2016-04-18 Rx Conf Call

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Attendees to be updated

  • Melva Peters (Chair and Scribe)
  • Scott Robertson
  • John Hatem
  • Daniel Zhang
  • Jose Costa Texeira
  • Michelle Miller
  • Steven Warman
  • Lee Supernant

Catalogue PSS

[Draft PSS Posting http://lists.hl7.org/read/messages?id=288115#288115]

  • discussion of the timing for this project - Jose raised concerns that this is a priority but Pharmacy is trying to focus on FHIR changes requests for the next few weeks
  • Jose has proposed to take to other work groups for input - Pharmacy indicated that he should not shop around the PSS until he finds a WG to take on this project
  • the project needs more work before it can been submitted for approval
  • April 18 - there is a need for formulary - was discussed in Orlando
    • Pharmacy is interested in this topic, but there is a thought that we need to get our base resources in better shape before we tackle this topic
    • May be able to tackle this after the September WGM
    • Could consider putting this as a 3 year plan item and start to tackle in September
    • The current Medication resource could be used to convey formulary information in some way - but it isn't exactly correct
    • using it, isn't a roadblock for implementers but some clarification would be appreciated - delaying isn't of concern
    • Need to include additional requirements related to a medication list as it relates to formulary
    • Jose can still work to gather requirements that will be considered when we tackled the project
Action: add as an agenda for Montreal to consider as a 3 year plan

Agenda for WGM

  • Asked for agenda items to be sent to the list

NCCN template orders

  • Lee Suprenant requested input on the ChemotherapyOrderTemplates work.
 Action: Lee will document the items that should be targeted for Pharmacy.
  • Lee requests time in the next call for further discussion or a separate call.
  • Lee completed categorization, needs next steps identified for the columns marked as "maybe".
  • On 2/8 - reviewed Lee's categorizations
  • Lee plans to continue to join our calls as we work through the list.
  • John recommended we would through the list before Lee takes the list to the FHIR workgroup.
  • 3/7 - continued to work through the list to determine what group should deal with each item (row).
  • Discussion from April 11:
    • 2 spreadsheets were shared with the Pharmacy WG list
      • catalogue of top issues
      • Regimen mapping to FHIR - mapping of data model to MedicationOrder resource
    • some of the topics are being discussed on the workflow calls
    • Pharmacy Related Topics
    • Divided Doses
      • currently do not handle this
      • believe this to be an extension
      • could include this a text in the text element or possibly the additionalInstructions
    • will use an extension - on <dosequantity> to include a <modifierextension>
    • Model the maxamount per period and/or introduce ratio instead of quantity
      • April 18th - will model as an extension
    • There are some remaining issues but are less common


  • Order Sets/Protocol - discussion needs more clarity - being discussed in Work Flow meetings
  • Composite orders - discussion needs more clarity - being discussed in Work Flow meetings
    • how are multiple orders represented and are linked or grouped together
  • Medication resource - changes to this may need to come back to Pharmacy
    • still need to understand the requirements

FHIR Discussion Items DEFERRED


  • A = Dosage Related
  • B = Terminology
  • C = Misc
  • D =
  • E = Examples
  • F = Multiple indications/reason for order
  • G = Status
  • H = Medication Related
  • I = Mappings

FHIR tracker items to cover this week, April 18

  • Tracker Item 9603 - Medication dosage rate shouldn't have range option
    • on the MedicationOrder, the range makes sense, but on the MedicationAdministration, the rate range may not make sense
    • in the ICU - knew exactly what the rate was at a given point in time
    • a range for rate - not used in 100% of systems - may rarely be needed - if it is needed could use an extension
    • neither Epic or Cerner support this
    • Motion to remove dosage.rate by Michele - seconded by John from MedicationAdministration 5/1/0 Carried
Action:  Melva to update GForge and assign to Michelle
  • Tracker Item 5990/7742 - Wrong VS expansion
    • could bind to Snomed CT
Action:  Melva to propose an exemplar value set for method
  • Tracker 9302
    • Include parameters in dosing - "if x happens, decrease dose by y"
    • Discussion of how to handle - there may be some overlap with the discussion going on in the workflow discussions
    • Will need to include conditional dosing choice in our MedicationOrder resource - could reference an observation resource or diagnosticReport resource or Procedure resource to the DosageInstruction
      • may not be able to use this because these are actual events that exist but the parameters will point to conditions that do not exist
    • Discussion with Lloyd - may want to handle the more simple use cases but not try to manage the more complex conditions
      • Be guided by what the implementers are doing today
      • Could use text as part of AdditionalInstructions
    • Implementers - Michelle and Daniel will investigate and help to guide the decision
  • Tracker 9301 - Add Verifier on MedAdministration and MedicationDispense
    • Include on agenda for April 25

FHIR tracker items from last week, followup/update action items

  • Tracker 7560 - has been re-assigned to a different WG - Pharmacy doesn't haven't to deal with
  • Tracker 8476 - Clarification on medicationOrder.dispense.medication vs medicationDispense.medication
    • Discussion of whether we need the Dispense.medication - could be an extension
      • Include in the agenda for next week and determine what to do - either remove or add a comment on how to use
    • recommendation that we remove medicationOrder.dispense.medication
Action:  John to reach out to Lloyd or Grahame to confirm if this is an issue
  • Tracker 9296 - Consider new statuses (Proposed, Draft, Under Review) for MedicationOrder and MedicationAdministration.
    • discussion of the granularity - have draft already and Proposed is part of workflow discussion
    • suggest that we leave as is for now
Action: post a question to the list serve to seek information - John will start the discussion for the question - discussion ongoing
  • Tracker 8489 - Medication related indicators - maintenance dose, over the counter
    • Leave as "Considered for Future Use" and discuss when we look at formulary requirements
  • Tracker 9286 and 5827 - Review the need for status on a Medication Resource.
    • Setup a discussion with Lloyd re: modelling for these items before we make a decision
  • Tracker 8783 - Medication Order Status resolution - review the 2 questions in the tracker item.
    • Consider along with 9296
  • Tracker 8378 and 8276 - consider adding the reason for all statuses changes on MedicationPrescription.

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.

Joint Meeting with ISO/IHE Pharmacy

  • Room is available courtesy of Canada Health Infoway - waiting for a response from Michael Tan

Template Work

  • Kai to let Pharmacy know when ready for review

Other business

Next meeting

  • Monday, April 25, 2016
    • Agenda