2017-08-07 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

Name	email	Attend
Jean Duteau	jean@duteaudesign.com	x (Scribe)
John Hatem	jnhatem@hotmail.com	x (Chair)
Melva Peters	mpeters@gevityinc.com
Scott Robertson	scott.m.robertson@kp.org	x
Michelle Miller	Michelle.M.Miller@cerner.com

Agenda Items and notes

CIMI Pharmacy Model Update

• Update from John Hatem
  • June 19, 2017 - next meeting is Thursday, June 21. Expect a more detailed report in two weeks about progress of mapping of Pharmacy resources to CIMI logical model.
  • June 26, 2017 - John H has meet with ClaudeN several times to work on aligning the CIMI Pharmacy model with Pharmacy Medication Request resource. Claude is preparing a presentation to review the work with Pharmacy - current proposed Pharmacy conf call is: July 17, 2017
  • 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.

Tracker Items

FHIR Tracker

• On July 24 call we will discuss tracker item: 13392
  • Jean Duteau led the discussion on the impact of IDMP on the Pharmacy FHIR Medication resource. Jean provided a straw man model for Medication that added IDMP content to the Medication resource.
  • Two action items came out of the discussions
    • Look at the OpenMedicine paper that Jose sent out to get better names and descriptions for our attributes as well as determine if we are missing some attributes
    • Identify examples of the various medications that we would need to ship around in orders/dispenses/administrations/statements to see what we actually need.
• July 31, 2017
  • Use cases - coded product vs non-coded product
    • John will work with others on how detailed we need to provide information on packaging
    • Discussion of when a medication is ordered that is included multiple products; or when medication is order with specific packaging - need to define use cases

Action:  Provide examples of the various medications that we would need to ship around in orders/dispenses/administrations/statements to see what we actually need
Action:  John to coordinate the analysis of packaging information needed for requests, dispenses, administrations and statements - additional attributes that are needed when code is not specific enough

• August 7, 2017 - John will report on what type of "medication" information is needed in our Pharmacy Medication resource re: Packaging.

Medication Related (Group = A)

* 13392 Enhance the Medication resource for alignment with the IDMP Authorized Medicinal Product model * 12396 Medication package and product

• 12395 Basis of Strength Substance
  • this is already included in IDMP
  • Motion: moved by Jose - not persuasive that this is not part of the 80% for the medication resource and should be an extension - Jose/Jean - 7/0/0 Carried
• 12671 Consider adding "maintenance drug Indicator" on medication when discussing formulary.
  • discussion that this is more likely an extension
  • Motion: moved by John - not persuasive - John/Jose - 6/0/0 - Carried - would be an extension

Dosage Related (Group = B)

• 13381 We need a way to express <daysAdministeredAmount> and <daysNotAdministeredAmount> in Dosage
  • Found non-persuasive as not in the 80% rule. Scott/Jean - 2-0-0
• 13380 Possible new element in Dosage: calculationBasis
  • Found non-persuasive as not in the 80% rule. Scott/Jean - 2-0-0
  • New tracker item added for MedicationStatement.supportingInformation as we believe it is missing
• 13317 Allow Dosage to express a medication should start/stop relative to an event
  • use additionalInstruction to convey as text. If needed to be codified, should be an extension/change on Timing datatype. Jean/Scott - 2-0-0
• 12791 Update dosage Instruction to include pre-condition and therapeutic target
  • confer with group in next call on how this should be done - text vs codified

Misc (Group = none)

• 13546 Add non-clinical supportingInfo examples
  • Agree to add an example. Scott/Jean - 2-0-0
• 13044 Fix performer on MedicationAdministration - update description and add role back in with appropriate value set
  • waiting on changes from Workflow
  • Logical model for workflow has Performer (0..*) with roles from SNOMED
  • John - we were asked to constrain that role list but we decided at the time not to include role. Now we want to have it and need it to work with the definition in workflow.
  • Michelle - if role is a static aspect of the performer, then we don't need it (it's available in the specific resource describing that person). We need role if it related to the specific event and may not be consistent across related events.
  • extensive discussion ... does this include performer/verifier? That was previously advised (by FHIR) to be done with provenance. This may result in a "stack" of provenance events related to the order (ordered by, verified by, modified by, ...). This isn't how most systems are designed ... would be extensions(?) ... at least it would work. Event history (links to provenance) doesn't link to the most recent status ... would have to track through the provenance find the most recent state.
  • 6/12 we have not reach the end of this discussion
    • John - the specific tracker can be addressed by adding role to medicationRequest, but this may not address the intent.
• 13043 Fix performer on MedicationDispense - update description and add role back in with appropriate value set
  • waiting on changes from Workflow
• 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.
• 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.
• 13384
  • Since FHIR-I does not see the need for a change, we will not be changing. Jean/Scott - 2-0-0

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
  • June 19, 2017 - Request of new resource - Catalog Entry is being documented. The big picture view of a Catalog would be the use of a Composition resource that has a reference to a Catalog Entry resource and each Catalog Entry resource has a reference to a Medication resource.
  • June 26, 2017 - JohnH stated that there is a request from the Catalog team that Pharmacy provide a "logical model" to the Catalog team in a similar manner to that created by the Lab group. JohnH to reach out to JeanD to create this type of model.
  • July 24, 2017 - Pharmacy formulary requirements shared with Catalog project.
  • Next Catalog meeting is Wednesday, August 2, 2017
  • July 31, 2017 - meeting will be held this week. Requirements have been provided

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
  • July 31, 2017 - next meeting is planned for August 15.
  • Next meeting will be held August 15

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

CDA Value Set Updates

• Don Lloyd sent an email to the Pharmacy WG about reviewing required updates to CDA value sets that are Pharmacy-centric
  • We requested that the spreadsheet mentioned in the email be sent to us so we can review.

Action Item List

• June 19, 2017 update
  • Action item list is being updated. The list now is down to 50 open items. John H will continue to work the list by reviewing the minutes and reaching out to folks to assess if specific items can be closed.
  • We will continue to review the list in our calls for the next few meetings.
• June 26, update. Action item list is down to ~ 30 open items. John H will continue to work the list.
• July 31 update: John is working on cleaning up the action item list

Next meeting

• Monday, August 14, 2017 at 1pm Eastern - NOTE, new time for weekly teleconference