote: 8-0-0 Motion passed. See gForge item for details.
  • 13382 We need Dosage.text to be a CodeableConcept
    • Discussed on June 26, 2017. Motion by JohnH that this item is Not Persuasive, seconded by JeanD. Vote: 8-0-0 Motion passed. See gForge item for details.
  • The following 4 tracker items were NOT discussed on June 26, 2017.
  • 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)

  • 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
      • 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
    • Discussed on June 26, 2017. Motion by JeanD that the item is Not Persuasive, seconded by MichelleM. Vote: 7-0-0 motion Passed. See gForge for details.
    • we discussed 13537 which is a request to update Medication Administration by removing the NotGiven Boolean and adding in a new status code - not done. Since this is coming from workflow we decided to wait until this is added to the Event logical model for Workflow and evaluate the definition of "not done" and assess it's relevance for Pharmacy. In general there was a positive reaction to this request.
    • we discussed 13538 which is a request to update Medication Dispense by removing the notGiven Boolean and adding in a new status code - not done. Since this is coming from workflow we decided to wait until is added to the Event logical model for Workflow, and evaluate the definition of "not done" and assess it's relevance for Pharmacy.
      • Michelle mentioned we may also want to review Patient Care 12592 before we make our changes since there was some discussion about how this change should/should not impact the Request resource.
    • 13536 - this was a request to add a new attribute for documenting the brand name for a medication. No vote this week, but we felt that our definition for medication.code was updated to reflect this is where the brand name can be found. During our discussion it was discovered that the medication.code description needs to be updated, since part of the description that documents how brand or generic descriptions can be documented was not brought forward from our FHIR v2 materials.
      • Motion by MichelleM that the item is Persuasive with Mod, seconded by JohnH. Vote: 8-0-0 motion passed. See gForge for details. Note that the change with this item is to update the description, by adding in text that was present in version 2 of the FHIR specification

Order Service Catalogue FHIR Project

  • To follow the Order Catalog work, use the following listserv: ordercatalog@lists.hl7.org
  • Background
    • under Orders WG.
    • Catalogue vs Formulary. Catalog is a superset of Formulary, includes orderable items beyond medications.
    • expect one or two new resources
    • Jose and John involved
  • Updates
    • June 19, 2017 - Request of new resource - Catalog Entry is being documented. The big picture view of a Catalog would be the use of a Composition resource that has a reference to a Catalog Entry resource and each Catalog Entry resource has a reference to a Medication resource.
    • June 26, 2017 - JohnH stated that there is a request from the Catalog team that Pharmacy provide a "logical model" to the Catalog team in a similar manner to that created by the Lab group. JohnH to reach out to JeanD to create this type of model.
    • Next Catalog meeting is Wednesday, June 28

International Chemotherapy Implementation FHIR IG

  • Chemotherapy IG Wiki Page
  • Background
    • NCCN and other European input to support broad requirements. Specific implementations would constrain as needed
  • Update from John Hatem
    • June 19, 2017 - next meeting is Tuesday, June 20. Expect report of progress on the IG in next weeks con call.
    • June 26, 2017. No report this week.

CIMI Pharmacy Model Update

  • Update from John Hatem
    • June 19, 2017 - next meeting is Thursday, June 21. Expect a more detailed report in two weeks about progress of mapping of Pharmacy resources to CIMI logical model.
    • June 26, 2017 - John H has meet with ClaudeN several times to work on aligning the CIMI Pharmacy model with Pharmacy Medication Request resource. Claude is preparing a presentation to review the work with Pharmacy - current proposed Pharmacy conf call is: July 17, 2017

Blood Products/Transfusion/Tissue Update

  • Background:
    • based in Patient Care. also includes Orders
    • Blood Products/etc moving into FHIR. Want to maintain alignment with Orders and Pharmacy resources
  • Eric H has sent out a Doodle poll to determine a meeting time for OO, PC and Pharmacy to discuss. No final meeting time has been reached as of June 26, 2017.

v2 Chap 11 & 12 deprecation

  • Background
    • Scott is contact
    • Patient Care has proposed to deprecate Chapters 11 Patient Referral & 12 Patient Care in v2
    • v2.9 already in publication process, could be deprecated in v2.10
    • Orders has already claimed interest in some segments
  • June 19, 2017 update
    • Scott will continue to review to assess if Pharmacy requires some content from Chapters 11 or 12.
    • If others have opinions on this topic, please forward your findings/thoughts to Scott Robertson.
  • June 26, 2017 update
    • Scott did not find any issues requiring Pharmacy input. Only open question is whether we can remove this from our Agenda going forward.

Action Item List

  • June 19, 2017 update
    • Action item list is being updated. The list now is down to 50 open items. John H will continue to work the list by reviewing the minutes and reaching out to folks to assess if specific items can be closed.
    • We will continue to review the list in our calls for the next few meetings.
  • June 26, update. Action item list is down to ~ 30 open items. John H will continue to work the list.

Pharmacist Care Plan Project

  • June 26, 2017: Scot reported that Pharmacy does NOT have to vote on this work. A call will be scheduled in the future to review this work.


AOB

Next meeting

  • Monday, July 10, 2017 at 1pm Eastern - NOTE, new time for weekly teleconference
  • NOTE there will be NO call on July 3, 2017 due to holiday in the US