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Date:  

Quarter: Q1

Agenda Topics

  • Finalize Agenda
  • Determine Reps to other quarters
  • Discuss Hot Topics
  • Approve Minutes
  • Prep for Joint FHIR Meeting

Supporting Documents

Minutes/Conclusions Reached

  • Finalized Agenda (updated on Confluence)
  • Determined Reps to other quarters (updated on Confluence)
  • Discuss Hot Topics (added two to agenda updated on Confluence)
  • Approved Minutes - Motion: Daniel/John, 4-0-0
  • We have plans for Pharmacy resources that will discuss with FHIR
  • Reviewed Workflow mappings of MedDispense/Admin/Statement
    • Made some decisions on changing attributes to match the pattern

Action Items

Date:   

Quarter: Q2

Agenda Topics

  • Work on IDMP and MedicationKnowledge resources
  • Work on Medication Logical Model

Supporting Documents

IDMP wgm summary May 2019.pptx

Minutes/Conclusions Reached

  • Reviewed current status of resources
    • MedicationKnowledge has been approved by FMG - maturity level 1
    • FDA is using MedicationKnowledge in a proof of concept on a project
  • Jean has done a mapping from SPL to RegulatedMedicinalProduct
    • there are some issues, but also issues with mapping to MedicationKnowledge
    • Will need to be able to do an SPL mapping - will need to work through any issues
    • Jean and Rik to review
  • Discussion of why we don't have a "super" resource that includes all attributes that could be profiled down
    • This was not the direction provided by FMG
  • Review of names
    • suggest "ingredient" rather than "RegulatedProductIngredient"
    • ClinicalParticulars - may be a problem as a "plural"
      • potential names: ClinicalCharacteristics, ClinicalIssueDefinition, ClinicalPotentialIssue, Clinicalssue, ClinicalPotentialIssue, ClinicalUseIssue
      • Indication doesn't seem to fit
      • Prefer the use of "ClinicalUseIssue"
      • Motion:  Rik/Jean to accept the names and to take the resource proposals for RegulatedMedicinalProduct, RegulatedAdministrableProduct, RegulatedPackagedProduct, RegulatedManufacturedItem, RegulatedAuthorization, Ingredient, SubstanceDefinition, ClinicalUseIssue to FMG:  12-0-2
  • Will schedule joint meeting in Atlanta

Action Items


Date:   

Quarter: Q3

Agenda Topics

  • Review of Formulary IG

Supporting Documents

Minutes/Conclusions Reached

  • Review of meeting with BR&R with Grahame
  • Review of status of pharmacy FHIR material with Grahame
    • IG - how to run process for medication administration
    • IG - how to run home medication administration processes
  • Review of Formulary IG
    • da Vinci had started work on payer data exchange
    • within NPRM - requirement to exchange data - at member requests - payer to payer and payer to 3rd party app
      • in addition, requirement to exchange directory information as well as drug plan (pharmacy coverage)
    • MITRE had been tasked to do similar work with formulary
    • decided to add to work of daVinci work
    • daVinci has updated PSS to include
    • general agreement to do minimum set of requirements from CMS that are posted on GITHUB
    • work with Pharmacy to review MITRE work and propose changes
    • MITRE will create a reference implementation
    • AEGIS will create test suites
    • New IG will be done on R4
    • Use cases: Med Copays under Health Plan and Shopping for Health Plans
      • "what are my medications?" - out of scope for this IG
      • "tell me about medication[x] - in scope for this IG
    • Consumers may be patients or providers
    • Current IG - has represented formulary as a profile on List
      • uses US Core Medication - but should use MedicationKnowledge
      • not specific to a patient although there may be patient characteristics
    • Suggestions for IG
      • Include more descriptions about the actual use cases
      • use MedicationKnowledge
    • Will discuss being a co-sponsor for PDex and the owner of the IG
      • Motion: Pharmacy agrees to be a co-sponsor of the PDex project - Melva/Jean - 5-0-1
      • Motion:  Pharmacy will take ownership of the Formulary IG from FM pending confirmation from FM that there are no concerns - Jean/Bob - 6-0-0

Action Items

  • Jean Duteauwill discuss with FM the ownership of the IG - will update IG proposal
  • Melva Peters to submit NIB for Drug Formulary project

Date:   

Quarter: Q4

Agenda Topics

  • Project Management
    • Schedule for Conference calls
    • DMP
    • M&C
    • SWOT
    • Reaffirmation/Withdrawal of 5 year items
    • Forward Planning
    • Project Review
    • 3 year plan review
    • Action Item list review
  • FHIR Tracker items
    • Workflow Alignment Issues

Supporting Documents

Minutes/Conclusions Reached

  • Project Management
    • Schedule for Conference calls
      • for implementers - will join when they can, but can't consistently call in
        • a change in day/time will not help
      • ask implementers to try to make comments in tracker if they are interested or join if there is a specific tracker
      • will make time if they are able
      • no change
    • DMP
      • reviewed DMP
      • no changes proposed
      • Motion:  Accept the default DMP - Melva/Daniel - 3-0-0
    • M&C
      • no need to update - was reviewed in 2018
    • SWOT
      • no need to update - was reviewed in 2018
    • Reaffirmation/Withdrawal of 5 year items
      • need to publish/withdraw
    • Forward Planning
    • Project Review
    • 3 year plan review
    • Action Item list review
  • FHIR Tracker items

Action Items

Date:   

Quarter: Q1

Agenda Topics

  • CDA Pharmacist Care Plan (Zabrina)
  • FHIR Tracker items

Supporting Documents

PhCP Updates May 2019 HL7 WGM.pptx

Minutes/Conclusions Reached

Pharmacist Care Plan Implementation Guides

  • Zabrina presented on the Pharmacist Care Plan Implementation Guide
  • Over 20 vendors have implemented either the CDA or FHIR versions
  • May 2019 ballot had 10 comments with 1 negative on CDA and 9 comments with no negatives on FHIR
  • https://www.ecareplaninitiative.com/  has a lot of information about implementing the care plan documents

FHIR Tracker Items

  • #21301 - Rename MedicationKnowledge - MOTION: Not Persuasive Zabrina/Jean 4-0-0
  • #21237 - Fix the description of MedicationRequest.category - MOTION: Persuasive Jean/Daniel 4-0-0
  • #20673 - Discussed this item but we still don’t have enough information to make a decision.
  • Only tracker item left to discuss is #20184

Date:  

Quarter: Q2

Agenda Topics

  • Joint with FHIR-I

Supporting Documents

Minutes/Conclusions Reached

Meeting with FHIR-I

  • Ewout attended this quarter.  We reviewed all of the following items in Lloyd McKenzie's email:
  • Pharmacy has three resources we would like to be normative in R5.  Medication and Medication Request are on track with current work.  Medication Statement requires input from implementers regarding use in production systems.

  • No additional information beyond getting input on where Pharmacy resources are being used in production.  
  • Pharmacy is working on updating some of our bindings to terminology with our Vocabulary facilitator. 
  • Medication Knowledge target is 2; Medication Administration target is 3; Medication Dispense target is 4
  • Tracker items are being addressed and follow up with implementation folks also helps keep the Pharmacy resources on target
  • John Hatem has expressed interest to do IG review or potentially IG development to Ewout, Graham G and Melva Peters. 
  • Pharmacy is exploring IGs for Medication Administration for both inpatient clinical use and for patient facing applications, Active Medication List, Formulary and other topics.  

Other discussions this quarter

  • Gabby, a representative from Google discussed two issues ( she will create trackers for these items) she was interested in.  The first was the need to add a Location to the Medication Administration resource.  The second issue was related to how to identify active medications and use both Medication Request and Medication Statement consistently.  
    • John H mentioned that Pharmacy has identified this week the need to add a Location to the Medication Administration resource. 
    • John H and others also mentioned that Pharmacy will discuss this issue on Wednesday Q3.  
  • Michelle Miller provided a brief overview of the Wednesday Q3 discussion on how they have used Medication Statement and Medication Request and potential areas for improvement in the documentation.  


Action Items

  • none

Date:  

Quarter: Q3

Agenda Topics

  • FHIR tracker items
  • UNICOM by Julie James

Supporting Documents

Minutes/Conclusions Reached

  • Brief intro on Pharmacy FHIR resources for new folks attending
  1. 6 Pharmacy resources in total
  2. Medication, MedicationRequest, MedicationStatement (soon to be renamed to MedicationUsage), MedicationAdministration, MedicationDispense, MedicationKnowledge (just approved by FMG)
  • Different Medication code sets across the world
  1. G-standard in the Netherlands
  2. CCDD in Canada
  3. RXNORM in U.S.
  4. Etc.
  • UNICOM by Julie
  1. CEF (Connecting Europe Facility) project. As part of it, the framework will allow interfacing prescriptions and dispenses across countries in Europe regardless what local codes they use.
  2. SNOMED and HL7 BR&R are working on MedicinalProduct* FHIR resources to support IDMP.
  3. Rik's ppt file also has some good summary of the current state.
  4. <<IDMP wgm summary May 2019.pptx>>
  • Discussed a question regarding completed MedicatoinRequest and MedicationStatement
  1. Q: If there is a completed MedicationRequest, should there be a MedicationStatement with a status of "taken" kind?
  2. A: It depends on what's the problem you want to resolve. If you'd like to see what medication the patient should be taking, look into MedicationRequest resource, which includes domestic orders (order placed natively inside the system) and patient reported meds; If you'd like to see what medication the patient has taken, look into MedicationStatement which describes patient's usage of meds at a given point. In another word, a completed MedicationRequest doesn't necessarily mean a taken'ish MediationStatement. It's possible the request was marked as completed from a procedural or administrative perspective. A completed MedicationAdminstration does guarantee a taken MedicationStatement.
  3. We will be talking about how to represent active medication list in FHIR in Wed Q3. Welcome to join if interested.

Action Items

  • None

Date:  

Quarter: Q4

Agenda Topics

Supporting Documents

Minutes/Conclusions Reached

Action Items

Date:  

Quarter: Q1

Agenda Topics

  • Pharmacy Templates - MedicationDispense and MedicationAdministration
    • Ballot reconciliation
    • Plans to publish Medication Order and Medication Statement content
    • Questions from Lisa

Supporting Documents

ballotcomments_CDAR2_IG_PHARM_TEMPLATES_R1_D2_2019MAY_amalgamaged.xls

Minutes/Conclusions Reached

  • Pharmacy Templates - MedicationDispense and MedicationAdministration
    • Ballot reconciliation - see updated ballot spreadsheet
    • Plans to publish Medication Order and Medication Statement content
      • do we need to publish separately?
      • This is an STU update so we do not have to publish separately
      • MOTION:  Jean/Kai publish the new IG as an update to STU R1 - CARRIED - 11-0-0
    • Questions from Lisa
      • How to distinguish medication statement from administration
        • Have code=ASSERTION
      • Prescription
        • includes substance administration request and supply request
      • Dispense - is a supply request with a relationship to substance administration

Action Items

  • Melva Petersto create publication request for Templates
  • Melva Peters Add agenda to discuss move to CDA R2.1 in September 2019 

Date:  

Quarter: Q2 -CANCELLED

Agenda Topics

Supporting Documents

Minutes/Conclusions Reached

Action Items

Date:  

Quarter: Q3

Agenda Topics

  • Review 20673
    • See update in tracker item
  • Discussion of US Meds Implementation Guide - move to Release 4 
    • need to determine what the plan is for this
    • Will it be merged into US Core
      • if that is the case
  • Active Medication List - IG - plan for new project
    • History
      • DSTU2 - MedicationOrder resource - only scope - authorization to dispense
        • represented active med list using MedStatement
      • STU3 - renamed MedicationOrder to MedicationRequest
      • R4 - MedicationStatement - aligned with workflow patterns - removed separate status and notTaken attributes - merged
        • can't used MedStatement to represent medication list
        • forced to use MedRequest in R4
      • R5 - MedStatement is being renamed to MedicationUsage
    • MedicationStatement
      • Review of statuses and definitions - this is a status of the use of the medication and not about the "statement" about the medication
        • Active - medication is still being taken - okay
        • Completed - The medication is no longer being taken - need to update the 
    • For R4 - active medication list - can't use medicationStatement
      • MedicationRequest + MedicationStatement
      • MedicationStatements only
      • MedicationRequests only - consensus that this is the way it should be done for the US
    • Next steps
      • concerns that there may be some urgency for a IG for active medication list for R4
      • update to US Meds for R4
  • From Brett - no discussion
    • On MedicationStatement, how do I say I ‘intended’ to take but am ‘not-taking’?
    • What do you think about adding ‘takenAsOrdered’ as an extension to R4? (assuming impossible to add as first class element in R4)
    • How do you request and access the patient’s active medication list? (remember doing a lot of work on US Meds using MedicationStatement? I feel like with the changes to R4 I am not quite clear how this translates…other than query both)
    • In the future, I want to run through all the MedicationStatement and MedicationRequest statuses to create some examples – I get twisted a bit.…on US Meds trackers, all open ones should have proposed dispositions. I can prepare a block after the WGM.

Supporting Documents

Minutes/Conclusions Reached

Action Items

  • Michelle Miller and Melva Peters draft one-pager on agreement on active medication list, next steps including review of statuses, etc and clarifications needed for R4

Date:  

Quarter: Q4

Agenda Topics

  • Standardized Medication Profile Project Discussion
  • Review of global projects for Pharmacy implementations - with a focus on FHIR IGs
    • Implementations from NL - profiles and extensions

Supporting Documents

Minutes/Conclusions Reached

  • Standardized Medication Profile Project Discussion
    • This is a project NCPDP wanted brought to HL7
    • Impact Act in the US has defined a data attributes to standardized medication profile
      • mappings to Script standard - NCPDP
      • mappings to HL7 CDA templates and FHIR resources - HL7
    • will develop a white paper for ballot
    • full approval expected from NCPDP shortly - task force will be assigned
    • in parallel, HL7 will do some work
    • Concerns about how we work together - we can't join their calls
      • NCPDP will join our calls - 
      • "Medication Profile" - need to describe in introduction what it is and what it isn't
        • overlap with use of the term "profile" - IHE, FHIR
      • Concerns raised about how we actually work together with NCPDP on this joint project - the project has been approved at this point
      • Potential overlap with active medication list project/work
    • White paper will define the set of data elements should be part of a medication profile 
      • Jean will lead project calls that will NCPDP members together with HL7 members
    • Work that should be considered as part of this project
  • Review of global projects for Pharmacy implementations - with a focus on FHIR IGs
    • Implementations from NL - profiles and extensions
    • Would be good to create a Confluence page for capturing what countries/companies are implementing

Action Items

  • Tom de Jong to create a tracker item with the extensions that have been created
  • Melva Peters to create a Confluence page with a table
  • Tom de Jong to send link to NL profiles to Melva

Date:  

Quarter: Q4

Agenda Topics

Supporting Documents

Minutes/Conclusions Reached

Action Items

1 Comment

  1. Here is a link to the standard valueset-reference extension on the Coding data type: http://www.hl7.org/fhir/extension-valueset-reference.html