Pharmacy FHIR Maturity - November 9, 2016

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November 9, 2016

Attendees

  • Michelle Miller (Cerner)
  • Danielle Friend (Epic)
  • Daniel Zhang (Epic)
  • John Hatem
  • Marla Albitz (Wolters Kluwer)

Project Team

  • Brett Marquard
  • Eric Haas
  • Melva Peters
  • Mera Choi
  • Saurav Chowdhury
  • Tricia Lee Wilkins

Discussion

  • Next meeting November 23, 2016
    • Melva to make sure that the meeting is posted to the HL7 Pharmacy list
  • Connectathon
    • Planned
      • Patient and provider access to medications
      • Patient or provider adding new medication to patient's ("active") medication
        • Cerner - support adding medication statements but not orders - for providers
          • not orders and for patients - still to be determined for 2017
        • Epic - trying to support but not sure it will be ready for January
          • first priority will be MedStatement
          • will check to see if write access is for both providers and patients
  • Medications Lists
    • Outpatient Lists (Ambulatory)
      • what is current medication list?
        • Cerner - user can filter the display - by status or other means to refine the view
          • there was a request for active medication list - can't be done in DSTU2 - in STU3 - have added a category element to distinguish types of medications
          • difficult to do without the category element to help with this
            • no concerns with existing value set
          • the resource should support all types of medications
          • not sure you can use encounter, organization to do this filter
          • Active - expect to see OTC, provider prescribed, other provider ordered (and told about) and administrations
            • if attached to an institution - should be able to access inpatient medications too
          • have 1 medication list for a given a patient - can be filtered
            • inpatient meds are in the database but status is likely in an end state status (eg. completed or stopped) so they wouldn't be displayed based on the filters/preferences
          • in CCD - what is included? Michelle to check
        • Epic - have a way to get full list of all medications including stopped meds, etc
          • outpatient list - only things that are active are outpatient meds
          • admitted - outpatient prescriptions are paused during admission so not active on the inpatient list
          • existing outpatient medications may be suspended and new orders are written. Upon discharge, inpatient order is stopped and new order may be written
        • discharge medications for future use - wouldn't be considered as active - would become active
        • 2 different orders - community prescription - if want to continue as an inpatient - becomes a new order
          • MAR is more task driven - not necessarily the medication list
          • there are 2 different component - list of orders AND the MAR (administrations) - different level of granularities
          • categories - doesn't cover the MAR list requirements
    • Inpatient Medication List
      • Orders - may be filtered by status or categories - no statement about whether they were administered
        • there may be a use case for including community prescriptions (e.g. inhaler) - assuming that the medication is not re-ordered in the hospital
      • Inpatient med list is not the MAR
      • can't currently be done with DSTU2 - with STU3 - will use as combination of status and category to get the subset of list
      • Cerner is deriving medicationStatements from orders
      • Epic is also deriving medicationStatements from orders
    • Discharge Medication List
      • What is on this list?
        • Epic - any medications that are considered still active and then meds that were active at time of discharge
          • can't differentiate discharge list from inpatient list
      • Cerner - for med reconciliation - can determine actions that were taken at discharge = snapshot - may be possible to add new medication after snapshot or reconciled list is produced
      • could use list resource - but hasn't been implemented
      • don't want to do with for discharge list - need to print everything on current/active medication list including new meds after snapshot/reconciliation
  • Summary - medication list - category and status are key for view - will include for Connectathon
  • Draft IG has been published - Draft IG Outline
Action:  Asked participants to review
Action:  Please sign up for Connectathon