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    Meeting ID: 323 199 8494
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Web session

Attendees

NameOrganization
Melva Peters

Jenaker Consulting

Jean Duteau

Duteau Design

Margaret WeikerNCPDP
Peter SergentHL7 New Zealand
Pooja BabbrahPOCP
Daniel ZhangEpic
Scott RobertsonKaiser Permanente
Maggie BuchingerSurescripts
Steve SaillardEpic
Gary Schoettmer
Frank McKinneyPOCP
John Hatem
Danielle BancroftFRED IT
Brett Marquard

Agenda Items and Notes

US Meds Update Discussion (Brett Marquard)

  • April 20, 2020
    • Update to US Meds - Project 1393
      • US Medications Implementation Guide Update 
      • will update PDMP mappings to R4
      • migrate some profile that have moved to US Core
      • will need to notify Public Health and CQI that the project has changed
      • no need to get SD and TSC approvals
      • Will submit NIB 
      • Plan to ballot in September cycle
      • Brett will update deliverable and target dates
      • Motion to approve PSS:  Brett - seconded by John - 10-0-1 CARRIED
      • Brett will take to Public Health
      • melva will forward to CQI
      • once approvals are in place - forward to PMO
  • 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MedicationDispense/MedicationAdministration profiles, and remove any Medication List guidance from the guide that is superseded by US Core.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
      • http://build.fhir.org/ig/HL7/US-Core-R4/branches/med-lists/all-meds.html - 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?
      • https://www.hl7.org/special/Committees/projman/searchableProjectIndex.cfm?action=edit&ProjectNumber=1291
      • https://www.hl7.org/special/Committees/projman/searchableProjectIndex.cfm?action=edit&ProjectNumber=1393
    • 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

  • April 20, 2020
    • Use cases - Medications 

      • This section lists the use cases for using catalogs of medications.

        • A health care organization maintains its medication formulary and shares it to the applications used by its physicians, nurses and pharmacists to support medication prescription, dispense and administration.
        • A content vendor publishes the general catalog of medications authorized to a national market. Health care organizations of the country import subsets of this general catalog so as to synchronize their local medication formularies.
        • Variant 1: In addition to the general catalog of medications, the content vendor hosts the medication formularies of each of its client organizations who interact with the server to use their own medication formulary in their medication workflows, as well as to maintain this medication formulary over time (inserting/updating/retiring items).
        • A health care organization provides medication formularies to its patients for educational purposes.
        • An organization exposes the set of standardized vocabularies needed to support full semantic interoperability for prescription, dispense and administration of medications within a jurisdiction (e.g. a country). This reference set is represented as a generic catalog of all the medications that are usable within the jurisdiction. This generic catalog is imported in whole or in parts by the applications of the prescribers, carers and dispensers of the jurisdiction.
      • Pharmacy has been asked to review and provide updates to the use cases
      • Team is working on lab use cases - likely September ballot cycle.  Pharmacy content will follow on
      • Review of Interaction Framework 
        • 3 actors - catalog owner, catalogue custodian, Catalogue consumer
      • Use Cases - review notes
        • A health care organization maintains its medication formulary and shares it to the applications used by its physicians, nurses and pharmacists to support medication prescription, dispense and administration.
          • presume this is within an institution
          • provides a list of medications that are orderable - limited scope
          • not typically based on a specific patient's coverage for the inpatient setting
          • there may be a flag on the formulary that would indicate - need pre-authorization or if high cost
        • Patient - want to see medications that I'm insured for - there could be more than 1 of these per organization - varies by conditions, employer groups
          • may include medications that are not covered
        • Consumer or provider facing drug information - 
          • provide drug information - compedium
          • catalogue of information - could construct using a FHIR construct
        • Decision Support
  • April 13, 2020
    • reviewing current IG
    • will review use cases and then notify Francois when ready for review
  • Review Use Cases

Updates from Workflow

  • April 20, 2020 - no discussion

Healthcare Product

  • April 20, 2020 - no discussion

NCPDP Updates

V2-FHIR Mapping

Projects

  • Real Time Pharmacy Benefit Check -

Issues pulled From Block Vote 3

    • Frank has reached out to Eric on multiple occasions and notified him that we would be voting on them today.  No response has been received from Eric.
    • Motion by Frank - seconded by Pooja that we accept proposed disposition for FHIR-25659, FHIR-25660, FHIR-25661, and FHIR-25665 - Vote 11-0-1 Carried

ID

Summary

Submitter

FHIR-25659

use single namespace

Eric Haas

FHIR-25660

use standard profile views

Eric Haas

FHIR-25661

example request narratives

Eric Haas

FHIR-25665

use GraphDefinition

Eric Haas

  • Daniel will be submitting a new issue for the next release of the IG
  • Since NCPDP and HL7 are working on RTPBC - hope there will be 1 standard named in regulation, rather than 2 for provider facing and consumer facing apps
    • NCPDP sub-task group is just getting started - goal is to find a way to keep in sync
    • proposed rule says "tool" 
      • NCPDP - decision hasn't been made about the approach - looking at what is available and then will make decision.
  • 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 20, 2020 - no discussion
  • 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

FHIR

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

AOB

Next meeting

  • April 27, 2020 at 4pm Eastern


Action Items