Jan 2011 WGM Minutes

Pharmacy Working Group Meeting Minutes Sydney, Austrailia, Mon 10th January to Thursday 14th January 2011

Monday 10th January; Q1

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Nicolas Canu Phast FR Nicolas.canu@phast.fr

Peter Sergent Medtech NZ peter@techsus.co.nz

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Mollie Ullman-Cullere Dana Farber Cancer Institute USA Mollie_Ullman-cullere@dfci.harvard.edu

1. Introductions

2. Agenda Review (Hugh Glover)

Hugh reviewed the entire weeks schedule and we discussed in detail each days work to educate the new members about the agenda topics and to assess if we need to make any changes. No changes were made. Action Items: John to bring structured document materials that are relevant to pharmacy to the Wednesday Q2 meeting. . (done) Hugh to ask Catherine Chronoki to provide an update on ePSOS (done – though subsequently could not take place)

3. Cambridge WG Meeting Minutes • Postponed review and voting on the minutes Action Item: Hugh to ask on Rx List Serv for location of most current version of Cambridge WG Meeting minutes. (done)

4. Peter Sergent discussion of New Zealand use of V3 content • Current practice: 1. Electronic creation of a prescriptions are all done via PMS systems and this includes a web service interface to an authorization authority and this system provides an approval number that is added to the prescription when it is printed. 2. The printed prescription is then taken to a pharmacy for dispense 3. At dispense, a v2 message that wraps a CDA prescription is sent to a centralized (national) repository • Desired new practice (what v3 structures should be used)(they made decision to not use HL7 v2) 1. Electronic creation of prescriptions is done in PMS system, authorization is done via web services, authorization ID is per item. Drug-drug interaction is typically done at this step. 2. Send the prescription (order) electronically to the central (national) system 3. Central system may respond as follows  Accept prescription  Reject prescription e.g. it is not valid semantically 4. Pharmacy pulls down the prescription into their local system and may respond as follows:  Accept prescription and dispense medications, and also send electronic dispense information to central repository.  Reject prescription e.g. ask order entry person to update / amend the prescription 5. Other Interactions from the Order Entry system  Stop order is sent to central system to cancel the order  Entered in Error – this was also sent as a Stop order to the central system.  Hold/Suspend – not used in this setting in NZ • Why are they doing this? Transparency to the entire process. GPs have used PCs/technology for almost 25 years. “it is just the next step” • This process is describing only the community pharmacy scenarios. They are not addressing inpatient or other institutional scenarios. • Prescription ID is the link between the order and the dispense transactions.

Monday 10th January; Q2

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Nicolas Canu Phast FR Nicolas.canu@phast.fr

Peter Sergent Medtech NZ peter@techsus.co.nz

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Mollie Ullman-Cullere Dana Farber Cancer Institute USA Mollie_llman-cullere@dfci.harvard.edu

Scott Robertson (Chair) Kaiser USA Scott.m.robertson@KP.org

Trish Williams Australian Standards Authority AU Trish.williams@ecu.edu.au

1. Agenda Update a. We will adjust Wednesday Q2 to meet with Structured Documents to review the pharmacy content in Structured Documents. 2. Overview of Pharmacy and Medication Domains • Overview provided by Hugh Glover • Pharmacy DMIM is the starting point for the review. The discussion covered topics like how useful our content is and how one can navigate it to answer questions. • Hugh encouraged questions and an open dialog about how useful our Pharmacy artifacts were to the attendees.

Monday 10th January; Q3

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle.com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Nicolas Canu Phast FR Nicolas.canu@phast.fr

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Mollie Ullman-Cullere Dana Farber Cancer Institute USA Mollie_llman-cullere@dfci.harvard.edu

Scott Robertson Kaiser USA Scott.m.robertson@KP.org

Melva Peters Canada Health Infoway CA mpeters@infoway-inforoute

Jean Duteau Gordon Point Informatics CA Jean.duteau@gpinformatics.com

1. Ballot Review (Scott Robertson) a. Scott pulled up ballot comments and we began to review negative major ballot items. . b. Ballots reviewed: i. Medication Supply and Event - all negative majors have been reviewed. See ballot resolution spreadsheet for details. ii. Medication CMETs - review of negative major ballot comments was started. Several discussions resulted. 1. The review of these ballot issues raised several publishing questions and several discussion points that require follow up with Gunther, after discussions with publishing. 2. Note that there are artifacts in CPM (R_ProductKind for instance) that Gunther is assuming should be used instead of the Medication CMETS we have placed (and harmonized with CMP) in the CMP ballot. Action Item: Hugh to follow up with Gunther.

Monday 10th January; Q4

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle.com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Nicolas Canu Phast FR Nicolas.canu@phast.fr

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Mollie Ullman-Cullere Dana Farber Cancer Institute USA Mollie_llman-cullere@dfci.harvard.edu

Scott Robertson Kaiser USA Scott.m.robertson@KP.org

Melva Peters Canada Health Infoway CA mpeters@infoway-inforoute

Jean Duteau Gordon Point Informatics CA Jean.duteau@gpinformatics.com

Jared Davisa Medical Objects AU jared@medical.objects.com.au

1. Ballot Review (Scott Robertson) a. Ballots reviewed: i. Continue Medication CMETs discussion. All remaining Medication CMETs were reviewed at a high level and follow up discussions with Woody and/or Gunther will be held by Hugh to assess next steps. ii. Next ballot topics to be reviewed later. 2. New HL7 Project on how to engage with academia (Molly Ullman-Cullere) a. Reviewed new HL7 Project related on how to engage with academia b. Deliverable for this project would be a white paper. Pharmacy WG elected not to be an interested party 3. Clinical Genetics and Pharmacy (Molly Ullman-Cullere) a. Molly reviewed content with examples where genetic information and some pharmacy related content were intertwined. b. This content is based on several pilot projects in the US. c. It appears as if the content can be referenced in our Pertinent Information actRelationship off the order. 4. Continued Ballot Review (Scott Robertson) a. Common Order Ballot Review i. Need to evaluate our walkthroughs ii. See the ballot comment spreadsheet for resolutions.

Tuesday 11th January; Q3

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Yoichi Ishikawa National Hospital for Children JP Ishikawaph–kkr@umin.ac.jp

Daisuke Koide University of Tokyo JP Kiode-tky@umin.net

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Richard Townley-O’Neill NEHTA AU Richard.townleyoneill@nehta.com.au

Scott Robertson (Chair) Kaiser USA Scott.m.robertson@KP.org

Melva Peters Canada Health Infoway CA mpeters@infoway-inforoute

1) Ballot Review (Scott Robertson) a) Medication Knowledge Based Query: i) See Ballot Comments spreadsheet for resolution 2) Action Item list Review (John Hatem) a) Plan of action is to review all items in the Action Item list during another ballot review quarter this week. The reviewers will quickly assess if an item can be closed, if yes, then close the item. If there are ANY questions, the item will not be changed. b) Hugh will review all of the POME items in the list and update their status. (done jointly with group) c) Update Action Item list will be reposted to Pharmacy Subversion Directory 3) Ballot Review Continued (Scott Robertson) a) We spent time reviewing other issues in the various ballots. Negative minor issues were reviewed. b) See ballot spreadsheets for details.

Tuesday 11th January; Q4

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Richard Townley-O’Neill NEHTA AU Richard.townleyoneill@nehta.com.au

Scott Robertson (Chair) Kaiser USA Scott.m.robertson@KP.org

Melva Peters Canada Health Infoway CA mpeters@infoway-inforoute

Jean Duteau Gordon Point Informatics CA Jean.duteau@gpinformatics.com

1) Ballot Review Continued (Scott Robertson) a) We spent time reviewing other issues in the various ballots. (Negative minor issues were reviewed. b) See ballot spreadsheets for details. c) Discussions on Gunther’s comments related to the use of CPM artifacts to reproduce our Medication CMETs in CPM. d) A Publication issue came out of the ballot review, related to how we can improve our communication of the artifacts and their relationship to various architectures. i) Action Item: Meet with Woody and describe the problems and investigate how we can address this in publication. Jean Duteau and Hugh Glover will meet with Woody as an initial step. e) Completed review of all Major and Minor Negative Ballot Comments f) Scott R will review all remaining ballot comments and bring any issues he deems appropriate for discussion back to the larger group later in the week. 2) Status of Ballot Review a) General discussion was that the only topic that needs to be reballoted next time from the January 2011 Pharmacy ballot was Medication Knowledge Base Query. 3) May 2011 Ballot Discussion (Hugh Glover) a) Hugh leading discussion to help bring focus to our May 2011 ballot planning session in Q1 on Wednesday. Hugh generated a Work Planning document.

Wednesday 12th January; Q1

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Nicolas Canu Phast FR Nicolas.canu@phast.fr

Peter Sergent Medtech NZ peter@techsus.co.nz

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Scott Robertson Kaiser USA Scott.m.robertson@KP.org

1) Medication Statement and Medication Administration Discussion (Hugh Glover) a) Discussion is centered on both data we collect and how we use the data. b) Scott, Nicolas, Hugh, Tim, Peter and John all actively engaged in this dialog. c) Sources of the data of interest are: Clinical systems, Rx order entry systems, Medication Administration Record systems, Pharmacy Dispense systems, Rx Billing Claims systems. d) The users of these systems will generate medication statements and medication administrations. The receivers of this data are often Clinical Systems. The use of this data is often to provide input into medication lists, or to update medication administration record systems, etc. Often the data is aggregated and relationships between data are maintained so that one can traverse between order and administration, orders and medication history, orders and dispenses, etc. e) Some of the goals and this is not an exhaustive list are to create standard structures for exchanging the medication statements, the medication administrations, etc. At some point there may also be a need to exchange a more comprehensive aggregation of data that includes medication statements, medication administrations, medication orders and dispensed medications. f) Scott Robertson has volunteered to create a diagram of our white board discussions and will submit to be included in the minutes. Update: Scot has sent jpeg photo images of the white board diagrams. g) We acknowledge that we still need to create a scope statement for the Medication Statement and Medication Administration Topic.

Wednesday 12th January; Q2

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Nicolas Canu Phast FR Nicolas.canu@phast.fr

Peter Sergent Medtech NZ peter@techsus.co.nz

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Scott Robertson Kaiser USA Scott.m.robertson@KP.org

Catherine Chronaki Forth / HL7 Hellas GR chronaki@ics.forth.gr

Christof Gessner HL7 Germany DE Christof.gessner@imxdx.de

David Hay HL7 NZ NZ David.hay25@gmail.com

Stephen Chu NEHTA Australia AU Stephen.chu@nehta.gov.au

Melva Peters Canada Health Infoway CA mpeters@infoway-inforoute

Peter Sergent Medtech NZ peter@techsus.co.nz

Bob Dolin Lantana USA Bob.dolin@lantana.Group.com

Larry McKnight Siemans USA Lawrence.mcknight@siemans.com

1) Joint meeting with Structured Documents

2) David Hay from NEHTA described use of CDA documents and pharmacy content in New Zealand.

3) iCARDEA Device presentation File:Icardea-presentation-SD-WG-Sydney2011 v1.zip (Catherine Chronaki) iCardea presentation by Catherine Chronaki to Pharmacy at Sydney WGM, Jan 2011, Wed Q2 a) Presentation copy requested on January 18, 2011. b) Discussion about how to identify “guidance” for the use of terms and codes found in various models, and or other content in HL7 or IHE. Bob Dolin described one source of guidance (not formalized as normative etc.) found in Structured Documents Wiki on HL7. The scenarios, for example, include information about how to deal with “author” and devices.

4) Structured Documents and Pharmacy Content a) Location of CDA content b) Bob Dolin described location of templates. These templates are not available to the general HL7 community yet.

Wednesday 12th January; Q3

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Nicolas Canu Phast FR Nicolas.canu@phast.fr

Peter Sergent Medtech NZ peter@techsus.co.nz

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Scott Robertson Kaiser USA Scott.m.robertson@KP.org

Stephen Chu NEHTA Australia AU Stephen.chu@nehta.gov.au

Peter MacIsaac HP AU Peter.macisaac@hp.com

Sabine Broch EMA EU Sabine.broch@ema.europa.eu

Nick Halsey EMA EU Nick.halsey@ema.europa.eu

Vada Perkins FDA USA Vada.perkins@fda.hhs.gov

Panagiotis Telonis EMA EU Pagagiotis.telonis@ema.europa.eu

1) IDMP report (Tim Buxton) a) Tim is presenting the status of the IDMP work. Copy of presentation requested on January 18, 2011. b) The presentation included very detailed questions related to the content, the use of the content and how the content can be communicated to the “systems” that may benefit from incorporating IDMP content into their products. c) Tim also covered some of the related ballot issues and timing over the next year and has included a graphical picture of what the ballot timeline look like. 2) No discussion of Harmonization Proposals (Hugh Glover) a) Action Item: We will need to discuss harmonization proposals on one of our conference calls.

Wednesday 12th January; Q4

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Nicolas Canu Phast FR Nicolas.canu@phast.fr

David Hay HL7 NZ NZ David.hay25@gmail.com

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Scott Robertson Kaiser USA Scott.m.robertson@KP.org

Stephen Chu NEHTA Australia AU Stephen.chu@nehta.gov.au

Sabine Broch EMA EU Sabine.broch@ema.europa.eu

Nick Halsey EMA EU Nick.halsey@ema.europa.eu

Jean Duteau Gordon Point Informatics CA Jean.duteau@gpinformatics.com

Vada Perkins FDA USA Vada.perkins@fda.hhs.gov

Panagiotis Telonis EMA EU Pagagiotis.telonis@ema.europa.eu

Sam Heard Ocean AU Sam.heard@oceaninformation.com

1) How to get input from other Realms into Pharmacy WG Content and Direction (Hugh Glover) a) Hugh is leading a discussion on how other realms use/don’t use our content and if not why? b) David Hay spoke to how he started by using CDA rather than Pharmacy V3 content because the CDA content was easier to grasp. However after a tutorial by Hugh earlier in the week on Pharmacy content, he did state that he was able to understand how the Pharmacy content fits together. The other challenge was how to address HL7 v3 messaging; this required going somewhere else to get that knowledge. c) Stephen Chu spoke to how he started also with CDA and some internal analysis from third party system stakeholders that pushed them to use CDA - all materials were in one place. After they started to dive into their project they began to see some of the limitations in using CDA for some of the pharmacy use cases they had. It was difficult to locate the right content and understand it, but with several sessions with the pharmacy committee, Stephen did get answers and direction for his questions. IHE was also explored and they were able to get input into IHE profiles. Community prescribing, hospital workflow, advice and other profiles were used (6 in total) and explored as well. They ended up using CDA R2 and also custom developed services to address all of their pharmacy content. d) Use Cases: Create Order, Cancel/Stop Order, Update Order, Dispense Medication are use cases that are all required by David Hay in Australia. e) Nicholas Canu spoke several times about the French use of CDA/IHE approaches and their value. He stated that HL7 messaging needs more work related to persistency and context, and that CDA also has issues. This leaves the French in a wait and see perspective until the standards address their concerns. Some of the major challenges are the “architecture” and the medication terminology services that need to be specified. f) Stephen stated he needs implementation guide and templates and other content to support understanding the content. g) Continuing discussion with contributions from many.

Thursday 13th January; Q1

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Nicolas Canu Phast FR Nicolas.canu@phast.fr

Peter Sergent Medtech NZ peter@techsus.co.nz

Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Scott Robertson Kaiser USA Scott.m.robertson@KP.org

Dadong Gu Phast FR Dadong.gu@phast.fr

Jean Duteau Gordon Point Informatics CA Jean.duteau@gpinformatics.com

1) Cambridge Rx WG Meeting Minutes (Hugh Glover) a) Motion to accept minutes: John Hatem. Seconded by Tim Buxton . Accept: 7 Abstain: 0 Oppose: 0 2) Work Planning Discussion (Hugh Glover) a) Ballot of Medication Statement and Medication Administration March 4th First draft b) January Ballot corrections should be completed by May for inclusion in Normative 2011 edition. c) IDMP Messaging – Preparation for May Ballot. i) Discussion is where to locate the IDMP content. We will create a new topic and put it in Pharmacy. Hugh will put the candidate content together. d) Implementation Guide Project – out of conversations this week, one of the requests, suggestions was that Pharmacy creates an Implementation Guide. The discussion is about what form and what content would be considered for inclusion in such a guide. We reviewed other IGs and discussed the nature of the IG. i) Action Item: Add Rx Wiki pages – to be done by Hugh Glover. ii) Action Item: Add this item as a conference call discussion to include input from co-chairs and others. 3) Conference Call Schedule (Hugh Glover) a) Hugh was seeking input in the current time for the conference call. No change in time. 4) Room Requirements (Hugh Glover) a) Hugh was seeking input regarding if we needed meetings with Structured Documentation and other groups in the next WG meeting. Questions were answered. Room requirements for May meeting - usual 5 days, joints with OO Tuesday morning. Hosting Structured Documents Wed Q2 (HG later confirmed with Bob Dolin). Hugh will convey information to co-chairs

Thursday 13th January; Q2

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Nicolas Canu Phast FR Nicolas.canu@phast.fr

Scott Robertson Kaiser USA Scott.m.robertson@KP.org

Dadong Gu Phast FR Dadong.gu@phast.fr

1) Review Clinical Statement model (Hugh Glover) a) The older Medication CMETs are no longer present in the Clinical Statement work. b) The uses of the CPM “cmets” (though not formally CMETS) have not been harmonized with the former Pharmacy Medication CMETS. The Pharmacy Medication CMETS have been updated to be fully derivable from CPM. A future step in Pharmacy is to harmonize that content with the CPM “cmets”. c) Pharmacy will attend Clinical Statement Q3 and provide input into Clinical Statement CMETs. 2) Discuss Medication Statement / Medication Administration Scope Statement (Hugh Glover) a) A long discussion covering content, descriptions and how this topic would be represented in Clinical Statement resulted in some more white boarding. Scott Robertson will capture the white board diagrams. b) Hugh Glover has captured some notes related to the scope statement and the group will edit scope statement and submit it back to list serv for conference call discussion.

Thursday 13th January; Q3

1) Pharmacy Committee met with Clinical Statement this quarter a) Hugh, Scott, Jean, John H all attended the CS meeting. We reviewed the Medication CMETS and how they fit into the new updated CS model. b) CS reviewed their new model c) Pharmacy provided feedback about why the new CS model did not meet current Medication CMET requirements. Pharmacy agreed to work with CPM folks to address this issue.

Thursday 13th January; Q4

Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Scott Robertson Kaiser USA Scott.m.robertson@KP.org

1) Action Item Review (John Hatem) a) Did a detailed review of Action Item list. Updated status with input from Scott Robertson and Hugh Glover. Updated list will be posted to Subversion. b) Meeting Adjourned – See you all in Orlando.