Meeting Information

Phone Number: +1 253 215 8782 US
Meeting ID: 532 857 1160

Find your local number: https://zoom.us/u/aemmW7I5Zo

Zoom: https://zoom.us/j/5328571160

Chair:  Michelle Miller
Scribe:  Michelle Miller

Attendance

Quorum (chair + 3) met?  Yes

Agenda

1. Agenda Review
2. Approve previous meeting minutes 2021-04-22 Patient Care FHIR Conference Call
   1. Motion:  Stephen/Thom
3. Pharmacy Joint Discussion
4. CareTeam.participant.role
5. JIRA change requests

Pharmacy / Patient Care Joint

BiologicallyDerivedProduct 

• For rhogam, it is stored in pharmacy, and ordered/administered like medications.  John Hatem believes this could be in scope of MedicationRequest/MedicationAdministration
• Blood products are requested from Blood Bank, not Pharmacy.  John asserts that the resource structure is similar (primary building blocks are there).  Russ asserts the difference is that decision support is before the fact (type, cross-matching, meeting criteria for patient's need) vs after the fact 
• Insulin is biologically derived, but understood to be a medication.  Vaccines are similar to medications, but have their own resource.
• Maternal breast milk (2 person check), but otherwise administered like a nutrition order, so "event" administration is captured as NutritionIntake, which has boundaries of oral / enteral .  (By contrast, TPN is an IV and is a Pharmacy MedicationAdministration)
• 3 different supply systems (blood bank, nutrition, pharmacy) - similar admin details captured

Start with  FHIR-8458 - Getting issue details... STATUS

Emma says blood transfusion is an entire workflow / process that may touch multiple resources.  The focus of the change request is on the transfusion of the blood product. 

MedAdmin is a specialized Procedure.

ServiceRequest / Procedure

• CON:  structurally missing dosage instructions

MedicationRequest / MedAdmin

• PRO:  structurally aligned

New Resource:  BloodProductAdministration 

• Conclusion is to create a new resource (similar to how NutritionIntake is a specialized admin resource) for safety.  Not part of a formulary of blood products (like meds are).
• Don't need Dosage data type since it is heavier than what's needed on the admin side (not talking about frequency/schedules for an event in the past).
• How order Blood Products?  Ask O&O if this falls within the scope of ServiceRequest?

Reviewing other use cases in  FHIR-12993 - Getting issue details... STATUS

1) Charting against any physicians order that is not a diag test or medication (activity, placement of a line/tube or drain (foley cath, IV)

2) Respiratory therapy charting against oxygen or ventilator

3) Rehab staff charting against the tasks they are performing (gait training...) -> may be part of Activity

4) Hemodialysis, peritoneal dialysis (this maybe considered a procedure...) → John Hatem will take an action item back to Pharmacy

5) A patient receiving Blood Products → new resource for BloodProductAdministration

Boundaries of BiologicallyDerivedProduct – when to use MedRequest/MedAdmin (dispensed from Pharmacy, e.g. rhogam) vs new BloodProductAdmin (blood bank manages supply) vs ServiceRequest/Procedure (e.g. organ transplant; lavage; do we need dosage added?)Hans Buitendijk

https://chat.fhir.org/#narrow/stream/implementers/topic/Radiation.20therapy

• John - diagnostic procedures - many variations (CT NM, MRI, etc.) - all have something (contrast agents) injected into body - they don't come from the pharmacy – could be a specialized nuclear pharmacy (external company) or compounded/made/prepared on site due to short life
• Stephen - treatment of cancer (oncology), gamma rays - drug therapy, chemotherapy, radiation therapy, light therapy should be Procedure/ServiceRequest
  • John Hatem will take back a suggestion to add a pertinent negative statement in Med* resources that Med* shouldn't be used for radiation therapy

CareTeam.participant.role

The Multiple chronic condition care plan project team is working on disambiguating a set of participant roles:

MCC care plan requirements:

• PCP
• Caregiver (unpaid – eg family)
• Caregiver (paid)Care Team Members, including:
• PCP
• Caregiver (unpaid – eg family)
• Caregiver (paid)

Example value set is missing non-professional care providers (i.e. caregiver unpaid, caregiver paid)

No JIRA exists yet...

The value set was changed post-R4 per  FHIR-20566 - Getting issue details... STATUS  (making a distinction between role vs relationship).

Should we narrow the codes to those that are "is-a" Person in the healthcare environment (person) SCTID: 303118004, so we are including some care giver (unpaid) roles?

Person in the healthcare environment (person) SCTID: 303118004

CDA value set includes the following, but FHIR doesn't

• 429577009 Patient advocate (person)
• 116154003 Patient (person)
• 133932002 Caregiver (person)

JIRA Change Requests Discussed

Patient Care Backlog

FHIR-31417 - Getting issue details... STATUS  - defer to next week

FHIR-29817 - Getting issue details... STATUS  – defer to next week

Adjourn

Adjourned at 6:35pm Eastern

Next Meeting

Preliminary Agenda Items

1. Agenda Review
2. Approve previous meeting minutes
3. JIRA change requests