2017-11-20 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

• Stephen Chu
• Floyd Eisenberg
• John Hatem (Chair)
• Melva Peters (Scribe)
• Jean Duteau
• Scott Robertson

Agenda Items and notes

FHIR

FHIR Tracker Items

FHIR Tracker

Workflow Changes (Group = Workflow)

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. 

Statement

• GF #14023 MedicationStatement Alignment
• November 6, 2017
  • John reviewing changes to align MedicationStatement with Workflow (see spreadsheet for details)
  • Our dateAsserted doesn't have a match in Workflow. We're not deleting. John will bring to the attention of the Workflow group.
  • taken/notTaken ... this is a longer discussion. Out of time for today
• November 13, 2017 - alignment with Workflow pattern will be discussed today
  • See spreadsheet with changes attached to Gforge
  • Moved by Melva - seconded by Scott to approve the changes as per spreadsheet - 4-0-0 Carried

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 catalogentry 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.
• Other open tracker items
  • GF #12396 - Medication package and product
  • GF #13392 - Enhance Medication resource for alignment with IDMP model

Misc (Group = none)

• GF #13943 Add discharge medication profile to QI-core
  • Floyd Eisenberg to join call on Oct 30th to discuss
  • November 20, 2017
    • In US - electronic clinical quality measurement - use quality data model
    • missed discussion!
    • in CDA - includes discharge meds
    • in FHIR - use category - add "discharge" to the exemplar value set
      • Motion: Moved by Melva - seconded by Stephen to add "discharge" to the exemplar Category value set - 5-0-0 Carried
• GF #14111 Weight based dosage examples
  • See update to tracker item

Action:  Melva to create 2 examples for discussion next week

• GF #13978 Clarify MedStatement.status values
• GF #13905 prn medications need boolean and optional reason
  • 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

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

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
  • November 13: no meetings, no update
  • November 20: No update. John to followup with project team

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

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

Clozapine REMS registry message - Mike Henderson

• • Does there exist, or is there planned, any HL7 V2 messaging for the US Clozapine REMS or similar Clozapine registries?
  • VA has a significant mental health care population - a registry exists but doesn't use standards based messaging - uses mail messages
  • There is a dispense event messages and a query
  • Has someone dealt with this yet?
    • Michelle will check to see if anyone using Cerner is communicating with the REMS registry
  • Mike will send more information about what data is in mail messages
  • November 20:
    • Mike sent an email about the mail message

Action: Melva to follow up with Mike about next steps

Action Item List

• August 7 update: John is working on cleaning up the action item list

Ballot Reconciliation - Templates

• File:Consolidated CDAR2 IG PHARM TEMPLATES R1 O1 2017SEP amalgamated.xls

MedicationKnowledge Resource

• 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
Action:  Consider a joint meeting with BR&R in New Orleans

Next meeting

• Monday, November 27, 2017 - 4pm Eastern