Pharmacy Work Group - Orlando · Web viewPharmacy Working Group Meeting Minutes . Baltimore, MD....

Pharmacy Working Group Meeting Minutes

Baltimore, MD

September 10-14, 2012Monday 10 September 2012 Q3...................................................................................................................... 3

Monday 10 September 2012 Q4...................................................................................................................... 5

Tuesday 11 September 2012 Q1..................................................................................................................... 7



Tuesday 11 September 2012 Q4...................................................................................................................10

Wednesday 12 September 2012 Q1............................................................................................................ 11



Thursday 13 September 2012 Q1................................................................................................................ 18



Friday 14 September 2012 Q1.......................................................................................................................22



document.doc 1 D R A F T

Action ItemsAction: Hugh already has an action to follow up on this 3

Action: J-H to speak with Austin about withdrawing his negatives 3

Action item: Julie has agreed to put the concept domains forward, including the names and the definitions. She will work with Wendy H on this. 5

Action Item: Hugh to follow up with O&O regarding the suggested change required to support this issue. 6

Action item: Tom will draft the approach pharmacy will use to represent ‘and’ & ‘or’ in Rx queries. 6

Action: Hugh – to ask Hans and Karen for guidance on how to deal with remaining ballot 7

Action: Hugh – Create a single comment to apply to existing ballot comments and bring to committee later this week. 7

Action: Review action items recorded in action item log. 7

Action: Review action items recorded in Action List on SVN 8

Action: Melva – send publication request and information to Lynn 9

Action: Melva – will ensure implementation table of content discussion is on the agenda for Friday for one of the quarters 9

Action: Melva – Check the clinical statement scope statement to see if it includes balloting of changes to our models. 9

Action: General – See 3yr plan sept 2012 on SVN for Project 856 9

Action: Scott to get WG6 agenda from Christian – Done (attached below) 12

Action: Add ISO WG6 as a standing agenda item for Pharmacy WG 12

Action: Scott to resolve WG references in Project Insight (and any other places) 13

Action: Scott to report to Pharmacy WG on Quality CDA IGs project 13

Action: Revisit Out of Cycle Agenda on the first Pharmacy WG conference call (co-chairs) 15

Action: Publish draft Meeting Agenda as far in advance as possible (co-chairs/Tom) 15

Action: Melva to submit room requests to HQ 15

Action: J-H to talk to Electronic Services about a Ballot Sandbox 15

Action: Hugh will update the Pharmacy Wiki, including the area associated with the Medication Profile. 21

Action: see OOC IHE joint meeting information on the Wiki http://wiki.hl7.org/index.php?title=2012-10_Out_of_Cycle_Meeting_-_Paris 25


Monday 10 September 2012 Q3AttendeesName Organization Country EmailNicolas Canu PHAST France [email protected] Duteau Duteau Design Canada [email protected] Robertson Kaiser Permanente USA [email protected] de Jong HL7 The Netherlands Netherlands [email protected] Hatem Oracle USA [email protected] James (Scribe) Blue Wave Informatics UK [email protected] Glover (Chair) Blue Wave Informatics UK [email protected]

Quorum Met: Yes

Agenda Topics Review and Finalise WGM Agenda Representatives to other meetings Introductions Approve May 2012 WGM Meetings Overview of ballot planning Status of e-mail threads since last WGM

Supporting Documents Agenda Minutes from May 2012 Vancouver WGM

Minutes/Conclusions Reached No Introductions were required The Agenda was reviewed and discussed; scribes and representatives to other groups were

assigned. The Minutes from the May WGM in Vancouver were displayed; they had been previously

reviewed and discussed on conference call. Tom moved to formally accept the Minutes, Scott seconded; Vote: Against: 0 Abstain: 0 For: 6

Ballot Planning Order R2 and Dispensing R2 were worked on in the Norway OOC. The storyboards

have been reordered; there is one more storyboard to be added to the PubDb, and there are diagrams to create. There are also RMIMs to update and the DMIM to review.PHER have been using a text editor (e.g. Notepad) with files in SVN, then all the PubFacilitator has to do is a (simple) paste into the PubDb; there are fewer issues than managing storyboards in Word. J-H and Scott are going to set this up.January ballot will therefore have Order R2 and Dispense R2 (content to be present by November 11th).

There are outstanding negatives on Medication Statement from Austin; on Common Order from Scott and Austin and on Common Dispense from Scott.The Pharmacy CMETs has outstanding negatives from Freida Hall (on behalf of VA)

Action: Hugh already has an action to follow up on thisAction: J-H to speak with Austin about withdrawing his negatives


Medication Dispense is clear and will be published in the next Normative Edition. E-mail Threads

Most threads since Vancouver have been FHIR related and will be discussed in the Pharmacy FHIR sessions.


Monday 10 September 2012 Q4AttendeesName Organization Country EmailJean-Henri Duteau Duteau Design Canada [email protected] de Jong HL7 The Netherlands Netherlands [email protected] Hatem Oracle USA [email protected] James (John) Blue Wave Informatics UK [email protected] Glover (Chair) Blue Wave Informatics UK [email protected] Huang Canada Infoway Canada [email protected] Brooks MoHH Singapore [email protected]

Quorum Met: Yes

Agenda Topics Harmonization Proposal Discussion Pharmacy Hot Topics Clinical Statement Outstanding Items (John) Review Action List (John) - Moved to Tuesday Q1

Supporting Documents Agenda Harmonization Proposal

Agenda Topics Harmonization Proposal Discussion

Jean Duteau described the need for adding Negation Indicator to our models. The reason is to assure we are adequately representing the semantics of no substitution.

The second issue we discussed was associated with getting the vocabulary domain models aligned with both the negation and the non negation use cases.

Action item: Julie has agreed to put the concept domains forward, including the names and the definitions. She will work with Wendy H on this.

Motion by Tom de Jong to accept suggested changes for vocabulary after they have been implemented. Second by Jean Duteau. For: 5 Against: 0 Abstain: 1

Pharmacy Hot topics Reviewed existing hot topics on Rx Wiki. The discussion was to assess for updates, or

adding in new entries. Hugh will update the topics as ‘resolved’ or with other statuses. The topics we discussion are:

Collection of Guidelines – discussed publication date, and effective time for the guideline. See comments added to this topic.

Definitions that need more clarity – Encoded Order vs. Pharmaceutical Advice. They are not the same. Pharmaceutical Advice is a broader concept that include both Encoded Order and other information e.g. drug-drug interaction checking. After discussion we agree that multiple names are fine as long as there are clear, unambiguous definitions. In publishing our pharmacy materials we did agree that we should select one term in our materials, and not use multiple terms for the same thing.

Interpretation of Effective Time for Acts in Definition Mood – see hot topic wiki updated comments.


mailto:[email protected]

Action Item: Hugh to follow up with O&O regarding the suggested change required to support this issue.

Process and Pickup: 1 issue or 2 – we have agreed that we have no need to support the processes internal to the pharmacy when preparing the dispensed medication.

Rules for Using ‘and’ & ‘or’ in Queries – see comments on hot topics wiki. Action item: Tom will draft the approach pharmacy will use to represent ‘and’ & ‘or’ in Rx

queries. Storage Conditions and Shelf Life – Hugh checked model and we have addressed

these requirements. Discussion on wide ranging issues related to the use of our models. Are they being used?

How should that affect what we produce? To be discussed again during our planning session.

Minutes/Conclusions Reached Action: see in line above.


Tuesday 11 September 2012 Q1AttendeesName Organization Country EmailNicolas Canu Nicolas Canu Nicolas Canu [email protected]

Tom de Jong HL7 The Netherlands Netherlands [email protected] Hatem Oracle USA [email protected] James (Scribe) Blue Wave Informatics UK [email protected] Glover (Chair) Blue Wave Informatics UK [email protected] Hallowell Siemens USA [email protected] Chu NEHTA Australia [email protected] Klimek NCPDP US [email protected] Met: Yes

Agenda Topics IDMP Ballot Status and Reconciliation Discuss IDMP CMETS for Pharmacy Review action list (continued if needed) - John

Supporting Documents Agenda IDMP Ballot Comments Action List

Minutes/Conclusions Reached Discussion of IDMP ballot

Committee accept that ICH decisions mean that the content of the IDMP Ballot is now largely irrelevant and will be replaced by SPL.

Action: Hugh – to ask Hans and Karen for guidance on how to deal with remaining ballotAction: Hugh – Create a single comment to apply to existing ballot comments and bring to

committee later this week. Action Items

We reviewed the action item list. Action: Review action items recorded in action item log.


Tuesday 11 September 2012 Q2AttendeesName Organization Country EmailTom de Jong (Chair) HL7 The Netherlands Netherlands [email protected] Hatem (Scribe) Oracle USA [email protected] Duteau Duteau Design Canada [email protected] Hallowell Siemens USA [email protected] Met: Yes

Agenda Topics Action Item List review – see updated action item list on SVN.

Supporting Documents Updated action item list on SVN.

Minutes/Conclusions ReachedAction: Review action items recorded in Action List on SVN


Tuesday 11 September 2012 Q3AttendeesName Organization Country EmailMelva Peters (Chair) HL7 Canada Canada [email protected] Robinson Kaiser Permanente USA [email protected] de Jong HL7 The Netherlands Netherlands [email protected] Hatem Oracle USA [email protected] Duteau Duteau Design Canada [email protected] Hallowell (Scribe) Siemens USA [email protected]

Quorum Met: Yes

Agenda Topics Approval to publish Medication Knowledge Base Query R1 as Normative Ballot Planning and Preparation - January 2013

Supporting Documents Agenda 3 year plan document

Minutes/Conclusions Reached Approval to publish Medication Knowledge Base Query R1 as Normative

Motion by Jean – seconded by John Hatem to publish Mediation Knowledge Base Query R1 as Normative Vote: 5-0-0 (approved)

Action: Melva – send publication request and information to Lynn

Ballot Planning and Preparation - January 2013 See 3-year plan on SVN

Action: Melva – will ensure implementation table of content discussion is on the agenda for Friday for one of the quarters

Action: Melva – Check the clinical statement scope statement to see if it includes balloting of changes to our models.

Action: General – See 3yr plan sept 2012 on SVN for Project 856


Tuesday 11 September 2012 Q4AttendeesName Organization Country EmailTanya Achilles Canada Health Infoway Canada [email protected] de Jong (Chair) HL7 The Netherlands Netherlands [email protected] Hatem (Scribe) Oracle USA [email protected] Duteau Duteau Design Canada [email protected] Hallowell Siemens USA [email protected] James Blue Wave Informatics UK [email protected] Glover (Chair) Blue Wave Informatics UK [email protected] Tan NICTIZ Netherlands [email protected] Chu NEHTA Australia [email protected]

Quorum Met: Yes

Agenda Topics Review Glossary

Supporting Documents Google Docs pharmacy glossary link.

Minutes/Conclusions Reached Glossary discussion

Tom brought up the Google docs list of pharmacy glossary definitions and the review started. See the web site for updated definitions.


Wednesday 12 September 2012 Q1AttendeesName Organization Country EmailTom de Jong – Chair HL7 The Netherlands Netherlands [email protected] Robertson – Scribe Kaiser Permanente USA [email protected] Hay GS1 CH [email protected] Hallowell Siemens USA [email protected] Chu NEHTA Australia [email protected] Glover Blue Wave Informatics UK [email protected] Canu PHAST France [email protected] Hatem Oracle USA [email protected] Duteau Duteau Design Canada [email protected] Tan NICTIZ Netherlands [email protected]

Quorum Met: Yes

Agenda Topics Introductions Agenda overview ISO

ISO WG6 update ISO Dose Syntax project

Medication Profile

Supporting Documents Agenda

Minutes/Conclusions Reached ISO WG6 [Christian Hay]

Most work items concluded. IDMP close to conclusion Work item review in Vancouver, brainstorming new work item. Not a large group, not

fully representative of thefull group (~60-80). Two follow-up telecons to further develop new ideas.

Next WG6 in Vienna, Sept 24. Reviewed agenda. (attached) Concern about Drug Dictionary new work item. Relation to IDMP? What is the

value proposition? In development. Who brought it forward? Singapore. Structured dose instructions. [Scott] Tom – there is a related project (Tom part of

the group) in Holland. Machine-readable coding of med product packages Possible new work items: Dispense Record, Compound Medicine Progress report on 14872 – (last of IDMP). Still pending final work.

Discussion of relationship and interaction between HL7 and ISO WG6. Can HL7 Pharmacy see the NWIP documents while in development? Will distribute

as possible. Can HL7 Pharmacy, and others, call into the WG6 meetings/calls?

Medication Profile



Intro by Tom. Background: IHE whitepaper. Spend time now defining "medication profile". Initial points, follow up discussion

Prior email discussion [Hugh Glover]. IHE summary [Stephen Chu] Discussion from Vancouver [Michael Tan] Building Block approach [Jean Duteau] … context dependent Context independent definition – to support safe medication management. Julie

has identified 4 contexts – clinical, research, pharmacoepidemiology. Further discussion.

Is a profile what is known (dispenses), what is intended (orders), what should exist (care plan). What is the purpose? There are multiple, and not all are known. Does this include implied information?

Consider medication reconciliation: inputs are explicit & implicit information (dispenses, orders, statements). Output is explicitly known (statements).

Are profiles limited to medications. Stephen need the profile to include allergies and lab info. Is this still a medication profile or something else.

Should we consider "Medication Statement" as a distinct element used as a part of a larger "Profile"

[Stephen] take a step back. What is a profile. An FBI profile is a collection of information to describe the subject, hopefully to capture the subject. "Profile" is a general concept. [Scott] agree, the "Profile" is a business concept, we define aggregate data objects that can be included in the profile as business needs dictate.

[Rob] IT perspective. Start with a general concept. What are the building blocks. Start refining concept in relation to building blocks. Generally, you don't have to know the initial concept in detail.

[Stephen] proposed definition. Discussion: Medication history: what do you know about a patient's medication. How does allergy relate? Included if it is relevant. For a chemo patient, also interested in the treatment plan. There is interest in what is known, what is the situation, and what is planned. Is this

a profile? Rob – what about "Medication Management Profile". Everything relevant to safe

prescribing: medications known/planned, diagnosis, allergies, labs, other items relevant

Agreement on definitionsi. "Medication Profile" is an overused and nonspecific term

ii. "Medication Management Profile" a set of information about a patient, which is relevant to safe medication management for the patient

Action: Scott to get WG6 agenda from Christian – Done (attached below)Action: Add ISO WG6 as a standing agenda item for Pharmacy WG


Wednesday 10 September 2012 Q2Attendees: Hosted by Structured DocumentationAgenda Topics Pharmacy represented in Structured Docs, not specifically a joint meeting Status of MTM CDA IG ballot & Project New project: Quality reference for CDA IGs.


Minutes/Conclusions Reached Resolved issue of primary WG for MTM CDA IG project. Errors in Project Insight. Scott to

resolved Quality of CDA IGs: request for Pharmacy to sign on as a co-sponsor WG. In any case,

Scott will be participating. Hugh/Tom agreed to be co-sponsors, Scott will maintain link between project and Pharmacy WG.

Action: Scott to resolve WG references in Project Insight (and any other places)Action: Scott to report to Pharmacy WG on Quality CDA IGs project


Wednesday 10 September 2012 Q3AttendeesName Organization Country EmailTom de Jong HL7 The Netherlands Netherlands [email protected] Robertson Kaiser Permanente USA [email protected] Hallowell Siemens USA [email protected] Chu NEHTA Australia [email protected] Canu PHAST France [email protected] Hatem Oracle USA [email protected] Peters HL7 Canada Canada [email protected] James (Scribe) Blue Wave Informatics UK [email protected] Glover (Chair) Blue Wave Informatics UK [email protected]

Quorum Met: Yes

Agenda Topics Administrative Tasks 3 year plan Teleconference schedule Out of Cycle Wiki and Subversion Room requirements Ballot sandbox Work group health Implementation Guide for CDA R2.0 Consolidated CDA Templates – Pharmacy Content

Supporting Documents 3 Year Plan (on SVN)

Minutes/Conclusions Reached 3 Year Plan

The Pharmacy WG 3-year plan is reasonably up to date; it was further reviewed and updated.

The following are the highlights of that; the detail is present in the 3 Year Plan Spreadsheet on SVN.

A motion to “close the Clinical Statement Comparison project (number 834 on Project Insight) as the work has been completed”: Motion proposed by John, Melva. Against: 0 Abstain: 0 In Favour 8

Examination of Pharmacy use cases in CDA templates (item 857) was discussed and notes updated.

Medication Profile (item 856) - although the PSS has passed through Pharmacy, it has not been taken up to SD/TSC. The PSS was reviewed and amended.

Teleconference Schedule Current schedule: Monday 4pm Eastern (Pharmacy WG) and 5pm Eastern (Pharmacy

FHIR) Generally these times work so continue on. Any cancellations should be notified at least

24 hours in advance. Out of Cycle Meeting – Paris – October 2012

Joint meeting with IHE is confirmed as 24th October (Wednesday) in Paris (Phast Office).


HL7 Pharmacy Out of Cycle is confirmed as 25-6th October (Thursday/Friday) in Paris (Phast Office).

Permissions/notifications for these have been done. Agenda topics – see wiki “2012-10 Out of Cycle Meeting – Paris”.

http://wiki.hl7.org/index.php?title=2012-10_Out_of_Cycle_Meeting_-_ParisAction: Revisit Out of Cycle Agenda on the first Pharmacy WG conference call (co-chairs) Wiki and Subversion Use

It was discussed. Room Requirements

Wednesday Q4 – representatives only to Patient Care (not a joint) Meeting on Fridays? Yes – all day. Agreed to book a room for every quarter – no official joints, just send representatives to

OO, SD, PC, PS etc. Need to publish the draft agenda as far in advance as possible to try to avoid conflicts for

individuals (especially around Medication Profile work).Action: Publish draft Meeting Agenda as far in advance as possible (co-chairs/Tom)

Action: Melva to submit room requests to HQ Ballot SandboxAction: J-H to talk to Electronic Services about a Ballot Sandbox Work Group Health

Are OK, but need to ensure that we have Harmonisation participation, or to Minute that the WG has reviewed the proposals and have no comments.

Main documents are all OK: Mission & Charter – January 2012; SWOT – December 2011; DMP – December 2011

Our most critical thing that may cause issues is stalled ballots – there are outstanding actions on that and it has been discussed already this week (Q3 Monday)

Implementation Guide for CDA R2.0 Consolidated CDA Templates – Pharmacy Content John introduced the Implementation Guide for CDA R2.0 Consolidated CDA Templates

and described it in relation to the Pharmacy content. 5 or 6 Section level templates that concern pharmacy/medication (these do reference the

higher level templates that contain them). 5.38 Medication Activity – used by many section level templates; has sub-entries such as

“drug vehicle” which then has detail in tabular format with the RIM-level information There is also “Immunization Activity” template. What is the implication of this being a “US Realm” document? Having a consistent set of

CDA resources for the US is obviously an important thing. Would it be possible to compare the consolidated Medication templates with the epSOS Medication related templates (epSOS has used the CCD template)?

Discussion of template identifiers and how universal or realm-specific they are, and how much the conformance statements reflect the realm requirements in business rules (for example in CCD).


http://wiki.hl7.org/index.php?title=2012-10_Out_of_Cycle_Meeting_-_Paris

Wednesday 10 September 2012 Q4AttendeesName Organization Country EmailTom de Jong (Chair) HL7 The Netherlands Netherlands [email protected] Hallowell Siemens USA [email protected] Canu PHAST France [email protected] Hatem Oracle USA [email protected] Peters (Scribe) GP Informatics Canada [email protected] Duteau Duteau Design Canada [email protected] James Blue Wave Informatics UK [email protected] Glover Blue Wave Informatics UK [email protected]

Quorum Met: Yes

Agenda Topics Definitions

Medication Profile Medication Profile Requirements

Supporting Documents

Minutes/Conclusions Reached "Medication Profile" is an over-loaded and nonspecific term "Medication Management Profile" a set of information about a patient, which is relevant to

safe medication management for the patient Process by which you accumulate/build the set of information Review of discussion of Vancouver workElement NL CAN (1 jurisdiction) IHE PharmacyPrescribed Meds Yes Yes YesDispensed Meds Yes YesAdministered Med Yes NoMedication Statements Yes Yes Yes (and dietary)Use of alcohol and other drugs

Yes – under consideration to remove

No – although may be on local profile, but not DIS

Labs Yes No – not part of DIS, but may be retrieved from other system

Indications for use Yes (Tom confirmed that this is actually part of prescription)

Yes (but would be part of prescription record)

Diagnosis

Contraindications – conditions

Yes No

Contraindications – allergy/intolerances and reaction

Yes Yes

Reason for stop/start Yes Yes (but would be part


Element NL CAN (1 jurisdiction) IHE Pharmacyof prescription record)

Name of the prescriber Yes Yes (but would be part of prescription record)

Original Prescriber Yes NoName of Pharmacist Yes Yes (but would be part

of dispense)Patient – ID and demographics

Yes Yes Yes

Next steps If we agree that this is the scope, then we need to look at the building blocks 4 building blocks – prescriptions, dispenses, statements, administrations Annotations would be part of this – not a building block

Review of previously balloted generic query Review of current Canadian generic query model – have removed dispense event as an

entry point Review of Canadian PORX_MT060160CA

Discussion of whether our model would be 4 CMETs There is some summary information in the Canadian use case Could include the summary information as a separate class in the entry point Some consensus that our profile model would be 4 CMETs Summary information would be a separate class


Thursday 13 September 2012 Q1AttendeesName Organization Country EmailTom de Jong (Chair) HL7 The Netherlands Netherlands [email protected] Hallowell Siemens USA [email protected] Canu PHAST France [email protected] Hatem Oracle USA [email protected] Achilles Infoway CA [email protected] Sergent Techsys NZ [email protected] James Blue Wave Informatics UK [email protected] Glover(Scribe) Blue Wave Informatics UK [email protected] McNeil Surescripts USA [email protected] Tan NICTIZ NL [email protected]

Quorum Met: Yes

Agenda Topics Pharmacy resources for FHIR


Minutes/Conclusions Reached Debate on what the resources are for Pharmacy.

Identified Medication Order; Medication Supply; Medication Administration and Medication Statement. Concerned particularly with resolving exactly definition of Medication Statement.

Nicolas: there is likely to be a mixed economy where some parts of the messaging are done by CDA and others by V3 messaging and others in FHIR

Moved on to defining resource for Medication Administration Resources need to be identified - Tanya is taking notes Rob: V2 segments are another useful source of information Identified Medication as a resource that we will have to define Julie: Need to establish how FHIR will manage participations Hugh: Need to understand how resources are linked to the resource we are building. It is

not clear how the “core” concept applies to relationship between resources. Further debate about how to establish what is core and what is not.

Particular concern about items that are not widely used now but are likely to be used in the near future.





Thursday 13 September 2012 Q2AttendeesName Organization Country EmailTom de Jong HL7 The Netherlands Netherlands [email protected] Hallowell Siemens USA [email protected] Canu PHAST France [email protected] Hatem (Scribe) Oracle USA [email protected] Achilles Infoway CA [email protected] Sergent Techsys NZ [email protected] Glover(Chair) Blue Wave Informatics UK [email protected] Lotti HL7 Italy Italy [email protected] Beuchelt Mitre US [email protected] Frossi Insiel Mercato Italy [email protected] Rossi TBS Group Italy [email protected] Pole Gen Dynamics US [email protected] Met: Yes

Agenda Topics Introductions Meeting with SOA


Minutes/Conclusions Reached SOA Services Discussion

Gerald lead a discussion around the ballot ‘SOA service’ work. We passed ballot. Next discussion was related to adding some paragraph about how these services can be

created from our Pharmacy models i.e. generalize the process for use by other groups who want to do similar things.

Hugh was asking is there a specific group or focus of work that the representatives who attended this quarter, were interested in. He was seeking whether there was a specific project around which we could organize a project. The timeline on their work may extend out for several years, so it was determined there was not short term project.

In Italy there is a regulatory requirement that will require the use of services ( and a CDA document structure) to be used for Prescriptions throughout all of the regions in Italy ( 20 regions). We have asked to get a copy of the current requirements for handling Prescriptions. One of the representatives will send the info to the Pharmacy group.

Gerald suggested that for the short term we may want to create a ‘white paper’, rather than an Implementation Guide our next iteration on the services. The contents of the white paper would address FHIR related issues in dealing with these services.

Decision was made to update our current Project scope statement For the SOA project to address the new work. Gerald owns this task.

Continued Resource discussion from Q1 Our discussion will focus on attributes for Medication Administration Resource.

Tanya is maintaining a spreadsheet that captures our decisions.




Thursday 13 September 2012 Q3AttendeesName Organization Country EmailTom de Jong HL7 The Netherlands Netherlands [email protected] Hallowell Siemens USA [email protected] Schadow Pragmatic Data USA [email protected] Hatem (Scribe) Oracle USA [email protected]

Quorum Met: Yes

Agenda Topics MTM Ballot reconciliation

Supporting Documents MTM ballot documents

Minutes/Conclusions Reached Review Medication Therapy Management Ballot comments by Scott Robertson.

Scott presented a high level summary of the ballot and Scott has suggested that there will two scheduled meeting during our weekly Rx con calls

that will cover a walkthrough of the materials and then a follow on meeting that will solicit Rx input and voting on the content.

Meeting adjourned early. Rob H and John H worked on a Medication Statement definition.


Thursday 13 September 2012 Q4AttendeesName Organization Country EmailTom de Jong HL7 The Netherlands Netherlands [email protected] Tan NICTIZ NL [email protected] Hatem (Scribe) Oracle USA [email protected] Chu NEHTA Australia [email protected] Glover(Chair) Blue Wave Informatics UK [email protected]

Quorum Met: Yes

Agenda Topics Open Podium Preparation for IHE Pharmacy Joint meeting

Supporting Documents See Rx Wiki

Minutes/Conclusions Reached Discussed Medication Statement definition – we updated the definition and posted it on our

Wiki. Medication Profile discussion – Tom provided an update of what we did in past quarters this

WGM. Long discussion about Medication preferences – one example of a medication preference

would be when a patient informs the clinician that they don’t take a specific medication or class of medication. There are many other examples. How should this be modeled? One thought from Hugh was as an Observation e.g. Annotation. Stephen raised the issue about how the preferences would be made available to the

Medication Profile. Stephen raised another issue re: it is required to incorporate the “managed

contraindications” in the Medication Profile. Stephen raised an issue about how ‘off label’ medications are tagged or marked in a way

such that when these medications are in the patient profile, they can be identified.

Action: Hugh will update the Pharmacy Wiki, including the area associated with the Medication Profile.


Friday 14 September 2012 Q1Attendees: Joint with FHIR Agenda Topics Review outstanding questions with FHIR group


Minutes/Conclusions Reached


Core Not included in core / Potential Extension Question for FHIR Patient (subject) / Patient (record target) - Resource not controlled by Pharmacy. Do we need a Patient (subject) or Patient (record target) in core? Decision TBD. Location

Need more information to decide which values are included in core - informant, author, performer, dataEnterer, verifier, responsibleParty

Drug - Resource controlled by Pharmacy Substitution Event

Julie James question - How is FHIR going to handle the semantics of the reference?

Encounter Event Detected Medication Issue How does FHIR deal with recursions?

Prescription - Resource controlled by Pharmacy Observation Event

John Hatem question - Currently you can use a reason code or a relationship to an act. Ask FHIR if they are doing anything to resolve this.

SubAdminEvent id Annotation SubAdmin Event actionNegationInd - To be discussed with FHIR to understand how this is handled

Dispense Event - Resource controlled by Pharmacy

SubAdminEvent Status Code - To be discussed with FHIR to understand how this is to be handled

SubAdminEvent Code (values: Drug therapy, food, Immunization) - To be discussed with PHER and FHIR

SubAdminEvent effectiveTime

SubAdminEvent confidentialityCode - Talk to FHIR about how confidentiality is expected to work

SubAdmin Event reasonCode -(use case - I did not give the medication and this is the reason I did not give it) SubAdminEvent repeatNumber SubAdminEvent methodCode SubAdminEvent uncertaintyCode SubAdminEvent approachSiteCode SubAdminEvent targetSiteCode SubAdminEvent routeCode subAdminEvent doseCheckQuantity SubAdminEvent doseQuantity SubAdminEvent rateQuantity


Core Not included in core / Potential Extension Question for FHIR SubAdminEvent administrationUnitCode (e.g. to distinguish between puff and inhaler) - (this could be in the medication resource). We want this type of data to be supported in the core model. How are we planning to represent this type of data? - Pharmacy needs to come back to this when they have completed the rest of the resources. Device - Pharmacy needs to discuss this as it was missing from the V3 model.


Friday 14 September 2012 Q2AttendeesName Organization Country EmailTom de Jong HL7 The Netherlands Netherlands [email protected] Tan NICTIZ NL [email protected] Hatem (Scribe) Oracle USA [email protected] Peters (Chair) GP Informatics Canada [email protected] Robertson Kaiser Permanente USA [email protected] Met: Yes

Agenda Topics IHE Joint meeting agenda discussion

a. Tom suggested that all of the Rx members review the IHE white paper in some detail prior to the meeting.

b. Michael Tan is displaying the document and we are reviewing the content and have many questions. We agreed to review this material prior to the meeting.

c. Melva had updated on the Pharmacy Wiki the OOC IHE joint meeting agenda.

Supporting Documents Agenda IHE Pharmacy White Paper – Medication Documentation

Minutes/Conclusions ReachedAction: see OOC IHE joint meeting information on the Wiki http://wiki.hl7.org/index.php?

title=2012-10_Out_of_Cycle_Meeting_-_Paris




Friday 14 September 2012 Q3AttendeesName Organization Country EmailJohn Hatem (Scribe) Oracle USA [email protected] Peters (Chair) GP Informatics Canada [email protected] Robertson Kaiser Permanente USA [email protected] Duteau Duteau Design Canada [email protected] Met: Yes

Agenda Topics January 2012 Ballot preparation Review of action list

Supporting Documents Action List

Minutes/Conclusions Reached Scott and Jean worked to get Scott set up on SVN John reviewed Action list items with Jean and Melva


Friday 14 September 2012 Q4 - AttendeesName Organization Country EmailMelva Peters (Chair) GP Informatics Canada [email protected] Duteau Duteau Design Canada [email protected] Met: No

Agenda Topics Cancelled due to lack of attendance


Minutes/Conclusions Reached


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