2017-08-28 Rx Conf Call

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  • Melva Peters (Chair)
  • Michelle Miller
  • Tim McNeil
  • John Hatem
  • Scott Robertson
  • Joe Quinn

Agenda Items and notes

  • September 4th meeting will be cancelled

Cancelled vs Stopped - do we need both?

  • See email thread on pharmacy List Cancelled vs Stopped
    • there was a side bar discussion with Lloyd and Patient Care - Michelle to forward the email
    • we believe that forcing implementers to support task is a burden so we shouldn't move some statuses to task
    • agree we should not move "stopped" to task
Action:  Create tracker item to review/refine order statuses - may need to make more granular based on whether or not the patient has consumed the medication
Action:  respond to Lloyd - not to move "stopped" from MedicationRequest

CIMI Pharmacy Model Update

  • Update from John Hatem
    • July 17, 2017 - Claude Nanjo provided an overview of the CIMI logical model that incorporates the Pharmacy FHIR resource work. This work will be balloted as Informative in the HL7 September 2017 ballot.
    • July 31, 2017 - concerns raised about how Pharmacy will be involved and be expected to manage the content
      • will be balloted as informative
    • August 7, 2017 - John Hatem is following up with Claude N. on what type of commitment is expected from Pharmacy going forward.
    • August 14, 2017 - John has reached out to Claude. He has a general slide deck but will have to re-create a pharmacy specific version.
    • August 28, 2017 - ballot is open. It is not easy to read the ballot content without using the mapping spreadsheet and even then it isn't clear
Action: John to reach out to Claude and indicate that we believe a pharmacy specific is needed - complete


Action:  add tracker item to review category based on what other Work Groups have done for category - can make 0..* to include different contexts - complete

Tracker Items

FHIR Tracker

  • BR&R - IDMP work
    • may come and ask for a joint meeting

Medication Related (Group = A)

  • August 28, 2017: will discuss further in San Diego
    • may be 1 resource with multiple profiles or may be 3 resources that are harmonized - to be determined
      • we believe that Pharmacy WG should own "clinical Medication" and "drug knowledge" resources
  • July 31, 2017
    • Use cases - coded product vs non-coded product
      • John will work with others on how detailed we need to provide information on packaging
      • Discussion of when a medication is ordered that is included multiple products; or when medication is order with specific packaging - need to define use cases
Action:  Provide examples of the various medications that we would need to ship around in orders/dispenses/administrations/statements to see what we actually need
Action:  John to coordinate the analysis of packaging information needed for requests, dispenses, administrations and statements - additional attributes that are needed when code is not specific enough
  • August 7, 2017 - John will report on what type of "medication" information is needed in our Pharmacy Medication resource re: Packaging
  • 13392 Enhance the Medication resource for alignment with the IDMP Authorized Medicinal Product model
  • 12396 Medication package and product

Dosage Related (Group = B)

  • 12791 Update dosage Instruction to include pre-condition and therapeutic target
    • confer with group in next call on how this should be done - text vs codified

Misc (Group = none)

  • 13704 MedicationRequest.intent should be bound to RequestIntent valueset
Action:  followup with submitter to understand pharmacy use case for adding "option" - complete
  • 13695 Add Prescription date and Dispense date to MedicationStatement
    • would have this information if deriving from MedicationRequest
    • believe that this can be handled by the derivedFrom attribute where you can reference MedicationDispense and MedicationRequest. If needed in the MedicationStatement, this would be an extension
    • vote on in San Diego
  • 13690 Can reasonReference and reasonCode be combined into a choice
  • 13619 Clarify extension-pharmacy-core refills remaining
  • 13044 Fix performer 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
  • 13537 Collapse medicationAdministration.notDone into status
    • 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.
  • 13538 Collapse medicationDispense.notDone into status
    • 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.
    • August 28 - John checking to see what changes have happened to Workflow

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
    • New Lab resource was created. John Hatem will continue to monitor and attend meetings.
    • August 14: last meeting was specific to lab specimen
      • content of the resource is generic
    • August 28: no update. There will be a meeting this week
      • specimen resource - believed to be a definitional resource

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
    • Next meeting will be held August 15
    • no update - meeting will be held this week - John will attend
Action:  John will ask about ballot time frame
  • August 28 - meeting this week

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.
    • Meeting is currently scheduled for Aug 10, 2017
  • Updates
    • August 14, 2017
      • Minutes
      • meeting was held on August 10
      • scoped to Blood Transfusion for now - profiles on Pharmacy resources may work for the requirements
      • will continue to investigate requirements in preparation for the WGM Quarter
      • Michelle will post to Zulip inviting participation at WGM - complete

Action Item List

  • August 7 update: John is working on cleaning up the action item list


  • Joint meeting with Patient Care about Blood Products - additional topic will be added to the end of the meeting from CDS

Next meeting

  • Monday, September 11, 2017 Q3 - San Diego