2017-08-10 Patient Care FHIR Call

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

• Tracker Issues - https://docs.google.com/a/lmckenzie.com/uc?id=0B285oCHDUr09Mzh3b09rMFhEV1E
• Resolve QA Warnings to have resource FMM > 0
• Resolve QA Information messages to achieve FMM = 3
• Maintain QA checklist

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”)

• GF#13047 and GF#12966 Add DosageInstructions to Procedure/ProcedureRequest
  • Radiology Therapy discussion on Zulip
  • Blood, Tissue, Organ Donation on Zulip

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

• 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. John questions 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 blood product preparation, but more discussion needed (especially for the transfusion)
• 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 until orders to give

• 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 is a nutritional order?

• Test > Prepare > Request Dispense > Dispense Issue > Administration

Follow-up Needed

• What is being done in the real world? Request use cases from implementers
• Eric will sync with Margaret regarding donor breastmilk (consider donor extensions)
• Create Wiki page for brainstorming use cases and workflow

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

• GF#12676 Guidance request for GP SOAP in FHIR (Alexander Henket) -
• https://chat.fhir.org/#narrow/stream/implementers/topic/ClinicalImpression

Adjourn

Adjourned at <hh:mm am/pm> <timezone>.

Meeting Outcomes

Actions

Next Meeting/Preliminary Agenda Items Agenda review Approve previous meeting minutes 2017-08-03_Patient_Care_FHIR_Call Motion: <moved>/<seconded> Abstain - <#>, Negative - <#>, Approve - <#> gForge change request

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