2018-01-15 Rx Conf Call

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Attendees

• John Hatem (Chair)
• Stephen Chu
• Melva Peters
• Scott Robertson
• Michelle Miller

Agenda Items and notes

• New business

WGM Agenda

• Review updated Agenda - most recent updates were completed week ending Jan 12, 2018
• Discuss if any new updates are needed
• John will attend Workflow meeting - Monday Q4
  • Melva to move forward planning discussion
  • Scott will only be in attendance Monday and Tuesday
  • find time to discuss status issues when Michelle can attend

Pharmacy List

Joint Meeting

• 2017-11-27 discussion
  • During the last meeting of IHE Pharmacy in Bordeaux we discussed if there is any ground to use the moment of Cologne for a get together with HL7 Pharmacy, IHE Pharmacy and ISO WG 6.
  • From the IHE Pharmacy viewpoint we have our new profiles Mobile medication administration ( MMA) and Uniform Barcode Processing ( UBP) to present to you. If the HL7 Pharmacy group is interested we could set up initiatives to organize an one day meeting with IHE and ISO. This could for example be the Thursday, since you always participate with the ClinFHIR on the Fridays.
  • Please bring this forward in your conference call and let me know if there is any interest in a joint session in Cologne in May 2018.
  • May not all Co-Chairs present.
  • If we held it on a day, they would have to pay the daily rate.
  • could we do this as an online call at another time?
  • could may be do this at HL7 Pharmacy meeting in Cologne for this who are joining
• 2017-12-18 Waiting for feedback from Michael re: IHE and ISO interest in either an online meeting or other alternative
• 2018-01-08: Need to follow up with Michael re: options - Melva to followup
  • Melva followed up with Michael - Pharmacy current thinking is to explore online meeting rather than face to face in Cologne.
• 2018-01-15: Michael and Christian will join Pharmacy to discuss - Tuesday Q1

FHIR

FHIR Tracker Items

FHIR Tracker

Workflow Changes (Group = Workflow)

• Workflow harmonization changes have been made - should be reviewed

Statement

• Need to review table in MedStatement and update/remove
  • Dec 11, 2017 - note that the table was removed from MedStatement. This was not discussed on today's call.
  • Dec 18. 2017 - reviewed old table and the consensus was that we need an updated table. The current build does not have a table.

Action: John Hatem to prepare a candidate table for discussion at the next conference call.

• • January 15, 2018
    • can close this agenda item - tracker items have been added

Request

• GF#14020 - MedicationRequest Alignment
• November 6, 2017 - review any additional changes
  • Instantiates type - should be URI
• October 9, 2017 -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

Action:  John to reach out to Tom to see if there is a NL use case for "do not perform" using MedicationRequest.  Tom has been asked via email. 

• Discuss "do not perform" on Dec 4 call
  • After a long discussion we decided to review additional information on how this type of information is documented using FHIR more broadly. There was no decision or vote on adding "do not perform" to the Medication Request resource.
• No FHIR tracker items were discussed on call today - Dec 11, 2017
• January 15, 2018 - no use case determined at this point
  • we can update previous tracker item to indicate that this attribute will not be added to the MedicationRequest
  • discussion of whether this attribute says "do not prescribe" or "do not administer" or both
    • you can put a medication on hold already.
    • will add a note to the existing tracker item to indicate that the attribute will not be added until an implementer comes forward with the requirement to create an MedicationRequest that specifies "do not perform" - complete
    • close this agenda item

Medication Related (Group = A)

• Medication.Status
  • November 13, 2017
    • discussion of the response from MnM
      • asked how pharmacy is dealing with "entered in error"
        • status on catalog entry would handle this
        • long discussion of options
        • need to discuss further with Lloyd - what to understand whether the need to represent status - a short term need until catalog entry resource exist or does he see the need both options to exist

Action:  Melva to ask Lloyd to join a pharmacy call and discuss further

• • Medication.status - is mandatory - have an exemption from previous request to MnM
  • need to reapply the exemption
  • November 6, 2017
    • MnM to consider Nov 7th
  • November 13, 2017
    • discussion planned on the need for Medication.status in response to MnM questions.
  • November 27, 2017
    • Discussion of the need for a status on Medication.
    • There have been discussions about leaving the status in
    • Motion by Jean - seconded by John by to update the definitions and descriptions for Medication.status and give examples of how it would be used - 4-1-0 Carried
  • 2017-12-04 discussion
    • There was no discussion on Medication.status on today's call
  • 2018-01-15
    • no discussion
• Other open tracker items
  • GF #12396 - Medication package and product
  • GF #13392 - Enhance Medication resource for alignment with IDMP model

Dosage Related (Group = B)

• GF #14212 Update Dosage data type to allow 0..* cardinality for the dose.

Action: Reach out to submitter and ask him to join a call

• • Dec 18, 2017 We discussed this tracker item and agree our documentation should be improved. We also believe that updated examples such as those related to #14111 will help address this issue. No votes on this issue were taken.
• GF#14231
• GF #14111 Weight based dosage examples
  • See update to tracker item

Action:  Melva to create 2 examples for discussion next week

Status (Group I)

• Status
  • GF #14364
    • clean up definitions for our attributes to be sure that they are clear
    • possibly of invariants or comments on when the status/reason would be used

Action:  pull out all definitions for status and statusReason - and propose updates to wording

• • GF #14340

Action:  followup with Marten in New Orleans

• • GF #13878 Clarify definition for reasonNotTaken on MedicationStatement
    • Dec 4 discussion
      • see tracker item comments for a suggested approach on how to update the documentation. This info came in very late during today's meeting and we were not able to vote on the suggestion. We will address this in an upcoming conference call
    • January 15 - same issue as in GF#14364 - discuss at the same time
      • discussion of the level of granularity of "in progress" - do we need to have additional codes to differentiate "being prepared by the pharmacy" vs "not picked up". Added note to tracker item.
  • GF #13881 Definitions for MedDispense

Misc (Group = none)

• GF #13905 prn medications need boolean and optional reason
  • needs further discussion about use of choice or 2 attributes
• GF #13935 MedicationRequest intent
  • Discussion of request

Action:  Melva to reach out to submitter to request more information so we can understand the use case as well as how he distinguishes original-order and order

• • GF #14431 - Fix all examples in resources to include all attributes

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
  • November 13: discussions over the past few weeks have been on prep for Connectathon and cleaning up new resource for Catalog Entry, Observation Definition. Per latest discussions there will be no formal pharmacy workflow specific connectathon activity in New Orleans WGM.
  • November 20: No updates from this week
  • November 27: No updates - lab folks will be testing at Connectathon
  • Dec 4: No updates this week
  • Dec 11: No updates this week
  • Dec 18: No updates this week
  • 2018-01-08: Planning for connectathon - lab catalogue will be tested
    • resource has been refined - now called EntryDefinition
  • 2018-01-15: No meetings schedule - preparing for Connectathon

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
  • November 13: no update
  • November 20: no update
  • November 27: no update
  • December 4: no issues to discuss. Expect to see this issues discussed at next WG meeting in Jan/Feb 2018
  • 2018-01-08 - Wednesday Q3 - meeting with O&O

Action:  Melva to confirm with HQ about cancellation of Pharmacy Wed Q3

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
• 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: CIMI was pulled from the ballot
  • October 9: no update
  • November 13: Claude has reached out to discuss updates and follow up presentation to pharmacy - no time for this discussion has been set.
  • November 20: no update
  • November 27: no update
  • December 4: Claude responded that he is willing to attend the Dec 11 meeting to discuss CIMI model pharmacy related content. Will add to Dec 11 agenda.
  • December 11: Claude confirmed he will attend Dec 11 meeting to discuss CIMI model pharmacy related content.
    • Claude provided an overview including a walkthrough of an updated spreadsheet with mappings from the Pharmacy FHIR resources to the CIMI Reference model
      • CIMI is comprised of a Reference model and archetypes. The work that Pharmacy is reviewing is the Pharmacy related content in the CIMI reference model
      • The upcoming ballot in January 2018 will be a Comment only ballot on the CIMI Reference model. It will NOT cover the archetypes.
    • This meeting was recorded and saved in FreeConferenceCall
    • A link to the Google Doc spreadsheet can be found at: https://docs.google.com/spreadsheets/d/1XZUZg1-bKbumS8vcoRc4Vy8JR7NwFCooBm4zLeOTNe0/edit#gid=708341114
      • Items in the spreadsheet highlighted in yellow have not been modeled in CIMI (yet).

Action Item List

• December 18: no updates
• January 15, 2018: no updates

Ballot Reconciliation - Templates

• File:Consolidated CDAR2 IG PHARM TEMPLATES R1 O1 2017SEP amalgamated.xls
• December 4: No updates this week. Open ballot items now reduced to ~ 25. Expect all proposed resolutions will be brought to Conference call after the first of the year.

MedicationKnowledge Resource

• January 15, 2018
  • there will meetings and discussion in New Orleans
• November 13, 2017
  • was approved by TSC today
  • can consider aligning with definitional concepts - Specimen Definition, etc
• Should be approved by the TSC by next Monday
• Discussion of how we want to work on this project

Action:  Determine if we will schedule a separate call

Next meeting

• Monday, January 22, 2018 at 4pm Eastern