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Date: Monday, January 14, 2019

Quarter: Q1


Agenda Topics

  • Finalize Agenda
    • Use of Z segments - Dennis
  • Reps to other WGs
    • Tuesday Q2 - O&O - Rep - TBD
    • Tuesday Q4 - EHR - Podiatry Functional Profile - Rep - Christof
    • Tuesday Q4 - PH - Rep - no rep
    • Thursday Q1 - PC - CarePlan - Rep - no rep
  • Assign Roles for Quarters
  • If we have new attendees, review
    • Overview of Pharmacy material - V2, V3, FHIR
    • Overview of Template work
  • Hot Topics
  • Approval of October 2018 WGM Minutes
  • Prep for Joint FHIR meeting

Supporting Documents

Minutes/Conclusions Reached

  • Introductions around the table
  • Finalize Agenda
    • Pharmacy Care Plan Update - Tuesday Q3 old entry
    • Updates on resources - changes/plans
      • discussing Z-segments - Dennis Tribble - Wed Q4
  • Reps to other WGs
    • Tuesday Q2 - O&O - rep TBD - John to talk to Hans to determine topics
    • Tuesday Q4 - EHR - Podiatry Functional Profile - Christof
    • Tuesday Q4 - PH - no rep available
    • Thursday Q1 - PC - CarePlan - no rep available (Scott might be available)
  • Assign Roles for Quarters
    • Scribe & chair - agenda updated
  • If we have new attendees, review - Yes, new attendees
    • Overview of Pharmacy material - 
      • V2 - Scott very high level history; Jean overview of v2 in Canada; Dennis Tribble introduction to his desired to address Z-segment issues
      • V3 - Jean provided history - good models, some tooling, but not used much (Canada and Netherlands, and they're moving to FHIR).  primarily institutional.  Large vendors (e.g., Oracle) likely have large repositories nominally based on V3.  v3 models used as a basis for FHIR (but models are not identical)
      • CDA- 
        • CDA medication entries (model) were developed by Structured Documents.  
        • IHE, ePSOS, ONC (US) use CDA documents.  Other countries also using CDA more - not for prescriptions, but for information exchange including International Patient Summary.
        • the CDA medication model does not follow v3 pharmacy models
      • Templates - Pharmacy has developed Templates to harmonize medication content across V3, CDA, and FHIR.  Currently in ballot reconciliation - a couple negatives to resolve
      • FHIR
        • conscious decision to focus on FHIR.  Only address v2, v3, CDA if specific issues identified
        • resources
          • MedicationRequest
          • MedicationDispense
          • MedicationAdministration
          • MedicationStatement (may get renamed to MedicationUse)
          • Medication
          • MedicationKnowledge
            • drug information.  more than what is needed for prescribing, dispensing, admin.  not as detailed as IDMP.
            • working with BR&R developing a logical model to define scope for different resources.  kind of a new version of Common Product
          • ImmunizationRequest (similar, not a pharmacy resource)
          • ImmunizationAdministration (similar, not a pharmacy resource)
          • ImmunizationRecommendation (similar, not a pharmacy resource)
  • Approval of October 2018 WGM Minutes
    • first use of Confluence
    • MOTION: to approve Jean/Daniel  11/0/1 CARRIED
  • Prep for Joint FHIR meeting
    • problem with links in example messages.  looks to be a tooling issue
    • maturity model guidance
      • what is needed to prove use "across the full perspective of use"
      • if implementation are based on STU3, can we call R4 mature?
    • discussion and review for further introduction to FHIR and FHIR Pharmacy for newer attendees
  • Hot Topics (not discussed)

Date: Monday, January 14, 2019

Quarter: Q2

Agenda Topics

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

Supporting Documents

Minutes/Conclusions Reached

  • Introductions
  • Goal is to have the resource proposals ready to submit to FMG by the end of the WGM
  • Review of Medication Scope Diagram
    • Rik Smithies to include all of the Pharmacy resources in the "Clinical Uses"
  • Review of Common Logical Model
  • Discussion of the number of resources that are being proposed
    • Authorization - may need to be a common resource - genericize this so it can be re-used
    • Need to tackle the device and other regulated products before maturity level can go too high
      • may want to collapse some
      • doesn't necessarily have to be done before they get to level 1 or 2
      • should include a note to the fact that resources can change based on feedback
      • need to analyze the full regulated product space that are relevant to FHIR - e.g. food, cosmetics, etc
    • Maybe collapse some together and profile them - Lloyd not pushing for this
  • Authorization - many things get authorized
    • consider "procedure"
  • Devices - Julie uncomfortable with the inclusion of devices - so broad - will delay things if we have to do this
    • need to have some analysis complete before they resources move to a higher maturity level
  • The number of resources seems to be problematic
    • can we put a hierarchy into the list rather than a flat list
    • navigation from the list is only one of the issues - more content, risk of ensuring that the boundaries have been defined
  • Grahame - some potentially re-usable - Interaction, Contraindication, Indication, Undesirable Effect
    • they are in context now, rather than standing alone
    • in general use - these will grow with metadata 
    • when resources made generic - will pick up metadata
    • could be 'datatypes'
      • but they are stand-alone
      • LM - doesn't see them as datatypes
  • Melva Peters Rik Smithies Jean Duteau Want to have work happening with CDS for joint submission for Interaction, Contraindication, Indication, Undesirable Effect
  • Rik Smithies Authorization - clinical study and product authorizations belong in BR&R
    • Recommend reaching out to Patient Care, O&O, PA and FM - looking at creating a resource for "authorization" and defining scope boundaries
  • Melva Peters to update MedicationKnowledge resource to use new resources
  • shown the validity of the overall resources - developed the collateral to describe
  • Still discussion of the sharing of the resources with other domains
    • go ahead and get approvals for MedicinalProduct, Packaged, etc - things that are not candidates for sharing with other domains
    • do not seek FMG approval for the Interaction, Contraindication, Indication, Undesirable Effect resources at this point
      • will talk to Clinical Decision Support
      • Melva Peters plan joint meeting with BR&R, Pharmacy and CDS for Montreal to discuss
  • Discussion of names - 
    • PharmaceuticalProduct - suggest change to "AdministrableProduct"
  • Review of content - needs to be understandable to implementers

Date: Monday, January 14, 2019

Quarter: Q3

Agenda Topics

  • Withdrawal Ballot Reconciliation
  • Reaffirmation Ballot Reconciliation
  • Discussion of "take indefinitely" (Request from Rik)

Supporting Documents

Consolidated WITHDRAW_IDMP_DOSE_R1_N1_2019JAN_20190107090236.xls

Consolidated WITHDRAW_IDMP_UNITSMEASURE_R1_N1_2019JAN.xls

Minutes/Conclusions Reached

Date: Monday, January 14, 2019

Quarter: Q4

Agenda Topics

  • FHIR Tracker Items

Supporting Documents

  • https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=<#####> (substitute tracker number for <#####>)

Minutes/Conclusions Reached

  • Discussed Pharmacy FHIR tracker items, in order.  Notable discussion and actions below
    • 19333 
      • specific to Australia, no representation during discussion.  
      • action item:  John Hatem will follow up with Vincent McCauley for clarity.  some things have changed (ProcedureRequest is now ServiceRequest) and been added.  need to see if current features will meet his need.
    • 19843
      • suggest use of supportingInformation for the related MedicationStatement(s).  this is currently available.  
      • Melva Peters Add "MedicationStatement" as an example to the supportingInformation description.
      • Motion: use supportingInformation, add "medicationStatement" to description.  Danielle/Scott 8/0/0 PASS
    • 19468
      • significant discussion.  but, really depends on how Argonaut is handling OTC MedStatements.  
    • 19469
      • why: MedicationStatement is really about medication use
      • need others to discuss further
    • 19640
    • 19910
    • 19913
      • asking Cerner & Epic on how they use "continuous" vs "iv bolus" vs "iv push" vs ..., or just a rate.  yes.  Epic has a frequency of "continuous" with rate in another term 
      • discussion on various 

Date: Tuesday, January 15, 2019

Quarter: Q1


Agenda Topics

  • Phast review of MedicationKnowledge
  • Work on MedicationKnowledge and alignment with Common Medication Model

Supporting Documents


Minutes/Conclusions Reached

  • Phast gave a presentation on the use of the MedicationKnowledge resource in their drug metathesaurus - IOmed
    • content contains Pharmaceutical Product, Medicinal Product, Medicinal Product Package, Dose Form, Route of Administration, Unit of Presentation, Substance
    • planning to add contraindications, interactions, administration guidelines, costs
    • Conclusions: scope and boundaries are unclear; Medication represents actual drug, which resource represents abstract drug; how to associate abstract medication with various manufactured drugs
  • A conversation ensued around the relationship of Medication and MedicationKnowledge.  Phast has assumed a closer relationship than the committee conceived.  The committee needs to clarify this relationship as well as determining how the hierarchy of medicines, including abstract products and dispensable products, should be represented using MedicationKnowledge and/or Medication resources.

Date: Tuesday, January 15, 2019

Quarter: Q2


Agenda Topics

Supporting Documents

Lloyd McKenzie email 1-14-2019.pdf

Minutes/Conclusions Reached

Discussion followed topics laid out in Lloyd's email of 1/14/2019

  • What resources can go normative in R5
    • maybe Medication
  • (3) What resources are candidates for moveing up
    • Medication M3 -  probably the best candidate to move up to M4
    • MedicatinDispense M2, MedicationAdministrationM2 - not ready to move up
    • MedicationRequest M3, MedicationStatement M3 - should be M4, need to document use
    • MedicationKnowledge might be candidate for M1
    • action cochair will communicate to Graham on moving resources up
  • (4) issues moving up through maturity model
    • Main issue is documentation of the "entire scope" of the resources
    • Some projects (e.g., Argonaut) may address this
    • Connectathon has some production systems which may serve a documented uses
  • (5) anticipated new IGs
    • no current plans for new IGs
    • Focused on MedicationKnowledge
      • meeting this week with BR&R and Graham clarify direction to move forward.
  • (6) no issues keeping up with trackers (because we have Melva Peters)
  • we don't have any pending ballots, so note on tightening requirements to ballot doesn't apply to us (at present)

other issues

  • links in our examples don't work.  this is a tooling issue.  
    • Jean Duteau will create a tracker for example link issue


Discussion on gForge 14469 

  • changing MedicationStatement to MedicationUse
  • brief discussion on rationale
  • Motion to accept by Jean, second by Jenni, vote 6-0-0.  Motion Passed

Date: Tuesday, January 15, 2019

Quarter: Q3

Agenda Topics

  • FHIR tracker items

Supporting Documents

  •  N/A

Minutes/Conclusions Reached

  • FHIR tracker items discussed this quarter
    • #19344 this appears to be a timing datatype issue. The discussion was where  in timing would a person enter/capture ASAP, STAT? Pharmacy believes that the proper change is to add a code for 'NOW' to EventTiming which is bound to Timing.repeat.when.  This would allow any use of Timing to specify now.  We are pushing this to FHIR-I for their review.
    • #19468 Motion: John/Dennis  Vote: 7-0-0  
    •  See gForge for details about tracker item resolutions. 

Date: Tuesday, January 15, 2019

Quarter: Q4


Agenda Topics

  • FHIR Tracker items

Supporting Documents

  • N/A

Minutes/Conclusions Reached

  •  FHIR tracker item discussed this quarter:  
    •  #19698  Motion: Dennis/Margaret  Vote:  6-0-0
    •  #19640 Motion: Jenni/Daniel Vote: 6-0-0  (FYI- during the discussion reviewed #19313 and #17169)
    •  see gForge for more details regarding these tracker decisions. 

Date: Wednesday, January 16, 2019

Quarter: Q1

Agenda Topics

  • Pharmacy Templates - finish ballot reconciliation and determine next steps

Supporting Documents

Minutes/Conclusions Reached

  • Review of the status of the Pharmacy templates project
  • Have a few outstanding negative comments - some have been referred to CDA Management Group
  • Still comments outstanding from Gay Dolin about use of extensions
    • List of extensions has been provided to Gay - waiting for her feedback
    • The extensions have been in use for many years in other projects - Kai has provided the background on the history of the extensions in the CDA Management Group this week
  • See updates to ballot reconciliation spreadsheet for 
  • Multiple attempts have been made to resolved the unperson requested comments - but have not been able to 
  • Next steps
    • Kai to go through both ballot comment lists and make sure all updates have been applied
    • Once that is complete - will do an intermediate publication
      • Kai will provide update content for review and then publication request - expect end of February
    • Start working on Medication Dispense and Administration once the guide has been published - scope of this ballot will only be dispense and administration
    • Goal is to have new material ready for discussion in Montreal - ballot cycle for September
    • Inform Structured Documents that we will be publishing and then adding new content
  • Update of work that was done as epSOS - there are more extensions that have been created that have not been included in the Universal Templates
    • epSOS CDA ManufacturedProduct
      • marketingAuthorizationHolder - for cross border e-prescription
        • may be the manufacturer but may be different
        • this exists in UV Medication (simple) - manufacturerOrganization
        • no changes for Pharmacy
        • Christof will review with the project the requirement - is it the manufacturer or the marketingAuthorizationHolder
        • Christof will review the order of the attributes
      • free text representation of strength
        • has used the desc attribute - should be the full name, but epSOS has used it for part of the name (just the strength)
        • want a "strength" on the product level
        • This is not a legal use of the description
        • in Germany, have extended the datatype for FHIR
        • could consider adding an extension on the datatype

Date: Wednesday, January 16, 2019

Quarter: Q2

Agenda Topics

Supporting Documents

Minutes/Conclusions Reached

  • Reaffirmation Ballot Reconciliation
    • All reaffirmation ballots have passed
  • Schedule for Conference calls
    • would like to have more implementer involvement
    • May post to Zulip or send email if implementer feedback is needed
  • DMP
    • no need to update - approved in September 2018
    • Melva Peters to followup with Anne to confirm she has received DMP - website has not been updated
  • M&C
    • no need to update - approved in September 2018
    • Melva Peters to followup with Anne to confirm she has received - website has not been updated
  • SWOT
    • no need to update - approved in September 2018
    • Melva Peters to followup with Anne to confirm she has received - website has not been updated
  • Reaffirmation/Withdrawal of 5 year items (NIBs are due by October 14)
    • no new ones are needed
  • Forward Planning
    • Potential projects
      • FHIR Profile/Implementation Guide for pharmacy resources
        • start with simple examples - create a new prescription, modification, cancellation
        • could be a combination from profile and implementation
        • genericize US Core/US Meds
        • Melva to create a 3 year plan item for FHIR profile/IG
      • Reach out to Affiliates about what they are doing with FHIR in the pharmacy space
  • Project Review
  • 3 year plan review
  • Action Item list review
    • Followup with patient care on patient preference/practitioner preference work - where are they at with this work
  • daVinci Project
    • eCDX - should Pharmacy be an interested party for this project?
    • Da Vinci eHealth Record Exchange 20190115 V1.1.pptx
    • Motion:  John/Scott - Pharmacy WG will be an interested party in the eClinical Data Exchange (eCDx) Project
      • 6-0-0 Carried
    • ePayer Data Exchange Project
      • Motion:  John/Shelly - Pharmacy WG will be an interested party in the ePayer Exchange Project
        • 6-0-0 Carried
  • EST Liaison - Jean volunteered

Date: Wednesday, January 16, 2019

Quarter: Q4

Agenda Topics

  • Discussion of Z-segments (Dennis)
  • Conditional Dosage Requirements

Supporting Documents

Minutes/Conclusions Reached

  • Discussion of Z-segments (Dennis)
    • Dennis will create a draft PSS and bring it to Pharmacy for review
  • Melva Peters to send link to PSS (paper and Confluence) to Dennis
  • FHIR Maturity
    • Grahame believes that MedicationStatement should be Normative
    • Pharmacy needs to draft a statement about the maturity of all of our resources by the end of the week
  • Use of MedicationKnowledge for calculating MME
    • no gaps at this point
  • Conditional Dosage Requirements - GF 15136
    • want to look at NCPDP structured SIG as input to the work as well as our V3 material
    • could be done as an extension on Dosage
    • V3 material includes what we need - get data elements from V3 and create an extension
      • examples added in to tracker item
      • Jean Duteau to create an extension on Dosage - will review on conference call
      • Scott M. Robertson will add in examples from NCPDP to ensure we can meet use cases
      • Jean Duteau will find spreadsheet from Canada
  • Tracker Items
    • GF 19640 -
      • discussed this issue again.  There was a vote on Tuesday Q4 but based on further information, it was re-considered.
      • Gforge has been updated with the new resolution and vote
    • GF 19990 - see Gforge for vote

Date: Thursday, January 17, 2019

Quarter: Q1


Agenda Topics

  • Conditional Dosage Requirements
  • Work on maturity level of resources - current and goals
  • FHIR tracker items

Supporting Documents

  • N/A

Minutes/Conclusions Reached

  • Update provided on our plan for conditional dosage requirements
  • Discussion on maturity level of pharmacy resources
    • Need to update spreadsheet as follows
      • Med Dispense needs to be update 
        • add Canadian system - "prescribe it"
        • removing Epic
    • Move Medication to maturity level 5 and plan for normative in next ballot cycle
    • Move MedicationAdministration to maturity level 3
    • Move MedicationDispense to maturity level 4
    • Move MedicationRequest to maturity level 5 and plan for normative in next ballot cycle
    • Move MedicationStatement to maturity level 4
      • what is preventing us from moving this to level 5 is lack of info on the number of production implementations
      • what impact will the name change in MedicationStatement to MedicationUsage have on the maturity level?
    • Move MedicationKnowledge to maturity level 1
      • this presumes FMG approval of this resource
      • Melva Peters notify Grahame Grieve about Pharmacy maturity level decisions
  • FHIR tracker items discussed this quarter
    • #19911 Motion: Jean/Dennis 4-0-1  See gForge for details.
    • #19913 the issue with this tracker is where to capture "continuous", IV Push, IV bolus
      • Julie James can you recommend a value set for this kind of data
    • #19915 Motion: John/Jean 5-0-0  See gForge for details
    • #19470 Motion: Jean/Dennis 5-0-0  See gForge for details
    • #19694 Motion: Jean/Dennis 5-0-0  See gForge for details

Date: Thursday, January 17, 2019

Quarter: Q2


Agenda Topics

Supporting Documents

Minutes/Conclusions Reached

  • Update from Todd Cooper on the Dental Interoperability Project
    • Investigative project / white paper is the approach they will start with
      • Use cases ~ 12 will be available by end of January, 2019
      • Discussions with Patient Care are planned for first half of February, 2019
      • Medication Lists bidirectional are high priority
      • Senior dental care issues e.g. antibiotics, etc. 
      • Ask is for review and comment from Pharmacy
  • Conditional Dosage discussion
    • feedback on how this is addressed in the Netherlands
    • see #15136 tracker for details that arose from this discussion