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Date

 

Chair
StatusCompleted
Comments

Dial-in Number

Web session

Attendees

NameOrganization
Melva Peters (Chair)

HL7 Canada/Jenaker Consulting

Peter Sergent

HL7 New Zealand

Frank McKinney
Tim McNeilSurescripts
Scott RobertsonKaiser Permanente
Jean DuteauDuteau Design
John Hatem

Agenda Items and Notes

Outstanding Action Item List

Catalogue Project

  • There was a meeting last Friday
  • Ready to start Pharmacy use cases in the next couple of weeks
  • Trying to get a meeting with Lloyd and FMG
  • Would like to have Jean join the Workflow call - Friday at 9am Pacific
  • Have discussed some of the attributes that are included - for example, cost

Updates from Workflow

  • Meeting today -
    • Lloyd has asked Pharmacy to follow up with US Core to ensure that they are no putting events in MedicationRequests
      • US Core believes they are not putting events in MedicationRequest
      • Need to look at the wording in US Core around their guidance - related to GF #23856
      • Pharmacy does not agree that the proposed updated wording - MedicationRequest - US Core has updated wording to include "patient report medications" - this is changing the scope for US Core that is not conformant with FHIR Core
      • Jean has added to the tracker item and will add a new tracker item that will be raised with the US Core Team and Workflow
      • Send an email to Brett/Eric, copy SD WG Co-chairs and Lloyd
    • How to deal with destroying part of the administration - eg patient ordered 75mg but 25mg is destroyed
      • have not dealt with this use case

Healthcare Product

  • Will continue to meet for another month
  • Documentation has been created - definitions of devices, deviceDefinition, SupplyRequest, etc
  • Asking for feedback
  • Will work on helping with wording
  • Examples of medications that have a relationship to a device - John has found a definitional article that may help with this
    • need to come up with some examples of different meds with devices
    • there may be 2 different orders where there is a device - 1 for the medication to go into the device and 1 for the device
    • Will post examples/wording to the list

NCPDP Updates

  • Standardized Medication Profile (Joint Project)
    • Task Group at NCPDP working on it
    • Scott will find out more information this week
    • Melva is interested in finding out how we are working together on this project with NCPDP
    • NCPDP has completed their analysis - 
      • will send to NCPDP and HL7 Pharmacy list
    • September 9, 2019 - joint meeting has been scheduled for Wednesday at 12 noon Eastern
      • there will be meeting this week
    • October 7, 2019 - call last week held to update on activities at WGM
      • updated spreadsheet with FHIR and CDA mappings is completed
      • next call will be to review mappings and then will start on white paper
    • October 14, 2019 - next call is October 16th to finalize spreadsheet and plan white paper
  • Specialty Medication PSS
    • PSS has been started - initial version has been drafted and reviewed by Pharmacy
    • will be going through NCPDP and then will come back to HL7
    • October 7, 2019 - PSS is being worked on
  • LTC e-Prescribing Model
    • October 14, 2019
      • NCPDP calls - HL7 Pharmacy can participate
      • Jean has reviewed V2 model
      • Will be looking at all of the conversations

Projects

  • Real Time Benefit Check - Pooja
    • mapping of data elements
    • NCPDP is working on the B2B transaction
    • trying to mirror on patient facing side as closely as possible to those fields
    • Have started to do the mapping between NCPDP transaction and FHIR resources
    • Meeting with FM to make sure have what is needed on response side
      • Request from EHR from their system to payer PBM - payer id, BIN #, date, etc
      • There are some elements that are part of the MedicationRequest or Dispense 
    • Working on this over next couple of weeks
    • Looking to see if they can get a track at Connectathon - have reached out to a mobile app vendor
    • Balloting - target is January
    • August 19, 2019
      • TSC discussion today - concerns about having NCPDP content in HL7/CARIN project
        • Margaret Weiker - NCPDP has discussed with CARIN.  NCPDP is satisfied that the IG will reference NCPDP documents
    • September 9, 2019 - approved by the TSC
    • October 7, 2019
      • Will add this as a standing agenda topic going forward
      • A connectathon was held in Atlanta to test how will be building the transaction - will now be building the IG
      • Frank McKinney will be working on the IG
      • Pharmacy has sponsored with Financial Management co-sponsoring
      • used FM resources - for the connectathon
      • okay to proceed as is with Pharmacy as the sponsor
      • planning to ballot in January
      • NIB - to be submitted - 
      • Goal to have draft IG by November 1st
        • will work with WGs on guidance
        • IG to be reviewed by November 1st
        • Shoot for rest of dates
        • IG Proposal must be submitted to FMG and approved by NIB deadline
      • CARIN RTPBC Pharmacy WG topics - 20191007fm.docx 

      • NDC code - "representative" NCD11s are used in US e-prescribing

        • suggest that Frank should post on Zulip - to see if it should be 10 digit or 11 digit or both
        • in the real world - the source for NDC - is the knowledge bases rather than FDA
        • http://build.fhir.org/ndc.html
        • needs to be a freely available source for the data
        • NCPDP defined the definition for NCD11Product Identifier
      • Device orders
        • are devices in scope for ordering via MedicationRequest
        • may put this out of scope for this IG
        • may be able to used NDC for non-medications
        • FDA may require a UDI 
        • CARIN may decide that if a product has a UDI, may be out of scope in initial phase
      • RxNorm
        • for e-prescribing - explicit constraint - convention to limit use to semantic brand name, semantic clinical drug, branded package, generic package
        • is it okay to constrain to these?
        • This is a constraint that can be put into the IG
      • Quantity
        • quantity UoM value sets - can constrain to what is needed, code system doesn't need to be in HL7
          • not sure which is needed
          • There is a NCI units of measure value set
          • could constrain the UOM or may need to create a new one - Jean can help with creating a value set if needed
          • Will figure out requirements and come back to us - if just need ml, gram, each - could constrain and create value set from UCUM
            • if need larger set - need to create new 
      • Dispense as Written
        • substitution - could use boolean
      • Preferred Dispensing Pharmacy - use dispensingRequest.performer
        • it is in R4
      • to represent a prescription - 
        • different than the Formulary IG
        • doing a pre-authorization of a prescription 
        • okay to use claim resource, but if not, use MedRequest 
        • The response coming back is "claim-like" with pricing but can be alternatives and pricing
        • Claim and ClaimResponse make sense
    • October 14, 2018
      • Draft NIB: http://www.hl7.org/Special/committees/tsc/ballotmanagement/EditNIB.cfm?ballot_document_sdo_id=1074&Action=Edit
      • Motion - Jean Duteau - John Hatem - at approve the NIB - 6-0-0
        • Jean submitted NIB
      • Review draft RTPBC request mapping
      • Discuss referencing of NCPDP-maintained value sets (ECLs) such as…
        • Quantity unit of measure (NCPDP ECL 600-28 Unit of Measure. Three values: EA, GM, ML)
        • Residence Type (NCPDP ECL 384-4X. Values include Home, Skilled nursing facility, etc.)
        • RTPBC response contains processing codes (e.g., PA Required), DUR contraindication codes, etc.
        • Paul Knapp from Financial Mgmt. WG indicated they’re facing the same thing with X12 value sets. Mentioned maybe using NamingSystem...?
        • Issues of value sets that are proprietary - NCPDP/X12 - need to determine how to create codesytem and valueset
        • Scott will look into this from an NCPDP perspective
      • Discuss Claim/ClaimResponse convention: Populate “native” elements in addition to attached resources… in order to ease processing at the recipient. E.g., Claim.item.productOrService.code = [the NDC], which is also present in the attached
      • Discuss bundling vs containing the supporting resources (Patient, etc.)
        • My understanding: Contain when the content isn’t a complete representation of the thing
        • Seems to fit our use case, where the receiving party only needs bits of Patient, Practitioner, MedicationRequest information to do its work
        • But I understand there might be differences of opinion about when to bundle vs contain
        • Does the Pharmacy WG have a position?
          • what are you expecting receiving system to do with the information
            • if you are expecting to store - don't do it as a contained resource
            • MedicationRequest - could be done as a contained resource 

Pharmacy Templates

  • July 8, 2019: Melva to reach out to Kai - complete
    • Forwarded Kai the ballot reconciliation spreadsheet - he will work on the updates
  • August 4, 2019
    • Kai to produce final version
  • August 12, 2019 - no update
    • Melva has emailed Kai to get an update
  • August 19, 2019
    • Melva has been in contact with Kai.  Will get update on next call
  • September 9, 2019 - final version has been received
    • Publication Request will be approved in Atlanta
  • October 7, 2019 - will be bringing revised publication request to Pharmacy for approval
  • October 14, 2019

Medication List

Formulary Project

FHIR

Gforge Trackers - Link to Gforge Tracker

Triaged Trackers

  • #24831
  • #24701
  • #24700
  • #24690
  • #24651
  • #24561
  • #24105
  • #24101
  • #24100
  • #24099
  • #24098
  • #24097
  • #24096
  • #24095
  • #24091
  • #23979
  • #22148 - MedicationDispense.performer.actor
    • CareTeam doesn't fit (80/20) into the current actor roles
    • but does point out that the person counseling the patient should be able to be recorded
    • will wait until John H is available as this originates from Workflow
    •  waiting for a response from Lloyd
  • #19913 - Valueset for Dosage.method
    • This issue is related to the Zulip chat related to "infusions".  Once we have improved the value set to support "IV Push" and "IV Bolus", it should be possible to query for all medications who have a route of Intravenous, and exclude in the query those medications who have a method of IV Push or IV Bolus.
    • See Pharmacy List Topic where this same issue is discussed.   
    • Melva to reach out to Julie about how we can pick specific codes from the hierarchy
  • #16095 - Medication Knowledge Resource 
  • #15509 - Example Scenarios for Pharmacy
  • #15136 - Conditional Dosages
    • Reach out to CDS to see if they have done any work in this space
    • Melva Peters Create examples from Oncology, NCPDP and GF19694

Waiting for Input

  • #22933 - Make MedicationStatement Status extensible
    • Melva to reach out to requester for more information
    • Status now Waiting for Input
  • #20184 - binding for site in Dosage
  • #17222  this tracker is about the assessment of whether Medication Request resource could support anesthesia gas orders.  We did receive a document from Anesthesia and will follow up with them about their use cases.  
    • John Hatem will follow up with anesthesia regarding pharmacy feedback and to assess next steps
  • #20673 MedAdmin category CodeableConcept
    • reach out to John Silva with a time limit for response - otherwise we will close
    • Status now Waiting for Input

Any Other Business

  • Plan a review session for new attendees via teleconference

Next meeting

  • October 21, 2019 at 4pm Eastern
    • Agenda topics
      • Medication List


Action Items

  • John Hatem to add tracker item related to destroying part of a dose
  • Jean Duteau  has added to the tracker item and will add a new tracker item that will be raised with the US Core Team and Workflow
  • Jean Duteau Send an email to Brett/Eric, copy SD WG Co-chairs and Lloyd
  • Melva Peters will submit Templates Publication Request