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1a. Project Name

NHSN Inpatient Medication Administration Reports (NHSN-Medication-Administration-FHIR) (HL7 Implementation Guide for FHIR® Release 4)

1b. Project ID

1654

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact being Reaffirmed or proceeding to Normative directly after being either Informative or STU?

No

1e. Today's Date

1f. Name of standard being reaffirmed

1g. Project Artifact Information

1h. ISO/IEC Standard to Adopt

1i. Does the standard include excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption?

1j. Unit of Measure

2a. Primary/Sponsor WG

Pharmacy

2b. Co-Sponsor WG

Public Health

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballotRequest periodic project updates; specify period in text box below (e.g. 'Monthly', 'At WGMs', etc.)

2c. Co-Sponsor Update Periods

Update at each major milestone (e.g. NIB, prior to Connectathon, etc.)

2d. Project Facilitator

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2e. Other Interested Parties (and roles)

2f. Modeling Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2g. Publishing Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2h. Vocabulary Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2i. Domain Expert Representative

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2j. Business Requirements Analyst

2k. Conformance Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2l. Other Facilitators

2m. Implementers

Emory University Hospital

3a. Project Scope

This IG will support electronic submission of line-level medication administration data to the National Healthcare Safety Network (NHSN). The intent of this project is to establish an electronic submission standard that is vendor-neutral that leverages existing workflows and eliminates duplicate documentation. This project will work with EHR vendors to identify data elements that can be used to describe medications administered (name, formulation, route, dose, duration) to hospitalized patients (inpatients) diagnosed with COVID-19 as part of NHSN COVID-19 reporting pathways.

With feedback from CDC and pharmacy informatics SMEs, this project will develop the following IG:
• HL7 Implementation Guide for FHIR® Release: NHSN Inpatient Medication Administration Reports

Attachments

3b. Project Need

Medication data are integral to informing the quality, safety, and costs of U.S. healthcare, supporting federal, state, and local public health, and guiding clinical decision-making in patient care. In inpatient workflows, medication administration—as captured by electronic medication administration (eMAR) records—is considered the gold standard for accurately measuring in-hospital medication exposure, including identifying the exact medications patients have received, in what formulations, doses, and for what duration of time. Published data indicate that alternate data sources for medication exposure, such as pharmacy “order” (or billing) data and medication “lists” are inaccurate representations of in-hospital medication exposure. Pharmacy order/billing data are discordant with medication administration data due to variability in when billing events occur relative to actual medication administration (1,2). For example, order/billing can occur upon order entry or upon dispensing, neither of which reflects actual medication administration to the patient. Despite an order/billing event, actual administration to the patient can be held, missed, or discontinued (prior to a discontinuation order reaching the pharmacy). Medication “lists”, such as those generated during medication reconciliation, remain a relatively new concept in clinical workflows and are based on processes that are highly variable across U.S hospitals with regard to their accuracy and comprehensiveness (3). Medication lists can also have a high level of discordance with actual administration of medications (4,5). The need for medication administration information has never been clearer as during the COVID-19 pandemic, where identification of the medications that acutely ill hospitalized patients with COVID-19 had received was integral to understanding clinical management of this new public health threat and directing public health resources, including scarce medications. The continued reliance on the “medication list” resource instead of the “medication administration" resource is a severe limitation in achieving accurate representation of medication exposure in U.S. healthcare data through FHIR resources. 
  
1. Courter JD, Parker SK, Thurm C, Kronman MP, Weissman SJ, Shah SS, Hersh AL, Brogan TV, Patel SJ, Smith MJ, Lee BR, Newland JG, Gerber JS. Accuracy of administrative data for antimicrobial administration in hospitalized children. J Pediatric Infect Dis Soc 2018;7(3):261-63.  
2. Schwartz DN, Evans RS, Camins BC, Khan YN, Lloyd JF, Shehab N, Stevenson K. Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers. Infect Control Hosp Epidemiol 2011;32(5):472-80.   
3. Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation. BMJ Qual Saf 2016; 25(9):726-30.
4. Rose AJ, Fisher SH, Passche-Orlow MK. Beyond medication reconciliation. The correct medication list. JAMA 2017;317(20):2057-8. 
5. Gupta A, Yek C, Hendler RS. Phenytoin toxicity. JAMA 2017;317(23):2445-6. 

3c. Security Risk

No

3d. External Drivers

CDC/NHSN Application Release cycles

3e. Objectives/Deliverables and Target Dates

Submit for STU Ballot(First Ballot Cycle): 2021 May Ballot
Complete STU Reconciliation: 2021 Sept WGM
Project End Date (all objectives have been met): 2024 May WGM

3f. Common Names / Keywords / Aliases:

3g. Lineage

n/a

3h. Project Dependencies

None

3i. HL7-Managed Project Document Repository URL:

Will add pages under the Public Health Project Roadmap menu item

3j. Backwards Compatibility

No

3k. Additional Backwards Compatibility Information (if applicable)

3l. Using Current V3 Data Types?

No

3l. Reason for not using current V3 data types?

FHIR

3m. External Vocabularies

Yes

3n. List of Vocabularies

SNOMED, LOINC, RxNorm

3o. Earliest prior release and/or version to which the compatibility applies

4a. Products

FHIR Implementation Guide

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

4c. FHIR Profiles Version

4d. Please define your New Product Definition

4d. Please define your New Product Family

5a. Project Intent

Create new standard

5a. White Paper Type

5a. Is the project adopting/endorsing an externally developed IG?

5a. Externally developed IG is to be (select one)

5a. Specify external organization

5a. Revising Current Standard Info

5b. Project Ballot Type

STU to Normative

5c. Additional Ballot Info

5d. Joint Copyright

No

5e. I understand I must submit a Joint Copyright Letter of Agreement to the TSC in order for the PSS to receive TSC approval.

no

6a. External Project Collaboration

6b. Content Already Developed

6c. Content externally developed?

6d. List Developers of Externally Developed Content

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Quality Reporting Agencies, Payors

6f. Other Stakeholders

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Clinical Decision Support Systems

6g. Other Vendors

6h. Providers

Clinical and Public Health Laboratories, Healthcare Institutions (hospitals, long term care, home care, mental health)

6h. Other Providers

6i. Realm

U.S. Realm Specific

7d. US Realm Approval Date

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Oct 19, 2020

7c. Co-Sponsor Approval Date

Oct 22, 2020

7c. Co-Sponsor 2 Approval Date

7c. Co-Sponsor 3 Approval Date

7c. Co-Sponsor 4 Approval Date

7c. Co-Sponsor 5 Approval Date

7c. Co-Sponsor 6 Approval Date

7c. Co-Sponsor 7 Approval Date

7c. Co-Sponsor 8 Approval Date

7c. Co-Sponsor 9 Approval Date

7c. Co-Sponsor 10 Approval Date

7e. CDA MG Approval Date

7f. FMG Approval Date

Oct 14, 2020

7g. V2 MG Approval Date

7h. Architecture Review Board Approval Date

7i. Steering Division Approval Date

7j. TSC Approval Date



 Show Changes

Version

7

Modifier

Sarah Gaunt

Modify Date

Oct 22, 2020 20:44

1a. Project Name

NHSN Inpatient Medication Administration Reports (NHSN-Medication-Administration-FHIR) (HL7 Implementation Guide for FHIR® Release 4)

1b. Project ID

1654

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Process Improvement Committee

2b. Co-Sponsor WG

Public Health

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballotRequest periodic project updates; specify period in text box below (e.g. 'Monthly', 'At WGMs', etc.)

2c. Co-Sponsor Update Periods

Update at each major milestone (e.g. NIB, prior to Connectathon, etc.)

2d. Project Facilitator

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2f. Modeling Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2g. Publishing Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2h. Vocabulary Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2i. Domain Expert Representative

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2k. Conformance Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2m. Implementers

Emory University Hospital

3a. Project Scope

This IG will support electronic submission of line-level medication administration data to the National Healthcare Safety Network (NHSN). The intent of this project is to establish an electronic submission standard that is vendor-neutral that leverages existing workflows and eliminates duplicate documentation. This project will work with EHR vendors to identify data elements that can be used to describe medications administered (name, formulation, route, dose, duration) to hospitalized patients (inpatients) diagnosed with COVID-19 as part of NHSN COVID-19 reporting pathways.

With feedback from CDC and pharmacy informatics SMEs, this project will develop the following IG:
• HL7 Implementation Guide for FHIR® Release: NHSN Inpatient Medication Administration Reports

3b. Project Need

Medication data are integral to informing the quality, safety, and costs of U.S. healthcare, supporting federal, state, and local public health, and guiding clinical decision-making in patient care. In inpatient workflows, medication administration—as captured by electronic medication administration (eMAR) records—is considered the gold standard for accurately measuring in-hospital medication exposure, including identifying the exact medications patients have received, in what formulations, doses, and for what duration of time. Published data indicate that alternate data sources for medication exposure, such as pharmacy “order” (or billing) data and medication “lists” are inaccurate representations of in-hospital medication exposure. Pharmacy order/billing data are discordant with medication administration data due to variability in when billing events occur relative to actual medication administration (1,2). For example, order/billing can occur upon order entry or upon dispensing, neither of which reflects actual medication administration to the patient. Despite an order/billing event, actual administration to the patient can be held, missed, or discontinued (prior to a discontinuation order reaching the pharmacy). Medication “lists”, such as those generated during medication reconciliation, remain a relatively new concept in clinical workflows and are based on processes that are highly variable across U.S hospitals with regard to their accuracy and comprehensiveness (3). Medication lists can also have a high level of discordance with actual administration of medications (4,5). The need for medication administration information has never been clearer as during the COVID-19 pandemic, where identification of the medications that acutely ill hospitalized patients with COVID-19 had received was integral to understanding clinical management of this new public health threat and directing public health resources, including scarce medications. The continued reliance on the “medication list” resource instead of the “medication administration" resource is a severe limitation in achieving accurate representation of medication exposure in U.S. healthcare data through FHIR resources. 
  
1. Courter JD, Parker SK, Thurm C, Kronman MP, Weissman SJ, Shah SS, Hersh AL, Brogan TV, Patel SJ, Smith MJ, Lee BR, Newland JG, Gerber JS. Accuracy of administrative data for antimicrobial administration in hospitalized children. J Pediatric Infect Dis Soc 2018;7(3):261-63.  
2. Schwartz DN, Evans RS, Camins BC, Khan YN, Lloyd JF, Shehab N, Stevenson K. Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers. Infect Control Hosp Epidemiol 2011;32(5):472-80.   
3. Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation. BMJ Qual Saf 2016; 25(9):726-30.
4. Rose AJ, Fisher SH, Passche-Orlow MK. Beyond medication reconciliation. The correct medication list. JAMA 2017;317(20):2057-8. 
5. Gupta A, Yek C, Hendler RS. Phenytoin toxicity. JAMA 2017;317(23):2445-6. 

3c. Security Risk

No

3d. External Drivers

CDC/NHSN Application Release cycles

3e. Objectives/Deliverables and Target Dates

Submit for STU Ballot(First Ballot Cycle): 2021 May Ballot
Complete STU Reconciliation: 2021 Sept WGM
Project End Date (all objectives have been met): 2024 May WGM

3g. Lineage

n/a

3h. Project Dependencies

None

3i. HL7-Managed Project Document Repository URL:

Will add pages under the Public Health Project Roadmap menu item

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

No

3l. Reason for not using current V3 data types?

FHIR

3m. External Vocabularies

Yes

3n. List of Vocabularies

SNOMED, LOINC, RxNorm

4a. Products

FHIR Implementation Guide

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Create new standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Quality Reporting Agencies, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Clinical Decision Support Systems

6h. Providers

Clinical and Public Health Laboratories, Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Oct 19, 2020

7c. Co-Sponsor Approval Date

Oct 22, 2020

7f. FMG Approval Date

Oct 14, 2020

Version

6

Modifier

Sarah Gaunt

Modify Date

Oct 22, 2020 20:39

1a. Project Name

NHSN Inpatient Medication Administration Reports (NHSN-Medication-Administration-FHIR) (HL7 Implementation Guide for FHIR® Release 4)

1b. Project ID

1654

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Process Improvement Committee

2b. Co-Sponsor WG

Public Health

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballotRequest periodic project updates; specify period in text box below (e.g. 'Monthly', 'At WGMs', etc.)

2c. Co-Sponsor Update Periods

Update at each major milestone (e.g. NIB, prior to Connectathon, etc.)

2d. Project Facilitator

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2f. Modeling Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2g. Publishing Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2h. Vocabulary Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2i. Domain Expert Representative

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2k. Conformance Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2m. Implementers

Emory University Hospital

3a. Project Scope

This IG will support electronic submission of line-level medication administration data to the National Healthcare Safety Network (NHSN). The intent of this project is to establish an electronic submission standard that is vendor-neutral that leverages existing workflows and eliminates duplicate documentation. This project will work with EHR vendors to identify data elements that can be used to describe medications administered (name, formulation, route, dose, duration) to hospitalized patients (inpatients) diagnosed with COVID-19 as part of NHSN COVID-19 reporting pathways.

With feedback from CDC and pharmacy informatics SMEs, this project will develop the following IG:
• HL7 Implementation Guide for FHIR® Release: NHSN Inpatient Medication Administration Reports

3b. Project Need

Medication data are integral to informing the quality, safety, and costs of U.S. healthcare, supporting federal, state, and local public health, and guiding clinical decision-making in patient care. In inpatient workflows, medication administration—as captured by electronic medication administration (eMAR) records—is considered the gold standard for accurately measuring in-hospital medication exposure, including identifying the exact medications patients have received, in what formulations, doses, and for what duration of time. Published data indicate that alternate data sources for medication exposure, such as pharmacy “order” (or billing) data and medication “lists” are inaccurate representations of in-hospital medication exposure. Pharmacy order/billing data are discordant with medication administration data due to variability in when billing events occur relative to actual medication administration (1,2). For example, order/billing can occur upon order entry or upon dispensing, neither of which reflects actual medication administration to the patient. Despite an order/billing event, actual administration to the patient can be held, missed, or discontinued (prior to a discontinuation order reaching the pharmacy). Medication “lists”, such as those generated during medication reconciliation, remain a relatively new concept in clinical workflows and are based on processes that are highly variable across U.S hospitals with regard to their accuracy and comprehensiveness (3). Medication lists can also have a high level of discordance with actual administration of medications (4,5). The need for medication administration information has never been clearer as during the COVID-19 pandemic, where identification of the medications that acutely ill hospitalized patients with COVID-19 had received was integral to understanding clinical management of this new public health threat and directing public health resources, including scarce medications. The continued reliance on the “medication list” resource instead of the “medication administration" resource is a severe limitation in achieving accurate representation of medication exposure in U.S. healthcare data through FHIR resources. 
  
1. Courter JD, Parker SK, Thurm C, Kronman MP, Weissman SJ, Shah SS, Hersh AL, Brogan TV, Patel SJ, Smith MJ, Lee BR, Newland JG, Gerber JS. Accuracy of administrative data for antimicrobial administration in hospitalized children. J Pediatric Infect Dis Soc 2018;7(3):261-63.  
2. Schwartz DN, Evans RS, Camins BC, Khan YN, Lloyd JF, Shehab N, Stevenson K. Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers. Infect Control Hosp Epidemiol 2011;32(5):472-80.   
3. Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation. BMJ Qual Saf 2016; 25(9):726-30.
4. Rose AJ, Fisher SH, Passche-Orlow MK. Beyond medication reconciliation. The correct medication list. JAMA 2017;317(20):2057-8. 
5. Gupta A, Yek C, Hendler RS. Phenytoin toxicity. JAMA 2017;317(23):2445-6. 

3c. Security Risk

No

3d. External Drivers

CDC/NHSN Application Release cycles

3e. Objectives/Deliverables and Target Dates

Submit for STU Ballot(First Ballot Cycle): 2021 May Ballot
Complete STU Reconciliation: 2021 Sept WGM
Project End Date (all objectives have been met): 2024 May WGM

3g. Lineage

n/a

3h. Project Dependencies

None

3i. HL7-Managed Project Document Repository URL:

Will add pages under the Public Health Project Roadmap menu item

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

No

3l. Reason for not using current V3 data types?

FHIR

3m. External Vocabularies

Yes

3n. List of Vocabularies

SNOMED, LOINC, RxNorm

4a. Products

FHIR Implementation Guide

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Create new standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Quality Reporting Agencies, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Clinical Decision Support Systems

6h. Providers

Clinical and Public Health Laboratories, Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Oct 08, 2020

7f. FMG Approval Date

Oct 14, 2020

Version

5

Modifier

Dave Hamill

Modify Date

Oct 16, 2020 18:39

1a. Project Name

NHSN Inpatient Medication Administration Reports (NHSN-Medication-Administration-FHIR) (HL7 Implementation Guide for FHIR® Release 4)

1b. Project ID

1654

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Publishing

2d. Project Facilitator

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2f. Modeling Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2g. Publishing Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2h. Vocabulary Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2i. Domain Expert Representative

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2k. Conformance Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2m. Implementers

Emory University Hospital

3a. Project Scope

This IG will support electronic submission of line-level medication administration data to the National Healthcare Safety Network (NHSN). The intent of this project is to establish an electronic submission standard that is vendor-neutral that leverages existing workflows and eliminates duplicate documentation. This project will work with EHR vendors to identify data elements that can be used to describe medications administered (name, formulation, route, dose, duration) to hospitalized patients (inpatients) diagnosed with COVID-19 as part of NHSN COVID-19 reporting pathways.

With feedback from CDC and pharmacy informatics SMEs, this project will develop the following IG:
• HL7 Implementation Guide for FHIR® Release: NHSN Inpatient Medication Administration Reports

3b. Project Need

Medication data are integral to informing the quality, safety, and costs of U.S. healthcare, supporting federal, state, and local public health, and guiding clinical decision-making in patient care. In inpatient workflows, medication administration—as captured by electronic medication administration (eMAR) records—is considered the gold standard for accurately measuring in-hospital medication exposure, including identifying the exact medications patients have received, in what formulations, doses, and for what duration of time. Published data indicate that alternate data sources for medication exposure, such as pharmacy “order” (or billing) data and medication “lists” are inaccurate representations of in-hospital medication exposure. Pharmacy order/billing data are discordant with medication administration data due to variability in when billing events occur relative to actual medication administration (1,2). For example, order/billing can occur upon order entry or upon dispensing, neither of which reflects actual medication administration to the patient. Despite an order/billing event, actual administration to the patient can be held, missed, or discontinued (prior to a discontinuation order reaching the pharmacy). Medication “lists”, such as those generated during medication reconciliation, remain a relatively new concept in clinical workflows and are based on processes that are highly variable across U.S hospitals with regard to their accuracy and comprehensiveness (3). Medication lists can also have a high level of discordance with actual administration of medications (4,5). The need for medication administration information has never been clearer as during the COVID-19 pandemic, where identification of the medications that acutely ill hospitalized patients with COVID-19 had received was integral to understanding clinical management of this new public health threat and directing public health resources, including scarce medications. The continued reliance on the “medication list” resource instead of the “medication administration" resource is a severe limitation in achieving accurate representation of medication exposure in U.S. healthcare data through FHIR resources. 
  
1. Courter JD, Parker SK, Thurm C, Kronman MP, Weissman SJ, Shah SS, Hersh AL, Brogan TV, Patel SJ, Smith MJ, Lee BR, Newland JG, Gerber JS. Accuracy of administrative data for antimicrobial administration in hospitalized children. J Pediatric Infect Dis Soc 2018;7(3):261-63.  
2. Schwartz DN, Evans RS, Camins BC, Khan YN, Lloyd JF, Shehab N, Stevenson K. Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers. Infect Control Hosp Epidemiol 2011;32(5):472-80.   
3. Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation. BMJ Qual Saf 2016; 25(9):726-30.
4. Rose AJ, Fisher SH, Passche-Orlow MK. Beyond medication reconciliation. The correct medication list. JAMA 2017;317(20):2057-8. 
5. Gupta A, Yek C, Hendler RS. Phenytoin toxicity. JAMA 2017;317(23):2445-6. 

3c. Security Risk

No

3d. External Drivers

CDC/NHSN Application Release cycles

3e. Objectives/Deliverables and Target Dates

Submit for STU Ballot(First Ballot Cycle): 2021 May Ballot
Complete STU Reconciliation: 2021 Sept WGM
Project End Date (all objectives have been met): 2024 May WGM

3g. Lineage

n/a

3h. Project Dependencies

None

3i. HL7-Managed Project Document Repository URL:

Will add pages under the Public Health Project Roadmap menu item

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

No

3l. Reason for not using current V3 data types?

FHIR

3m. External Vocabularies

Yes

3n. List of Vocabularies

SNOMED, LOINC, RxNorm

4a. Products

FHIR Implementation Guide

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Create new standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Quality Reporting Agencies, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Clinical Decision Support Systems

6h. Providers

Clinical and Public Health Laboratories, Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Oct 08, 2020

7f. FMG Approval Date

Oct 14, 2020

Version

4

Modifier

Sarah Gaunt

Modify Date

Oct 14, 2020 21:19

1a. Project Name

NHSN Inpatient Medication Administration Reports (NHSN-Medication-Administration-FHIR) (HL7 Implementation Guide for FHIR® Release 4)

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Publishing

2d. Project Facilitator

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2f. Modeling Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2g. Publishing Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2h. Vocabulary Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2i. Domain Expert Representative

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2k. Conformance Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2m. Implementers

Emory University Hospital

3a. Project Scope

This IG will support electronic submission of line-level medication administration data to the National Healthcare Safety Network (NHSN). The intent of this project is to establish an electronic submission standard that is vendor-neutral that leverages existing workflows and eliminates duplicate documentation. This project will work with EHR vendors to identify data elements that can be used to describe medications administered (name, formulation, route, dose, duration) to hospitalized patients (inpatients) diagnosed with COVID-19 as part of NHSN COVID-19 reporting pathways.

With feedback from CDC and pharmacy informatics SMEs, this project will develop the following IG:
• HL7 Implementation Guide for FHIR® Release: NHSN Inpatient Medication Administration Reports

3b. Project Need

Medication data are integral to informing the quality, safety, and costs of U.S. healthcare, supporting federal, state, and local public health, and guiding clinical decision-making in patient care. In inpatient workflows, medication administration—as captured by electronic medication administration (eMAR) records—is considered the gold standard for accurately measuring in-hospital medication exposure, including identifying the exact medications patients have received, in what formulations, doses, and for what duration of time. Published data indicate that alternate data sources for medication exposure, such as pharmacy “order” (or billing) data and medication “lists” are inaccurate representations of in-hospital medication exposure. Pharmacy order/billing data are discordant with medication administration data due to variability in when billing events occur relative to actual medication administration (1,2). For example, order/billing can occur upon order entry or upon dispensing, neither of which reflects actual medication administration to the patient. Despite an order/billing event, actual administration to the patient can be held, missed, or discontinued (prior to a discontinuation order reaching the pharmacy). Medication “lists”, such as those generated during medication reconciliation, remain a relatively new concept in clinical workflows and are based on processes that are highly variable across U.S hospitals with regard to their accuracy and comprehensiveness (3). Medication lists can also have a high level of discordance with actual administration of medications (4,5). The need for medication administration information has never been clearer as during the COVID-19 pandemic, where identification of the medications that acutely ill hospitalized patients with COVID-19 had received was integral to understanding clinical management of this new public health threat and directing public health resources, including scarce medications. The continued reliance on the “medication list” resource instead of the “medication administration" resource is a severe limitation in achieving accurate representation of medication exposure in U.S. healthcare data through FHIR resources. 
  
1. Courter JD, Parker SK, Thurm C, Kronman MP, Weissman SJ, Shah SS, Hersh AL, Brogan TV, Patel SJ, Smith MJ, Lee BR, Newland JG, Gerber JS. Accuracy of administrative data for antimicrobial administration in hospitalized children. J Pediatric Infect Dis Soc 2018;7(3):261-63.  
2. Schwartz DN, Evans RS, Camins BC, Khan YN, Lloyd JF, Shehab N, Stevenson K. Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers. Infect Control Hosp Epidemiol 2011;32(5):472-80.   
3. Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation. BMJ Qual Saf 2016; 25(9):726-30.
4. Rose AJ, Fisher SH, Passche-Orlow MK. Beyond medication reconciliation. The correct medication list. JAMA 2017;317(20):2057-8. 
5. Gupta A, Yek C, Hendler RS. Phenytoin toxicity. JAMA 2017;317(23):2445-6. 

3c. Security Risk

No

3d. External Drivers

CDC/NHSN Application Release cycles

3e. Objectives/Deliverables and Target Dates

Submit for STU Ballot(First Ballot Cycle): 2021 May Ballot
Complete STU Reconciliation: 2021 Sept WGM
Project End Date (all objectives have been met): 2024 May WGM

3g. Lineage

n/a

3h. Project Dependencies

None

3i. HL7-Managed Project Document Repository URL:

Will add pages under the Public Health Project Roadmap menu item

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

No

3l. Reason for not using current V3 data types?

FHIR

3m. External Vocabularies

Yes

3n. List of Vocabularies

SNOMED, LOINC, RxNorm

4a. Products

FHIR Implementation Guide

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Create new standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Quality Reporting Agencies, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Clinical Decision Support Systems

6h. Providers

Clinical and Public Health Laboratories, Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Oct 08, 2020

7f. FMG Approval Date

Oct 14, 2020

Version

3

Modifier

Sarah Gaunt

Modify Date

Oct 08, 2020 20:56

1a. Project Name

NHSN Inpatient Medication Administration Reports (NHSN-Medication-Administration-FHIR) (HL7 Implementation Guide for FHIR® Release 4)

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Publishing

2d. Project Facilitator

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2f. Modeling Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2g. Publishing Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2h. Vocabulary Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2i. Domain Expert Representative

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2k. Conformance Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2m. Implementers

Emory University Hospital

3a. Project Scope

This IG will support electronic submission of line-level medication administration data to the National Healthcare Safety Network (NHSN). The intent of this project is to establish an electronic submission standard that is vendor-neutral that leverages existing workflows and eliminates duplicate documentation. This project will work with EHR vendors to identify data elements that can be used to describe medications administered (name, formulation, route, dose, duration) to hospitalized patients (inpatients) diagnosed with COVID-19 as part of NHSN COVID-19 reporting pathways.

With feedback from CDC and pharmacy informatics SMEs, this project will develop the following IG:
• HL7 Implementation Guide for FHIR® Release: NHSN Inpatient Medication Administration Reports

3b. Project Need

Medication data are integral to informing the quality, safety, and costs of U.S. healthcare, supporting federal, state, and local public health, and guiding clinical decision-making in patient care. In inpatient workflows, medication administration—as captured by electronic medication administration (eMAR) records—is considered the gold standard for accurately measuring in-hospital medication exposure, including identifying the exact medications patients have received, in what formulations, doses, and for what duration of time. Published data indicate that alternate data sources for medication exposure, such as pharmacy “order” (or billing) data and medication “lists” are inaccurate representations of in-hospital medication exposure. Pharmacy order/billing data are discordant with medication administration data due to variability in when billing events occur relative to actual medication administration (1,2). For example, order/billing can occur upon order entry or upon dispensing, neither of which reflects actual medication administration to the patient. Despite an order/billing event, actual administration to the patient can be held, missed, or discontinued (prior to a discontinuation order reaching the pharmacy). Medication “lists”, such as those generated during medication reconciliation, remain a relatively new concept in clinical workflows and are based on processes that are highly variable across U.S hospitals with regard to their accuracy and comprehensiveness (3). Medication lists can also have a high level of discordance with actual administration of medications (4,5). The need for medication administration information has never been clearer as during the COVID-19 pandemic, where identification of the medications that acutely ill hospitalized patients with COVID-19 had received was integral to understanding clinical management of this new public health threat and directing public health resources, including scarce medications. The continued reliance on the “medication list” resource instead of the “medication administration" resource is a severe limitation in achieving accurate representation of medication exposure in U.S. healthcare data through FHIR resources. 
  
1. Courter JD, Parker SK, Thurm C, Kronman MP, Weissman SJ, Shah SS, Hersh AL, Brogan TV, Patel SJ, Smith MJ, Lee BR, Newland JG, Gerber JS. Accuracy of administrative data for antimicrobial administration in hospitalized children. J Pediatric Infect Dis Soc 2018;7(3):261-63.  
2. Schwartz DN, Evans RS, Camins BC, Khan YN, Lloyd JF, Shehab N, Stevenson K. Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers. Infect Control Hosp Epidemiol 2011;32(5):472-80.   
3. Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation. BMJ Qual Saf 2016; 25(9):726-30.
4. Rose AJ, Fisher SH, Passche-Orlow MK. Beyond medication reconciliation. The correct medication list. JAMA 2017;317(20):2057-8. 
5. Gupta A, Yek C, Hendler RS. Phenytoin toxicity. JAMA 2017;317(23):2445-6. 

3c. Security Risk

No

3d. External Drivers

CDC/NHSN Application Release cycles

3e. Objectives/Deliverables and Target Dates

Submit for STU Ballot(First Ballot Cycle): 2021 May Ballot
Complete STU Reconciliation: 2021 Sept WGM
Project End Date (all objectives have been met): 2024 May WGM

3g. Lineage

n/a

3h. Project Dependencies

None

3i. HL7-Managed Project Document Repository URL:

Will add pages under the Public Health Project Roadmap menu item

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

No

3l. Reason for not using current V3 data types?

FHIR

3m. External Vocabularies

Yes

3n. List of Vocabularies

SNOMED, LOINC, RxNorm

4a. Products

FHIR Implementation Guide

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Create new standard

5b. Project Ballot Type

STU to Normative

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Quality Reporting Agencies, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Clinical Decision Support Systems

6h. Providers

Clinical and Public Health Laboratories, Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

Version

2

Modifier

Sarah Gaunt

Modify Date

Oct 08, 2020 17:34

1a. Project Name

NHSN Inpatient Medication Administration Reports (NHSN-Medication-Administration-FHIR) (HL7 Implementation Guide for FHIR® Release 4)

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Publishing

2d. Project Facilitator

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2f. Modeling Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2g. Publishing Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2h. Vocabulary Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2i. Domain Expert Representative

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2k. Conformance Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2m. Implementers

Emory University Hospital

3a. Project Scope

This IG will support electronic submission of line-level medication administration data to the National Healthcare Safety Network (NHSN). The intent of this project is to establish an electronic submission standard that is vendor-neutral that leverages existing workflows and eliminates duplicate documentation. This project will work with EHR vendors to identify data elements that can be used to describe medications administered (name, formulation, route, dose, duration) to hospitalized patients (inpatients) diagnosed with COVID-19 as part of NHSN COVID-19 reporting pathways.

With feedback from CDC and pharmacy informatics SMEs, this project will develop the following IG:
• HL7 Implementation Guide for FHIR® Release: NHSN Inpatient Medication Administration Reports

3b. Project Need

Medication data are integral to informing the quality, safety, and costs of U.S. healthcare, supporting federal, state, and local public health, and guiding clinical decision-making in patient care. In inpatient workflows, medication administration—as captured by electronic medication administration (eMAR) records—is considered the gold standard for accurately measuring in-hospital medication exposure, including identifying the exact medications patients have received, in what formulations, doses, and for what duration of time. Published data indicate that alternate data sources for medication exposure, such as pharmacy “order” (or billing) data and medication “lists” are inaccurate representations of in-hospital medication exposure. Pharmacy order/billing data are discordant with medication administration data due to variability in when billing events occur relative to actual medication administration (1,2). For example, order/billing can occur upon order entry or upon dispensing, neither of which reflects actual medication administration to the patient. Despite an order/billing event, actual administration to the patient can be held, missed, or discontinued (prior to a discontinuation order reaching the pharmacy). Medication “lists”, such as those generated during medication reconciliation, remain a relatively new concept in clinical workflows and are based on processes that are highly variable across U.S hospitals with regard to their accuracy and comprehensiveness (3). Medication lists can also have a high level of discordance with actual administration of medications (4,5). The need for medication administration information has never been clearer as during the COVID-19 pandemic, where identification of the medications that acutely ill hospitalized patients with COVID-19 had received was integral to understanding clinical management of this new public health threat and directing public health resources, including scarce medications. The continued reliance on the “medication list” resource instead of the “medication administration" resource is a severe limitation in achieving accurate representation of medication exposure in U.S. healthcare data through FHIR resources. 
  
1. Courter JD, Parker SK, Thurm C, Kronman MP, Weissman SJ, Shah SS, Hersh AL, Brogan TV, Patel SJ, Smith MJ, Lee BR, Newland JG, Gerber JS. Accuracy of administrative data for antimicrobial administration in hospitalized children. J Pediatric Infect Dis Soc 2018;7(3):261-63.  
2. Schwartz DN, Evans RS, Camins BC, Khan YN, Lloyd JF, Shehab N, Stevenson K. Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers. Infect Control Hosp Epidemiol 2011;32(5):472-80.   
3. Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation. BMJ Qual Saf 2016; 25(9):726-30.
4. Rose AJ, Fisher SH, Passche-Orlow MK. Beyond medication reconciliation. The correct medication list. JAMA 2017;317(20):2057-8. 
5. Gupta A, Yek C, Hendler RS. Phenytoin toxicity. JAMA 2017;317(23):2445-6. 

3c. Security Risk

No

3d. External Drivers

CDC/NHSN Application Release cycles

3e. Objectives/Deliverables and Target Dates

Submit for STU Ballot(First Ballot Cycle): 2021 May Ballot
Complete STU Reconciliation: 2021 Sept WGM
Project End Date (all objectives have been met): 2024 May WGM

3g. Lineage

n/a

3h. Project Dependencies

None

3i. HL7-Managed Project Document Repository URL:

Will add pages under the Public Health Project Roadmap menu item

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

No

3l. Reason for not using current V3 data types?

FHIR

3m. External Vocabularies

Yes

3n. List of Vocabularies

SNOMED, LOINC, RxNorm

4a. Products

FHIR Implementation Guide

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Create new standard

5b. Project Ballot Type

STU to Normative

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Quality Reporting Agencies, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Clinical Decision Support Systems

6h. Providers

Clinical and Public Health Laboratories, Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

Version

1

Modifier

Sarah Gaunt

Modify Date

Oct 08, 2020 04:02

1a. Project Name

NHSN Inpatient Medication Administration Reports (NHSN-Medication-Administration-FHIR) (HL7 Implementation Guide for FHIR® Release 4)

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Publishing

2d. Project Facilitator

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2f. Modeling Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2g. Publishing Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2h. Vocabulary Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

2i. Domain Expert Representative

Nadine Shehab (ftn0@cdc.gov, nadine.shehab@lantanagroup.com)

2k. Conformance Facilitator

Zabrina Gonzaga (zabrina.gonzaga@lantanagroup.com) Sarah Gaunt (sarah.gaunt@lantanagroup.com)

3a. Project Scope

This IG will support electronic submission of line-level medication administration data to the National Healthcare Safety Network (NHSN). The intent of this project is to establish an electronic submission standard that is vendor-neutral that leverages existing workflows and eliminates duplicate documentation. This project will work with EHR vendors to identify data elements that can be used to describe medications administered (name, formulation, route, dose, duration) to hospitalized patients (inpatients) diagnosed with COVID-19 as part of NHSN COVID-19 reporting pathways.

With feedback from CDC and pharmacy informatics SMEs, this project will develop the following IG:
• HL7 Implementation Guide for FHIR® Release: NHSN Inpatient Medication Administration Reports

3b. Project Need

Medication data are integral to informing the quality, safety, and costs of U.S. healthcare, supporting federal, state, and local public health, and guiding clinical decision-making in patient care. In inpatient workflows, medication administration—as captured by electronic medication administration (eMAR) records—is considered the gold standard for accurately measuring in-hospital medication exposure, including identifying the exact medications patients have received, in what formulations, doses, and for what duration of time. Published data indicate that alternate data sources for medication exposure, such as pharmacy “order” (or billing) data and medication “lists” are inaccurate representations of in-hospital medication exposure. Pharmacy order/billing data are discordant with medication administration data due to variability in when billing events occur relative to actual medication administration (1,2). For example, order/billing can occur upon order entry or upon dispensing, neither of which reflects actual medication administration to the patient. Despite an order/billing event, actual administration to the patient can be held, missed, or discontinued (prior to a discontinuation order reaching the pharmacy). Medication “lists”, such as those generated during medication reconciliation, remain a relatively new concept in clinical workflows and are based on processes that are highly variable across U.S hospitals with regard to their accuracy and comprehensiveness (3). Medication lists can also have a high level of discordance with actual administration of medications (4,5). The need for medication administration information has never been clearer as during the COVID-19 pandemic, where identification of the medications that acutely ill hospitalized patients with COVID-19 had received was integral to understanding clinical management of this new public health threat and directing public health resources, including scarce medications. The continued reliance on the “medication list” resource instead of the “medication administration" resource is a severe limitation in achieving accurate representation of medication exposure in U.S. healthcare data through FHIR resources. 
  
1. Courter JD, Parker SK, Thurm C, Kronman MP, Weissman SJ, Shah SS, Hersh AL, Brogan TV, Patel SJ, Smith MJ, Lee BR, Newland JG, Gerber JS. Accuracy of administrative data for antimicrobial administration in hospitalized children. J Pediatric Infect Dis Soc 2018;7(3):261-63.  
2. Schwartz DN, Evans RS, Camins BC, Khan YN, Lloyd JF, Shehab N, Stevenson K. Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers. Infect Control Hosp Epidemiol 2011;32(5):472-80.   
3. Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation. BMJ Qual Saf 2016; 25(9):726-30.
4. Rose AJ, Fisher SH, Passche-Orlow MK. Beyond medication reconciliation. The correct medication list. JAMA 2017;317(20):2057-8. 
5. Gupta A, Yek C, Hendler RS. Phenytoin toxicity. JAMA 2017;317(23):2445-6. 

3c. Security Risk

No

3d. External Drivers

CDC/NHSN Application Release cycles

3e. Objectives/Deliverables and Target Dates

Submit for STU Ballot(First Ballot Cycle): 2021 May Ballot
Complete STU Reconciliation: 2021 Sept WGM
Project End Date (all objectives have been met): 2024 May WGM

3g. Lineage

n/a

3h. Project Dependencies

None

3i. HL7-Managed Project Document Repository URL:

Will add pages under the Public Health Project Roadmap menu item

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

No

3l. Reason for not using current V3 data types?

FHIR

3m. External Vocabularies

Yes

3n. List of Vocabularies

SNOMED, LOINC, RxNorm

4a. Products

FHIR Implementation Guide

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Create new standard

5b. Project Ballot Type

STU to Normative

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Quality Reporting Agencies, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Clinical Decision Support Systems

6h. Providers

Clinical and Public Health Laboratories, Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR