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Date:  Friday 9/25/2020

Time:  10-11:30am

CQI Hosted CDS and Pharmacy

Chair: Floyd Eisenberg

Scribe: Patty Craig

Agenda brought forward by CQI

  • Medication List Guidance (including patient-reported)
  • MedicationKnowledge usage
  • Medication usage period (especially as it relates to cumulative medication duration and tapered dose)
  • Potential Drug-Drug Interaction (PDDI)

Meeting Recordings

NOTE:  You must be logged into HL7's Confluence site in order to download the MP4 files so you can play them.

Video with Gallery View 623 MB

Video with Speaker View 544 MB


Meeting Minutes

  • Potential Drug-Drug Interaction (PDDI) CDS IG (slide deck for presentation)
    • Ballot Results
      • Ballot Count 9, all in person
      • 14 negative
      • 32 affirmative
        • 1 affirmative-a
        • 14 affirmative-s
        • 7 affirmative-t
        • 2 affirmative-q
        • 8 affirmative-c
      • 1 no vote
    • Ballot Concerns
      • Was the scope of the IG inpatient or outpatient?
        • If so, how related to NCPDP SCRIPT?
      • Security - making sure the data in the card is restricted to that needed for CDS
      • Configuration based hook coordination - need to figure out where information concerning CDS Hooks and how/when it is maintained
      • Filtering
      • Should other interactions be included?
      • Question about when the the PDDI happens in the workflow
    • Paul Denning asked about 'DetectedIssue'
      • It is referenced in the Gaps in Care IG, but not in the PDDI IG 
      • It is thought that this would be a good concept to add to the IG for the next ballot version


  • Medication List Guidance (including patient-reported)
    • US Core was changed in R4 for 'MedicationRequest'
      • For medication ordered by the provider, intent=order
      • For medications that are self-prescribed, intent=plan
      • QI Core needs to be updated to match the above values for "intent"
    • Pharmacy is working on document guidance on how to retrieve a medication list.   This is a work in progress.
      • Not sure if this will be part of R4 or it might wait until R5.
      • This is currently an IG, but a question is whether or not this belongs in the core FHIR specification.
      • CDS / CQI question:  Is this the best way to ask how long a patient is on a medication (accumulated)?
        • CQI will enter a Pharmacy tracker item to request how to calculate the accumulated time a person is on / off the medication.


  • MedicationKnowledge usage
    • Currently at Mature Level 1.
    • Need to add bindings.  It does have some real-time implementers, but are looking for others.
    • Does not have the Knowledge Base vendors (e.g., Walter Kluwer) involved in the project. 
    • The Opioid MME IG includes a Calculator which can be referenced in different FHIR data models.
      • In particular, the calculator is being used with Quality Data Model as part of the specification of a Potential Opioid Overuse electronic Clinical Quality Measure (eCQM), and as part of the computable representation of the CDC Opioid Prescribing Guideline in both FHIR STU3 and FHIR R4 versions.
      • Bryn Rhodes is sending Pharmacy a request to add information to the Medication resource to support the calculator.


  • Medication usage period (especially as it relates to cumulative medication duration and tapered dose)
    • Question is how long a patient has been on a medication.
      • The information is in MedicationRequest Timing attributes Frequency, Count, and Period
      • Frequency and Duration has to do with the administration of the medication
      • Discussion occurred on what is reflected within the MedicationRequest when a doctor or a patient changes how a drug is to be taken. 
        • Dose changes typically creates a new order
        • If the patient already has the drugs at home and the doctor tells them to take the drug differently they may not put through a new order until the patient needs to fill a new prescription
      • Bryn Rhodes was requested to provide Pharmacy examples of how Count is used to ensure it is working as expected.
        • Count is the number of times the Timing repeats

Note:  Patient Care (PC) hosted Vocabulary, Orders and Observations (OO) during this same time.

Action items

  • CQI will enter a Pharmacy tracker item to request how to calculate the accumulated time a person is on / off the medication.
  • Bryn Rhodes is sending Pharmacy a request to add information to the Medication resource to support the calculator.
  • Bryn Rhodes was requested to provide Pharmacy examples of how Count is used to ensure it is working as expected.


Meeting Adjourned at 11:05am.