Pharmacy SIG Meeting Minutes - San Antonio

Pharmacy Special Interest Group Meeting Minutes

Monday 8th May; Q1

Fola Parrish / DOD / US /
Gary Meyer / Cardinal Health / US /
John Hatem / Oracle / US / john.hatem@oracle .com
Lynne Gilbertson / NCPDP / US /
Mary Jarquin / US Dept. of Veterans Affairs / US /
Michael van Campen / Gordon Point Informatics / Canada /
Rob Hallowell / Siemens Medical / US /
Tom de Jong / HL7 the Netherlands / Netherlands /

Welcome and Opening Remarks
Introductions
Review of the agenda
Some minor additions and changes made to the agenda. Chairs and scribes assigned
Ballot Comments
General Discussion on Ballot Comments
Question from John:
Is there a formal template for capturing model changes that result from ballot reconciliation?
Answer by chairs: this will partly be captured in the ballot spreadsheet, but the minutes should also point to the consolidated action list (which is maintained by Michael and also contains results of the peer review).
Review of ballot comments:
There were 4 ballot spreadsheets sent in, with a total of about 40 comments. Quite a few of those are minor or major negatives.
There were 2 ballot spreadsheets sent in, with a total of about 20 comments. Most of these were from Günther, relating to inconsistencies with the SPL ballot (to be discussed in joint session).
There were 3 ballot spreadsheets sent in, with a total of about 25 comments. Only a few of those are negatives. But we also have to deal with overflow from last meeting (comments were not dealt with then).
Phoenix WGM Minutes
Review of minutes:
The minutes were posted by Julie in mid-February, but are not in the ‘minutes’ section but in the ‘documents’ section. We downloaded them.
Before the minutes were approved, Tom suggested to do a more thorough review of the minutes from Phoenix, to make sure that no decisions or action items are ‘lost’.
Action: Tom and John will review Phoenix minutes to capture any relevant decisions and action items.
Meeting minutes will be approved (after review) on Wednesday Q2.
Consolidated action item list:
This list contains some leftover action items from the Jan 2006 ballot and a whole bunch of action items that resulted from the peer review.
All agreed that these action items should be treated as ‘ballot comments’ in the sense that they will lead to model revisions wherever necessary. Further review will be done during the time scheduled for ballot review.
Michael led us through some of the action items. Tom will be the ‘model manager’ for this meeting, but no model changes were made at this time. Tom will capture all model changes with date & initials, just like Hugh.
A need was identified to look back in our notes from previous discussions, to see what was decided (or not) about the performer on a dispense. The same for location and destination and the roles they connect to (assignedOrganization vs. serviceDeliveryLocation). This also relates to the list server thread about the use of assignedOrganization vs. the use of the scoper of an assignedPerson. To be continued…
Motion from Tom, seconded by Michael:
To create an official position within the SIG: ‘list server monitor’. The task of this person would be to keep track of discussions on the Pharmacy list server and make sure that they are brought to a conclusion and that these conclusions are captured in the consolidated action list.
Michael seconds and has a friendly amendment to include the O&O list server. The general sense is that any O&O discussion that’s specifically relevant to Pharmacy should be cross-posted to Pharmacy. Michael withdraws
For – 7, Against – 0, Abstain – 0;Motion carried.

Pharmacy Special Interest Group Meeting Minutes

Monday 8th May; Q2

Garry Cruickshank / Canada Infoway / Canada /
Gary Meyer / Cardinal Health / US /
John Hatem / Oracle / US /
Mary Jarquin / US Dept. of Veterans Affairs / US /
Rob Hallowell / Siemens Medical / US /
Tim McNeil / RxHub / US / tim.mcneill@rxhub,.net
Tom de Jong / HL7 The Netherlands / Netherlands /
Wendell Ocasio / Northup Grumman / US /

DMIM and RMIM Walkthroughs
Pharmacy DMIM
ActProcess – combined medication process
Header: links substance administration and supply processes
Structure of these 3 classes repeats itself in RMIMs
Wendell O. – generic O&O model has a choice box – lab does similar
This was a ballot comment – will be discussed later
“Source Of” – generic act relationship
Component2 – links header to substance administration
If medication order consists of multiple line items, each line item consists of a substance administration and a supply
ISSUE (TdJ): Need to be more clear about how “source of” act relationship is intended
distinguish between overall header and line items
link portions of a line item order
patient – may not be consistent with lab where subject may not be record target
substance administration definition – “formulary”
supporting clinical information
height, weight
lab results
reason (indication for use)
substance administration – recursion
for nested schedules for administration
criteria choice box
precondition, trigger, goal
rules for starting and stopping based on certain external conditions
Rob – limited to start/stop? What about substitution?
“Think About” – business use case for expanding criteria to substitution
e.g. sliding scale insulin (if this, then that)
supply process
consumable (e.g. stock bottles used to package an order)
location – pharmacy
destination – where product will be delivered
links to medication
from header (direct target) – default
also links from substance administration (consumable) or supply (product)
institutional orders – give these 2 pills together, but written up as one order
different substance administration instructions
at DMIM level, all three are options
RMIMs
Broken down by stage in business cycle
Medication Order Topic
Prescription fulfillment request
e.g., prescription is faxed from provider to pharmacy
pre-determination
what would be the response if I sent out this order?
Activate prescription notification
Sending to HUB/repository
ISSUE (TdJ) Add “record” to interaction titles when sending to central agency
Garry - “record” suggests something firm happened
John H. - does HL7 define “record”?
Look at “record” and define/use it consistently
Common Order Topic
Order already exists, in most cases just referring to ID of an existing order
Medication and Common Order Topics together are basically RQO mood in our business cycle
Substance administration request
No performer
Rare case when order would specify who would administer
Wendell - why isn’t performer on the header?
Only at supply request level
John – performer doesn’t apply to admin, only to supply
Links to medication
Now limited to orderable medications
ISSUE (TdJ) Annotation in medication order RMIM should be shadow of one at header
Option
Can have 2 different ways of doing (e.g., route), and here are the specifics of each
Verifier – at Order level
e.g. assistant needs provider verification
nurse has to look at physician’s order to verify against previous orders
cosigning
SIG (instructions)
Wendell - Can be complicated, coded, but it if it is just text, where does it belong?
TdJ – official position is that textual representation of SIG should not be used with this message
Would use unusable in another realm
Should look closely at meaning of the SIG and use coded SIG
If you want to keep the textual instructions, put in Act.text
Should never be used for a computer to process
Medication Dispense and Common Dispense Topics
“record” is spelled out in all interaction titles – implies that these are all specific to repositories
NOTE: need to review interaction names and be consistent
ISSUE: (TdJ) Artifacts in these topics don’t look like what we talked about in Phoenix, and they don’t align with the DMIM

Medication Statement
Used to record other medications
For patient medication profile
ISSUE: (TdJ) Doesn’t align with DMIM
Need to look at structure of DMIM
Wendell – choice box around header and line items in the DMIM would resolve this
Small messages like this may not need header
Would align DMIM better with O&O
Medication Model DMIM
Only messages are queries against drug databases
Shadow vs. specific clone
Shadow points directly to point in model
Specific clone can have specific associations coming off of it
Similar to “by ref” vs. “by value”
ISSUE: (TdJ) May need to relax cardinalities in DMIM

Pharmacy Special Interest Group Meeting Minutes

Monday 8th May; Q3

Barbara McKinnon / Point of Care Partners / US /
Bertil Pippen /
Carol Newall / NHS / UK /
Fola Parrish / DOD / US /
Garry Cruickshank / Canada Infoway / Canada /
Gary Meyer / Cardinal Health / US /
Gunther Schadow / Regenstrief Institute / US /
John Hatem / Oracle / US /
Lloyd McKenzie / Canada Infoway / Canada /
Mary Jarquin / US Dept. of Veterans Affairs / US /
Rob Hallowell / Siemens Medical / US /
Tom de Jong / HL7 The Netherlands / Netherlands /

Harmonize the Medication D-MIM with SPL
Gunther used his ballot comments on the Medication D-MIM as the focal point for the discussion about the differences and issues he found in harmonizing the two models.
Tom de Jong was directly updating the Ballot Spreadsheet for Medication D-MIM. See spreadsheet for resolution of ballot issues we reviewed.
Meeting discussion notes follow:
Add functionality that supports placing a package within another package using the “Content “ role. Action item: make changes to Medication D-MIM to the Content role, modeling the work after SPL.
Action: Make changes for the “MedicinePart” role, as they were modeled in SPL to “Part”.
Discussed “medication class” name and differences – the pharmacists agreed that the name “medication class” was the correct name and the issues was not going to be persuasive. Not action item.
Action: “Some Role” changed to Role.
Discussion about changing various roles, Approval, Policy and the Action Item:
add Approval and Policy to “manufactured product”. It was not going to be added to “Part”.
Some discussion about “Ingredient”, but it was decided to not make any changes about ingredient.
Additional discussion mentioned that Policy examples were: Controlled Substance and Restricted Use Drugs.
Discussion about how to represent “Characteristics” - as observations or some new attribute on an entity.
Tom, Lloyd, Gunther and others discussed this in some detail. This resulted in the following motion from Lloyd M, seconded by Gary Meyer.
Motionfrom Lloyd McK, seconded by Gary M:
Add Characteristics observation class to medication D-MIM as currently modeled in SPL (to Part and Manufactured Product) as well as to Medication.
For – 4, Against – 0, Abstain – 0;Motion carried.
Tom was also going to solicit more information on the topic of modeling “characteristics” as an entity versus an observation.
Active Moiety is not consistent between the SPL model and the Medication D-MIM. Action item: Rx should review and assess what needs to be done.
There is no Medicine class on the specialized kind role on the substance. Action item: Rx should review and discuss this and solicit feedback from Julie who felt strongly about this previously. Pending the feedback and discussions not changes will be made to the model.
General discussion about how Substance Administration knowledge is represented in the SPL model, and how it is represented, or not represented in the Medication D-MIM. Action Item: Rx will investigate how to harmonize this portion of the SPL model with the Medication D-MIM or other content as created by Rx SIG.