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Agenda Items and Notes

Outstanding Action Item List

Meeting Notes from previous meeting

• 2022-03-28 Agenda/Meeting Notes - Pharmacy

Project Review

Project Proposals

• Project Proposals in Review -
  • PSS-2002 - Getting issue details... STATUS

Project Scope Statements

• Project Scope Statements 
  • PSS-2008 - Getting issue details... STATUS
  • PSS-2003 - Getting issue details... STATUS

Catalog Updates (John Hatem)

• 04 Apr 2022 - No Pharmacy specific issues came up on the call. 

Workflow Update (John Hatem) 

• 04 Apr 2022- No pharmacy specific issues came up on the call.  Discussed Workflow trackers. 
  • No updates to the existing patterns but it is next on LM list of to-dos.  He will notify all folks when these updates are completed.

Healthcare Product Update (John Hatem)

• 04 Apr 2022 - Trackers discussed and a review of Biologically Derived Products resource
  • Are the following products typically carried by Pharmacy systems:  Lantus, Humira, Remicade, Rituxan, Enbrel, Herceptin, Avastin, Botox ?
    • Check out this link for other medications that are biologics: FDA Approved Biologics List And Medical Conditions That They Treat | Joseph Han, PharmD Intern | RxEconsult
    • Based on feedback during the call, we have confirmation that Pharmacy resources do need to reference Biologically Derived Products resource
  • Note that in BDP the item being ordered is only available via the "identifier" element.  

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
• 04 Apr 2022 - no update

NCPDP Updates (NCPDP Members)

WG18 Patient Consent TG:

• Propose submitting the updated IG for the September HL7 ballot
• NCPDP DERF has been submitted for the May WG Meeting
  • Connectathon participation/testing is a requirement for going to ballot at HL7. If you want this to be available as a standard, we need your participation!
• A meeting is scheduled for April 14 at 11:00 am Central time
• 28 Mar 2022 
• 04 Apr 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

  • FHIR-36634     Consider Addition of Formulary Status Information

  • FHIR-36633     New NCPDP Coverage Restriction Values + Consider Addition of Next Available Fill Date

• 04 Apr 2022 

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
• 04 Apr 2022 HL7 review calls have started with little participation.  Will be pivoting to work via email to the known participants, with progress reviewed on the calls.  next meeting is April 18

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 
• 04 Apr 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 follow-up 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
• 04 Apr 2022 

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

And a notice on the following Technical Correction

• 04 Apr 2022 Motion to accept the dispositions was made by Corey Spears seconded by Dave Hill.  Vote was:  12-0-1
  • Corey raised a new question about when to bring bulk data export to Pharmacy for review. Corey could wait until we are seeking a vote or we could discuss earlier to bubble up any issues or concerns before we get too far. He has the overall design done. 

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
• 04 Apr 2022 - neither Aaron or Brendan attended today's meeting.
  • Scott M. Robertson to reach out to Aaron and Brendan to see if questions are resolved

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
• 04 Apr 2022 Matt has a few questions but will take more time than appropriate on this call.  Matt will send an invite for a discussion call tomorrow, April 5

FHIR (Group)

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

Any Other Business

• FHIR-33991 - MedicationUsage - need to have multiple usage instances if you have different patterns of adherence
  • Scott to report back to Emma
  • 04 Apr 2022 Emma responded and seems satisfied.  Emma asked for the answer to be posted in Jira (FHIR-33991)and Zulip, and MedicationUsage narrative updated with this information  FHIR-36701 - Getting issue details... STATUS

Next meeting

• 11 Apr 2022 

Tasks

• 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