2018-04-23 Rx Conf Call

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Attendees

  • Melva Peters (Chair and Scribe)
  • Tim McNeil
  • John Hatem
  • Jean Duteau
  • Scott Robertson
  • Christof Gessner
  • Stephen Chu

Agenda Items and notes

Action Item List

WGM - Scott to update availability - 4/23 complete
15136 - Change Dosage to support conditional doses
 Action: Scott to pull material from NCPDP
 Action: John to pull V3 material
15589 - Pharmacy missing isModifierReason
 Action: Jean to talk to Grahame/Lloyd - about the criteria for when is an element flagged as a Modifier
MedicationKnowledge
Action: Jean and Melva to liase to work on updates
Action:  look at material from Chile to see if definitions can be updated
Action:  Melva to add MedicationKnowlege to FHIR Tracker so that new comments/changes can be added

WGM Agenda

[WGM Agenda on Wiki]

  • Scott and Melva will be attending
  • Jean and John will be able to dial in for MedicationKnowledge discussion

Joint Meeting with IHE Pharmacy and ISO TC215 WG 6

  • Feb 26, 2018: no discussion
  • March 5, 2018: no decision
  • March 12, 2018: will decline a joint meeting for Cologne
    • will commit to provide an update to IHE Pharmacy and ISO as a power point, but can not do a F2F meeting at this time.
  • March 19, 2018: Looks like there will be a joint meeting on Friday, May 18th
  • March 26, 2018: Scott sent possible agenda topics
  • April 9, 2018: Update with current status - who is attending, any further updates to agenda, etc.
    • Melva and Scott will be attending
    • initial agenda items sent to IHE and TC215 WG6
  • April 16, 2018:
    • no further information on agenda item
  • April 23, 2018
    • from Christian Hay 3/19/2018
      • At this time, on the ISO side, we don’t know who is going to participate; that would certainly impact the content on our side.
      • From the current work items @ ISO I would like mentioning the following; a * signalise which seems to me the most interesting for an in-depth work:
        • a. ISO/TS 16791 Requirements for international machine-readable coding of medicinal product package identifiers
        • b. *ISO/NP/DTS 23261 'Requirements for accessing digital medicinal products information by using the existing data carrier'
        • c. *ISO/NP/DTS 22756 Requirements for a knowledge base for clinical decision support systems
        • d. Implementation guide for ISO/TS 19256 Health informatics – Requirements for medicinal product dictionary systems for health care

MedicationKnowledge Resource

  • Melva and Jean are creating a draft resource in the build. The next step is to review the existing tracker items to see which can be done with the current draft content, which need to have data elements added, and which will remain out of scope.
  • Feb 26, 2018: no discussion
  • March 5, 2018: no discussion
  • March 12, 2018: FMG wants to see the PSS once co-sponsors have been approved
  • March 19, 2018: Melva will see if she can publish a local version for review
  • March 26, 2018:no discussion
  • April 9, 2018: update by Jean
    • reviewed structure at [1]
    • a first cut ... more work to be done
    • mainly pulled from v3.
    • some review relative to Saskatchewan, KP formularies and FDB
    • still need to validate will work for use cases / requirements
    • medicationClassification can be used for many different different classification for one MedicationKnowledge
    • batch ... is this needed in MedicationKnowledge?
    • Note that this is not as detailed as IDMP
    • amount vs packaging.quantity ... need to clarify
    • 'type' needs clarity: this is branded, generic, PHPID, etc. need better definition.
    • need input from Medication Knowledge vendors (Multum, FDB, etc), formulary, catalog stakeholders
  • April 16, 2018:
    • Jean's email of April 13, 2018 -- This is a list of the changes/clarifications/discussion items that came out of the review of the MedicationKnowledge resource:
      • generalizedMedicine = Reference(MedKnowledge)
      • patientCharacteristics.value = choice of datatypes
      • indication = reference(observation)
      • drugCharacteristics.value = choice of datatypes
      • .
      • type - needs better definition
      • ingredientItem - reference(medication)? - do we need a reference to medication or just to substance?
      • Contraindications - do we want to include a structure for contraIndications?
      • batch - description isn't proper - is it needed?
      • packaging.quantity = how does it differ from amount?
        • how do I express strength + total quantity
      • halfLife - description needs to be fixed
      • Cost - add a typeCode for type of cost (manufacturer price, claim reimbursement, patient cost)
      • fix graphic on UML
      • isBrand - may be needs to include different types - isBrand, isGeneric, isInnovator, other
        • Discussion
      • add substitution allowed attribute
      • Need to look at other parameters other than halfLife
      • Need to consider the name
Action: Jean and Melva to liase to work on updates
Action:  look at material from Chile to see if definitions can be updated
Action: Melva to post to Zulip asking implementers for feedback
  • April 23, 2018

FHIR

Open Pharmacy FHIR Tracker Items

15871 Different refill duration or quantity

  • FHIR extension - first fill instructions - quantity and days supply - must populate at least one
  • initial quantity and initial duration
  • add initial fill backbone element in dispenseRequest - with 2 attributes - quantity (simpleQuantity) and duration
    • cardinality 0..1 on backbone
    • cardinality on attributes 0..1 - need a constraint that one or the other must be filled
  • motion to add new backbone - Jean/John - 5/0/0

15879 Dispense interval not defined

  • FHIR extension exists in Canada - minimum period of time that must occur between dispenses
  • use case is related to minimum period of time that must occur before dispense can occur
  • proposal to add new attribute - "DispenseInterval" - minimum period of time that must have occurred between dispenses
  • cardinality 0..1
  • datatype is Duration
  • Motion: add new DispenseInterval attribute to DispenseRequest - John/Scott - 6/0/0

15840 - Free-text representation of strength

  • this applies to Medication
  • text string to represent the strength - e.g. "100mg" or 1000IU/ml
  • options:
    • add extension for a string on ratio datatype -
    • change "amount" to be a choice of ratio or string
Action:  Jean to follow up with FHIR-I about a possible extension for "ratio"

15905 - Comment for Dosage.doseAndRate

  • need comment for Dosage.doseAndRate
  • April 9, 2018 - Christof asked to review 14212 for completion
    • was the value set binding done? dose-and-rate-type is present: calculated, ordered
    • everything is done and applied!
  • Stephen asked if the multiple iterations might conflict? is there a mechanism to prevent such conflicts?
    • new tracker item 15905 created for a doseAndRate comment that the multiple instances of doseAndRate cannot conflict.
  • April 16, 2018: no discussion
  • April 23, 2018:

15105 - MedicationStatement - alignment with WorkFlow

    • notTaken was removed
    • need to consider how to reflect what the prescriber thinks should be taken by the patient - is this a medStatement or is this a MedRequest?
  • Lloyd believes should be using a MedRequest with a "plan" status
  • Choices:
    • take MedStatement back to the way it was
    • US Core - embrace List
    • follow Lloyd's suggestion to use MedRequest with "Plan" status
    • use status field to identify if a prescriber believes the patient should be on this med and uses taken element to identify if the patient is following the order and taking the medication - could previous do this before we aligned MedStatement with workflow
  • March 5, 2018: - deferred until March 12, 2018
    • Ask Lloyd to join call - complete - he can't join on March 12. Need to provide an update to him
  • March 12, 2018:
    • Lloyd believes that MedStatement should only be an indicator of whether the patient/provider says they are taking the medication
    • Options:
      • revert back to having "notTaken"(pre workflow harmonization)
      • provider instructions for medication - should use MedicationRequest - with intent element
      • implement List resources to get active medication list - not preferred
      • current resource with "not taken" as a status - not preferred
    • Need to take this conversation more public -
      • Workflow group - Melva to ask Lloyd to add to Workflow agenda
      • Zulip - posting to Zulip
        • add Workflow discussion
  • April 16, 2018: no discussion
  • April 23, 2018:

15688 - MedicationRequest.category ValueSet

14455 - Workflow report

  • File:Workflow pharmacy issues Jan 2018.xlsxx
    • new report has been run
    • MedicationRequest
      • instantiates - currently supported but workflow has changed the pattern
        • John to talk to Lloyd about the changes needed
    • MedicationAdministration -
      • instantiates - currently supported but workflow has changed the pattern
        • John to talk to Lloyd about the changes needed
    • MedicationDispense
      • Performer - we believe we are consistent
        • Melva to reach out to Lloyd and ask if this is an error in the report - email sent to Lloyd - there is an error on the report.
          • new report to be generated
      • statusReason
        • will add to suppressed-workflow-warnings - different name
        • John to followup with workflow about the reference to DetectedIssue - still outstanding
  • April 16, 2018: (is there a new report?) - no discussion
  • April 23, 2018:

15136 - Change Dosage to support conditional doses

Action: Scott to pull material from NCPDP
Action: John to pull V3 material
  • April 9, 2018: minor update, more work needed
  • April 16, 2018: no discussion
  • April 23, 2018:

15589 - Pharmacy missing isModifier Reason

  • Pharmacy missing isModifierReason
  • MedicationRequest.substitution.allowed
    • do not believe that this should be a "isModifier"
    • will discuss on March 12 call when we have implementers on the call
  • Medication.amount
    • do not believe that this should be a "isModifier"
    • will discuss on March 12 call when we have implementers on the call
  • March 19, 2018:
    • discussion of the purpose of the isModifier flag - discussion of whether there should be isModifier used more often than it is
    • medicationRequest.substitution - will use the wording from the current element and elaborate "this is the element that must be understood from the substitution element. In the substitution block - this is the element that must be understood to understand the meaning of the block
    • medication.amount - agree it is a Modifier
      • should only specify the amount when the medication.code doesn't provide this information
      • then this can not be ignored
  • April 9, 2018: still as a modifer. still pending input
Action: Jean to talk to Grahame/Lloyd - about the criteria for when is an element flagged as a Modifier
  • April 16, 2018: no discussion
  • April 23, 2018:

15509 - Create example scenarios for Pharmacy

12396 - Medication package and product

Updates from Workflow

  • March 26, 2018: no discussion
  • April 9, 2018: workflow meeting this week focused on ballot comments.
  • April 16, 2018: no discussion
  • April 23, 2018: meeting held today
    • Workflow issues - Lloyd will be fixing the report and re-issuing
    • MedicationDispense.statusReason - is okay that this will be either a reference or a CodeableConcept - will not be added to the pattern for event

US Meds - PDMP Mapping

  • work on GitHub
  • added banners for those sections of the material that is open for ballot
  • New tab has been added for PDMP
    • Brett will send out a link with updated material by end of day on Wednesday - Pharmacy WG will comment
    • rename "Request" column to PDMP data attribute
    • suggest more clarifying information on the scope and context
    • Motion to approve this content going to ballot pending one final review of content by Wednesday end of day - Melva/John - 6/0/0 - CARRIED
  • Updates were provided and feedback was given to Brett M. Feedback was incorporated into published material.
  • 4/9/2018 - previously discussed, some updates by Brett, approved for ballot. Can close this.
  • April 16, 2018: In ballot - no discussion until after ballot close
    • will be on the agenda for WGM or subsequent teleconference
  • April 23, 2018: no discussion

Catalogue Project

  • March 5: last weeks meeting addressed open issues related to getting the Entry Definition resource cleaned up. There were no Pharmacy specific issues.
  • March 12, 2018: there was a meeting - cleaning up material to get content into the build
    • entryDefinition has a classification element
  • March 19, 2018: no updates
  • March 26, 2018: no discussion
  • April 9, 2018: all Catalogue project meetings cancelled until after HL7 Workgroup meeting in Cologne
  • April 23, 2018: no updates

Blood Products/Transfusion/Tissue Update - Project 1370

  • Feb 26, 2018: no discussion
  • March 5, 2018: no updates
  • March 12, 2018: no meetings have been held since New Orleans
  • March 19, 2018: no updates
  • March 26, 2018: no discussion
  • April 9, 2018: no discussion
  • April 23, 2018: no discussion

Drug Interaction PSS

  • Project meetings will be held Wednesday at 9am Pacific
  • March 26, 2018: no discussion
  • April 16, 2018: no discussion
  • April 23, 2018: no discussion
Action:  reach out to project facilitators - get update in Cologne


AOB

Next meeting

  • April 30, 2018