2017-10-09 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

• John Hatem (Chair)
• Melva Peters (Scribe)
• Tim McNeil
• Jean Duteau

Agenda Items and notes

FHIR

MedicationKnowledge Resource

• discussion in San Diego about a new resource for medication knowledge
  • after a lengthy discussion Grahame told us to proceed with a project and a resource proposal
  • working name is MedicationKnowledge
  • goal is to include in Comment only ballot for January cycle
• Review Project Scope Statement - need to review and approve
• reach out to drug knowledge base vendors - FDB, MediSpan, etc; Apelon, IMO, Multum announcing new project
• Michelle will reach out to Multum - are there requirements that should be included for medication knowledge?
• Daniel - Epic - no plans to expose knowledge base via API
• Motion to approve Project - Daniel - seconded by Michelle - 3-0-0 Carried
• should we ask others to be interested party - BR&R, Patient Care, O&O and CDS
  • File:HL7 Pharmacy - MedicationKnowledge FHIR Resource.docx
• Review Resource Proposal - need to review and approve
  • MedicationKnowledge resource proposal
  • add Patient Care and Clinical Decision Support
  • expand on "some commercial systems" to be specific
  • update the scenario - "This resource can be used to query for a drug or set of drugs coverage details in a particular formulary"
  • Motion to accept resource proposal: John/Michelle - 3-0-0 Carried
• October 2 Update:
  • Wiki page created MedicationKnowledge Project Page
  • Pharmacy will determine how best to deal with meetings once the project has been approved
• October 9 update:
  • Changes were bade to the PSS based on feedback from FMG. These changes resulted in making this project Investigative, and also impacted dates and deliverables. We will discuss on today's call.
  • Melva reviewed changes to the PSS
  • Need to reach out to Patient Care, O&O, BR&R and CDS to see if they want to be an interested party or co-sponsor
  • Motion to approve the Project as an Investigative project - Melva/Jean - 3-0-0 Carried

FHIR Tracker Items

FHIR Tracker

• there will be changes to our resources to align with Workflow event and request patterns based on Pharmacy WG decisions

Workflow Changes

Request

• See analysis spreadsheet
  • Definition - new Workflow name is "instantiates" -
  • StatusReason - add
  • "doNotPerform"
  • requester - change from backbone to align with pattern
    • PractitionerRole needs to be added in as a reference
    • remove agent
    • remove onBehalfOf
  • add practitionerType to recorder
  • performer - references - add CareTeam and PractitionerRole
  • add insurance
  • Motion - to make the changes as identified in spreadsheet - Melva/Jean - 3-0-0 Carried

Dispense

• Proposed changes
  • actor - add a reference to PractitionerRole
  • remove onBehalfOf
  • notDone - remove attribute
  • add notDone to status value set
  • change name of notDoneReason to "statusReason"
    • statusReason[x] - codeableConcept or reference to DetectedIssue
      • invariant on reference - status must be notDone
• Motion: to make changes as identified in spreadsheet - Melva/Jean - 3-0-0 Carried

Action:  Melva to create tracker item and attach spreadsheet

Medication Related (Group = A)

• Other open tracker items
  • GF #13999 - see Gforge - approved
  • GF #13954 - Add serial number to medication
    • Need more information

Action:  Invite Jose to an upcoming teleconference

• • GF #12396 - Medication package and product
  • GF #13392 - Enhance Medication resource for alignment with IDMP model

Misc (Group = none)

• GF #13978 Clarify MedStatement.status values
• GF #13905 prn medications need boolean and optional reason
• GF #13537 13537 Collapse medicationAdministration.notDone into status
  • we discussed 13537 which is a request to update Medication Administration by removing the NotGiven Boolean and adding in a new status code - not done. Since this is coming from workflow we decided to wait until this is added to the Event logical model for Workflow and evaluate the definition of "not done" and assess it's relevance for Pharmacy. In general there was a positive reaction to this request.
• GF #13538 13538 Collapse medicationDispense.notDone into status
  • we discussed 13538 which is a request to update Medication Dispense by removing the notGiven Boolean and adding in a new status code - not done. Since this is coming from workflow we decided to wait until is added to the Event logical model for Workflow, and evaluate the definition of "not done" and assess it's relevance for Pharmacy.
    • Michelle mentioned we may also want to review Patient Care 12592 before we make our changes since there was some discussion about how this change should/should not impact the Request resource.
  • August 28 - John checking to see what changes have happened to Workflow
  • October 5 - Changes have been made to both the Event and Request patterns. One more change is being made to the Event pattern before we can move on alignment updates.

• GF #13881 Definitions for MedDispense
• GF #13878 Clarify definition for reasonNotTaken on MedicationStatement
• GF #13935 MedicationRequest intent
• GF #13999 MedicationRequest intent value set
• Oct 5 - workflow changes have been made to the Request pattern. John will discuss the proposed changes to the Medication Request resource on the Oct 9 conference call.

Order Service Catalogue FHIR Project

• To follow the Order Catalog work, use the following listserv: ordercatalog@lists.hl7.org
• Background
  • under Orders WG.
  • Catalogue vs Formulary. Catalog is a superset of Formulary, includes orderable items beyond medications.
  • expect one or two new resources
  • Jose and John involved
• Updates
  • New Lab resource was created. John Hatem will continue to monitor and attend meetings.
  • August 14: last meeting was specific to lab specimen
    • content of the resource is generic
  • August 28: no update. There will be a meeting this week
    • specimen resource - believed to be a definitional resource
  • September 25: not started up
  • October 2: actively being discussed - John attending calls
  • October 9: no update

International Chemotherapy Implementation FHIR IG

• Chemotherapy IG Wiki Page
• Background
  • NCCN and other European input to support broad requirements. Specific implementations would constrain as needed
• Update from John Hatem
  • Next meeting will be held August 15
  • no update - meeting will be held this week - John will attend

Action:  John will ask about ballot time frame

• August 28 - meeting this week
• September 25: no update - meetings have been cancelled
• October 2: has not met for a few weeks
  • John to follow up with project team
  • October 9: no update

Blood Products/Transfusion/Tissue Update

• Background:
  • based in Patient Care. also includes Orders
  • Blood Products/etc moving into FHIR. Want to maintain alignment with Orders and Pharmacy resources
• Eric H has sent out a Doodle poll to determine a meeting time for OO, PC and Pharmacy to discuss.
  • Meeting is currently scheduled for Aug 10, 2017
• Updates
  • August 14, 2017
    • Minutes
    • meeting was held on August 10
    • scoped to Blood Transfusion for now - profiles on Pharmacy resources may work for the requirements
    • will continue to investigate requirements in preparation for the WGM Quarter
    • Michelle will post to Zulip inviting participation at WGM - complete
  • October 9: no update

CIMI Pharmacy Model Update

• Update from John Hatem
  • July 17, 2017 - Claude Nanjo provided an overview of the CIMI logical model that incorporates the Pharmacy FHIR resource work. This work will be balloted as Informative in the HL7 September 2017 ballot.
    • A recording of the presentation was made and is available in MP4 format.
    • Here is a link to the CIMI mappings to the Pharmacy FHIR resources: https://docs.google.com/spreadsheets/d/1XZUZg1-bKbumS8vcoRc4Vy8JR7NwFCooBm4zLeOTNe0/edit#gid=796576522
  • July 31, 2017 - concerns raised about how Pharmacy will be involved and be expected to manage the content
    • will be balloted as informative
  • August 7, 2017 - John Hatem is following up with Claude N. on what type of commitment is expected from Pharmacy going forward.
  • August 14, 2017 - John has reached out to Claude. He has a general slide deck but will have to re-create a pharmacy specific version.
  • August 28, 2017 - ballot is open. It is not easy to read the ballot content without using the mapping spreadsheet and even then it isn't clear

Action: John to reach out to Claude and indicate that we believe a pharmacy specific overview is needed - complete

• • October 9: no update

Action Item List

• August 7 update: John is working on cleaning up the action item list
• September 25 update: Claude believes more information needs to be provided to navigate through the material
  • he is willing to come to Pharmacy WG
• October 2 update: was pulled from the ballot

Next meeting

• Monday, October 16th, 2017 - 4pm Eastern