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    Meeting ID: 323 199 8494
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Web session

Attendees

NameOrganization
Melva Peters (Chair)Jenaker Consulting
Peter SergentHL7 New Zealand
Danielle BancroftFRED IT
Shelly SpiroPharmacy HIT Collaborative
Phung MatthewsPOCP
Christof GessnerHL7 Germany
Jean DuteauDuteau Design
Bryn Rhodes
Peter Muir
John HatemIndependent Consultant


Agenda Items and Notes

Meeting Notes from previous meeting

Project Review

Project Proposals

  • US Public Health Profiles Library:  PSS-1805 - Getting issue details... STATUS
    • Pharmacy needs more information before deciding if they should be involved in this project - still waiting for a response to comment

Project Scope Statements

Discussion of MedicationKnowledge and possible issues for CDS

  • proposed changes for MedicationKnowledge
  • ongoing discussion/concern about the scope of MedKnowledge and MedicinalProductDefinition
  • Jean completed an analysis
  • there are some attributes in MedKnowledge that are not part of the definition, but there are attributes that overlap
    • cost isn't definitional
    • guidelines may not be definitional
  • proposal was to pull out content that are definitional and are in MedicinalProductDefinition
    • improve the link to the definition
    • Knowledge would provide jurisdictional specific information about the drug
  • Is the modelling different in the definition
    • in many cases, it is structured differently because there is more information in the definition - more detail
    • in almost all cases, MedicationKnowledge is a subset of the information that is in MedicinalProductDefinition
    • do we need to put guidance in our resource about
    • will have to explain as part of scope where there may be duplicate information
  • Is there ever a circumstance where you would have a code (e.g. hospital specific code) but also need to reference MedicinalProductDefinition
    • need to discuss this
  • Comments from Bryn
    • need to know ingredients and relative strengths of ingredients
    • in MedicationKnowledge - was straight forward and clear
    • in MedicinalProductDefinition - can't answer the same questions
      • can see ingredients, but don't know the relative strengths
        • have to look inside the ingredients to find strengths
      • can answer the question, but need to consider that ingredient is specific to a product
      • there are some ballot comments - may be changes that make this harder to determine
    • problem with the proposal - what was easy before, is now harder to find
      • at least one level of indirection
      • names are not the same
      • 3 level of hierarchy to look for ingredients and then dig information out
      • disservice to those that have been well served by the existing MedicationKnowledge
  • Options
    • could include a backbone of the definitional items
      • reference to definition and/or attributes that were previously included
      • there could be push back - could just contain the definitional items - need to justify this
    • maybe clearly defining the scope would be a better option - scope and boundaries
  • Next steps
    • reach out to Francois about use by Catalog Project - Jean to reach out
    • take to FMG and describe the problem
      • hearing from implementers that the approach adds complexity
      • can we include definitional information?
    • need to push back to BR&R on the level of complexity - Bryn to submit trackers
    • Is there another project that is using MedKnowledge?
    • Input - have a proposed solution -  Jean to create a new build
      • duplication of definitional information - apply to a local build - Jean to apply
    • Rxnorm is a good use case!  look at international models that are not regulatory
    • reach out to Patrick Werner - project in Chile - Melva to reach out on Zulip

FHIR Resources - Normative Candidates

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

  • MedicationRequest
  • Medication

Catalog Updates (John Hatem)

  •  - no updates
  •  - no updates

Workflow Update (John Hatem)

  •  - no updates
  •  - no updates

Healthcare Product Update (John Hatem)

  •  - no update
  •  - no updates

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
  •  - no updates
  •  - as far as are aware, no further information is needed unless they reach out to us
  •  - remove from agenda - they will reach out.

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?
  • https://chat.fhir.org/#narrow/stream/implementers/topic/Radiation.20therapy
  •  Discussion
  •  no update
  •  
    • attended May 6th meeting
    • sorting out any questions about new FHIR resources
      • new resource for blood product administration - too different from other workflows
      • non-medication administration for dialysis - is a new resource needed?
        • general idea to take medicationAdministration and Immunization and create a new resource
    • Christof to monitor and attend as he is able
    • confirm if John is able to attend
    • bring this up in joint meeting with Patient Care at WGM
  •  - no update
  •  - remove from agenda.  
    • John will reach out to confirm no requirement for Pharmacy to participate

NCPDP Updates (NCPDP Members)

  • NCPDP Task Group working on Patient Consent - for specialty prescribing -  Frank McKinney
    •  - starting up again this week with bi-weekly calls
      • will be focusing on coming to an approach to informing the clinic process on drugs that need consent and the type of consent needed and representing the type of consents
    •  - no update
  • Specialty Medication Enrolment PSS update - Specialty Medications
    •   - Publication request approved by FMG, now going to TSC
    •  -  Publication request was approved by TSC
  • Standardized Medication Profile - Standardized Medication Profile Jean Duteau
    • - pending minor editing from NCPDP, then can send publication request
      • there are some links that needed to be fixed
      • Scott will draft publication request to come back to Pharmacy
    •  - content sent by Shelly
      • need to draft publication request - Scott and Margaret
  • MTM - create FHIR IG Scott M. Robertson
    • on hold waiting for MCC eCare Plan Summary to be completed
    •  -  on hold
    •  - on hold
  • RealTime Pharmacy Benefit Check for Consumers (Tim McNeil/Frank McKinney)
    •  - analyzing on payer side for implementation
      • looking at timing
    •  - no update
  • Consultant Pharmacist Task Force - will be creating a guidance document for consultant note on the FHIR IG - Scott/Shelly
    • jointly published 
    • would need a project proposal 
    •  - reviewing guidance document, want to update with FHIR
      • not ready yet for proposal

Global Supply Chain Project (Scott)

  •  - no meeting since before WGM
  •  - no updates

Medication List guidance project

  •  - no updates
  •  

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 - Improve description of PlanID TRIAGED
      • new field description in tracker.  not specific to HIOS-generated.
      • Motion to accept disposition in tracker  David Hill/Margaret Weiker (10-0-1) passes
  •  
    • Qualifier of copay amount - FHIR-32178
      • Dave Hill/Tim McNeil - to accept proposed disposition - 8-0-1 - Accepted
    • may be some changes coming
    • Will add discussion for next week
    • May be able to discuss next steps for specification at WGM
  •  
    • 5 new issues have been added
    • no decision made about STU update vs ballot as new issues are being identified - likely a few weeks out
    • FHIR-31591 - wrong code included for drug
      • agree technical correction
    • FHIR-32723 - valueset tables not being displayed correctly - definition field is blank
      • agree technical correction
    • FHIR-32622 - change request
      • uses list, but shouldn't
      • short-term fix - examples will be updated and add guidance
      • will address more comprehensively in a subsequent release
      • may change to insurancePlan, but need to assess if this is the correct resource to use - low maturity
    • FHIR-32627 - search parameter codes should be lower case
      • this will be a breaking change - will add guidance to say being contemplated
      • need a "-" between names
    • FHIR-32625 - menu doesn't allow navigation
      • changing menu bar
    • Motion to approve proposed resolutions for the above issues - Dave Hill - Corey Spears - 10-0-0 Carried
  •  

Mission and Charter

  •  
    • Mission.docx
    • review for next meeting and add to agenda to approval

FHIR (Group)

Trackers - link to pharmacy unresolved Jira trackers 

  • Jean will attend BR&R call June 15th at 4pm Eastern - re: nutritional information

AOB

  • Meeting Room  request - Monday through Thursday - Melva to put request in

Next meeting

  • Join BR&R call on June 15th at 4pm Eastern - FHIR Issue re: nutritional information
  • June 21, 2021 - 4pm Eastern

Action Items