2018-04-09 Rx Conf Call

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Attendees

• Scott Robertson (Scribe)
• John Hatem (Chair)
• Jean Duteau
• Christof Gessner
• Stephen Chu
• Tim McNeil

Agenda Items and notes

US Meds - PDMP Mapping

• [1]
• added banners for those sections of the material that is open for ballot
• New tab has been added for PDMP
  • Brett will send out a link with updated material by end of day on Wednesday - Pharmacy WG will comment
  • rename "Request" column to PDMP data attribute
  • suggest more clarifying information on the scope and context
  • Motion to approve this content going to ballot pending one final review of content by Wednesday end of day - Melva/John - 6/0/0 - CARRIED
• Updates were provided and feedback was given to Brett M. Feedback was incorporated into published material.
• 4/9/2018 - previously discussed, some updates by Brett, approved for ballot. Can close this.

FHIR

The following tracker items were resolved:

FHIR Tracker Items

• 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

• 15688 - MedicationRequest.category Valueset

• 14455 - Workflow report - File:Workflow pharmacy issues Jan 2018.xlsx
  • new report has been run
  • MedicationRequest
    • instantiates - currently supported but workflow has changed the pattern
      • John to talk to Lloyd about the changes needed
  • MedicationAdministration -
    • instantiates - currently supported but workflow has changed the pattern
      • John to talk to Lloyd about the changes needed
  • MedicationDispense
    • Performer - we believe we are consistent
      • Melva to reach out to Lloyd and ask if this is an error in the report - email sent to Lloyd - there is an error on the report.
        • new report to be generated
    • statusReason
      • will add to suppressed-workflow-warnings - different name
      • John to followup with workflow about the reference to DetectedIssue - still outstanding

• 15136 - Change Dosage to support conditional doses
  • Discussion of the requirement - this is related to conditional dose
  • Scott to pull material from NCPDP
  • John to pull V3 material
  • start to gather requirements and look at existing FHIR material including CDS

• 15589 - Pharmacy missing isModifierReason
  • MedicationRequest.substitution.allowed
    • do not believe that this should be a "isModifier"
    • will discuss on March 12 call when we have implementers on the call
  • Medication.amount
    • do not believe that this should be a "isModifier"
    • will discuss on March 12 call when we have implementers on the call
  • March 19, 2018:
    • discussion of the purpose of the isModifier flag - discussion of whether there should be isModifier used more often than it is
    • medicationRequest.substitution - will use the wording from the current element and elaborate "this is the element that must be understood from the substitution element. In the substitution block - this is the element that must be understood to understand the meaning of the block
    • medication.amount - agree it is a Modifier
      • should only specify the amount when the medication.code doesn't provide this information
      • then this can not be ignored

Action: Jean to talk to Grahame/Lloyd - about the criteria for when is an element flagged as a Modifier

• 15509 - Create example scenarios for Pharmacy
  • need to draft some scenarios

• 12396 - Medication package and product

Action Item List

• March 26, 2018: no discussion
• April 9, 2018: update needed

MedicationKnowledge Resource

• Melva and Jean are creating a draft resource in the build. The next step is to review the existing tracker items to see which can be done with the current draft content, which need to have data elements added, and which will remain out of scope.
• Feb 26, 2018: no discussion
• March 5, 2018: no discussion
• March 12, 2018: FMG wants to see the PSS once co-sponsors have been approved
• March 19, 2018: Melva will see if she can publish a local version for review
• March 26, 2018:no discussion
• April 9, 2018: update by Jean
  • reviewed structure at [2]
  • a first cut ... more work to be done
  • mainly pulled from v3.
  • some review relative to Saskatchewan, KP formularies and FDB
  • still need to validate will work for use cases / requirements
  • medicationClassification can be used for many different different classification for one MedicationKnowledge
  • batch ... is this needed in MedicationKnowledge?
  • Note that this is not as detailed as IDMP
  • amount vs packaging.quantity ... need to clarify
  • 'type' needs clarity: this is branded, generic, PHPID, etc. need better definition.
  • need input from Medication Knowledge vendors (Multum, FDB, etc), formulary, catalog stakeholders

Joint Meeting with IHE Pharmacy and ISO TC215 WG 6

• Feb 26, 2018: no discussion
• March 5, 2018: no decision
• March 12, 2018: will decline a joint meeting for Cologne
  • will commit to provide an update to IHE Pharmacy and ISO as a power point, but can not do a F2F meeting at this time.
• March 19, 2018: Looks like there will be a joint meeting on Friday, May 18th
• March 26, 2018: Scott sent possible agenda topics
• April 9, 2018: Update with current status - who is attending, any further updates to agenda, etc.
  • Melva and Scott will be attending
  • initial agenda items sent to IHE and TC215 WG6

Catalogue Project

• March 5: last weeks meeting addressed open issues related to getting the Entry Definition resource cleaned up. There were no Pharmacy specific issues.
• March 12, 2018: there was a meeting - cleaning up material to get content into the build
  • entryDefinition has a classification element
• March 19, 2018: no updates
• March 26, 2018: no discussion
• April 9, 2018: all Catalogue project meetings cancelled until after HL7 Workgroup meeting in Cologne

Blood Products/Transfusion/Tissue Update - Project 1370

• Feb 26, 2018: no discussion
• March 5, 2018: no updates
• March 12, 2018: no meetings have been held since New Orleans
• March 19, 2018: no updates
• March 26, 2018: no discussion
• April 9, 2018: update status

Updates from Workflow

• March 26, 2018: no discussion
• April 9, 2018: workflow meeting this week focused on ballot comments.

AOB

• Unstructured Strength in FHIR
  • Christoff to put a tracker in to consider this change with some examples
• WGM Agenda

Action: start to draft an agenda for the Cologne meeting - Melva

Drug Interaction PSS

• • Project meetings will be held Wednesday at 9am Pacific
• March 26, 2018: no discussion

Next meeting

• April 16, 2018: