2017-10-16 Rx Conf Call

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Attendees

  • Melva Peters (Chair)
  • Mike Henderson
  • John Hatem
  • Jose Costa Texeira
  • Jean Duteau
  • Michelle Miller

Agenda Items and notes

Pharmacy List

  • Clozapine REMS registry message - Mike Henderson
    • Does there exist, or is there planned, any HL7 V2 messaging for the US Clozapine REMS or similar Clozapine registries?
    • VA has a significant mental health care population - a registry exists but doesn't use standards based messaging - uses mail messages
    • There is a dispense event messages and a query
    • Has someone dealt with this yet?
      • Michelle will check to see if anyone using Cerner is communicating with the REMS registry
    • Mike will send more information about what data is in mail messages

FHIR

FHIR Tracker Items

FHIR Tracker

Workflow Changes

Request
  • October 9, 2017 -See analysis spreadsheet
    • Definition - new Workflow name is "instantiates" -
    • StatusReason - add
    • "doNotPerform"
    • requester - change from backbone to align with pattern
      • PractitionerRole needs to be added in as a reference
      • remove agent
      • remove onBehalfOf
    • add practitionerType to recorder
    • performer - references - add CareTeam and PractitionerRole
    • add insurance
    • Motion - to make the changes as identified in spreadsheet - Melva/Jean - 3-0-0 Carried
Action:  Melva to create tracker item and attach spreadsheet - complete
Action:  John to reach out to Tom to see if there is a NL use case for "do not perform" using MedicationRequest
Dispense
  • October 9, 2017 - Proposed changes
    • actor - add a reference to PractitionerRole
    • remove onBehalfOf
    • notDone - remove attribute
    • add notDone to status value set
    • change name of notDoneReason to "statusReason"
      • statusReason[x] - codeableConcept or reference to DetectedIssue
        • invariant on reference - status must be notDone
  • Motion: to make changes as identified in spreadsheet - Melva/Jean - 3-0-0 Carried
Action:  Melva to create tracker item and attach spreadsheet - complete
Administration
  • October 16, 2017 -
    • mapping to event logical model
    • Changes needed
      • Definition - maps to "instantiates" -
      • Status - add "not given" as a status
        • add change "reasonNotGiven" to "statusReason" and update description
        • delete "NotGiven" attribute
      • Performer
        • Add PractitionerRole
        • remove onBehalfOf
    • will discuss and vote on next call
    • related GF#13537 - collapse notDone into status - MedicationAdministration
      • look at on October 23rd call - related to workflow changes
Statement

Medication Related (Group = A)

  • Medication.Status
    • Medication.status - is mandatory - have an exemption from previous request to MnM
    • need to reapply the exemption
  • Other open tracker items
    • GF #13954 - Add serial number to medication
      • Jose provided - serial number - each physical instance is given a unique number (box or tablet)
      • in some cases, this is the packaging or the preparation
      • Medication doesn't have an identifier
      • becoming mandatory by European regulation by 2019
      • suggest that this is an extension at the moment and when it becomes a requirement for more systems
        • Jose has defined an extension already that meets this requirements
      • Motion: to find this not persuasive and should be met via an extension - Jean/John - 3/1/1
Action:  Invite Jose to an upcoming teleconference - complete

Dosage Related (Group = B)

Misc (Group = none)

  • GF #13978 Clarify MedStatement.status values
  • GF #13905 prn medications need boolean and optional reason
  • GF #13537 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.
  • GF #13538 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
    • October 5 - Changes have been made to both the Event and Request patterns. One more change is being made to the Event pattern before we can move on alignment updates.

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
    • September 25: not started up
    • October 2: actively being discussed - John attending calls
    • October 9: no update

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
  • September 25: no update - meetings have been cancelled
  • October 2: has not met for a few weeks
    • John to follow up with project team
    • October 9: no update

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
    • October 9: no update

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
    • October 9: no update

Action Item List

  • August 7 update: John is working on cleaning up the action item list
  • September 25 update: Claude believes more information needs to be provided to navigate through the material
    • he is willing to come to Pharmacy WG
  • October 2 update: was pulled from the ballot

Ballot Reconciliation - Templates

AOB

Next meeting

  • Monday, October 23rd, 2017 - 4pm Eastern