2018-05-07 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

• John Hatem (Chair and Scribe)
• Jean Duteau

Agenda Items and notes

Action Item List

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

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
• April 30, 2018
  • Meeting scheduled for Tuesday in Cologne to finalize

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
• April 30, 2018

FHIR

Open Pharmacy FHIR Tracker Items

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: no discussion
• April 30, 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:

Action:  Melva to followup with Lloyd and Michelle

• April 30, 2018

15688 - MedicationRequest.category ValueSet

• MedicationRequest.category Valueset
• April 9, 2018: added to tracker
• April 16, 2018: no discussion
• April 23, 2018: no discussion
• April 30, 2018

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: no discussion
• April 30, 2018

15136 - Change Dosage to support conditional doses

• Change Dosage to support conditional doses
• Discussion of the requirement - this is related to conditional dose
• start to gather requirements and look at existing FHIR material including CDS

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: no discussion
• April 30, 2018: reviewed v3 model to see what should be pulled forward into resource(s).
  • moved John H/Jean D as persuasive
  • Jean will discuss with Melva for additions

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: no discussion
• April 30, 2018

15509 - Create example scenarios for Pharmacy

• Create example scenarios for Pharmacy
• need to draft some scenarios
• April 16, 2018: no discussion
• April 23, 2018: no discussion
• April 30, 2018: no discussion
• May 7, 2018:

12396 - Medication package and product

• Medication package and product
• April 9, 2018 - brought back to discuss
• April 16, 2018 - no discussion
• April 23, 2018: no discussion
• April 30, 2018:
• May 7, 2018:

Updates from Workflow

• 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
• April 30, 2018: reviewed tracker items. nothing specific to pharmacy
• May 7, 2018: reviewed tracker items during Workflow meetings. No specific pharmacy issues.

US Meds - PDMP Mapping

• work on GitHub
• 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
• April 30, 2018: no discussion
• May 7, 2018:

Catalogue Project

• April 9, 2018: all Catalogue project meetings cancelled until after HL7 Workgroup meeting in Cologne
• April 23, 2018: no updates
• April 30, 2018: no meetings until after Cologne WGM
• May 7, 2018: no discussion

Blood Products/Transfusion/Tissue Update - Project 1370

• April 9, 2018: no discussion
• April 23, 2018: no discussion
• April 30, 2018: no discussion
• May 7, 2018: no discussion

Drug Interaction PSS

• April 16, 2018: no discussion
• April 23, 2018: no discussion

Action:  reach out to project facilitators - get update in Cologne

• April 30, 2018
• May 7, 2018: no discussion

Next meeting

• May 28, 2018 - TBC