2016-08-15 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

• John Hatem (Chair)
• Ken Sinn
• Melva Peters (Scribe)
• Daniel Zhang
• Michelle Miller
• Scott Robertson
• Yunwei Wang
• Marla Albitz
• Tricia Lee Wilkins

ListServ / Zulip Discussions

• List Serve Postings
• Zulip
  • Medications to be given for one day at multiple times - e.g. 1 day at 0800, 1600 and 2200 - how to include?
    • Timing

Action:  followup to ask about the submitted about the xml as the data type doesn't look correct - done

Pharmacy September Workgroup meeting draft agenda

• Draft Agenda is available for review and comment.
• Pharmacy will meet Monday thru Thursday September 19 - 22
• arrange FHIR discussions around topics
  • Mappings
  • Terminology
  • Examples

Action:  reach out to Kai - Pharmacy Template
Action: reach out to Brett - SDWG
Action:  reach out to CDS - re: dosageInstruction datatype
Action:  Clinicians on FHIR preparation - add time on Tuesday

FHIR Maturity

• Current Maturity status: discuss during call
  • spreadsheet has been submitted - MedicationOrder and Medication - MM2

Action:  followup with FMG to see if we need to do anything else
Action:  add time for discussion in Baltimore for other resources
Action:  add implementers for MedicationStatement as it has been part of Argonaut - Marla

QA of Pharmacy FHIR STU3

• Pre ballot QA completed. Any new issues should be captured through the ballot process.
• Thank you to everyone who reviewed and updated the ballot
• If you registered for the ballot, please submit comments
• If you didn't, submit a Gforge tracker item

FHIR Discussion Items

• SEE SPREADSHEET OF OUTSTANDING CHANGE REQUESTS 2016-01-25 IN DROPBOX

Action:  this spreadsheet will be removed - if necessary, a new spreadsheet will be created based on the STU3 ballot
Action:  Melva will clean up dropbox

FHIR Medication Module page

• [1]
• new, general introduction, page. added for all FHIR "areas"
• has been updated
• if you have comments - raise tracker item
• this item will be closed

CDS Request

• Background
  • The CDS Work Group as part of reconciling ballot comments for the CQF-on-FHIR Ballot has created a resource in FHIR that can be used to describe "templates" for intent resources like MedicationOrder, ProcedureRequest, etc. The resource is called ActivityDefinition (https://hl7-fhir.github.io/activitydefinition.html).
  • As part of specifying the template for a MedicationOrder, we need to be able to specify the dosageInstruction and dispenseRequest elements. Rather than copying the element from the MedicationOrder resource definition, we are planning on defining a DosageInstruction and a DispenseRequest type that we could reference, rather than duplicating the maintenance of those elements.
  • Do you have any questions or concerns with this approach? The initial step is just to define the data types based on the MedicationOrder structure and will not involve any changes to the MedicationOrder resource.
  • Pharmacy WG has some concerns about the fact that CDS may be creating
• July 18 Update
  • more info see CDS Pharmacy FHIR request
  • suggestion that a datatype may be an option but that it will not be done it time for the freeze for STU3 - would need special permission to put a substantive change in to the release
  • continue to discuss on our teleconferences and possibly include time on the agenda for Baltimore

Action:  Scott to start a wiki page on this topic, CDS Pharmacy FHIR request - complete
Action:  Melva  to reach out to CDS to continue the discussion

Outstanding June 13 items

• 10125 - International Realm Pharmacy extensions Profile
  • Each resource is supposed to have a core profiles

Action:  review the pharmacy-extensions-spreadsheet.xml to determine which should be moved to core - MedicationOrder and MedicationDispense
Action:  close this agenda item - gForge tracker is still open and will be discussed

Outstanding June 6 Items

• 8783 - Medication order status
  • Epic is withdrawing the gForge issue due to the recent addition of MedicationOrder.eventHistory.

 Action:  Marla to follow up with Lloyd to check if workflow will impact this (e.g. removal of MedicationOrder.eventHistory)

• • July 25 Update - Yunwei noted that recent FHIR Workflow discussions use Provenance rather than eventHistory. There was also an email from Lloyd (july 19) stating "The recommendation from workflow is to use references to Provenance rather than an in-resource structure". Too late to change for ballot. will need to address in reconciliation.

Action:  include agenda item for Baltimore

Renaming MedicationOrder to MedicationRequest Discussion

• Email received July 4, 2016 from Lloyd
  • The FHIR Workflow task force has been working for almost the past year to come up with guidelines to improve the consistency of how workflow (the process of requesting something to happen and then reporting the results of that request) are handled across all FHIR resources. Its scope encompasses clinical, administrative and financial resources. We've had relatively broad participation in the bi-weekly calls and very broad participation in the face-to-face sessions at HL7 WGMs.
  • While the project is still testing the recommendations using a variety of use-cases, we are sufficiently confident in the stability of the recommendations, that we voted last week to request all impacted work groups to apply the relevant changes to their resources for inclusion as part of the upcoming STU 3 ballot.
  • We recognize that the timelines for making this occur are tight. In the event that a work group cannot make the changes requested, we invite them to, at minimum, provide an implementation note highlighting the intention to adjust each affected resource to align with the workflow pattern and to include a hyperlink to the "workflow.html" page. (This page doesn't exist yet, but it will.)
  • We also recognize that not all of these recommendations will fall into the 80% for all resources. Work groups are asked to do the following for each recommendation:
    • Apply the recommendation from the FHIR workflow task force as part of core
    • Create extensions to support those data elements that are relevant but not commonly used by the domain
    • Indicate that they feel the recommendation should not apply to their resource by posting an email to the fhirworkflow list server indicating why they believe a given recommendation is inappropriate for a given resource.
    • ((The list of resources believed to be impacted by the FHIR Workflow recommendations are provided in the attached spreadsheet. Most of the listed resources are categorized as either a "request" - a resource that indicates a specific intention for something to occur; or an "event" - a resource that represents a specific occurrence that could have been done in response to a request. A few event resources are marked with a question-mark as it's not clear whether they are requested or not. It's possible that one or more resources in the spreadsheet that were not categorized should in fact be listed as a "request" or an "event". Feel free to apply the workflow recommendations to uncategorized resources if you feel they should apply.
  • In addition to these categorizations, the workflow project calls for the Order and OrderResponse resources to be removed. They are superseded by Task. As well, the scope of ProcessRequest and ProcessResponse should be revised to leverage Task for the purpose of requesting the current state of a resource and for soliciting a state change.
  • The recommendations are as follows:
    • Request
    • Add a note in the introduction section that the resource is a "request" resource from a FHIR workflow perspective, including a hyperlink to workflow.html#request.
    • Rename the resource to [xxx]Request instead of [xxx]Order (request resources are used for plans, recommendations and proposals, not just orders
    • Ensure all of the data elements present in the "request" pattern document (attached) are present in the resource, keeping consistency with the naming where possible and adapting definitions to reflect domain-specifics
    • Ensure the status element for the resource has a terminology that aligns with the "request" states as well. (Note that all statuses related to fulfillment progress are now handled by Task.)
  • Event
    • Add a note in the introduction section that the resource is an "event" resource from a FHIR workflow perspective, including a hyperlink to workflow.html#event.
    • Ensure all of the data elements present in the "request" pattern document (attached) are present in the resource, keeping consistency with the naming where possible and adapting definitions to reflect domain-specifics
    • Ensure the status element for the resource has a terminology that aligns with the "request" states as well. (Note that all statuses related to fulfillment progress are now handled by Task.)
• From January 25 meeting: Lloyd shared the proposal to rename all request type resources to <resource>_Request. Seeking consistent name for all resources and term that encompasses larger swath of types of requests. An element beneath the tag instance would state the particular request, such as 'order'. This impacts the current Pharmacy Medication Order FHIR resource.

 Completed Action: Rx WG to discuss to determine if we agree or not. - agreed (with no vote) to comply with change but not needed to be made yet, per Lloyd

• Lloyd suggested that we hold off on making the change, if we decide to make the change. Wait for FHIR Infrastructure group to workout additional details before we make the changes. May have impact on how other data elements are name or included.
• Discussion: If we agree to the change, we'll need to review the description and other content for our resource to ensure that it accurately reflects the usage. This type of change will mean changes for implementers and it may not be as intuitive for implementers.
  • No decision to be made today. Will consider on a future call
  • Discussion - July 11 Meeting
    • John described the change proposed - we can alias resource to include MedicationOrder
    • Moved by John - seconded by Marla to add note to introduction section to Medication Order Add a note in the introduction section that the resource is a "request" resource from a FHIR workflow perspective, including a hyperlink to workflow.html#request. and to add an implementation note highlighting the intention to adjust each affected resource to align with the workflow pattern and to include a hyperlink to the "workflow.html" page. - 7/0/0 Carried
    • Moved by John - seconded by Marla to add note to introduction section to Medication Dispense, MedicationAdministration, MedicationStatement - Add a note in the introduction section that the resource is a "request" resource from a FHIR workflow perspective, including a hyperlink to workflow.html#request. and to add an implementation note highlighting the intention to adjust each affected resource to align with the workflow pattern and to include a hyperlink to the "workflow.html" page. 7/0/0 Carried

Action:  Review attributes to be added on August 22 call

FHIR Workflow Meetings Status

• Discussion of Pharmacy Workflow Mockup (John)
  • No Workflow meetings the week of August 8th. Meetings expected to resume week of August 15th.

Other business

• None

Next meeting

• Monday, August 22, 2016
• Agenda
  • Maturity Level for MedicationStatement
  • Review Workflow attributes that need to be added