2018-07-16 Rx Conf Call

Related Links Pharmacy Home Page Conference call minutes

Attendees

• Melva Peters (Chair and Scribe)
• Scott Robertson
• Peter Sergent
• Jean Duteau
• Michelle Miller

Agenda Items and notes

Use of Confluence

• further discussion after review done by Co-chairs

Harmonization Proposals

• • no items from the Pharmacy perspective
  • Jean moved and Tim seconded - approve existing and will not attend harmonization call - 5-0-0

Action:  Melva to send email to harmonization list after July 21st.

SNOMED on FHIR teleconference calls

• Every other Tuesday - June 19th at 4pm Eastern
• John and Scott will be attending
• emphasis will be to fix deficits in SNOMED - narrow focus
• June 25, 2018: Scott and John attended and the project thanked us for participating. We clarified our use of the Medication resource and answered multiple questions. The next agenda will have a few remaining Medication related questions.
• 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 16, 2018: next call is tomorrow - no update

FHIR

Open Pharmacy FHIR Tracker Items

16095 - MedicationKnowledge Resource

• Melva and Jean are creating a draft resource in the build. The next step is to review the existing tracker items to see which can be done with the current draft content, which need to have data elements added, and which will remain out of scope.
• Feb 26, 2018: no discussion
• March 5, 2018: no discussion
• March 12, 2018: FMG wants to see the PSS once co-sponsors have been approved
• March 19, 2018: Melva will see if she can publish a local version for review
• March 26, 2018:no discussion
• April 9, 2018: update by Jean
  • reviewed structure at [1]
  • a first cut ... more work to be done
  • mainly pulled from v3.
  • some review relative to Saskatchewan, KP formularies and FDB
  • still need to validate will work for use cases / requirements
  • medicationClassification can be used for many different different classification for one MedicationKnowledge
  • batch ... is this needed in MedicationKnowledge?
  • Note that this is not as detailed as IDMP
  • amount vs packaging.quantity ... need to clarify
  • 'type' needs clarity: this is branded, generic, PHPID, etc. need better definition.
  • need input from Medication Knowledge vendors (Multum, FDB, etc), formulary, catalog stakeholders
• April 16, 2018:
  • Jean's email of April 13, 2018 -- This is a list of the changes/clarifications/discussion items that came out of the review of the MedicationKnowledge resource:
    • generalizedMedicine = Reference(MedKnowledge)
    • patientCharacteristics.value = choice of datatypes
    • indication = reference(observation)
    • drugCharacteristics.value = choice of datatypes
    • type - needs better definition
    • ingredientItem - reference(medication)? - do we need a reference to medication or just to substance?
    • Contraindications - do we want to include a structure for contraIndications?
    • batch - description isn't proper - is it needed?
    • packaging.quantity = how does it differ from amount?
      • how do I express strength + total quantity
    • halfLife - description needs to be fixed
    • Cost - add a typeCode for type of cost (manufacturer price, claim reimbursement, patient cost)
    • fix graphic on UML
    • isBrand - maybe needs to include different types - isBrand, isGeneric, isInnovator, other
      • Discussion
    • add substitution allowed attribute
    • Need to look at other parameters other than halfLife
    • Need to consider the name

Action: Jean and Melva to liase to work on updates - complete
Action:  look at material from Chile to see if definitions can be updated
Action: Melva to post to Zulip asking implementers for feedback - compete

• April 23, 2018
• April 30, 2018
• June 4, 1018: See tracker 16095
  • Review of material from ISO
  • Review of material from NZ
• June 18, 2018
  • Melva has applied some of the changes - please review
• June 25, 2018: Melva walked through the changes that have been made
• 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 
Action:  talk to Jose

• July 16, 2018: likely applies to a MedicationDispense and a MedicationAdministration
  • Michelle is following up with Pharmacy team at Cerner -
  • currently - if you want to include batch information for each of the ingredients - must use the ingredient.itemReference to a Medication - you can not use a CodeableConcept - need to add some clarification to the resource
• Some comments received from Rik Smithies

Action:  Melva to reach out to Rik to see if can schedule call to discuss

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

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

• July 16, 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 16, 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 16, 2018: no discussion

15772 - Definitions for identifiers in Pharmacy resources

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

Action:  review and compare definitions for identifiers on pharmacy resources

• July 16, 2018: no discussion

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 16, 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 16, 2018: Michelle participated in Workflow call today
  • Lloyd was going back and forth between using "intent" vs tags - leaning more towards using tags - was not voted on today
  • Michelle will be posting a Zulip to get input from implementers
  • Discussion applies broader than medication request
  • Implications of digital signatures - can change intent without breaking digital signatures. Tags may work better.
  • New intent value - easier to see - may be mitigated with documentation - tag buried in meta.
  • more discussion to be had

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 16, 2018: no discussion

17435 - MedicationRequest: why are route and additionalInstruction part of the 0..* dosageInstruction

• route and additionalInstruction
  • respond to tracker item with vaginal tablet/cream examples -added to tracker item
• July 16, 2018: requester has responded
  • Motion: Find the tracker not persuasive with mod - Jean Duteau/Scott Robertson: no change to resource but an example will be created - 4-0-0 Carried

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

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

• July 16, 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 16, 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 16, 2018: no discussion

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:

Action:  Melva will followup with Brett on next steps

• July 16, 2018: no discussion

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 16, 2018: no discussion

Blood Products/Transfusion/Tissue Update - Project 1370

• May 7, 2018: no discussion
• June 4, 1018: no updates

Action: Melva to follow up with O&O

• June 11, 2018: no updates
• June 18, 2018: There is a draft resource - Biologically derived project

Action:  Melva to followup with O&O

• June 25, 2018: Melva commented on O&O Zulip chat - no response

Action:  Melva to followup with O&O - complete

• July 9, 2018: We have worked on that in the IHE PaLM space and at this time decided to not expand the underlying HL& base standard messages for that project - the profile was published for comment twice - latest version is here:
  • http://ihe.net/uploadedFiles/Documents/PaLM/IHE_PaLM_Suppl_TMA_Rev2.0_PC_2018-04-27.pdf
• I have cced Dan Rutz, who has been heading the effort.
• July 16, 2018: will remove from agenda - followup in Baltimore

Pharmacy template ballot reconciliation

• July 9, 2018 - will be working on this and will extend into August
• July 16, 2018: Call tomorrow with Kai to work through reconciliation

AOB

• none

Next meeting

• July 23, 2018 at 4pm Eastern