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Attendees

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Agenda Items and Notes

Outstanding Action Item List

Meeting Notes from previous meeting

• 2022-03-21 Agenda/Meeting Notes - Pharmacy - accepted by general consent

Project Review

Project Proposals

• Project Proposals in Review -
  • PSS-2000 - Getting issue details... STATUS - no need to be involved at this time

Project Scope Statements

• Project Scope Statements 
  • None to review

Catalog Updates (John Hatem)

• 28 Mar 2022 - no meeting this past week

Workflow Update (John Hatem) 

• 28 Mar 2022- no meeting this week

Healthcare Product Update (John Hatem)

• 28 Mar 2022 - discuss Device and Biological Derived Product trackers - no pharmacy specific issues. 

EHR conformant reconciled medication list (cRML)

• a sub-project of EHR Reducing Clinician Burden
• developing a use case/scenario of medication reconciliation between prescriber, patient, assistant, and social worker.  excludes MedRec by pharmacist.  Looking at how technology can reduce the time required by prescriber/assistant, improve the quality of the medication list, and improve patient care (reduce errors and frustrations
• Scott, Shelly and John at attending
• 21 Feb 2022 
  • cRML group has pretty much completed the use case/scenario
  • A vendor has come forward to implement system(s) to illustrate the "improvements" expressed in the use case. 
• 07 Mar 2022- Update from March 3rd meeting - John and Scott attended the meeting.  No Pharmacy concerns at this time
• 14 Mar 2022 No meeting this week.  I have provided an overview document on Medication Reconciliation to get agreement about what it is.  I will share the content in a future meeting. 
• 21 Mar 2022 - no update
• 28 Mar 2022 - no updates - still coordinating with new pilot vendor

NCPDP Updates (NCPDP Members)

WG18 Patient Consent TG:

• Propose submitting the updated IG for the September HL7 ballot
• Propose submitting NCPDP DERF at the May WG Meeting
• A meeting is scheduled for March 31st at 11:00 am Central time
• 28 Mar 2022 

MC Consumer and Provider RTPB Standards Monitoring Sub-Task Group

• Next meetings are scheduled for April 4th and April 18th at Noon Central Time
• Will be bringing issues on the RTPB IG in the future 
• 14 Mar 2022 - task group will help to support consistency of NCPDP RTPBC standards with CARIN standard - have looked at new features that have been added to NCPDP real time pharmacy benefit check messaging
  
  • have submitted them for consideration to be added to CARIN Real Time Benefit Check via JIRA - have submitted them as comments, but will update them to change requests
    • FHIR-36294 - Consider Addition of Deductible Accumulator Fields to Consumer RTPBC response
    • FHIR-36295 - Consider addition of Patient Sex Assigned at Birth to Consumer RTPBC request
    • FHIR-36296 - Consider adding section to Consumer RTPB Check Imp Guide dedicated to pricing guidance
    • FHIR-36297 Consider adding clarification of types of products supported with Consumer RTPB Check Imp Guide
• 21 Mar 2022 - 2 additional issues will be added this week - this will complete the review based on the review of the NCPDP standard
  
  • no impact to Pharmacy resources
  • once all issues have been added - will bring in those from Financial Management who are interested
  • no one currently funded to do the work on this IG
• 28 Mar 2022 - 2 additional issues have been added

WG14 Consultant Pharmacist TG

• Continue the process of updating the current C-CDA guidance document, “Consultant Pharmacist Consult Note v1.0: Guidance on the Use of the HL7 CDA Consolidated Templates for Clinical Notes R2.1 Consult Note”, to incorporate FHIR Resources.

• A meeting is scheduled for March 31st at 10:00 am Central time
• 21 Feb 2022 
  
  • will be presenting to StrucDoc and PtCare
• 28 Feb 2022 expect kick-off announcement this week
• Discussed adding additional use cases to document.
• March 7th - the IG will have its kick-off announcement shortly
• 14 Mar 2022 
  
  • had kick off meeting today
  • will be starting biweekly meetings on March 21st
  • expect to have ready for September 2022 Ballot Cycle
• 21 Mar 2022 no meeting today
• 28 Mar 2022 - next meeting is April 4

WG18 Specialty Requirements for ePrescribing Task Group

• Adding Patient Consent to Specialty Medication Enrollment Guide
   http://build.fhir.org/ig/HL7/fhir-specialty-rx/index.html
• No meetings are scheduled at this time
• 21 Mar 2022 - target to ballot in September
• 28 Mar 2022 

Meeting information can be obtained at https://dms.ncpdp.org/

Projects

Pharmacy Templates

• 31 Jan 2022 - discussed how to add an extension to support Marketing Authorization Holder
  
  • Christof will follow up with stakeholders to discuss Jean's suggested approach
• 14 Feb 2022 - Christof presented discusses to the group and trying to convince them about the MAH - 1 org and will be either manufacturer or MAH
• 21 Feb 2022 
• 28 Feb 2022
  • Georgio is trying to get this ready for May 2022.  Christof will be working with Georgio.  still need to get PDF from Kai.
  • CDA-2075 - Getting issue details... STATUS - non persuasive, Christof / John H 13-0-0  (Christof would have withdrawn but Jira workflow wont allow it to be withdrawn)
• 14 Mar 2022 - work underway to complete the work for ballot
  • Kai has been involved in discussion
  • Final content deadline for May ballot - March 27th
    • Pharmacy needs to approve final content on March 21st!
  • Melva to followup with Giorgio to get status on the content for ballot
• 21 Mar 2022 
  
  • HL7_PHARM_Templates-R2-v201.pdf
  • just received content yesterday and have not had a chance to review - today is the last day we can approve content for ballot
  • Motion - Melva - Scott - to approve the delay of the content for the September 2022 Ballot Cycle given the lack of review - approved 9-0-4 
    • discussion of doing an evote
• 28 Mar 2022 - will need NIB for September ballot

PDex Formulary (Corey)

• continuing to work on
• Expect some items to vote on for next week
• PSS will need to be reviewed by Pharmacy
• 21 Feb 2022 
  
  • Formulary IG under general PDex PSS, adding bulk data requires a revision to PSS
  • Draft in Word, not in confluence yet
  • added bulk data, "authorized individuals and organizations", additional use cases (e.g., future care), access by non-members
  • will be creating new resource
  • question related to "individuals" should include non-individuals (parties). (not a request for change)  
  • question if there any privacy concerns (no PHI)
  • on HRex diagram - PSS work is built on top of HRex, there is more in HRex that is not used in PDex
  • Motion to accept changes to PSS:  Corey Spears / Tim McNeil  7-0-1 PASSED
  • no other updates to report
• 28 Feb 2022 
  

  • email to go out for a block vote on these issues

    Issue key	Summary	Resolution
    FHIR-36143	Add invariant to InsurancePlanLocation requiring address or geolocation extension	Persuasive
    FHIR-36142	Make FormularyItem PharmacyType cardinality 1..*	Persuasive
    FHIR-36137	Update CapabilityStatement to make Location SHALL	Persuasive
    FHIR-35365	FormularyItem extensions need descriptive descriptions	Persuasive with Modification

  • Motion to approve the Block Vote: Corey Spears / Scott Robertson: 11-0-1
• 14 Mar 2022 - Corey
  • FHIR-35586 - Drug Tier CodeSystem
    • defined in formulary IG
    • question of whether it is mature enough to move in to THO or if there is an existing code system that should be used
    • expect that payers will have their own - will be extensible
    • not aware of code system that could be used
    • leaning to finding this either not persuasive or considered for future use
      • not persuasive - if need to get implementation experience before making a final decision 
      • considered for future use - will consider doing this in the future
      • Lean to "considered for future use" unless they are really guide specific
  • 13 items (including FHIR-35586)
    • Block Vote 2 - Corey will send them to the Pharmacy List and we will vote on March 21st
• 21 Mar 2022 - 
  • There were actually 14 in the block votes (not 13 as noted above)

• • Motion to accept 14 tickets as proposed - Corey Spears - Dave Hill - 11-0-2
    • Corey will update the Jira issues with vote
• 28 Mar 2022 upcoming block vote - will be voted on next Monday - Corey will send to Pharmacy List

  • Issue key	Summary	Disposition	Reporter
    FHIR-35196	Issue with Presenting Drug Alternatives description	Persuasive with Mod.	celine_lefebvre
    FHIR-35198	Add Drug Covered Under Different Benefit	Considered for Future Use	celine_lefebvre
    FHIR-35366	Simplify FormularyItem by inlining drug codes	Nor Persuasive with Modification	jmandel

    And a notice on the following Technical Correction

    Issue key	Summary	Disposition	Reporter
    FHIR-36343	Update Formulary Structure Diagram to use correct profile names	Persuasive	corey_spears

Ongoing Questions

Representing FHIR Compound Medications

• Aaron Berdofe and Brendan Keeler will be joining to discuss how to represent compound medications
  • http://hl7.org/fhir/medicationexample0319.html
  • http://hl7.org/fhir/medicationexample0317.html
• 21 Feb 2022 
  
  • a particular question of Aaron's group: contrasting a product (manufactured) with expressed ingredients vs a compound to be made from multiple specific ingredients
  • also questions of how to express strength of the compounded product
• 28 Feb 2022 action item Scott to reach out to Aaron and Brendan
• 14 Mar 2022 - Scott to reach out
• 21 Mar 2022 - Scott has not reached out yet

• 28 Mar 2022 - Scott sent response to Aaron and Brendan

  • no response yet

Compound Medication CDA Examples

• review of proposed examples using CDA for recording compounded medications
• <!-- Example mixture: diphenhydrAMINE hydrochloride 3 mg/mL ELIX 1.6667 mL, lidocaine 3 % SOLN 1.6667 mL, aluminum & magnesium hydroxide-simethicone 400-400-40 mg/5mL SUSP 1.6667 mL →
• https://github.com/mjszczep/C-CDA-Examples/blob/Drug-Mixture/Medications/Drug%20Mixture/Drug%20Mixture%20(C-CDAR2.1).xml
• Scott and Melva will work on this and provide example
• 21 Feb 2022 
  • Scott is getting closer on updating the examples ... revising Matt's and creating one or two "more normal" compounds
• 28 Feb 2022 
  
  • Scott M. Robertson Scott will get the examples out this week
• 14 Mar 2022 - Scott has not been able to work on examples
  • hope to get them to Matt by tomorrow
• 21 Mar 2022 - Scott provided examples last week
  • Scott to reach out to Kai about example in Art Decor
  • discussion of what denominator means - it is the concentration in the final product
• 28 Mar 2022 - outstanding question on what to do with quantity
  • wording different between CDA ingredient and FHIR ingredient
    • CDA - ingredient.quantity - believe it represents the strength
    • FHIR has strength attribute
  • assume that the unit of measure for each ingredient will be the same as the doseQuantity

FHIR (Group)

Trackers - link to pharmacy unresolved Jira trackers (see trackers for details / resolutions)

Any Other Business

• Do we have any issues with BDP here is the link:  BiologicallyDerivedProduct - FHIR v4.6.0 - no discussion on 14 Mar 2022 
  • 21 Mar 2022 
    • scope of medication - John to put it out the list to see if the scope makes sense.
    • may make sense that we add Biologically Derived product to our resources
  • 28 Mar 2022 - John Hatem to add JIRA issue to add 
• FHIR-33991 - MedicationUsage - need to have multiple usage instances if you have different patterns of adherence
  • Scott to report back to Emma
• CARIN RTPBC - STU Extension needed
  • implementers are getting ready to start getting engaged - confirmed that it should be extended for 2 years
  • looking at next steps for new version
  • Motion by John Hatem/Corey Spears to extend for an additional 2 years - 11-0-1 Carried
  • Melva Peters to draft extension request

Next meeting

• 04 Apr 2022 
  • FHIR-36388 - move to technical correction -agree to change - see JIRA
  • FHIR-36389 - move to technical correction -agree to change - see JIRA
  • FHIR-36396 - move to technical correction -agree to change - see JIRA
  • FHIR-34413 - discussion, but will come back to next week
    • John to look at requirements for pumps

Tasks

• Melva Peters to reach out to CARIN about who is working on the RTPBC project
• Melva Peters - check with STU expires for RTPBC IG
• Melva Peters  to reach out to Kai and Giorgio to thank them the work and letting them know about the delay - due to the inability to review the final content in time for the vote to approve going to ballot
• Scott M. Robertson to reach out to Kai about example in Art Decor
• Melva Peters - to raise issue with TSC about EHR project 
• Scott M. RobertsonStephen Chu   to report back to Emma on MedicationUsage