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Melva Peters (scribe)

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      Meeting ID: 323 199 8494

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Web session


Jean Duteau (Chair)

HL7 Canada/Duteau Design

Melva Peters

Jenaker Consulting

Frank McKinneyPOCP
Tim McNeilSurescripts
Brett Marquard
Danielle FriendEpic
Margaret WeikerNCPDP
John Hatem
Pooja BabbrahPOCP
Scott RobertsonKaiser Permanent
Steve SaillardEpic
Jenni SyedCerner
Daniel ZhangEpic
Maggie BucchingerSurescripts
Eric Haas

Agenda Items and Notes


  • Reminder that we have switched over to Zoom for meetings starting today
  • Surescripts can't use Zoom desktop, but can use browser
  • NCPDP - recommends not using desktop

US Meds Update Discussion (Brett Marquard)

  • April 13, 2020
    • PSS
      • Brett will populate PSS in Confluence with latest scope
        • This project will upgrade the PDMP mappings to FHIR R4, add ASAP mappings, upgrade the MedicationDispense/MedicationAdministration profiles, and remove any Medication List guidance from the guide that is superseded by US Core.

        • This project will not enhance US Core profiles, nor provide additional guidance on profiles that belong in US Core. Any relevant lessons for US Core will be logged as trackers for a future US Core release.

    • MedRequest in US Core
      • discussing an errata publication for US Core
      • - includes some proposed changes
      • How do we get all meds patient is actually taking - Patient reported medications PLUS practitioner ordered medications
        • Plan - could be used by practitioners
          • use case - I plan to prescribe this drug in the future
          • need to filter out unintended "planned" medications
        • See JIRA FHIR-25035 for proposed updates - this will be reviewed
          • Update the existing language to the following:

            Requirements to access “all medications” and “all active medications” for a patient:

            1. A MedicationRequest resource query:
              1.  SHALL be all that is required.
                1. See the General Guidance section for additional rules and expectations for Servers Requiring Status. 1. Only MedicationRequest resources with an intent = ‘orders’
              2. The MedicationRequest SHALL include all -medications-MedicationRequest resources with an `intent` = 'order' representing authorized medication orders directly derived from the system's orders.
              3. The MedicationRequest SHALL include all prescribed and “self-prescribed” MedicationRequest resources with an `intent` = 'plan' representing reported medications.
                1. SHALL use reported[x] to indicate the MedicationRequest record was captured as a secondary “reported” record rather than an original primary source-of-truth record. It may also indicate the source of the report.
                2. When recording “self-prescribed” medications SHALL use intent = “order”
                3. When recording “self-prescribed” medications-orders-, *SHALL*SHOULD use the requester to indicate the Patient or RelatedPerson as the prescriber.
          • Motion to accept the proposed disposition and forward to Cross Group Project for approval - Brett - seconded by Melva - 13-0-0
  • April 6, 2020
    • US Meds 
      • discussion of proposed language for PSS
      • HL7 published the original version of the US Medications implementation guide based on FHIR R3 in 2017 to provide guidance for patient and provider access to patient medications. A future release improved the guidance, and added a section mapping FHIR to NCPDP and PMIX to support PDMP exchange. The PDMP FHIR mappings are FHIR 3 based, and based on prior industry standards.

      • Broad industry adoption of FHIR R3 in the US did not occur, and the latest US regulation requires certified HIT systems support FHIR R4, and US Core.

        • Fetching All Medications, Active Medications, and All Medications for an Encounter

        • Get All Medications

        • Get All Active Medications

        • Get All Medications for an Encounter

      • Fortunately, many of the lessons from the US Meds guide were included in the US Core upgrade to FHIR R4. For example, the following guidance is now included in US Core:

      • The MedicationDispense and MedicationAdministration profiles are not included in US Core due to minimal adoption.

      • This project will upgrade the PDMP mappings to FHIR R4, add ASAP mappings, upgrade the MedicationDispense/MedicationAdministration profiles, and remove any Medication List guidance from the guide that is superseded by US Core.

      • This project will not enhance US Core profiles, nor provide additional guidance on profiles that belong in US Core. Any relevant lessons for US Core will be logged as trackers for a future US Core release.

      • Melva will reach out to Lynn/Dave to see if we should update one of the existing PSS or create a new one.  How do we track against 3 PSS for 1 IG?
    • MedicationRequest in US Core
      • US Core needs to re-word the use of intent
      • Pharmacy is going to look at statuses in MedicationUsage and pull them out to attributes
      • For patient reported meds - pharmacy would support the publication of an errata
      • Future - Pharmacy will be also looking at the overlap between intended medications between medicationrequest and medicationusage
      • Changes to US Core - Brett will come back to work on proposed wording on a future call - there may be some additional edits that need to be made
  • March 30, 2020
    • The FHIR US Meds implementation guide based on FHIR R3 published in 7/2019 with a new section for PDMP. The project ran under two different PSSs: Project #1291 and Project #1393.
    • This past week we received a request to upgrade to R4, and update the PDMP mappings to latest standards and scripts.
    • There are a few questions floating around for me:
      • US Core published in 11/2020 and now includes medication list guidance. Should the guidance in US Meds be deprecated in favor of US Core? (which I also know you requested changes to in Sydney!)
        • Active medicines list
      • The github repo is named ‘FHIR-ONC-Meds’, should we rename to match current intent, which seems to be primarily a PDMP interaction guide?
      • What is the preferred HL7 process for an upgrade to R4 and deprecation of content: STU update, ballot, other? My initial thinking is ballot, but I am curious to your input.
        • Asking pharmacy working group?
          • Update medication and dispense to R4
          • Update PDMP to R4
          • Remove anything that is currently in US Core
        • Discussion
          • Could consider pointing US core and US meds at each other
          • Needs additional thinking, as PDMP mapping is still used
          • Upgrade driven by PDMP, re-brand guide to PDMP version and continue to test IG update
          • Retain Med Admin and Dispense but leave the rest in US Core
          • Recommend new project scope statement to cover, Brett to draft proposal and come back to pharmacy to discuss next week

Catalogue Project

Updates from Workflow

  • April 13, 2020
    • John did not attend this weeks meeting

Healthcare Product

  • April 13, 2020
    • today's call was related to inventory and how to represent - existing resource or a definitional resource
    • Want to look at Medication List Guidance project to see if they can use framework

NCPDP Updates

  • Specialty Medication Prescribing PSS update - Specialty Medications
    • April 13, 2020
      • Confluence page has been updated
      • Virtual Connectathon Track has been accepted
      • working version of the FHIR IG - link is on the page
      • will be reviewed on NCPDP call tomorrow
      • suggest that a review be scheduled with HL7 Pharmacy WG - for next week
  • Standardized Medication List - Standardized Medication Profile
    • April 13, 2020
      • there was a meeting scheduled last week - Margaret will update page with future meetings

V2-FHIR Mapping


  • Real Time Pharmacy Benefit Check -
    • Block Vote 4:

      • had followup conversations about some of issues
        • new requirements - propose for future release
        • Jean has reached out to MnM to get some guidance about what can be added
        • would like to fix broken issues for now and add others as considered for future use
          • some are nice to have
          • wording - adding additional data elements
            • maybe consider updating this wording
          • suggest adding new JIRA issues for 4 items that will be considered for future use - Daniel will create new JIRA issue
      • okay to vote on the following - Frank moved - Daniel seconded to approved dispositions of the following 9 items with additional change to FHIR-26504 - 12-0-0 Carried





Replace the carin-rtpbc-billing-unit-value-set with UCUM for consistency across FHIR

Paul Knapp


To have an option to return what is paid by the PBM would be helpful…

Daniel Zhang


a more broadly used codeset like NCIT or UCUM should be used…

Daniel Zhang


Some payers consider [DUR info] important information to get patients on more clinically appropriate alternatives…

Daniel Zhang


Medications may have an alternative that’s only appropriate based on a certain diagnosis…

Daniel Zhang


[restricted opioid prescriber] might be important for them to know as well…

Daniel Zhang


The goals of this standard can already be accomplished by the NCPDP standard…

Daniel Zhang


Practitioner.identifier is constrained to an NPI

Craig Newman


Value Sets only available to NCPDP members

Craig Newman

Pulled From Block Vote 3

  • were discussed in Ballot Reconciliation calls - 
  • have exchanged emails with Eric, but have not been able to discuss
  • Frank will reach out to Eric indicating that Pharmacy will be voting on the proposed disposition - 
  • Use of US Core Profiles - with constraints
    • US Realm has suggested that should base Patient and MedicationRequest profiles on US Core but not which must support will not be conformed to
      • need to figure what to do about this
      • will likely clarify in IG how align to the US Core profiles - when a US Core profile exists that aligns to use case - will align to them
    • Organization and Practitioner will be based on US Core
    • Will make decision on Thursday





use single namespace

Eric Haas


use standard profile views

Eric Haas


example request narratives

Eric Haas


use GraphDefinition

Eric Haas

  • Medication List Guidance
    • Confluence Pages: Patient Medication List Guidance
      • Melva reviewed the context page
      • will be starting to put some words around the content
      • Danielle will help with content
      • Melva to start FHIR IG Proposal
    • Universal need for doing e-prescribing over FHIR
    • focus on use cases for e-prescribing IG - have an plan to create an IG
      • there are some AU requirements from e-prescribing - that can feed in to next project
    • FHIR IG Proposal has been approved
    • Medication list FHIR IG approved

VA Vista - Jay Lyle

  • April 13, 2020
    • no discussion
  • John met with Jay Lyle - trying to map DSTU2 to current systems
    • looking at about 100 elements in outpatient space 
    • John reviewed and met with Jay to review - closed off some
    • identified some extensions - if the attribute existed in R4 suggested he used this to model the extension
    • Jay will followup with Jean with some specific issue
    • Will continue the discussions with Jay
    • Jay will come back to Pharmacy and send updated spreadsheet


Trackers - link to pharmacy unresolved Jira trackers 

  • FHIR-26563
    • in principle, agree that we could add a reference, but need to do more analysis on how we would handle the requirements
      • bigger picture of relationships
      • continue to discuss


Next meeting

  • April 27, 2020 at 4pm Eastern

Action Items

  • Brett Marquardwill update PSS for US Meds and come back on April 20th call