2018-08-13 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

• John Hatem (Chair)
• Melva Peters (Scribe)
• Christof Gessner
• Peter Sergent
• Lisa Nelson
• Jean Duteau
• Scott Robertson
• Michael Clifton
• Joe Quinn
• Stephen Chu

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

• August 13, 2018: no discussion

Use of Confluence

• further discussion after review done by Co-chairs
• August 13, 2018: no discussion

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 - John attended, suggestions about the terminology value sets on Medication Administration will be discussed on August 13, 2018 call.
• August 13, 2018: no discussion

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

• August 13, 2018: no discussion

FHIR

Open Pharmacy FHIR Tracker Items

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
• August 13, 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
• August 13, 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
• August 13, 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
• August 13, 2018: Started review of spreadsheet

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
  • August 13 - there were no workflow calls Wednesday of last week or this week
• August 13, 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
• 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

• August 13, 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
• June 11, 2018: no discussion
• June 18, 2018: will be discussed with MedKnowledge
• July 9, 2018: no discussion
• July 30, 2018: no discussion
• August 13, 2018: no discussion

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
• August 13, 2018: no discussion

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
• August 13, 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
• 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
• August 13, 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
• August 13, 2018: last week there were discussion related to the upcoming connectathon and use of the Catalogue resources. No action items for Pharmacy.

Pharmacy template ballot reconciliation

• July 9, 2018 - will be working on this and will extend into August
• July 30, 2018 - 2 items to discuss - see attached spreadsheet
  • Pharmacy Template Ballot Reconciliation Spreadsheet
  • see proposed dispositions in updated spreadsheet

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

• August 13, 2018
  • Moved by Jean - seconded by Scott to accept dispositions for comments where in person reconciliation not requested or where not waiting for input or where not previously voted on. 6-0-1 Carried
    • Stephen Chu Abstained

Action:  Melva to update spreadsheet

PSS Collaborative C-CDA R2.1 Template Review

• discussion by Lisa Nelson
• Review PSS and determine if Pharmacy should be a co-sponsor
  • idea to align CDA and FHIR better
  • CDA Management Group - trying to build better collaboration among Work Groups
  • Scope of this project is to pilot to see what it would take to build collaboration in some specific places - narrow scope
    • explore changes needed for CCDA R2.1 templates - identify tangible set of issues to make templates align better
      • list of deltas to bring views of the world align better
      • CDA Management group is the sponsor with SD, PC, FM and Pharmacy as co-sponsors
    • likely looking at Medication Activity template and Planned Medication Activity from Pharmacy
    • Pharmacy participation - Melva, John, Jean and Tom
    • discussion that Pharmacy would like to participate in the actual project work rather than as updates
  • Moved by Melva - seconded by Peter to approve Pharmacy as a co-sponsor contingent on the proposed changes 8-0-0 Carried

Next meeting

• August 20, 2018 at 4pm Eastern