Attendees

Discussion

FHIR IG vs Guidance Document

• During the HL7 May 2022 WGM, Pharmacy WG strongly suggested to create a FHIR IG rather than a guidance document.  The thought being that a FHIR IG would be more visible to the vendors using FHIR.
• Subsequently, I started the paperwork to alter the PSS and establish a FHIR IG
• It was pointed out to me that I agreed to the IG, but the group was not asked
• On the June 2nd Consultant Pharmacist Interoperability call, the group discussed the issue and decided to stay with a guidance document

Tasks/Status

Editorial Issues

•  review/change LTPAC-specific language to be more general (not within use cases) (sections 1-3) - Gary
  •  Sections 1-3
•  

FHIR IG Progress

• create FHIR development environment
  • establish FHIR repository
  • update PSS
    • draft 
    • Pharmacy approval
    • StrucDoc approval
    • open review
    • TSC approval
  • FHIR IG request
    • draft
    • Pharmacy approval
    • StrucDoc approval
    • open review
    • FHIR-I approval

Review for the correct mapping to CCDA and FHIR

• review header FHIR (section 5.1 / US Realm Header C-CDA_FHIR Mapping.docx) - compare to StructureDefinition-US-Realm-Header.html
• compare optionality in section 5 with optionality in FHIR Consultation Note
• review header CCDA content (section 5.1 / US Realm Header C-CDA_FHIR Mapping.docx) - compare to C-CDA US Realm Header
• compare optionality in section 5 with optionality in C-CDA Consultation Note
• review mapping FHIR ↔ CCDA (need to determine how to review)
•  

vocabulary and constraint issues

• identify all code sets/vocabularies (section 5) - where a field is assigned to a specific set of terms.  are these SNOMED, LOINC, HL7, NCPDP
• identify all constraints (section 5) - where a field is set to a (one and only one) specific value.  are these SNOMED, LOINC, HL7, NCPDP
•  

New use cases

• senior living 

• specialty pharmacy 
• pharmacy clinic (geriatric, CHF, diabetes, etc.)
• pharmacogenomics
• potentially Part D MTM:  CMR patient take-away format specified by CMS.  no consult note required, no regulatory requirement to communicate output to other clinicians; some?/most?/all? Programs have some type of reporting (similar to a consultation note).  Is this something to include/suggest in the document.

How does information blocking apply?

• the information must be provided (available) to the patient
• if appropriately asked (other than patient - payer, clinician, etc.), information must be provided
  • includes routine "search requests" for information that may be available
• is it "blocking" if the information is not generally released??  If you don't know where to send the information, is it blocking?
• information can/should/must be provided in a form that addresses USCDI data classes and clinical document types 
  • FAQs https://www.healthit.gov/curesrule/resources/information-blocking-faqs?options=2450b60a-e96a-4f4c-ab17-40aac81e40be
  • Consultation Note    11488-4
  • Discharge Summary Note    18842-5
  • History and Physical    34117-2
  • Procedure Note    28570-0
  • Progress Note    11506-3
  • Imaging Narrative    18748-4
• Do we need to include something about information blocking in our document?
  • 13 Jun 2022 not at this time

Any Other Business

Next meeting

Monday, June 27, 2022  1 pm ET / 10 am PT