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Sept 2011 WGM Minutes

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Pharmacy Working Group Meeting Minutes San Diego, CA, USA; Monday 12 September 2011; Q3 Attendees:

John Hatem Oracle USA john.hatem@oracle .com

Hugh Glover Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk Tom de Jong (Chair) HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl Scott Robertson Kaiser Permanente USA scott.m.robertson@kp.us Julie James Blue Wave UK Julie_james@bluewaveinformatics.co.uk Line Saele HVIKT Norway Line.sele@helse-vest-ilet.no Melva Peters (scribe) Gordon Point Informatics CA Melva.peters@gpinformatics.com Derrick Evans Allscripts USA Derrick.evans@allscripts.com Agenda Topics • Introductions • Agenda Review • Review of Minutes – Orlando WGM • Review of 3 year work plan • SWOT and Mission and Charter Review Supporting Documents • None Minutes/Conclusions Reached 1. Introductions 2. Agenda Review (Tom de Jong) • Tom reviewed the entire weeks schedule • See updated version of the Agenda – Tom will post to list serve • Status of email threads – Tom working on spreadsheet • There are some open questions • This topic will be tabled and discussed Tuesday Q3 3. Review of Minutes – Orlando WGM • Motion to accept Orlando, FL WG minutes by John Hatem and seconded by Scott Robertson. Motion passed 8 yes: 0 no; 0 abstains 4. Review of 3 year work plan • For next ballot cycle: • Medication Dispense and Supply Event Release 2 • Medication Order Release 2 • Institutional Use Cases Action: Melva to update project plan based on discussion Action: John to forward Melva his document 5. SWOT and Mission/Charter review • To be reviewed in a quarter later this week Adjourned 3:00 pm Pacific Action Summary • See action items identified in Minutes/Conclusions Reached section Next Meeting/Preliminary Agenda Items • None

San Diego, CA, USA; Monday 12 September 2011; Q4 Attendees: John Hatem Oracle USA john.hatem@oracle .com

Hugh Glover Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk Tom de Jong HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl Julie James Blue Wave UK Julie_james@bluewaveinformatics.co.uk Line Saele HVIKT Norway Line.sele@helse-vest-ilet.no Melva Peters (scribe) Gordon Point Informatics CA Melva.peters@gpinformatics.com Derrick Evans Allscripts USA Derrick.evans@allscripts.com Jean Duteau Gordon Point Informatics CA Jean.duteau@gpinformatics.com

Fumika Kubota Pharmaceuticals and Medical Device Agency JP Kubota-fumika@pmda.go.jp Telonis Panagiotis European Medicines Agency UK Panagiotis.Teleonis@ema.europa.eu

Agenda Topics • Overview of Pharmacy and CPM Domain Supporting Documents • None Minutes/Conclusions Reached 1. Introduction to Pharmacy and CPM Domain • Overview provided by Hugh Glover Adjourned 5:00 pm Pacific Action Summary • None Next Meeting/Preliminary Agenda Items • None

San Diego, CA USA; Tuesday 13 September 2011; Q1 Joint with O&O

THIS WAS A JOINT MEETING WITH O&O SO THESE ARE NOTES ONLY. 1. Nutrition Ballot Reconciliation - DAM • This will be re-balloted • Will include a business process flow of how the nutrition orders work • Information is mostly complete – dynamic model needs some work • Target January 2012 ballot for complete DAM – will also include some additional data • Will start on logical model project • Will include Pharmacy WG in these discussions about using Pharmacy models 2. Review of PSS – PRODUCT LOGISTICS • Version 2.9 standard • O&O owns Chapter 17 – so will be the sponsor of this Project • Target date May 2012 WGM • Approved by O&O as a project 3. IHE/XDW Strategy Action: Tom to raise in Structured Document as a topic for Joint SDWG/Pharmacy WG meeting 4. Composite Order • Patrick provided an overview • Includes common pieces, but may not contain all of the edge cases • Updated to use current version of RIM and Datatypes R2 • Once next version is complete, Patrick will forward to Pharmacy and arrange a review session

San Diego, CA, USA; Tuesday 13 September 2011; Q2 Joint with O&O THIS WAS A JOINT MEETING WITH O&O SO THESE ARE NOTES ONLY. 1. CPM Governance • Link on CPM Governance page (http://wiki.hl7.org/index.php?title=CPM_Governance) This is a draft for comment: • Principles • The Common Product Model is freely available for any HL7 to modeller to use for representation of clinical products, devices, substances or any other material that has to be identified, named and have its manufacturing, packaging, licensing or composition specified. • Modellers are encouraged to use the existing CMETs or if they are inappropriate to derive new CMETs from the core model. Alternatively CPM structures may be used as a pattern to follow. CMETs are much the preferred route since this makes change management easier and makes all CPM modelling visible from one source. • Where a modeller wishes to create a new CMET they should follow the procedure below to ensure that the CMET generated is not already covered by existing CMETs and that the concepts involved have been correctly used. • Procedure • Notify the OO list that a new CMET is required. • Time will be allocated on conference calls or at working meetings to ensure the requirements for the new CMET are discussed and understood. • The outcome of the discussion will be either agreement that a new CMET is required or agreement that an existing CMET is adequate. • Where a new CMET is required it should be developed and balloted as normal. • When a number for the new CMET is required the keeper of CMET numbering will only issue one with the confirmation of OO that the above procedure has been followed and a new CMET has been approved. • There was agreement that the draft governance was acceptable • Motion to adopt policy for CPM Governance on Wiki • Hugh moved/Gunther seconded • Carried: 3 abstain; 0 against; 20 in favour Action: Creation of a DMIM for CPM from which other RMIMs are proper constraints – Hugh 2. CPM Questions • 1 – Use case for national authority – territory that scopes the agency is not the same as the territory where authorization is valid in • Single authorization • 2 – Add a relationship from marketing act to approval • Gunther to edit comments • 4 – use case for SDLOC – need to be able to describe an organization • not just single address, but also also other addresses in other roles (eg location where safety location is processed which may not be the location where marketing approval is registered at) • “bricks and mortar locations” within an organization – it is a place Action: Model the requirements in the two ways suggested (as organizations vs as locations and then review. Will make a decision after the review (Julie). This will be brought back to an O&O conference call • CNID – Action: Julie to take away and see if Issue can be used. 3. Harmonization Proposals • It is expected that there will be proposals needed for concept sub-domains. Julie will post any requirements to the CPM Wiki. 4. Planning for January 2012 WGM • We will plan a joint meeting for next WGM – Tuesday Q2. There will not be a joint meeting Tuesday Q1.

San Diego, CA, USA; Tuesday 13 September 2011; Q3 Attendees:

John Hatem Oracle USA john.hatem@oracle .com

Line Saele HVIKT Norway Line.sele@helse-vest-ilet.no Tom de Jong (Chair) HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl Melva Peters (scribe) Gordon Point Informatics CA Melva.peters@gpinformatics.com Fumika Kubota Pharmaceuticals and Medical Device Agency JP Kubota-fumika@pmda.go.jp Ana Estrerich PHAST FR Ana.estelrich@phast.fr Jean Duteau Gordon Point Informatics CA Jean.duteau@gpinformatics.com

Julie James Blue Wave UK Julie_james@bluewaveinformatics.co.uk Hugh Glover Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk Terse Halvorson HL7 Norway Norway th@vali.no

Charles Rica ASIP Santi FR Charles.rica@sante.govv.fr

Caryn Harris Orion Health CA Caryn.harris@orionhealth.com Tim McNeil SureScripts USA Tim.mcneil@surescripts.com

Derrick Evans Allscripts USA Derrick.evans@allscripts.com

Agenda Topics • Review of Action Item List • Ballot Reconciliation – Medication Knowledge Base Query • Ballot Reconciliation – Medication Statement and Administration Supporting Documents • Ballot comment spreadsheets Minutes/Conclusions Reached 1. Review of Action Item List • Patient Generic Query items – discussion of whether these items should be closed. We will leave these items as open for now. • Patient Drug Contraindication Query – discussion of whether these items should be closed. We will leave these items as open for now. Action: Melva to talk to Dave Hamill about our open projects Action: John and Jean to review Action List and bring back to WG 2. Ballot Reconciliation – Medication Knowledge Base Query • Ballot passed • See consolidated ballot spreadsheet. Action: Confirm if this topic needs to be re-balloted rather than re-published – given that we are adding in new grouper and semantic text (Jean) Action: Register CPM CMETs Action: Review “semantics text” and update as appropriate to reflect attribute. Action: Will support the storyboard by reintroducing grouper element that will make characteristic optional. 3. Ballot Reconciliation – Medication Statement and Administration • Ballot Passed Action: Any items from ballot disposition tagged as “considered for future use” will be added to Action Item. (John Adjourned 3:00 pm Pacific Action Summary • See action items in Minutes/Conclusions Reached section Next Meeting/Preliminary Agenda Items • None

San Diego, CA, USA; Tuesday 13 September 2011; Q4 Attendees: John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Tom de Jong HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl Melva Peters Gordon Point Informatics CA Melva.peters@gpinformatics.com Fumika Kubota Pharmaceuticals and Medical Device Agency JP Kubota-fumika@pmda.go.jp Julie James Blue Wave UK Julie_james@bluewaveinformatics.co.uk Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk Tim McNeil SureScripts USA Tim.mcneil@surescripts.com

Agenda Topics • SWOT review • Mission and Charter Review • Ballot Disposition Votes Supporting Documents • SWOT document • Mission and Charter – HL7 website and April 2010 document • Ballot reconciliation spreadsheets Minutes/Conclusions Reached 1. Update SWOT document • Melva Peters update the SWOT document with input from the group. Action: Melva to post to Pharmacy List Serve Action: Agenda Item will be added for next Teleconference 2. Update Mission Charter • Working from April, 2010 updated document, the group edited the Mission charter and Melva will fine tune the document and post to Subversion and send out to the list for a future conference call discussion and approval. Action: Melva will update, create final copy for discussion and we will follow up on a future conference call. 3. Ballot Disposition Votes • Medication Statement motion by Tom de Jong to address Margie Kennedy issues. Seconded by Tim McNeil. Vote: 6 for/0 against/0 abstains • Medication Statement to address Nelson Tsing issues. Melva Peters raised the motion to accept the dispositions. Julie James seconded. Vote: 6 for/0 against/0 abstains Action: Contact Nelson Tsing from the VA to get more clarity on his ballot comment. • Medication Statement to address Scott Robertson issues. Tim McNeil raised the motion to accept the dispositions. Melva Peters seconded. Vote: 6 for/0 against/0 abstains • Medication Statement to address Austin Kreisler issues. Melva Peters raised the motion to accept the dispositions. Tim seconded. Vote: 6 for/0 against/0 abstains • Medication Knowledge Base Query to address issues raised by Melva Peters in her ballot comments. Tom de Jong motioned to accept the dispositions, Julie James seconded. Vote 6 for/0 against/0 abstains • Medication Knowledge Base Query to address issues raised by Austin Kreisler and Keith Boone. Julie James motioned to accept the dispositions, Melva Peters seconded. Vote 6 for/0 against/0 abstains Adjourned 5:00 pm Pacific Action Summary • See actions identified in Minutes/Conclusions Reached section Next Meeting/Preliminary Agenda Items • Review and approval of SWOT • Review and approval of Mission and Charter

San Diego, CA, USA; Wednesday 14 September 2011; Q1 Attendees: John Hatem Oracle USA john.hatem@oracle .com

Tom de Jong HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl Melva Peters Gordon Point Informatics CA melva.peters@gpinformatics.com Fumika Kubota Pharmaceuticals and Medical Device Agency JP kubota-fumika@pmda.go.jp Julie James (Scribe) Blue Wave UK julie_james@bluewaveinformatics.co.uk Hugh Glover (Chair) Blue Wave UK hugh_Glover@bluewaveinformatics.co.uk Tim McNeil SureScripts USA tim.mcneil@surescripts.com

Line Saele HVIKT Norway line.sele@helse-vest-ilet.no

Christof Gessner HL7 Germany Germany gessner@mxdx.de Thierry Geraud IHE Pharmacy / Phast France thierry.geraud@carefusion.com Rik Smithies HL7 UK UK rik@nprogram.co.uk Scott Robertson Kaiser Permanente USA scott.m.robertson@kp.us

Derrick Evans Allscripts USA derrick.evans@allscripts.com

Charles Rica ASIP Santé France charles.rica@sante.gov.fr Ana Estelrich Phast France ana.estelrich@phast.fr Stephen Chu NeHTA Australia stephen.chu@nehta.gov.au Perry Vonk SAIC USA vonkp@saic.com Tim Buxton EMA UK Tim.Buxton@ema.europa.eu Vince McCauley Standards Australia Australia vince,m@mccauleysoftware.com

Agenda Topics • IHE Pharmacy/epSOS Update • IHE Medication Documentation/profile topic Supporting Documents • IHE medication profile document Minutes/Conclusions Reached 1. Status Update from IHE Pharmacy / epSOS • epSOS • The epSos Project aims to have intra-European connectivity for prescriptions and patient summary. It uses the CDA standard. [At the time of the start of the epSOS project there was no IHE Pharmacy profile.] • All the current efforts in the project are focused on the deployment of the specifications – getting everybody in the participating nations on board. There may be some new requirements, but not at present. • Implementation is now devolved to the participating countries – to developing their national contact points (NCPs) which should then connect the national (ePrescribing) infrastructure. • IHE • Developing the "Supply chain/logistics" white paper and "Medication documentation" white paper are main areas of work. There is also the infusion pump work which is using HL7 V2. • We noted that creating a white paper for a new topic is useful approach before working to create specifications, to gather together business requirements and thoughts on the domain. 2. Overview of IHE medication documentation /profile topic • The IHE Medication Documentation White Paper (circulated to the Pharmacy list serve by Tom) is looking to produce guidelines to distinguish and interpret the different building blocks for medication information. It will discuss how to gather the information, how to reconcile it and (possibly) how to present it to the user in a view for them to use – although this latter (data representation) is usually out of scope of IHE. • This is likely to be broken down into sections for guidelines for the different steps of the medication process – prescribing information, dispensing information etc. • The guidelines should be architecture agnostic. • The white paper could lead to a change control for the PCC (Patient Care Co-ordination) profile or on the Reconciliation profile. There are no deadlines for the white paper process; development is usually driven by levels of vendor interest. The white paper is currently at the "brainstorming" level. • What can HL7 contribute to this paper: we have definitions of many of the concepts involved: prescriptions, dispenses, etc. and of the actors involved in the process. We also have some architecture patterns for the processes that we can contribute, rather than these having to be documented de novo. 3. (Other) Potential topics for joint HL7/IHE meeting • The Medication Documentation white paper will be a main area of discussion; Julie will give presentation based on what she has in her thesis to date and Tom will share the slides that he showed describing information flows into a Medication Document in this meeting. • We would probably like to aim for a joint white paper with IHE Pharmacy. • Showing – might be useful for the joint meeting • Also possible agenda topics include: • Infusion topic (IVs via pumps); • Substitution; • Showing the different medication-related models that exist in HL7 – CPM, Clinical Statement, Pharmacy Messages, CDA/CCD; • Roadmap for future co-operation 4. XDW • The bulk of the relevant discussion for this topic took place in the joint meeting with O&O Q1 Tuesday. • XDW is used in the CDA paradigm to manage workflow in a document that is separate from the CDA document. It record actions and gives instructions appropriate to an accompanying (CDA) document. It also has accompanying business rules to make it work. • The XDW specification has recently been re-written and put out for public consultation in IHE in order to get it into the profiles for Connectathon, but the timing is such that it may not make it through in time for the N American Connectathon. • XDW is a generic approach for any "workflow", IHE Pharmacy can then decide whether to use it or not to describe Pharmacy workflow. 5. ISO Business Requirements for a Dose Syntax • This – the business requirements for a Dose Syntax - has been accepted as a new work item for TC215WG6. • Scott is now the official ISO lead, although this has possibly not been communicated to the WG6 secretariat; Tim will sort this out with Shirin (the NEN secretariat). Adjourned 10:30 am Pacific Action Summary • None Next Meeting/Preliminary Agenda Items • None

San Diego, CA, USA; Wednesday 14 September 2011; Q3 Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk Tom de Jong (Chair) HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl Scott Robertson Kaiser Permanente USA scott.m.robertson@kp.us Julie James Blue Wave UK Julie_james@bluewaveinformatics.co.uk Thierry Geraud Care Fusion/IHE Pharmacy / PHAST FR Thierry.geraud@carefusion.com Melva Peters Gordon Point Informatics CA Melva.peters@gpinformatics.com Derrick Evans Allscripts USA Derrick.evans@allscripts.com Fumika Kubota Pharmaceuticals and Medical Device Agency JP Kubota-fumika@pmda.go.jp Tim McNeil SureScripts USA Tim.mcneil@surescripts.com

Ana Estrerich PHAST FR Ana.estelrich@phast.fr Jean Duteau Gordon Point Informatics CA Jean.duteau@gpinformatics.com

Isabelle Davias Sanofi US Isabelle.davias@sanofi-aventis.com

Agenda Topics • Forward Planing • Other Planning Supporting Documents • 3 year planning document Minutes/Conclusions Reached 1. Forwarding Planning discussion • Melva Peters reviewed our 3-year plan. We made adjustments to individual projects in the plan. In addition we have added new projects, made updates to existing projects, closed projects in the 3-year plan. • See Melva’s spreadsheet for details. • Motion put forth by Scott Robertson to close AfMS project, Shared Messages, Device projects. Seconded by John Hatem. Vote 13 for/0 against/0 abstain Action: Tom de Jong will create the project scope statement that will “examine pharmacy use cases to determine how our requirements can be met with CDA templates and identify extensions that may be needed”. 2. Other Planning • No change in weekly conference call times – Monday 4:00 PM Eastern. • Out of Cycle Meeting – General discussion on the agenda. Goal is to target the materials we produce in the OOC for the January ballot. To be discussed during out of cycle in order to assess if this is possible to accomplish in the January ballot. • Room requirements for next meeting – Tom dJ will work on this. • Post meeting survey – Tom dJ will fill this out. • Sandbox – Jean has confirmed that the Pharmacy group will continue to use Dropbox for early previews of our content. Action: Send out a survey regarding HL7 v2.x use of Pharmacy messages to the list serv. The answers will be used to guide us in our HL7 v3 institutional orders out of cycle work. Adjourned 3:00 pm Pacific Action Summary • See action items identified in Minutes/Conclusions Reached section Next Meeting/Preliminary Agenda Items • None


San Diego, CA, USA; Wednesday 14 September 2011; Q4 Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk Tom de Jong (Chair) HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl Scott Robertson Kaiser Permanente USA scott.m.robertson@kp.us Julie James Blue Wave UK Julie_james@bluewaveinformatics.co.uk Thierry Geraud Care Fusion/IHE Pharmacy / PHAST FR Thierry.geraud@carefusion.com Melva Peters Gordon Point Informatics CA Melva.peters@gpinformatics.com Derrick Evans Allscripts USA Derrick.evans@allscripts.com Fumika Kubota Pharmaceuticals and Medical Device Agency JP Kubota-fumika@pmda.go.jp Tim McNeil SureScripts USA Tim.mcneil@surescripts.com

Ana Estrerich PHAST FR Ana.estelrich@phast.fr Tim Buxton EMA UK Tim.buxton@ema.europa.eu

Isabelle Davias Sanofi US Isabelle.davias@sanofi-aventis.com Frank McKinney Frank McKinney Group US fm@frankmckinney.com


Agenda Topics • IDMP • Ballot Comment Review – IDMP • GS1 Overview Supporting Documents • IDMP Ballot Comment Spreadsheets Minutes/Conclusions Reached 1. Update on IDMP • Tim Buxton provided an update on IDMP 2. Ballot Comment Review on IDMP • Hugh Glover reviewed the IDMP ballot comments and dispositions. See the Ballot spreadsheets for details. • Motion by Tim Buxton to accept dispositions for the IDMP ballot. Melva Peters seconded the motion. Vote: 11 For : 2 abstained : 0 against the vote passed. 3. GS1 Overview • Christian Hay is providing an update on GS1. There were a number of discussions related to supply chain, pharmacy materials and the use of this information during the clinical processes related to medication processes e.g. ordering, administering. • Christian is also soliciting for participation in the GS1 work. Hugh was asking for more details on what this work would involve e.g. conference calls, etc. 4. EHR – Pharmacy Related Profiles Update • Scott Robertson provided a brief update on the EHR functional profile work. He identified that there is a need for subject matter experts to provide input into their work. The profiles are used to guide a vendor or a purchaser of software to understand what functions may be included in software or what the purchaser may want to look for. These same profiles may also be used to provide input into national requirements e.g. meaningful use in the US. Adjourned 5:00 pm Pacific Action Summary • None Next Meeting/Preliminary Agenda Items • None

San Diego, CA, USA; Thursday 15 September 2011; Q1

Attendees: John Hatem Oracle USA john.hatem@oracle .com

Hugh Glover (Chair) Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk Tom de Jong HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl Scott Robertson Kaiser Permanente USA scott.m.robertson@kp.us Julie James (Scribe) Blue Wave UK Julie_james@bluewaveinformatics.co.uk Thierry Geraud Care Fusion/IHE Pharmacy / PHAST FR Thierry.geraud@carefusion.com Fumika Kubota Pharmaceuticals and Medical Device Agency JP Kubota-fumika@pmda.go.jp Tim McNeil SureScripts USA Tim.mcneil@surescripts.com

Jean Duteau Gordon Point Informatics Canada Jean.duteau@gpinformatics.com

Perry Vonk SAIC USA vonkp@saic.com

Nicolas Canu PHAST France nicolas.canu@phast.fr Agenda Topics • Pharmacy Implementation Guide Supporting Documents • None Minutes/Conclusions Reached 1. Pharmacy Implementation Guides • Project Scope Statement is now updated and approved. • Hugh reviewed the Pharmacy Wiki Implementation Guide content in its current format/state. He showed the ballot introduction and highlighted areas that need work on e.g. the Timing information. • Hugh showed what he has done on the wiki for displaying information in different sections. He referenced work similar to this i.e. MnM Hot Topics page. There remains work on formatting and other tidying up tasks, but he didn’t think it would be too difficult. • The current Category:RX Implementation Topic is located here: 

http://wiki.hl7.org/index.php?title=Category:Rx_Implementation_Topic

• You can have other index pages to present pages in different sequences. • Who is our target audience? The developer of the jurisdictional implementation – not the individual software developer. • People who want to implement Pharmacy messages in a trading partner situation • A common starting point is that somebody who needs to use the Pharmacy content has been told "you need to implement pharmacy messages". • One of the first questions for an implementer is what architecture am I working under? This will determine the set of messages out of the total that need to implemented. • Suggest that they might draw out a business process model to see the interactions – both for yourself and for your partner(s) focusing on the major areas – how to do "prescribing"; how to do "dispensing" • Implementers will go to their own implementation guides, not to HL7 International, for detailed implementation guidance – so not to the level of snippets of xml. • Other topics/ideas to include in the implementation guide: o timing specifications o Common Product Model o Landing page – architectures on one axis, processes on other. If you know both, can go directly to the set of interactions. If you don't know, then you can go to the blurb about each, to find out more. o Once you get to a specific message payload, need to map to your own business elements – and to describe some of the details about how to do that. • Review of External Implementation Guides o Tom de Jong reviewed the Nictiz Medication Process implementation guide.  It starts with storyboards. Note that by this point the architecture is assumed; there is a separate document about the overarching architecture for the message flows.  Use links to the ballot – don't duplicate its content.  Have separated the dynamic from the static – have a library of static data structures – basically CMETs  Separate section on dosage that is applicable to both prescribing and dispensing, and a detailed subsection on how to use GTS in dose timing, particularly pointing out the pitfalls and how to avoid them (using datatypes R1) o Jean Duteau reviewed the IG for Saskatchewan.  This guide was similar but includes state diagrams, conformance profiles for the particular ventor types (separate documents). Also clearly states what is different from the pan-Canadian implementation, and why.  In queries, there are a lot of choice of queries – discusses value of one over another.  Some xml snippets for some datatypes – e.g. II but not for GTS (use bounded PIVL) and vocabulary sets.  All our attribute descriptions are against the DMIM, and have cut-and-paste to RMIMs. The suggestion is that we move these to the wiki. This will provide readers with detailed information in a more accessible format that what is in the ballot.  Take RMIM picture and divide it up with business names over the classes (like in teaching examples) Action: Hugh will create more structure in the Pharmacy Wiki to help move the Implementation Guide work forward. Adjourned 10:30 am Pacific Action Summary • See action items identified in Minutes/Conclusions Reached section Next Meeting/Preliminary Agenda Items • None

San Diego, CA, USA; Thursday 15 September 2011; Q2 Attendees: John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Tom de Jong (Chair) HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl

Scott Robertson Kaiser Permanente USA scott.m.robertson@kp.us

Julie James Blue Wave UK Julie_james@bluewaveinformatics.co.uk

Thierry Geraud Care Fusion/IHE Pharmacy / PHAST FR Thierry.geraud@carefusion.com

Tim McNeil Surescripts USA Tim.mcneil@surescripts.com

Perry Vonk SAIC CA vonkp@saic.com

Patrice Kuppe Surescripts US Patrice.kuppe@surscripts.com

Agenda Topics • Action Item List Review Supporting Documents Minutes/Conclusions Reached 1. Action Item List update • John Hatem reviewed all action items and with input from attendees, closed several items. Notes were also added for several items. • See the updated Action item list for more details. Adjourned 12:30 pm Pacific Action Summary • None Next Meeting/Preliminary Agenda Items • None

San Diego, CA, USA; Thursday 15 September 2011; Q3 Attendees:

John Hatem Oracle USA john.hatem@oracle .com

Hugh Glover (Chair) Blue Wave UK hugh_glover@bluewaveinformatics.co.uk Tom de Jong HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl Julie James (Scribe) Blue Wave UK julie_james@bluewaveinformatics.co.uk Thierry Geraud Care Fusion/IHE Pharmacy / PHAST France thierry.geraud@carefusion.com Tim McNeil SureScripts USA tim.mcneil@surescripts.com

Jean Duteau Gordon Point Informatics Canada jean.duteau@gpinformatics.com

Panagiotis Telonis European Medicines Agency UK Panagiotis.Teleonis@ema.europa.eu

Fumika Kubota Pharmaceuticals and Medical Device Agency Japan kubota-fumika@pmda.go.jp Agenda Topics • Ballot Preparation • Electronic Services Committee Feedback • Drug Knowledge query Ballot Base Feedback • New Action Items Supporting Documents • None Minutes/Conclusions Reached 1. Ballot Preparation • The group confirmed that we aim to complete the requirements and use cases for the Institutional messages for the next ballot. • We looked at the February OOS notes (on the wiki) that mention existing documents; we need to gather these together and review them on the TC 26th September. Action: Hugh: To gather together all the institutional materials that we have. 2. Electronic Services Committee Feedback (Jean) • The Electronic Services Committee liked "Dropbox" – HQ might buy an enterprise license for this (Jean and Lorraine C to investigate costs). 3. Drug Knowledgebase Query Ballot Feedback (Jean) • Drug Knowledgebase Query: we have changed the model as part of the reconciliation process, so this is deemed substantive and we do need to re-ballot. 4. New Action Items • Fuzzy medication statements (originally from ICSR use cases, but also occurs in medication history) – "I took medication x for only about 30 days or so". We agreed we should be able to persist a text string for this type of inexact statement. Action: Tom to list requirements for supporting this. • How to use Act Priority Code and how to model "PRN dosage". "PRN" should be modelled using the pre-condition construct. However, there may be confusion as there is a PRN concept in the current HL7 vocabulary (code system) for Act Priority. This vocabulary is not well structured – it has concepts in it that do not fit the concept domain (e.g. "UD – used as directed). The concept domain of ActPriority Description is "A code or set of codes (e.g., for routine, emergency,) specifying the urgency under which the Act happened, can happen, is happening, is intended to happen, or is requested/demanded to happen. Discussion: This attribute is used in orders to indicate the ordered priority, and in event documentation it indicates the actual priority used to perform the act. In definition mood it indicates the available priorities. It was suggested that we might submit a harmonisation proposal such that "UD" and "PRN" and "Pre-op" be removed from the Act Priority code system; alternatively, to propose a Pharmacy value set (possibly from Snomed® CT – child of SCTID 272125009 – priorities (Type:= qualifier value)). Action: Tom to prepare a harmonisation proposal for Act Priority Code clean-up. • Datatypes R2 has re-introduced EIVL – Event-related periodic interval. It is possible now to describe both frequency and EIVL. EIVL consists of a code and an offset – to allow the description of "40minutes before bedtime" – "40minutes" is the offset and "before bedtime" is the (coded) description of the regular event of daily life. We should no longer rule out the use of EIVL in specification of dosage instructions. Action: Tom to prepare a harmonisation proposal for additional EIVL concepts. Action: To add to the Dose Syntax/Timing information about how to use EIVL correctly (see also Implementation Topics To Do list). • Name Part Qualifiers (recent list discussion). Can the R2 (IDMP) Name Parts be used in datatypes R1.1 (pre-adopted parts). In R2, it is acceptable to leave the "type" attribute of EN blank, whereas in R1 this is not possible, and "Given" has been used. Action: To add something to the Implementation Guidance as to how to use Name Parts for medicines. Action: Hugh/Julie to follow up with Mead to make sure his use case is clearly understood and to find a solution. • We have confirmed that posting Minutes to the wiki is sufficient for requirements. But it is important that everyone can find the Minutes and therefore we should ask HQ to have a link from the HL7 website Pharmacy page to the Pharmacy wiki page (just like O&O). Action: Hugh to ask HQ to have a link from the HL7 website Pharmacy page to the Pharmacy wiki page. Adjourned 3:00 pm Pacific Action Summary • See action items identified in Minutes/Conclusions Reached section Next Meeting/Preliminary Agenda Items

San Diego, CA, USA; Thursday 15 September 2011; Q4 Attendees:

John Hatem (Scribe) Oracle USA john.hatem@oracle .com

Hugh Glover Blue Wave UK Hugh_Glover@bluewaveinformatics.co.uk

Tom de Jong (Chair) HL7 Netherlands/ NICTIZ Netherlands tom@nova-pro.nl

Julie James Blue Wave UK Julie_james@bluewaveinformatics.co.uk

Thierry Geraud Care Fusion/IHE Pharmacy / PHAST FR Thierry.geraud@carefusion.com

Mead Walker US dmead@comcast.net

Perry Vonk SAIC CA vonkp@saic.com

Gerald Beuchelt MITRE Company US beuchelt@mitre.org

Harry Solomon GE US Harry.solomon@ge.com

Bo Dagnall HP Enterprise Services US Bo.dagnall@hp.com

Ana Estelrich PHAST FR Ana.estelrich@phast.fr

Ken Rubin US Robert Warden UK rpworden@me.com

Ann Vassil Peytchev Epic US vassil@epic.com


Agenda Topics • Open Discussions/New Business Supporting Documents • None Minutes/Conclusions Reached 1. Open Discussions / New Business • SOA Discussion • Ken Rubin presented an idea related to an abstract content profile. hData and other components were discussed. An idea for how to use specific technology and retrieve data using a service that may be defined using SAEF processes. Both Ken (SOA) and Gerald (hData) spoke about contributing resources to this effort. • SOA behavior e.g. get, put, etc.( not functional dynamic workflow) defined by the SOA team • Pharmacy WG would provide content/payload and domain experience. • Ana suggested that we would not want to include the IHE white paper content in this project. • hData profile is specified by Gerald and others on his team • Ken has a Cerner proposal related to this suggested use case. • General discussion about what specific content we would provide. • Hugh expressed that BlueWave is interested in this project. • Action Item: Hugh G will serve as the Pharmacy lead for the SOA project. • Ken Rubin motioned to accept an agreement in principle to work on pharmacy hData content profile to target May, 2012 ballot. Seconded by Hugh Glover. Vote: 11 0 4 • Radiographic Contrast Agents • Harry Solomon is proposing management of radiographic contrast agents. • This is a HL7 version 2.x proposal. • Prior to administering the contrast, we want to bar code the contrast info. We need a query – greenfield query. • Point of administration contraindication checking at the time of administration. This is also a query. Contraindication checks ‘may’ include drug-drug, drug-drug allergy, drug – lab test checking. • Discussion about if we can address both the first proposal (SOA) and this proposal together. General impression is that while this second proposal may use ‘some’ elements of the SOA proposal, the radiographic proposal is more complex and will require additional services ( I think). This does not prevent us from going forward. • Broader discussion on how we can include clinical decision support and SOA services together in a single project. • Julie made the point that radiographic systems don’t have the same clinical decision support functions that are found in clinical systems that include this same functionality. • Action Item: Harry Solomon has the action item to get clinical decision support, pharmacy, SOA and diagnostic imaging all on a call to discuss this in more detail. • Harry S raised another issue with radiopharmaceuticals. Workflow, and information management, terminology, dosing measured on infusion into scanners, reporting doses to radiologists. This is a separate topic from the other radiology topic. • Green Pharmacy • Robert Warden presented a case for SIMBAA simplified model based application architecture. This approach simplifies the RMIM into a simpler class model. Robert demonstrated this with an example model for Patient and the attribute administrativeGender. He was able to create business names and preserve the ability to generate a fully specified v3 message structure and / or a green Pharmacy message structure. • General discussion about “Green” healthcare content. Action: Contact Bob Dolin to assure we are in the loop when green CDA covers Pharmacy content.

Adjourned 5:00 pm Pacific Action Summary • See action items identified in Minutes/Conclusions Reached section Next Meeting/Preliminary Agenda Items • None

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