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Web session


Melva Peters (Chair)Jenaker Consulting
Peter SergentHL7 New Zealand
Scott RobertsonKaiser Permanente
Jay Smith
Pooja BabbrahPOCP
Maggie BuchingerSurescripts
Shelly SpiroPharmacy HIT Collaborative
Corey SpearsMITRE
Frank McKinneyPOCP
Margaret WeikerNCPDP
David Hill
Carmen SmileyONC
Jean Duteau
John Hatemindependent

Agenda Items and Notes


Meeting Notes from previous meeting

Project Review

Project Proposals

  •  -  PSS-1799 - Getting issue details... STATUS  - CCDA to and from FHIR structural mapping
    • Not in our normal scope
    • reviewed, no need to participate noted by the group

Project Scope Statements

  •  - none to review

US Medication Implementation Guide

  • STU expired in January
  • Balloted new release in September 2020, but ballot reconciliation is on hold pending funding from ONC to complete
  • PBS metrics are impacted - PBS metrics are yellow on the May report - means that if we have new projects coming forward, the TSC may not allow them to proceed without cleaning up the metrics first!
  • Do we request an extension?
  • What do we do about the idle ballot from September 2020?
    • STU has expired. 
    • ONC wants it extended, but no funding for the idle ballot resolution.  Pharmacy doesn't have the resources or the content knowledge to complete reconciliation.
    • the core content from the STU IG has been moved to US Core, just the mapping for PDMP remains
    • discussed waiting another week before decision to give ONC/Brett M a chance to respond.  Will make the decision on next week's call
    • question: what if someone wants to re-ballot after expiration
    • (Carmen joined)
    • she has same question: how to restart about expiration. 
    • seems like will be a new project, picking up from where it left off
    • Motion: withdraw FHIR IG MED PDMP R1D1 2020SEP  John Hatem/Margaret Weiker (12-0-1) passes

HL7 V3: Medication; Knowledge-based Query, Release 1

  • approaching ANSI expiration - 2022-04-03 - need to either re-affirm or withdraw
    • should we reaffirm or withdraw
    • recent tendency is to reconfirm, but implication is that comments will be addressed, and there are no resources to do that update
    • better is to withdraw.  will remain as retired standard, just not ANSI normative
    • Motion: Withdraw Jean D/John Hatem (11-0-2)  passes   Will be a withdrawal ballot next cycle

FHIR Resources - Normative Candidates

These resources have been endorsed by their respective work groups as target normative candidates for R5:

  • MedicationRequest
  • Medication

Work Group Meeting Planning

  • Prep for May 2021 meeting
    • room requests have been made - Q1 to Q4 Monday to Thursday
      • we may cancel the Q1 sessions
    • Joint Meetings accepted
      • EHR WG - Monday Q3 and Q4 - 1 rep- Mega Report out
      • II - Wed Q4 - 1-2 RepsRadiation Dose Summary for Diagnostic Procedures on FHIR review
      • BR&R - accepted 2 quarters
        • close the loop on the MedicinalProductDefinition and MedicationKnowledge resources -clarification of their use 
        • review of Jean's analysis of mapping of MedicationKnowledge to MedicinalProductDefinition
      • CDS/CQI - Friday
      • Patient Care and Cross Group Projects - MedList Guidance
      • Public Health - vaccination
      • FHIR-I - rep to be sent
      • Patient Care - CareTeam Report out
    • joint meetings - Melva to reach out to groups
      • O&O - Common Product Model - John to raise on Health Care Product meetings
    • Reach out to HTA - new UCUM group - what is the plan for HL7 to be involved?
  •  - no discussion
  •  - no discussion
  •  - no discussion
  •  - Melva to work on the agenda for review next week
    • asked Pharmacy WG members to identify times that might be needed
    • Formulary - update and next steps
    • reach out to Catalog project to see if they want to meet
    • See updated agenda
    • Co-chairs to add in their availability
    • Not meeting any Q1.
    • Added HL7 general session to each day
    • topics slotted in.  Let co-chairs know if anything to add

Catalog Updates (John Hatem)

  •  - no specific issues for Pharmacy
    • there is an open tracker item - need Jean for the discussion
  •  - no meeting to discuss
  •  - April 9th meeting - working on Catalog trackers, but not specifically related to Pharmacy
  •  - no pharmacy specific topics
  •  - no update
  •  -
    • tracker item 32159: MedicationKnowledge.device shoud reference DeviceDefinition instead of Device
    • targeting Jan 2022 for next version with MedKnowledge and devices

Workflow Update (John Hatem)

  •  - no meeting
  •  - no Pharmacy specific content discussed.  Meeting was focused on BPMN related issues
  •  - April 12 meeting - cancelled; will reschedule discussion on Contract issues
  •  - met today; no pharmacy specific topics
  •   - no update
  •   - discussed trackers, nothing specific to pharmacy

Healthcare Product Update (John Hatem)

  •  - no meeting
  •  - very short meeting, discussed updates to Device Definition.  No votes and no Pharmacy specific issues. 
  •  - April 12th meeting - UDI and other tracker items - no Pharmacy specific issues discussed. 
  •  - only issue for us - updates to MedicationUsage to clarify boundaries for Observation and Questionnaire
    • O&O will provide language from DeviceUsage
  •  - discussion dosing and/or instructions for administration or settings
    • will be looking at how to do this
  •  - discussed devices, naming conventions, GUIDs.  nothing specific to pharmacy.  Biologically-derived products is still an open question.

LHS Care Plan DAM

  • LHS Care Plan DAM -
  • Update and action items from HL7 Learning Health Systems (LHS) patient centered 4-27-21 care team call about Care Plan Domain Analysis Model (DAM) – Consent Roles
  • ACTION ITEM: Identify the role of pharmacist and pharmacy staff (e.g., technician and administrative) for role-based access to clinical data.
    • What are their roles as part of the care team?
    • Which pharmacy actors will require a patient consent for clinical information or subset of that data for direct query into a system outside the pharmacy’s system if the pharmacist or pharmacy staff does not have consent access to that outside EHR system?
  • Scope: Scenarios should focus on highly specific and concise use cases that can quickly highlight whether a gap currently exists in the relevant DAMs. The collection of scenarios should provide a clear understanding of the modeling requirements for each respective DAM in order to support the scope of purpose of patient-centric, cross-functional, cross-disciplinary, and cross-organizational care teams.
  •  Using the MCC Care Plan use case as a model, identify the consent roles for pharmacists and pharmacy staff.
    • Betsy Johnson is a 65-year-old retired teacher with multiple chronic conditions (MCCs), which include CKD, type 2 diabetes, congestive heart failure, chronic pain, and clinical depression.
    •  A number of branching scenarios covering different aspects of information (e.g., care plan contents) privacy, confidentiality and security control requirements will be defined in this document. These branching scenarios will inform the refinement of the published Patient Centered Care Team logical model attributes and terminology value sets:
  • ACTION ITEM: LHS ask is for Pharmacy WG to create scenario 5 – Pharmacy simple use case for the consent roles of the pharmacists and pharmacy staff.
    •  Example Scenario 3 - Referral to podiatrist 
    • Betsy presents at her PCP clinic for routine health checks by her regular primary care physician. Upon examination of Betsy’s feet, her PCP discovered her both feet sensation, temperature peripheral perfusion is reduced around the lateral fifth to third metatarsal head. The dorsalis pedis pulse is reduced in size on both feet. Skin integrity of both feet remains intact. Patient agrees to a referral to see a podiatrist, but requests that her anxiety/clinical depression information be masked from viewing by the podiatrist. 
  • NOTES FROM 4-27-21 Call Scenario 5 - Pharmacy (simple use case for CDK patient why the pharmacist will need clinical information from another system)
    • Clinical roles
    • Patient prescribed a new medication that has renal function implications
      • Pharmacists need renal information from another system
    • Financial/administrative roles
    • Referrals from payers
  • ACTION ITEM: Have use case added to google document by May 11 LHS call
  •  - asked Shelly to create a draft of the scenario and share to the pharmacy List
    • Need to draft the role of the pharmacist and pharmacy staff
  •  - draft scenario
    • Betsy Johnson is a 65-year-old retired teacher with multiple chronic conditions (MCCs), which include CKD, type 2 diabetes, congestive heart failurechronic pain, and clinical depression.

      Betsy’s PCP notices that her clinical depression is not under control.  Betsy completes a genomic sequencing and then she is referred to a pharmacist for a pharmacogenomic recommendations to assure the right antidepressant is identified based on Betsy’s genomic tests.  Betsy consents for the lab to send the results of the genomic test to the pharmacist and for the PCP to refer her data to the pharmacist to review antidepressant medication,  The pharmacist will make a recommendation for antidepressant therapy based on Betsy’s genomic makeup and to review the other medications Betsy is taking for potential medication therapy problems or drug/disease interactions.

    • use case relative to consent
    • not discussed on last LHS call
    • note that the focus on the pharmacist, not the pharmacy
    • all pharmacists on a team would need to have the same access (not multiple pharmacist roles)
    • minor wordsmithing
    • Shelly will be post to their google doc.  John and Shelly will attend call

Radiation Therapy Discussion

  • Patient Care would like Pharmacy to join one of our FHIR conference calls (Thursdays at 5pm Eastern) to revive our prior discussions about radiation therapy.  We’re pushing to get Procedure normative and really need to start making some decisions about whether this needs a new resource, changes to Procedure/ServiceRequest, or Medication/MedRequest/MedAdmin.
  • Can you let me know a date when Pharmacy can join us for this discussion?
  •  Discussion
  •  no update

NCPDP Updates (NCPDP Members)

  • NCPDP Task Group working on Patient Consent - for specialty prescribing
    •  - no updates since last update
    •  - no updates
    •   - no updates
    •  - trying to get more participation from those who are knowledgeable with systems in clinics and EHRs; will inform prescribing process about consents
    •  - no updates
    •   - call out during WGM for participation.
  • Specialty Medication Enrolment PSS update - Specialty Medications
    •  - completed 
      • ballot reconciliation spreadsheet uploaded and withdrawals requested
      • when team is ready to publish, will complete publication request
    •  - waiting for publication request
    •  - still waiting for publication request - Frank to send
      • include on the agenda for next week
    •  Publication Request - Specialty Enrollments
    •  - no updates
  • Standardized Medication Profile - Standardized Medication Profile Jean Duteau
    •  - need to update front matter with cover sheet
      • need to talk to Lynn to find out what to do about the HL7 logo
      • content is complete - 
      • Motion by Jean Duteau - seconded by Shelly Spiro - approve to go to ballot - 13-0-2 Carried
      • final content must be sent to Lynn by April 11
      • this will be a pilot for Jira Balloting
    •  - Scott reached out to Lynn to get cover page 
      • Melva to follow up with Lynn to see what else was needed
    •  - in the ballot
      • ballot opened on April 16
      • using Jira Balloting
      • review Webinar and attend Q&A
    •  - NCPDP will be reviewing this week
      • still being balloted at HL7 - changes would need to go back through NCPDP
    •  - in ballot
  • MTM - create FHIR IG Scott M. Robertson
    • on hold waiting for MCC eCare Summary to be completed
    •  - on hold 
    •  - looking at what to do with CDA IG and make decision on next steps
    •  - no updates
    •  - remains on hold
  • RealTime Pharmacy Benefit Check for Consumers (Tim McNeil/Frank McKinney)
    •  - NCPDP Task Group
      • Consumer focused - nothing new - identify use cases and requirements - Carin IG - will be looking at this to see if this IG meets requirements
    •  - no updates
    •  - no updates
    •  - meetings underway to gather input from NCPDP Task Group on requirements
    •  - no updates
    •  - 

Global Supply Chain Project (Scott)

  •  - did not meet last week
  •  - expected to meet - Jose is leading the work
  •  - no updates
  •  - met last week
    • focusing on using Covid vaccine supply chain as a basis for what they want to do
  •  - discussions still going on
    • trying to settle on actors and scenarios at this point
  •  - no report ... "they're still plugging along"

Medication List guidance project

    • will cancel calls for April 1 and 8
    • John working on document to summarize where we are and what is left to be done
  •  - John working on a summary document
    • have cancelled meeting for this week
    • hope to have summary document for review next week
  •  no update
  •  - no update
    • cancel the call for this week
  •   - will cancel this week - plan to discuss at the WGM
    • John working on a summary
  •  - no meetings until after WGM

PDex Formulary

  •  - will have content to review on next weeks call - 3 issues and discussion of next steps for STU update
    • FHIR-30924 - Cost Sharing description
      • not a technical correction
      • See update in Jira
    • FHIR-31672
      • proposing clarification on what should be done - use "NA" -don't believe this is a technical correction
      • come back to this
    • proposed schedule
      • STU update - starting April 26
        • Melva to look at the process for an STU update and let Dave know what needs to be done for approvals
  •  - no discussion
    • FHIR-28293 - Getting issue details... STATUS
      • new field description in tracker.  not specific to HIOS-generated.
      • Motion to accept disposition in tracker  David Hill/Margaret Weiker (10-0-1) passes

FHIR (Group)

Trackers - link to pharmacy unresolved Jira trackers 


  • FHIR-32159 - Getting issue details... STATUS  
    • yes, should reference DeviceDefinition
    • Motion to approve disposition in tracker  Jean Duteau/John Hatem  (11-0-0) PASSES
  • potential tracker from John H - Device resource
    • devices vs medication.  devices are not "used up", but a syringe is used up.  
    • John Hatem will create tracker


Next meeting

  • May 17, 2021 at 4pm Eastern

Action Items