2017-08-10 Patient Care FHIR Call

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Meeting Information

Patient Care FHIR Resources Conference Call

Location: Conference Call
Phone Number: +1 770-657-9270
Participant Passcode: 943377
WebEx: https://cernermeeting.webex.com/join/michelle.m.miller

Date: 2017-08-10
Time: 5-6:30pm ET
Facilitator Michelle M Miller Note taker(s) Michelle M Miller
Attendee Name Affiliation


X Elaine Ayres NIH/Department of Clinical Research Informatics
X Dave Carlson VA
X Stephen Chu The Australian Digital Health Agency (ADHA)
Evelyn Gallego EMI Advisors LLC
X Eric Haas Haas Consulting
X Rob Hausam Hausam Consulting LLC
X Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Russ Leftwich InterSystems
X Tony Little Optum 360
X Jay Lyle Ockham Information Services LLC, VA
Russell McDonell Telstra Health
Lloyd McKenzie Gevity (HL7 Canada)
Larry McKnight Cerner
X Michelle M Miller Cerner
Lisa Nelson Life Over Time Solutions
Viet Nguyen Lockheed Martin, Systems Made Simple
M'Lynda Owens Cognosante
X Mike Padula The Children's Hospital of Philadelphia
Craig Parker Intermountain Healthcare
X Joe Quinn Optum
Simon Sum Academy of Nutrition and Dietetics
Iona Thraen Dept of Veterans Affairs
Serafina Versaggi Dept of Veterans Affairs
Buitendijk,Hans Cerner
JD Nolen
Kenneth McCaslin Accenture
Lorraine Constable
Patrick Loyd
Riki Merrick
X Melva Peters Gevity
X John Hatem
Jean Duteau
X Scott Robertson
Jose Costa Teixeira
Grahame Grieve
X Daniel Rutz
Quorum Requirements Met: yes

Agenda

Agenda Topics

  1. Agenda review
  2. Approve previous meeting minutes 2017-08-03_Patient_Care_FHIR_Call
    • Motion: Stephen/Eric
  3. OO/PC/Pharmacy Joint Discussion

Supporting Information

Minutes

Joint Discussion PC/OO/Pharmacy

Background

Recurring questions about how to handle biologically derived products (e.g. blood, tissue, organ) as well as procedures that are dosed (e.g. radiation-therapy, light therapy)

  • GF#8458 Is a blood transfusion closer to a medication administration or a procedure, or something else?
  • GF#12993 Please Create a NonMedicationAdministration object or an Administration object
  • GF#12673 How to handle HCT/TP
    • extension-device-din says
      • The distinct identification code required by §1271.290(c) for a human cell, tissue, or cellular and tissue-based product (HCT/P) regulated as a device - which is a conditional, variable portion of the production identifier (PI) of a Unique device Identifier (UDI). If the content is from an ICCBBA-encoded UDI, the URI to use for the system is: http://hl7.org/fhir/NamingSystem/iccbba-din. GS1 and HIBCC formatted UDIs do not currently convey the DIN element.
      • Note to balloters: The Orders and Observations Workgroup has not yet determined whether the Device resource will include Devices of Human (or other) Origin (tissue, blood, etc.) and so the need for Donation Identification number is currently being met through this extension. If it is determined a separate resource is to be used for Devices of Human (or other) Origin (tissue, blood, etc.) then this extension may be deprecated in the future. Feedback on this issue is welcome.
    • Per Feb 2016 OO ListServ discussing GF#9449, proposed boundaries included
      • Device: a manufactured item that is used in the provision of healthcare without being substantially changed through that activity. The device may be a medical or non-medical device
      • Substance: A homogeneous material with a definite composition
      • BiologicallyDerivedProduct: material extracted from a living mammalian organism or that is still living
  • 2017-04-13_Patient_Care_FHIR_Call
    • NMDP (National Marrow Donor Program) and CIBTMR (Center for International Blood and Marrow Transplant Research) would like to participate in helping develop a new resource for transplant material
    • It would include things like bone marrow, cord blood, peripheral blood stem cells - and any new resource could also address solid organs and blood transfusion although not part of the initial use case
    • Align with scope of ISBT128, the purpose of which is: to provide standards and guidance for the coding and labeling of medical products of human origin (MPHO): blood, cellular therapy, tissues, regenerated tissue, milk, fecal microbiota, topical products of human origin, in vivo diagnostic MPHO, and organs for transplant, as well as those plasma derivatives for which ABO is relevant. (we may want to extend the scope to “biological origin” rather than limiting to “human origin”)

Discussion

  • Topics
    • blood transfusion
    • blood products
    • human cell, tissue, or cellular and tissue-based product (HCT/P)
    • grafts
    • bone marrow
    • cord blood
    • peripheral blood stem cells
    • solid organs
    • blood transfusion
    • blood
    • cellular therapy
    • tissues
    • regenerated tissue
    • milk
    • fecal microbiota
    • topical products of human origin
    • in vivo diagnostic MPHO
    • organs for transplant
    • plasma derivatives for which ABO is relevant
    • bio-fabricated products or materials (e.g. stem cells embedded)
  • Should we focus on blood products initially?
    • Does MedicationAdministration fit?
  • John said charting of meds/blood products is typically done using the same workflow
  • Mike mentioned that blood products may require additional verification, but John said TPNs can also have similar requirements
  • Dan is working on IHE profiles - doesn't focus on supply, but rather patient workflows
  • Type and cross match order is a lab order - not handled by pharmacy - but that's ok
  • Blood Bank - want 2 units
  • Mike mentioned that there can be 2 orders (blood product, itself, provided by blood bank as well as the transfusion order to actually do the administration). In OR, may order it, but not use it. Question: whether the transfusion order is (or needs to be) a pharmacy order.
  • Blood Bank will look to match transfusion against volume of blood ordered. Transfusion is more like a nursing order more so than pharmacy order.
  • Some agreement to use MedicationRequest for the transfusion, but more discussion needed (especially for the type/cross)
  • Orders may be written at the same time, but transfusion must wait on typing and cross-matching.
  • Prepare order doesn't refer to specific unit (nor does transfusion), but administration would have specific unit
  • Standing orders to give O negative (trauma patients) until orders are received to give same blood type
  • Radiation therapy agents (i.e. contrast administration) may have similarities with MedicationAdministration
  • Prescribing (dosing) radiation therapy is different and Pharmacy hasn't considered whether it is in scope or not
  • Breastmilk and donor breastmilk - is that a nutritional order?
  • Workflow steps: Test > Prepare > Request Dispense > Dispense Issue > Administration

Follow-up Needed

  • Eric will sync with Margaret regarding donor breastmilk (consider donor extensions) in context of nutrition orders
  • Michelle will create Wiki page for brainstorming use cases and workflow -- Patient_Care_Blood_Products_and_Transfusions
  • What is being done in the real world?
    • For blood products, what data elements are collected? Goal is to assess gaps in resources.
    • Request use cases from implementers.

Decisions

Resource and Work Group Aligmment

  • How to represent blood products? Substance - but MedicationRequest will need to reference Substance directly
  • Order
    • Workflow 1:
      • Type and Cross -- ProcedureRequest
      • Transfusion of X Units -- MedicationRequest
    • Workflow 2:
      • Type and Screen
      • Cross match later
      • Transfusion Order
  • How to represent dispense of product from blood bank? MedicationDispense
  • How to represent statement from patient that patient has received blood products? MedicationStatement
  • How to represent transfusion "event"? MedicationAdministration

WGM Planning

Patient Care WGM agenda: PC_Sept_2017_WGM
Continue the Blood Product / Transfusion discussion on Wed Q3


SOAP / ClinicalImpression

Adjourn

Adjourned at 6:30pm Eastern.

Meeting Outcomes

Actions
  • Eric will sync with Margaret regarding donor breastmilk (consider donor extensions) in context of nutrition orders
  • Michelle will create Wiki page for brainstorming use cases and workflow
  • What is being done in the real world?
Next Meeting/Preliminary Agenda Items
  1. Agenda review
  2. Approve previous meeting minutes 2017-08-03_Patient_Care_FHIR_Call
    • Motion: <moved>/<seconded> Abstain - <#>, Negative - <#>, Approve - <#>
  3. gForge change request

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