ChairJohn Hatem

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    Meeting ID: 323 199 8494
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Web session


John Hatem (Chair/ Scribe)Independent Consultant
Sarah Gaunt
Phung MathewsPOCP
Peter Sergent
Tim McNeil
Christof Gessner
Shelly Spiro
Francois Macary
Corey S
Dave Hill

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
    •  - no medication profiles planned at this time - no interested as a co-sponsor on interested party
  •  - No project proposals discussed or reviewed. 

Project Scope Statements

  •  - no project scope statements discussed or reviewed

NHSN Inpatient Medication Administration Reports (FHIR IG) - Sarah Gaunt

    • Review ballot comments - discuss and vote: Getting issues...
    • Reviewed all 5 tracker items - Motion by Sarah G and Seconded by Tim M, to accept all resolutions for the 5 items passed by a vote of 7-0-2

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 - done
  •  - outstanding action items
    • leave until new information
  •  - no discussions

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

Workflow Update (John Hatem)

  •  - no updates

Healthcare Product Update (John Hatem)

  •  - no updates

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
    •  - meeting on Thursdays - looking at the way to convey the consent needed (with attachment)
      • looking at a means to inform prescriber about a patient program being available that would require consent from patient to be involved
    •  - no update
  • Specialty Medication Enrolment PSS update - Specialty Medications
    •   - Publication request approved by FMG, now going to TSC
    •  -  Publication request was approved by TSC
    •  - has been published!
    •  - no update
  • 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
    •  - at NCPDP Standardization Committee for review - looking at word smithing 
      • will bring back to HL7 - to see if they can be incorporated or if held for Version 2
    •  - no update
  • MTM - create FHIR IG Scott M. Robertson
    • on hold waiting for MCC eCare Plan Summary to be completed
    •  -  on hold
    •  - on hold
    •  - on hold 
    •  - no update
  • RealTime Pharmacy Benefit Check for Consumers (Tim McNeil/Frank McKinney)
    •  - analyzing on payer side for implementation
      • looking at timing
    •  - no update
    •  - no update - Task Group still looking at NCPDP requirements
    •  - 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
    •  - Scott reviewing requirements for next step
      • may just be an update to NCPDP material
      • if it needs to come to HL7 - needs a Project Proposal
    •  - no update

Global Supply Chain Project (Scott)

  •  - no meeting since before WGM
  •  - no updates
  •  - no updates
  •  - no updates

Medication List guidance project

  •  - John has created trackers related to updated wording
    • need additional work on other areas
  •  - to be discussed during next call July 12, 2021. 

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
  •  - no updates
    • FHIR-32718 - provide distinction between non-formulary, not covered and not found when searching drugs - Not Persuasive - there are other ways to get this information
      • separate tracker about adding guidance for queries to include a real drug
      • Motion to accept disposition - Scott Robertson - seconded by Corey Spears - 10-0-0 Carried
    • FHIR-32724 - add formulary ID field to coverageplan and MedicationKnowledge to differentiate formularies when more than one is available - Not persuasive
      • Motion to accept disposition - Scott Robertson - seconded by Corey Spears - 10-0-0 Carried
    • FHIR-31037 - CoveragePlan PlanIDType extension not defined for non-HIOS plans - Persuasive With Mod
      • Add guidance - for non HIOS plans, should be "other-plan-id"
      • Motion to accept disposition - Scott Robertson - seconded by Corey Spears - 10-0-0 Carried
  •  - Corey and Dave H, discussed two tracker items.  Both of these items should be reviewed by Jean Duteau
    • Tracker items discussed were: 
      • 31683 - again we need a technical point of view on this issue.  
        • we also provided some feedback and discussion about formulary approach using the new catalog approach.  we did not specify whether the new approach could solve this tracker issue.  
      • 31684 - the specific issues being discussed may be one for FMG and not specifially Pharmay.  Need Jean Dutean input

FHIR (Group)

Trackers - link to pharmacy unresolved Jira trackers 

See updates in Jira for the following


Next meeting

  • July 12, 2021 at 4pm Eastern

Action Items

  • Jean Duteau reach out to Francois about use by Catalog Project 
  • Bryn Rhodes need to push back to BR&R on the level of complexity - Bryn to submit trackers
  • Jean Duteau Input - have a proposed solution -  Jean to create a new build
    • duplication of definitional information - apply to a local build - Jean to apply
  • Melva Peters reach out to Patrick Werner - project in Chile - Melva to reach out on Zulip 
  • Melva Petersto submit WGM room requests
  • Melva Petersto forwarded update M&C to TSC for approval
  • Melva Petersto send wording to BR&R so they can use the same wording