Date: 5/28/2021

Quarter: Q3

CQI Hosted CDS and Pharmacy

Chair: Floyd Eisenberg

Scribe: Patty Craig

Chairs present: Paul Denning, Yan Heras


Meeting Minutes

  • Sept WGM scheduling
    • Will meet Thur Q1 with Pharmacy as a full joint call CDS-CQI-Pharmacy instead of the Friday sessions which only included 2 Pharmacy representatives
    • Will establish a separate quarter with CDS, CQI,  BR&R and Pharmacy based on recommended timing from the BR&R WG (pending)
  • Medication List Guidance (including patient-reported)
    • The Guidance for Medication Lists will be going onto the Medication Module and appropriate Resources.
    • Currently determining where to include on each page to ensure it isn't buried.
    • This is how to use Resources to solve questions about how to generate lists of medications related to "xxxx". 
    • Also adding Medication Reconciliation Guidance.
    • Expecting to have the Guidance available for review by the September WGM.

  • MedicationKnowledge usage
    • Question was should both MedicationKnowledge (owned by Pharmacy) and MedicinalProduct (owned by BR&R) exist because there is overlap
    • However, there are items like 'cost' in MedicationKnowledge that would never be in MedicinalProduct
    • Pharmacy will remove from MedicationKnowledge those items that are common between the two
    • This change will affect the MME (milligram equivalents) which is part of the FHIR Clinical Guidelines
    • Pharmacy and BR&R will work together as it relates to the Resources related to medications
    • Discussion around the fact that BR&R is using some of CDS Resources and CDS is thinking the two Workgroups should work together on changes
      • Pharmacy is recommending that individuals trying to use MedicinalProduct put in JIRA Tracker items if they find it difficult to use.
        • Bryn stated that he was able to easily identify what he needed to use from MedicationKnowledge, but MedicinalProduct was much more difficult to use
        • Given the issues identified by Bryn and others in how to use MedicinalProduct, Pharmacy may add Guidance in how to join it to MedicationKnowledge
        • Bryn believes that MedicationKnowledge should be a MetadataResource (specialization of a CanonicalResource)
          • Because it isn't, it has to be handled in a server specific method
          • There may be other medication resources that should also be a MetadataResource
          • Bryn created FHIR Tracker 32801
            • Note:  It is implied that when you follow the Metdata Resource, you will follow the CanonicalResource
    • Discussed FHIR Tracker 31021 concerning Using MedicationKnowledge instead of code system supplement.  Pharmacy will look at this Tracker with additional Workgroup members.

  • FHIR-31988 - QDM to QI-Core mapping update for Medication, Dispensed RESOLVED - CHANGE REQUIRED - author date time QDM mapping to MedicationDispense
    • Dispense is an event, so there would be no documentation that something wasn't dispensed 
      • However the MedicationDispense does have the status of 'decline' and the ability to include a reason
      • Will be adding a date to MedicationRequest to track when the status changed; however, not planning on adding to all Resources
      • Pharmacy will discuss further if a date of status change can be added to MedicationDispense
      • Pharmacy needs a FHIR Tracker to be created for this request - trackers place on the MedicationDispense Resource for R5  FHIR-32803 - requesting addition of statusChange, and FHIR-32804 - requesting addition of recorded (conceptually)
      • Also added tracker for QI-Core to model the extension for timing in MedicationDispenseNotDone consistent with the stateChange (dateTime) expected in MedicationDispense R5 - FHIR-32805

Action Items

  • None