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2018-08-06 Rx Conf Call

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Attendees

  • Melva Peters (Chair and Scribe)
  • Peter Sergent
  • John Hatem
  • Scott Robertson
  • Tim McNeil
  • Michelle Miller
  • Jean Duteau
  • John Silva

Agenda Items and notes

Pharmacy List topic

  • I recently started researching HL7 because as a pharmacy, we have received several HL7 Data Sharing agreements from 3rd party vendors. I am trying to find out if the Segments/Components/Subcomponents are customizable and excludable from a data set. For example, could we exclude PID from transmission through the interface, yet allow other segments to transfer outside our organization?
Action:  Scott to respond

Use of Confluence

  • further discussion after review done by Co-chairs

SNOMED on FHIR teleconference calls

  • Every other Tuesday - June 23rd at 4pm Eastern
  • July 9, 2018: Peter Sergent attended recent call - 2 questions about MedAdmin
    • Is dosage going to be aligned with the complex type used in Medication Statement?
    • They are concerned that the reason was non administration is bound to different Snomed hierarchies
    • have discussed in the past - because MedAdmin is different - have previously discussed not to change
    • CodeableConcept - did not have a suggestion for what it should be bound to
    • next call is next week - Peter will ask what they think it should be bound to
  • July 30, 2018: accepted position on dosage
    • asked further on multiple hierarchy - referred to chat pages - Need to find out more
    • in allergy/adverse event work done in UK - value sets include multiple hierarchies - more of a global issue that should be posed to FHIR-I
Action:  Melva to post question to Zulip - complete
  • August 6, 2018: John Hatem to attend call tomorrow to discuss

MedicationKnowledge Resource

  • July 9, 2018:
    • on the Zulip chat - how to reflect an instance of a medication - Medication resource does not have an identifier - intentionally left out - not part of the 80/20 - would use a code
    • need to answer the question about why there is no identifier on medication - identifies an instance of a "thing" - we have a code (which identifies the "kind" of thing)
    • use case - may be for a "bar code" on an IV bag -
    • we have "serial number" in the batch attribute - could we change the name to "identifier"
    • move the "serial number" to the top level and change to name to "identifier" - and change data type. Will discuss with implementers before making change
Action:  talk to implementers about how they deal with this - Cerner, Epic, Vince  - Melva to followup
Action:  talk to Jose - Melva to followup
  • August 6, 2018
Action:  do one more followup with implementers and Jose

FHIR

Open Pharmacy FHIR Tracker Items

17619 - MedicationDispense Shipment Tracking

  • August 6, 2018
    • Motion: this requirement should be treated as an extension on the MedicationDispense - John Hatem/Scott Robertson - 5-0-0 Carried

17575 - Fix codelists

  • August 6, 2018
    • need to fix all instances of codelist
    • Medication.status
    • MedicationKnowledge.status; characteristic; packageType
    • MedicationDispense: status; category; statusReason; performerFunction
    • MedicationAdmininistration: status; category; performerFunction
    • MedicationRequest: status; intent; category; statusReason; courseOfTherapy
    • Moved by Michelle Miller/Jean Duteau to fix these - 6-0-1 Approved

Mi

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

  • July 30, 2018: no discussion
Action:  Melva to reach out to Anesthesia Co-Chairs to get material
  • August 6, 2018: no discussion

16042 - Add attribute to indicate type of drug

  • this is part of medicationKnowledge and formulary
  • June 11, 2018: no discussion
  • June 18, 2018: will be discussed as changes to MedKnowledge.productType
  • June 25, 2018: for incident reporting - could use AdverseEvent - references medication, medicationAdministration, MedicationStatement
    • Patient Care is debating whether instance is intending to be a specific instance or a more generic definition - GF#13698
    • continue the discussion for this tracker as part of MedicationKnowledge
  • July 30, 2018: no discussion
  • August 6, 2018: no discussion

15800 - scope and description for MedStatement

  • June 4, 2018: no discussion
  • June 11, 2018: no discussion
  • June 18, 2018: no discussion - will be discussed in the context of GF# 15105
  • July 30, 2018: no discussion
  • August 6, 2018: no discussion

15772 - Definitions for identifiers in Pharmacy resources

  • June 4, 2018: no discussion
  • June 11, 2018: no discussion
  • June 18, 2018:
  • July 30, 2018: no discussion
Action:  review and compare definitions for identifiers on pharmacy resources
  • August 6, 2018 - John reviewing - will be ready for review next week

15509 - Create example scenarios for Pharmacy

  • Create example scenarios for Pharmacy
  • need to draft some scenarios
  • April 16, 2018: no discussion
  • May 7, 2018: no discussion
  • June 4, 2018: no discussion
  • June 11, 2018: no discussion
  • June 18, 2018: no discussion
  • June 25, 2018: no discussion
  • July 9, 2018: no discussion
  • July 30, 2018: no discussion
  • August 6, 2018: no update on where we are with this
    • John will raise this question in the Workflow calls

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
  • June 11, 2018: no discussion
  • June 18, 2018: waiting for feedback from Lloyd on whether new value will be added to "intent" value set
  • June 25, 2018: Michelle to send notes from meeting in Cologne with Lloyd
Action:  Melva to followup with Lloyd on tracker item related to request for new value in intent and copy Michelle on email - complete
  • July 9, 2018: no discussion
  • July 30, 2018: no discussion
  • August 6, 2018: Zulip conversation - somewhat stalled
    • intent is not a modifier - outcome of the discussion may hinge on this
    • if it is a tag - need to make sure that there is documentation
Action:  Michelle to reach out to Epic to get them to weigh in on the Zulip chat

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
  • June 11, 2018: no discussion
  • June 18, 2018: will be discussed with MedKnowledge
  • July 9, 2018: no discussion
  • July 30, 2018: no discussion
  • August 6, 2018

17411 - Add category property to allow representation of Therapeutic category

  • Category Property
  • believe this is an extension as it is not part of the 80/20 for prescribing, dispensing, administering
  • July 30, 2018: no discussion
Action:  Ask John to join a Pharmacy WG Call to discuss further
  • August 6, 2018: John to join next week

17375 - Medication.quantity refers to "package" and "packaged product"

  • Medication.quantity
    • need to update the definition -
    • change the Ingredient.amount - to medication.ingredient.strength - need to update the definition to clarify
    • update the usage notes for medication.amount - update definition - update how used with strength
    • continue discussion next week
  • July 30, 2018: no discussion
  • August 6, 2018: continue the discussion when Jean is on the call - potential to change the datatype on amount

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
  • June 11, 2018: no updates
  • June 18, 2018: no meetings until July
  • July 9, 2018: No participation through end of July from Pharmacy
  • July 30, 2018: no discussion
  • August 6, 2018: no workflow meetings

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 - complete
  • June 11, 2018
    • Missed 2 tracker items in block vote - belong to a different ballot - have been forwarded
      • 16032 Link is incorrect
      • 16094 Medicinal Product use indicator
    • Motion to find these two comments "not related" - Jean/Brett - 4-0-0 Carried
Action: Melva to review email from Austin to determine what has to be done about other comments
  • July 9, 2018:
  • July 30, 2018: no discussion
Action:  Melva will followup with Brett on next steps
  • August 6, 2018 - Brett working on getting the changes applied

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
  • June 11, 2018: no updates
  • June 18, 2018: meetings have been held but John hasn't been able to attend.
  • June 25, 2018: they are finalizing the resources for their meetings with FMG and the September WGM.
    • The resources they are working on include Entry Definition.
    • The are also seeking interested parties to use their resources in the next Connectathon
  • July 9, 2018: next meeting will be July 11th - no participation from Pharmacy through the end of July
  • July 30, 2018: no discussion
  • August 6, 2018: no updates

Blood Products/Transfusion/Tissue Update - Project 1370

  • May 7, 2018: no discussion
  • June 4, 1018: no updates
Action: Melva to follow up with O&O
  • June 11, 2018: no updates
  • June 18, 2018: There is a draft resource - Biologically derived project
Action:  Melva to followup with O&O
  • June 25, 2018: Melva commented on O&O Zulip chat - no response
Action:  Melva to followup with O&O - complete

Pharmacy template ballot reconciliation

Action:  Melva to reach out to submitters who wanted in person resolution - complete
Action: Melva to reach out to submitter where we needed clarification - complete
  • August 6, 2018
Action:  Melva to send spreadsheet to the list for review.  Will vote on this next week

AOB

Next meeting

  • August 13, 2018 at 4pm Eastern
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