Pharmacy Working Group Meeting Minutes
Phoenix, AZ
January 14 – 18, 2013
Monday 14 January 2013 Q1 4
Monday 14 January 2013 Q2 6
Monday 14 January 2013 Q4 7
Tuesday 15 January 2013 Q1 8
Tuesday 15 January 2013 Q2 11
Tuesday 15 January 2013 Q4 14
Wednesday 16 January 2013 Q1 15
Wednesday 16 January 2013 Q2 17
Wednesday 16 September 2013 Q3 18
Wednesday 16 September 2013 Q4 20
Thursday 17 September 2013 Q1 22
Thursday 17 September 2013 Q2 23
Thursday 17 September 2013 Q3 25
Friday 18 September 2013 Q1 26
Friday 18 September 2013 Q2 27
Action Items
Action: Hugh: Post approved Minutes to wiki and (or) official website – COMPLETE – POSTED ON HL7 PHARMACY WEBSITE 5
Action: Scott: to contact Andy S (in charge of CMETs) to see who requests publication of CMETs in the Normative edition. Dispense, once sorted, to be requested for publication (to Don) 5
Action: John H will update Action item list with actions from approved Sept 2012 WGM Minutes. 6
Action: Melva to post approved Sept 2012 WGM Minutes - complete 6
Action: Review Medication Order interactions and application roles – update as required. 7
Action: Review Medication Dispense interactions and application roles – update as required. 7
Action: Before tomorrow, do an attribute by attribute comparison between the CCD spec and Pharmacy’s models. (Tom) 10
Action: Recommend joint stewardship of Medication section between Pharmacy and Structured Documents WGs. 10
Action: Recommend that Structured Documents WG request involvement of the Pharmacy WG on medication questions. 10
Action: Capture diagram for inclusion in the minutes. - complete 11
Action: Follow up on FHIR dispositions and follow-up actions documented in ballot spreadsheet. 13
Action: Invite Christian to provide an ISO Work Group 6 update for May WGM meeting – Wednesday Q1 16
Action: Need to determine how HL7 Pharmacy Work Group participate in ISO projects that are of common interest – add this topic to agenda for upcoming teleconference 16
Action: Christian will provide an update on the status of the e-Prescription project 16
Action: Map/Document organizations/SDO’s that have pharmacy releated content – Discuss this further on an upcoming teleconference 16
Action: Julie will provide Stephen and Christian with material that the HL7 Pharmacy WG developed on a compound medicine model 16
Action: Follow up with IHE Pharmacy on status of Glossary and Medication Profile work status - 16
Action: Let HQ know Pharmacy have a 4th Co-chair (Melva) 18
Action: Create appropriate sources in SVN Scott to check requirements; Jean-Henri to create 18
Action: Melva to forward Project approval 858 to HQ 18
Action: Hugh to complete Project 838 Medication Statement Service Profile 18
Action: Melva to move project 817 to 3yr plan 18
Action: Melva to move end date of 558 to Sept 2013 18
Action: Hugh to complete project 501 IDMP 19
Action: Melva to check next milestone date for project 501 IDMP 19
Action: Project 557 Scott to check Medication CMETs are published 19
Action: Project 557 Melva to close project 19
Action: Project 236 and 235 also Medication Dispense R1 Melva to close – these are deprecated – also to find out how to resolve outstanding negatives 19
Action: Melva Project 189 completed and to be closed 19
Action: Hugh to talk to Don about wrong line in project summary – its not project 501 19
Action: Melva to schedule conference call schedule - COMPLETE 19
Action: Melva to book joint with FHIR and reps to Structured Docs 19
Action: Hugh will create agenda based on January agenda 19
Action: Pharmacy (Hugh) will take spec through normative publishing 24
Action: Mark Kramer (MITRE) will look into MITRE demo options 24
Action: Scott will give an overview of the EHR-S FM profile (30 mins) on an upcoming conf call. 25
Action: Hugh to save final contents of Dropbox in Subversion. 25
Action: At next WGM, we use SkyDrive as our file sharing mechanism. After that, we decide what our ultimate file sharing mechanism will be (Subversion, Dropbox, Skydrive). 25
Action: Melva to confirm with SDWG Co-Chairs- COMPLETE 27
Action: Melva will make meeting room requests for May WGM - COMPLETE 27
Monday 14 January 2013 Q1
Attendees
Name / Organization / Country / EmailJean Duteau / Duteau Design / Canada /
John Hatem / Oracle Corporation / USA /
Tanya Achilles / Canada Health Infoway / Canada /
Tom de Jong / HL7 The Netherlands / The Netherlands /
Brad Fonseca / Canada Health Infoway / Canada /
Scott Robertson / Kaiser Permanente / USA /
Julie James (Scribe) / Blue Wave Informatics / UK /
Hugh Glover (Chair) / Blue Wave Informatics / UK /
Quorum Met: Yes
Agenda Topics
· Agenda Review and Finalization and Planning for the week
· Representatives to other meetings
· Approve September 2012 WGM Minutes
· Overview of ballot planning
· Status of e-mail threads since last WGM
Supporting Documents
· Agenda
· September 2012 WGM Minutes
Minutes/Conclusions Reached
Agenda
· The group sorted through the Agenda, assigned chairs and scribes for the various quarters.
There are no co-chairs (or interim co-chairs) available for Monday Q3, and indeed very few possible participants, so it was agreed to have this session as cancelled.
· Apart from Hugh and Julie, none of the group will be around after Q2 on Friday, so there will be no formal Pharmacy WG meetings Q3&Q4 on Friday. Hugh will tell Lilian re: the room booking.
· The set of Scribes for the week were given access to the Dropbox for Minutes and the work practice was shared and agreed (save to Dropbox as you’re working, save somewhere locally on your own machine at the end of each quarter
· September Minutes
· The Minutes from the September 2012 meeting were reviewed. A motion to accept these Minutes was proposed by Jean, seconded by Tom. The motion was voted on as follows: Negative: 0; Abstain: 0; Affirmative: 7 - carried
The Minutes from the September WGM were accepted.
· Ballot Status
· CMETs – passed; no comments
Now need to be published; a publication request needs to be made – this may be our (Pharmacy) responsibility or it may be Andy S (CMETs)
· Dispense – passed, some negative minors and typos to fix etc. Revised version will need to be published. Aim to do this all this week.
· Order – did not pass, needs a missed interaction added. This will then need re-balloting as adding in the missed interaction is a substantive change. Also aim to sort this during the week.
· Note: the Netherlands did vote negative on both Dispense and Order but did not submit comments or a spreadsheet. Strictly, this is an illegal vote; the WG will accept the spreadsheet but it needs to be forwarded ASAP.
· FHIR Pharmacy Ballot
· There are a set of comments about the Pharmacy resources in the FHIR ballot; these are not critical to sort this week, not least because there are a lot of main FHIR methodology comments to be resolved that may affect the Pharmacy resources.
· e-mail Threads
· Tom will be putting together an e-mail summarising threads. There is a concern about clinical domain issues that occur in SD/CCD are discussed and sorted without any reference to the SMEs and domain WG elsewhere in the organisation. Tom will raise this at TSC this evening.
Action: Hugh: Post approved Minutes to wiki and (or) official website – COMPLETE – POSTED ON HL7 PHARMACY WEBSITE
Action: Scott: to contact Andy S (in charge of CMETs) to see who requests publication of CMETs in the Normative edition. Dispense, once sorted, to be requested for publication (to Don)
Monday 14 January 2013 Q2
Attendees
Name / Organization / Country / EmailJohn Hatem (scribe) / Oracle Corporation / USA /
Brad Fonseca / Canada Health Infoway / Canada /
Melva Peters (chair) / GP Informatics / Canada /
Tim McNeil / Surescripts / USA /
Quorum Met: Yes
Agenda Topics
· Pharmacy Overview for new members
· Action Item List review
Supporting Documents
· Agenda
· Action Item List
· Pharmacy January 2013 Ballot Materials
Minutes/Conclusions Reached
Pharmacy Overview
· Melva reviewed Pharmacy ballot material for new Pharmacy members.
Action Item List Review
· John H started Action Item List review. Melva took two items to follow up on re: Medication Order. Other Action items not discussed.
Action: John H will update Action item list with actions from approved Sept 2012 WGM Minutes.
Action: Melva to post approved Sept 2012 WGM Minutes - complete
Monday 14 January 2013 Q4
Attendees
Name / Organization / Country / EmailJean Duteau / Duteau Design / Canada /
John Hatem (scribe) / Oracle Corporation / USA /
Tom de Jong (chair) / HL7 The Netherlands / The Netherlands /
Brad Fonseca / Canada Health Infoway / Canada /
Scott Robertson / Kaiser Permanente / USA /
Quorum Met: Yes
Agenda Topics
· Medication Order Ballot Review
· Medication Dispense Ballot Review
Supporting Documents
· Agenda
· Ballot comment spreadsheets for Medication Order and Medication Dispense.
Minutes/Conclusions Reached
· Medication Order Ballot Review
· See Medication Order ballot spreadsheets for comments.
· One issue was found which needs to be explored in more detail, concerns whether we have all required interactions and application roles in the Medication Order materials.
· Motion: Propose to accept all ballot dispositions as described in the Medication Order ballot comment spreadsheets. Moved by: Jean Duteau Seconded by: Scott Robertson
· Vote For: 4 Against: 0 Abstain: 0 - CARRIED
Action: Review Medication Order interactions and application roles – update as required.
· Medication Dispense Ballot Review
· See Medication Dispense ballot spreadsheets for comments.
· Motion: Propose to accept all ballot dispositions as described in the Medication Dispense ballot comment spreadsheets. Moved by: John Hatem Seconded by: Scott Robertson
· Vote For: 4 Against: 0 Abstain: 0 - CARRIED
Action: Review Medication Dispense interactions and application roles – update as required.
· Open issue: Tom reported he will get his ballot comment spreadsheets (Med Order and Med Dispense) to the Rx WG later this week for review.
Tuesday 15 January 2013 Q1
Attendees
Name / Organization / Country / EmailTom de Jong (chair) / HL7 The Netherlands / The Netherlands /
Brad Fonseca (scribe) / Canada Health Infoway / Canada /
Lars-Gunnar Hartveit / Bergen / Norway /
Catherine Graeff / Sonora Advisory Group / USA /
Scott Robertson / Kaiser Permanente / USA /
Shelly Spiro / Pharmacy eHIT Collaborative / USA /
Tim McNeil / SureScripts / USA /
Stephen Chu / NEHTA / Australia /
Quorum Met: Yes
Agenda Topics
· Agenda change not confirmed
· Medication list in context of CCD
· Review action list (continued if needed) - John
Supporting Documents
· Agenda
· Example CDD from documentation (from Scott) (“SampleCCDDocument.xml” - http://www.hl7.org/implement/standards/product_brief.cfm?product_id=6 )
Minutes/Conclusions Reached
· Clinical/Continuity of Care Documents (CCD)
· Background:
· Pharmacy concepts are structured differently in CDA (Clinical Documents Architecture)
· CCD is an implementation of CDA/Clinical Care Record (CCR)
· Goal is to harmonize the two standards (CDA V3)
· Still some open issues
· An overview of the current medication profile
· Discussion:
· What is the best practice?
· Medication Profile: all relevant healthcare information on a given patient (relevant to the prescribing activity)
· Allergies/intolerances, (some) lab results, etc.
· Medication List: just the active/inactive prescription orders and their dispenses
· In CCD, just an active medication list
· There are status indicators.
· What are they?
· “Their” report is much simpler than what Pharmacy manages.
· HL7/IHE Pharmacy Glossary
· There currently isn’t a definition for “medication profile”
· IHE calls it “medication documentation”
· CCD is much more than just a medication list.
· Similar details as Pharmacy Medication Profile, but broken out into sections
· Pharmacy Payload Models
· Wrapped in such a way that they are messages
· Could plug them “as-is” into the CDA
· Medication statement (“post to profile” as reported by patient or by provider)
· Orderable medication
· Administrable medication
· Example CCD from documentation (from Scott) (“SampleCCDDocument.xml”)
· “classic” example of medication list contained in example document
· Free text or coded (depends on the Implementation Guide)
· There is a requirement that “text be present”
· A HTML table containing the following coded information is what is actually rendered in the document
· Human-readable
· No link between the table text and the structured components
· CDA has this functionality but not implemented in the CCD yet.
· You’re signing the sections not the entries.
· Produce a document that can be used to generate whatever output is required.
· CDA Release 1 was the human-readable version
· CDA Release 2 had more structured elements
· The producer of the document has the responsibility to make sure the human-readable table contains the exact same information as the structured components
· A Document has a “life of its own”
· Pharmacy Messaging is transitory
· PMS would need to create a new CCD from scratch
· You could, if the mapping is done properly, use the PMS’ pharmacy messaging to create the CCD
· Challenge to provide implementation guidance on getting Pharmacy messaging information into the CCD
· Question from Stephen: Given the constraints in the CDA/CCD in the Medication Section, how do we provide better guidance?
· Australia is implementing CDA constructs
· “owing script” concept -> Pharmacist emergency authorization of refills, request “owing” prescription to cover advanced medication.
· Mapping logical constructs into V2.4
· Medication list in CCD, is it a list of Medication Statements?
· Assertion by a provider of the medications taken by a patient
· Could be patient-driven
· Some implementation via Personal Health Record