2018-08-20 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

• Scott Robertson (Chair)
• John Hatem (Scribe)
• Peter Sergent
• Jean Duteau
• Joe Quinn
• Stephen Chu
• Michelle Miller
• Tim McNeil

Agenda Items and notes

Patient Care WG - Patient/Practitioner Preferences

• Patient Care WG joining call
  • August 20, 2018: Discussion about pharmacy specific patient and practitioner preferences.
    • Pharmacy agreed to evaluate how patient and practitioner preferences fit into our current resources.
    • Patient Care agreed to continue their work and modeling of preferences and pharmacy will provide input on how patient and practitioner preferences may be accomplished. In addition pharmacy will provide input into where and how the preferences will be used with existing pharmacy resources.

Pharmacy List topic

• I recently started researching HL7 because as a pharmacy, we have received several HL7 Data Sharing agreements from 3rd party vendors. I am trying to find out if the Segments/Components/Subcomponents are customizable and excludable from a data set. For example, could we exclude PID from transmission through the interface, yet allow other segments to transfer outside our organization?

Action:  Scott to respond

• August 13, 2018: no discussion
• August 20, 2018: responded, no reply

Use of Confluence

• further discussion after review done by Co-chairs
• August 13, 2018: no discussion
• August 20, 2018: see [[1]]

SNOMED on FHIR teleconference calls

• Every other Tuesday - June 23rd at 4pm Eastern
• July 9, 2018: Peter Sergent attended recent call - 2 questions about MedAdmin
  • Is dosage going to be aligned with the complex type used in Medication Statement?
  • They are concerned that the reason was non administration is bound to different Snomed hierarchies
  • have discussed in the past - because MedAdmin is different - have previously discussed not to change
  • CodeableConcept - did not have a suggestion for what it should be bound to
  • next call is next week - Peter will ask what they think it should be bound to
• July 30, 2018: accepted position on dosage
  • asked further on multiple hierarchy - referred to chat pages - Need to find out more
  • in allergy/adverse event work done in UK - value sets include multiple hierarchies - more of a global issue that should be posed to FHIR-I

Action:  Melva to post question to Zulip - complete

• August 6, 2018: John Hatem to attend call tomorrow to discuss - John attended, suggestions about the terminology value sets on Medication Administration will be discussed on August 13, 2018 call.
• August 13, 2018: no discussion
• August 20, 2018: no discussion last week, next meeting is on August 21

MedicationKnowledge Resource

• July 9, 2018:
  • on the Zulip chat - how to reflect an instance of a medication - Medication resource does not have an identifier - intentionally left out - not part of the 80/20 - would use a code
  • need to answer the question about why there is no identifier on medication - identifies an instance of a "thing" - we have a code (which identifies the "kind" of thing)
  • use case - may be for a "bar code" on an IV bag -
  • we have "serial number" in the batch attribute - could we change the name to "identifier"
  • move the "serial number" to the top level and change to name to "identifier" - and change data type. Will discuss with implementers before making change

Action:  talk to implementers about how they deal with this - Cerner, Epic, Vince  - Melva to followup
Action:  talk to Jose - Melva to followup

• August 6, 2018

Action:  do one more followup with implementers and Jose

• August 13, 2018: no discussion
• August 20, 2018: no discussion

FHIR

Open Pharmacy FHIR Tracker Items

17222 - Review Pharmacy resources to see if requirements for Medical Gases are met

• July 30, 2018: no discussion

Action:  Melva to reach out to Anesthesia Co-Chairs to get material

• August 6, 2018: no discussion
• August 13, 2018: no discussion
• August 20, 2018: no discussion

16042 - Add attribute to indicate type of drug

• this is part of medicationKnowledge and formulary
• June 11, 2018: no discussion
• June 18, 2018: will be discussed as changes to MedKnowledge.productType
• June 25, 2018: for incident reporting - could use AdverseEvent - references medication, medicationAdministration, MedicationStatement
  • Patient Care is debating whether instance is intending to be a specific instance or a more generic definition - GF#13698
  • continue the discussion for this tracker as part of MedicationKnowledge
• July 30, 2018: no discussion
• August 6, 2018: no discussion
• August 13, 2018: no discussion
• August 20, 2018: no discussion

15800 - scope and description for MedStatement

• June 4, 2018: no discussion
• June 11, 2018: no discussion
• June 18, 2018: no discussion - will be discussed in the context of GF# 15105
• July 30, 2018: no discussion
• August 6, 2018: no discussion
• August 13, 2018: no discussion
• August 20, 2018: no discussion

15772 - Definitions for identifiers in Pharmacy resources

• June 4, 2018: no discussion
• June 11, 2018: no discussion
• June 18, 2018:
• July 30, 2018: no discussion

Action:  review and compare definitions for identifiers on pharmacy resources

• August 6, 2018 - John reviewing - will be ready for review next week
• August 13, 2018: Started review of spreadsheet
• August 20, 2018:
  • Continued reviewing the definitions which resulted in creating a uniform definition across all identifiers for MedicationRequest, MedicationAdministration, MedicationDispense and MedicationStatement.
  • Motion to accept changes ( changes documented in spreadsheet that is being sent to Melva Peters to implement) was made by Jean Duteau, seconded by John Hatem: vote passed: 6-0-0
  • Action: Melva to update resource with changes - see spreadsheet sent by John Hatem

15509 - Create example scenarios for Pharmacy

• Create example scenarios for Pharmacy
• need to draft some scenarios
• April 16, 2018: no discussion
• May 7, 2018: no discussion
• June 4, 2018: no discussion
• June 11, 2018: no discussion
• June 18, 2018: no discussion
• June 25, 2018: no discussion
• July 9, 2018: no discussion
• July 30, 2018: no discussion
• August 6, 2018: no update on where we are with this
  • John will raise this question in the Workflow calls
  • August 13 - there were no workflow calls Wednesday of last week or this week
• August 13, 2018: no discussion
• August 20, 2018: no discussion

15105 - MedicationStatement - alignment with WorkFlow

• • notTaken was removed
  • need to consider how to reflect what the prescriber thinks should be taken by the patient - is this a medStatement or is this a MedRequest?
• Lloyd believes should be using a MedRequest with a "plan" status
• Choices:
  • take MedStatement back to the way it was
  • US Core - embrace List
  • follow Lloyd's suggestion to use MedRequest with "Plan" status
  • use status field to identify if a prescriber believes the patient should be on this med and uses taken element to identify if the patient is following the order and taking the medication - could previous do this before we aligned MedStatement with workflow
• March 5, 2018: - deferred until March 12, 2018
  • Ask Lloyd to join call - complete - he can't join on March 12. Need to provide an update to him
• March 12, 2018:
  • Lloyd believes that MedStatement should only be an indicator of whether the patient/provider says they are taking the medication
  • Options:
    • revert back to having "notTaken"(pre workflow harmonization)
    • provider instructions for medication - should use MedicationRequest - with intent element
    • implement List resources to get active medication list - not preferred
    • current resource with "not taken" as a status - not preferred
  • Need to take this conversation more public -
    • Workflow group - Melva to ask Lloyd to add to Workflow agenda
    • Zulip - posting to Zulip
      • add Workflow discussion
• April 16, 2018: no discussion
• April 23, 2018:
• April 30, 2018
• June 4, 2018: no discussion
• June 11, 2018: no discussion
• June 18, 2018: waiting for feedback from Lloyd on whether new value will be added to "intent" value set
• June 25, 2018: Michelle to send notes from meeting in Cologne with Lloyd

Action:  Melva to followup with Lloyd on tracker item related to request for new value in intent and copy Michelle on email - complete

• July 9, 2018: no discussion
• July 30, 2018: no discussion
• August 6, 2018: Zulip conversation - somewhat stalled
  • intent is not a modifier - outcome of the discussion may hinge on this
  • if it is a tag - need to make sure that there is documentation

Action:  Michelle to reach out to Epic to get them to weigh in on the Zulip chat

• August 13, 2018: no discussion
• August 20, 2018: no discussion

12396 - Medication package and product

• Medication package and product
• April 9, 2018 - brought back to discuss
• April 16, 2018 - no discussion
• April 23, 2018: no discussion
• April 30, 2018:
• May 7, 2018:
• June 4, 2018: no discussion
• June 11, 2018: no discussion
• June 18, 2018: will be discussed with MedKnowledge
• July 9, 2018: no discussion
• July 30, 2018: no discussion
• August 13, 2018: no discussion
• August 20, 2018: no discussion

17411 - Add category property to allow representation of Therapeutic category

• Category Property
• believe this is an extension as it is not part of the 80/20 for prescribing, dispensing, administering
• July 30, 2018: no discussion

Action:  Ask John to join a Pharmacy WG Call to discuss further

• August 6, 2018: John to join next week
• August 13, 2018: no discussion
• August 20, 2018: no discussion

17375 - Medication.quantity refers to "package" and "packaged product"

• Medication.quantity
  • need to update the definition -
  • change the Ingredient.amount - to medication.ingredient.strength - need to update the definition to clarify
  • update the usage notes for medication.amount - update definition - update how used with strength
  • continue discussion next week
• July 30, 2018: no discussion
• August 6, 2018: continue the discussion when Jean is on the call - potential to change the datatype on amount
• August 13, 2018: no discussion
• August 20, 2018: no discussion

Updates from Workflow

• April 23, 2018: meeting held today
  • Workflow issues - Lloyd will be fixing the report and re-issuing
  • MedicationDispense.statusReason - is okay that this will be either a reference or a CodeableConcept - will not be added to the pattern for event
• April 30, 2018: reviewed tracker items. nothing specific to pharmacy
• May 7, 2018: reviewed tracker items during Workflow meetings. No specific pharmacy issues.
• June 4, 1018: no updates
• June 11, 2018: no updates
• June 18, 2018: no meetings until July
• July 9, 2018: No participation through end of July from Pharmacy
• July 30, 2018: no discussion
• August 6, 2018: no workflow meetings
• August 13, 2018: no workflow meetings
• August 20, 2018: no workflow meetings

US Meds - PDMP Mapping

• work on GitHub
• April 16, 2018: In ballot - no discussion until after ballot close
  • will be on the agenda for WGM or subsequent teleconference
• April 23, 2018: no discussion
• April 30, 2018: no discussion
• May 7, 2018:
• June 4, 1018: Block vote
  • Comment Submitters
    • Arvind Jagannathan
    • Jose Costa Teixeira
    • Mark Cacciapouti
    • Michele Hudak
    • Ruth Berge
    • Scott Robertson
    • Thomson Kuhn
    • William Goossen
  • Line Items
    • 17196 Agree with approach - 2018-May Medication #23 (Jose Costa Teixeira) Considered - No action required
    • 16326 NCPDP mapping (Scott Robertson) Considered - Question Answered
    • 16327 Ballot name and link (Scott Robertson) Considered - Question Answered
    • 16629 Confirm if SSN is only identifier - 2018-May Medication #4 (Michele Hudak) Considered - Question Answered
    • 16032 Link is incorrect (Ruth Berge) Not Persuasive
    • 16093 Use indicator (Ruth Berge) Not Persuasive
    • 16094 Medicinal Product use indicator (Ruth Berge) Not Persuasive
    • 17197 Seems not to adhere to the Identification of Medicinal Products IDMP from ISO. - 2018-May Medication #24 (William Goossen) Not Related
    • 16091 garbled text in table legends (Ruth Berge) Persuasive
    • 16625 Remove specific call-out of Opioid abuse - 2018-May Medication #2 (Michele Hudak) Persuasive
    • 16626 Drop phrase %27any%27 on controlled substance - 2018-May Medication #3 (Michele Hudak) Persuasive
    • 16636 Did you actually mean MedicationStatement here when you wrote MedicationRequest%3F - 2018-May Medication #6 (Arvind Jagannathan) Persuasive
    • 16639 Reword this sentence within the PDMP section. - 2018-May Medication #7 (Arvind Jagannathan) Persuasive
    • 16642 Just a typo correction within the PDMP section. - 2018-May Medication #8 (Arvind Jagannathan) Persuasive
    • 16645 Change the format of the header for the PDMP Data Elements and Mappings section to properly show this is a new major section of this page. - 2018-May Medication #9 (Arvind Jagannathan) Persuasive
    • 16648 Provide a link to the FHIR RESTful specification within the CapabilityStatement description. - 2018-May Medication #10 (Arvind Jagannathan) Persuasive
    • 17161 “asterisk” misspelt - 2018-May Medication #20 (Thomson Kuhn) Persuasive
    • 17162 What is the meaning of the asterisk for this element. - 2018-May Medication #21 (Thomson Kuhn) Persuasive
    • 17195 Patient Profile Search Requirements - 2018-May Medication #22 (Mark Cacciapouti) Persuasive
    • 16623 Update reference to Opioids - 2018-May Medication #1 (Michele Hudak) Persuasive with Mod
    • 16624 Update reference to Opioids - 2018-May Medication #1 (Michele Hudak) Persuasive with Mod
    • 16633 Make the scope statement include the Argonaut Project scope statement for convenience. - 2018-May Medication #5 (Arvind Jagannathan) Persuasive with Mod

Block Vote

• have posted the block vote for 2 weeks - no requests to pull
• Motion by Brett - Dragan to approved disposition based on block vote and published spreadsheet - 7/0/0

Action: Brett to update Gforge 
Action: Melva to get spreadsheet extracted and posted on Ballot reconciliation
Action:  Melva to send Brett vote - complete

• June 11, 2018
  • Missed 2 tracker items in block vote - belong to a different ballot - have been forwarded
    • 16032 Link is incorrect
    • 16094 Medicinal Product use indicator
  • Motion to find these two comments "not related" - Jean/Brett - 4-0-0 Carried

Action: Melva to review email from Austin to determine what has to be done about other comments

• July 9, 2018:
• July 30, 2018: no discussion

Action:  Melva will followup with Brett on next steps

• August 6, 2018 - Brett working on getting the changes applied

Catalogue Project

• April 9, 2018: all Catalogue project meetings cancelled until after HL7 Workgroup meeting in Cologne
• April 23, 2018: no updates
• April 30, 2018: no meetings until after Cologne WGM
• May 7, 2018: no discussion
• June 4, 1018: no updates
• June 11, 2018: no updates
• June 18, 2018: meetings have been held but John hasn't been able to attend.
• June 25, 2018: they are finalizing the resources for their meetings with FMG and the September WGM.
  • The resources they are working on include Entry Definition.
  • The are also seeking interested parties to use their resources in the next Connectathon
• July 9, 2018: next meeting will be July 11th - no participation from Pharmacy through the end of July
• July 30, 2018: no discussion
• August 6, 2018: no updates
• August 13, 2018: last week there were discussion related to the upcoming connectathon and use of the Catalogue resources. No action items for Pharmacy.

Pharmacy template ballot reconciliation

• July 9, 2018 - will be working on this and will extend into August
• July 30, 2018 - 2 items to discuss - see attached spreadsheet
  • Pharmacy Template Ballot Reconciliation Spreadsheet
  • see proposed dispositions in updated spreadsheet

Action:  Melva to reach out to submitters who wanted in person resolution - complete
Action: Melva to reach out to submitter where we needed clarification - complete

• August 6, 2018

Action:  Melva to send spreadsheet to the list for review.  Will vote on this next week

• August 13, 2018
  • Moved by Jean - seconded by Scott to accept dispositions for comments where in person reconciliation not requested or where not waiting for input or where not previously voted on. 6-0-1 Carried
    • Stephen Chu Abstained

Action:  Melva to update spreadsheet

PSS Collaborative C-CDA R2.1 Template Review

• discussion by Lisa Nelson
• Review PSS and determine if Pharmacy should be a co-sponsor
  • idea to align CDA and FHIR better
  • CDA Management Group - trying to build better collaboration among Work Groups
  • Scope of this project is to pilot to see what it would take to build collaboration in some specific places - narrow scope
    • explore changes needed for CCDA R2.1 templates - identify tangible set of issues to make templates align better
      • list of deltas to bring views of the world align better
      • CDA Management group is the sponsor with SD, PC, FM and Pharmacy as co-sponsors
    • likely looking at Medication Activity template and Planned Medication Activity from Pharmacy
    • Pharmacy participation - Melva, John, Jean and Tom
    • discussion that Pharmacy would like to participate in the actual project work rather than as updates
  • Moved by Melva - seconded by Peter to approve Pharmacy as a co-sponsor contingent on the proposed changes 8-0-0 Carried

Next meeting

• August 27, 2018 at 4pm Eastern