Pharmacy FHIR Maturity - November 9, 2016

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November 9, 2016

Attendees

• Michelle Miller (Cerner)
• Danielle Friend (Epic)
• Daniel Zhang (Epic)
• John Hatem
• Marla Albitz (Wolters Kluwer)

Project Team

• Brett Marquard
• Eric Haas
• Melva Peters
• Mera Choi
• Saurav Chowdhury
• Tricia Lee Wilkins

Discussion

• Next meeting November 23, 2016
  • Melva to make sure that the meeting is posted to the HL7 Pharmacy list
• Connectathon
  • Planned
    • Patient and provider access to medications
    • Patient or provider adding new medication to patient's ("active") medication
      • Cerner - support adding medication statements but not orders - for providers
        • not orders and for patients - still to be determined for 2017
      • Epic - trying to support but not sure it will be ready for January
        • first priority will be MedStatement
        • will check to see if write access is for both providers and patients
• Medications Lists
  • Outpatient Lists (Ambulatory)
    • what is current medication list?
      • Cerner - user can filter the display - by status or other means to refine the view
        • there was a request for active medication list - can't be done in DSTU2 - in STU3 - have added a category element to distinguish types of medications
        • difficult to do without the category element to help with this
          • no concerns with existing value set
        • the resource should support all types of medications
        • not sure you can use encounter, organization to do this filter
        • Active - expect to see OTC, provider prescribed, other provider ordered (and told about) and administrations
          • if attached to an institution - should be able to access inpatient medications too
        • have 1 medication list for a given a patient - can be filtered
          • inpatient meds are in the database but status is likely in an end state status (eg. completed or stopped) so they wouldn't be displayed based on the filters/preferences
        • in CCD - what is included? Michelle to check
      • Epic - have a way to get full list of all medications including stopped meds, etc
        • outpatient list - only things that are active are outpatient meds
        • admitted - outpatient prescriptions are paused during admission so not active on the inpatient list
        • existing outpatient medications may be suspended and new orders are written. Upon discharge, inpatient order is stopped and new order may be written
      • discharge medications for future use - wouldn't be considered as active - would become active
      • 2 different orders - community prescription - if want to continue as an inpatient - becomes a new order
        • MAR is more task driven - not necessarily the medication list
        • there are 2 different component - list of orders AND the MAR (administrations) - different level of granularities
        • categories - doesn't cover the MAR list requirements
  • Inpatient Medication List
    • Orders - may be filtered by status or categories - no statement about whether they were administered
      • there may be a use case for including community prescriptions (e.g. inhaler) - assuming that the medication is not re-ordered in the hospital
    • Inpatient med list is not the MAR
    • can't currently be done with DSTU2 - with STU3 - will use as combination of status and category to get the subset of list
    • Cerner is deriving medicationStatements from orders
    • Epic is also deriving medicationStatements from orders
  • Discharge Medication List
    • What is on this list?
      • Epic - any medications that are considered still active and then meds that were active at time of discharge
        • can't differentiate discharge list from inpatient list
    • Cerner - for med reconciliation - can determine actions that were taken at discharge = snapshot - may be possible to add new medication after snapshot or reconciled list is produced
    • could use list resource - but hasn't been implemented
    • don't want to do with for discharge list - need to print everything on current/active medication list including new meds after snapshot/reconciliation
• Summary - medication list - category and status are key for view - will include for Connectathon
• Draft IG has been published - Draft IG Outline

Action:  Asked participants to review
Action:  Please sign up for Connectathon