2016-06-20 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

• John Hatem (Chair)
• Melva Peters (Scribe)
• Ken Sinn
• Yunwei Wang
• Daniel Zhang
• Marla Albitz

ListServ / Zulip Discussions

• Topic: Multiple route of administration on a single order
  • Comments received from Lee - in a protocol where a medication could be given orally or Intravenous
  • can use multiple dosage instructions
  • multiple dosage instructions - Lee assumed it is "and" - how do we handle "or"? -
    • timing could be used to indicate when each of the medications are to be administered

Action:  determine what additional guidance should be included to distinguish and/or or what we support - Melva
Action:  Ask Lloyd - if and/or is supported anywhere else - how is it being done - Melva

• Prescriber as part of MedicationStatement
  • different views of the application of the MedicationStatement

Action:  John will look at this and make a proposal for the change request for next weeks call.  John's proposal is to name the new attribute "original prescriber" and add this to the Medication Statement resource.  

• • Propose adding new attribute as an core extension - "Original Prescriber" to MedicationStatement - reference to a Practitioner
    • Moved by Melva - seconded by Marla - 4/1/0 - carried

Action:  Melva will update GForge and assign to Marla

• MedicationAdministration dosage.text
  • GF #10216 - Will be reviewed for June 27 meeting

Action:  Melva to update and propose change for next week

FHIR Maturity

• Getting our resources to Level 2 and 3
• Have identified several vendors that are using some of our resources which collective use all of our resources. Need to determine specifics of who and what, as well as, what documentation would be required to prove level.
• Response from Lloyd: For level 2, the requirement is that in some sort of real or test environment, at least 3 independently developed systems have shared the resource covering at least 80% of the data elements. You can capture the name of the connectathon or just a date and a list of the system vendors if it was done outside of connectathon (e.g. through Argonaut)
• Additional information provided by Michelle that can aid in collecting FMM evidence
  • Argonaut sprint testing schedule: https://github.com/argonautproject/implementation-program/wiki
  • Argonaut implementation guide: http://argonautwiki.hl7.org/index.php?title=Implementation_Guide#Data_Element_Query
  • Specifically, MedicationOrder and MedicationStatement (http://argonautwiki.hl7.org/index.php?title=Medications) are scheduled for Sprint 3 (July 2016)
• Email has been sent to Pharmacy List asking implementers to provide information

Action:  Add FDB news release
Action:  Daniel to provide Epic information

FHIR Discussion Items

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

June 20 items

• 10141 - Categories - long discussion of proposed changes

Action:  Melva to work on categories and definition and bring back for discussion next week

• 10096 - Change wording to An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does NOT include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.

and Remove "Comments: If displaying "number of authorized fills", add 1 to this number." - Melva - Marla - 5/0/0 - Carried

Action:  Melva to Update Gforge and assign to Marla

June 13 items

• 10164 - Add prescriber extension to MedicationStatement - approved - see above
• 10141 - Category
  • Discussion of the term for #4 "community prescription" rather than "prescription"
  • Discussion of whether this is part of the 80%

Action:  Define terms and definitions for MedicationStatement and MedicationOrder for review and voting on next weeks call.

• 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 Medication Dispense

• 10096 - numberofRepeatsAllowed is wrong on MedicationOrder

Action:  Look at for next week

• 10066 - Should route and site be inside dosage instruction line?
  • Deferred

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)

• Understand Lusia Li requirements and enter tracker item (if Lusia Li attends this session)
  • Home Medications
  • How to query for home medications?
  • If we add a category (to both MedicationStatement and MedicationOrder), then at minimum, we'd need 4 categories:
    • Inpatient (what is administered during the inpatient visit, which does NOT include discharge medications)
    • Outpatient (what is administered during the outpatient visit, e.g. ED visit or Oncology visits)
    • OTC/Hx (e.g. a subset of Med Statements that are modifiable because they don’t represent “real” orders in the system, but rather patient statements)
    • Prescription (e.g. “real” prescription orders, often filled by a retail pharmacy and is administered outside of the context of an encounter, often at home)

 Action:  Daniel will check if the inpatient encounter id is associated with discharge medications (written at the end of the inpatient encounter) - Response from Daniel - I verified that discharge meds were placed in the inpatient encounter in Epic. It won’t be feasible to tell if a med order is inpatient vs. outpatient based off the encounter type.

 Completed Action:  Michelle will log gForge requesting the addition of category and email gForge to the listserv

• Based on today’s pharmacy conference call, I had an action item to create a gForge for category. No official resolution yet, but enough support to warrant a gForge being logged.
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=10141

• We did discuss category being applicable within both MedicationStatement and MedicationOrder.

• The question about how to represent “knowledge of externally stored orders” wasn’t explicitly discussed that I recall, but warrants clarification – as our system implemented those as MedicationStatements, which are a mix of explicit medication compliance/use statements as well as implicit compliance of both over-the-counter medications as well as knowledge of externally stored orders (from patient statement about another provider who prescribed the med). A ‘patient statement’ (regarding OTC meds or prescriptions from other providers/external orders) is implicitly communicating compliance/use = was taken – otherwise, the patient wouldn’t have made the statement at all.

Renaming MedicationOrder to MedicationRequest Discussion DEFERRED

• 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

 Action: to followup with Lloyd to find out status and/or next steps

FHIR Workflow Meetings Status

• Status - there were no workflow meetings week of March 14th.
• Discussion of Pharmacy Workflow Mockup (John)
  • Pharmacy has been providing input into the workflow meeting discussions. One suggestion is that Pharmacy create a Pharmacy specific workflow case similar to the one that is being created for lab. This work has not started yet, but John will start working on this in April.
• Jun 13 discussion - meetings are continuing

Next meeting

• Monday, June 27, 2016
• Agenda
  • EventHistory - Lloyd has proposed that EventHistory should not be used - should use Providence
  • Maturity of each Resource
  • Renaming of MedicationOrder