2018-06-04 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

• Melva Peters (Chair and Scribe)
• Nagesh Bashyam
• Tim McNeil
• Amy Benson
• Brett Marquard
• Igor Sirkovich
• Julie James
• John Hatem
• Jean Duteau
• Stephen Chu

Agenda Items and notes

Recap - Cologne WGM and Joint Meeting

• Pharmacy Templates
  • will be meeting in Baltimore
• MedicationKnowledge/IDMP resources
  • SubstanceSpecification project review
    • Substance will be moving to BR&R - needs FMG
• Joint Meeting

Action: Forward notes from meeting to the list - complete

Use of Confluence

• further discussion after review done by Co-chairs

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 - complete
Action:  look at material from Chile to see if definitions can be updated
Action: Melva to post to Zulip asking implementers for feedback - compete

• April 23, 2018
• April 30, 2018
• June 4, 1018: See tracker 16095
  • Review of material from ISO
  • Review of material from NZ

Action:  Melva to apply changes discussed in Cologne for review

FHIR

Open Pharmacy FHIR Tracker Items

17255 - Long term medication flag in medication request

• could use MedicationRequest.category
• this existed in V3 models
• this is a valuable attribute for developing medication profiles - Julie proposed that we include a new attribute with tight definitions - "Course of Therapy Type"
  • see Gforge tracker

17222 Review Pharmacy resources to see if requirements for Medical Gases are met

Action:  Melva to reach out to Anesthesia Co-Chairs to get material

17203 doseAndRate Cardinality

• June 4, 2018: no discussion

16042 Add attribute to indicate type of drug

• this is part of medicationKnowledge and formulary

Action:  ask for the use case and examples from Finnie - complete

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
• June 4: There is a common extension to add free text to any datatypes - propose using free text extension
  • See Gforge for vote

15800 scope and description for MedStatement

• June 4, 2018: no discussion

15772 Definitions for identifiers in Pharmacy resources

• June 4, 2018: no discussion

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: no discussion
• June 4, 2018: no discussion

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: no discussion
• June 4, 2018: no discussion

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
• June 4, 2018: no discussion

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:
• April 30, 2018
• June 4, 2018: no discussion

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:
• June 4, 2018: no discussion

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.
• June 4, 1018: no updates

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:
• June 4, 1018: Block vote
  • Comment Submitters
    • Arvind Jagannathan
    • Jose Costa Teixeira
    • Mark Cacciapouti
    • Michele Hudak
    • Ruth Berge
    • Scott Robertson
    • Thomson Kuhn
    • William Goossen
  • Line Items
    • 17196 Agree with approach - 2018-May Medication #23 (Jose Costa Teixeira) Considered - No action required
    • 16326 NCPDP mapping (Scott Robertson) Considered - Question Answered
    • 16327 Ballot name and link (Scott Robertson) Considered - Question Answered
    • 16629 Confirm if SSN is only identifier - 2018-May Medication #4 (Michele Hudak) Considered - Question Answered
    • 16032 Link is incorrect (Ruth Berge) Not Persuasive
    • 16093 Use indicator (Ruth Berge) Not Persuasive
    • 16094 Medicinal Product use indicator (Ruth Berge) Not Persuasive
    • 17197 Seems not to adhere to the Identification of Medicinal Products IDMP from ISO. - 2018-May Medication #24 (William Goossen) Not Related
    • 16091 garbled text in table legends (Ruth Berge) Persuasive
    • 16625 Remove specific call-out of Opioid abuse - 2018-May Medication #2 (Michele Hudak) Persuasive
    • 16626 Drop phrase %27any%27 on controlled substance - 2018-May Medication #3 (Michele Hudak) Persuasive
    • 16636 Did you actually mean MedicationStatement here when you wrote MedicationRequest%3F - 2018-May Medication #6 (Arvind Jagannathan) Persuasive
    • 16639 Reword this sentence within the PDMP section. - 2018-May Medication #7 (Arvind Jagannathan) Persuasive
    • 16642 Just a typo correction within the PDMP section. - 2018-May Medication #8 (Arvind Jagannathan) Persuasive
    • 16645 Change the format of the header for the PDMP Data Elements and Mappings section to properly show this is a new major section of this page. - 2018-May Medication #9 (Arvind Jagannathan) Persuasive
    • 16648 Provide a link to the FHIR RESTful specification within the CapabilityStatement description. - 2018-May Medication #10 (Arvind Jagannathan) Persuasive
    • 17161 “asterisk” misspelt - 2018-May Medication #20 (Thomson Kuhn) Persuasive
    • 17162 What is the meaning of the asterisk for this element. - 2018-May Medication #21 (Thomson Kuhn) Persuasive
    • 17195 Patient Profile Search Requirements - 2018-May Medication #22 (Mark Cacciapouti) Persuasive
    • 16623 Update reference to Opioids - 2018-May Medication #1 (Michele Hudak) Persuasive with Mod
    • 16624 Update reference to Opioids - 2018-May Medication #1 (Michele Hudak) Persuasive with Mod
    • 16633 Make the scope statement include the Argonaut Project scope statement for convenience. - 2018-May Medication #5 (Arvind Jagannathan) Persuasive with Mod

Block Vote

• have posted the block vote for 2 weeks - no requests to pull
• Motion by Brett - Dragan to approved disposition based on block vote and published spreadsheet - 7/0/0

Action: Brett to update Gforge 
Action: Melva to get spreadsheet extracted and posted on Ballot reconciliation
Action:  Melva to send Brett vote

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
• June 4, 1018: no updates

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
• June 4, 1018: no updates

Action: Melva to follow up with O&O

Drug Interaction PSS

• April 16, 2018: no discussion
• April 23, 2018: no discussion
• April 30, 2018
• May 7, 2018: no discussion
• June 4, 1018: no updates
  • joint meeting scheduled for Baltimore

AOB

• None

Next meeting

• June 11, 2018 at 4pm Eastern