pharmacy work group - orlando · web view12412 need a better name for medication.product 12398...

Pharmacy Working Group Meeting MinutesSan Antonio, TXJanuary 16-20, 2017

Table of ContentsMONDAY 16 JANUARY 2017 Q1.............................................................................................................4

MONDAY 16 JANUARY 2017 Q2.............................................................................................................6

MONDAY 16 JANUARY 2017 Q3.............................................................................................................7

MONDAY 16 JANUARY 2017 Q4.............................................................................................................8

TUESDAY 17 JANUARY 2017 – Q1.......................................................................................................10

TUESDAY 17 JANUARY 2017 – JOINT WITH FHIR.........................................................................12

TUESDAY 17 JANUARY 2017 Q3..........................................................................................................13

TUESDAY 17 JANUARY 2017 Q4 - JOINT WITH PHER..................................................................15

WEDNESDAY 18 JANUARY 2017 Q1...................................................................................................16




THURSDAY 19 JANUARY 2017 Q1.......................................................................................................21




FULL LIST OF ATTENDEES.................................................................................................................26

Action ListACTION: CONFIRM WITH HANS IF THERE ARE ANY TOPICS FOR O&O FOR TUESDAY Q2 - COMPLETE........................................................................................................................................5

ACTION: SCOTT TO CREATE PUBLICATION REQUESTS FOR 2 REAFFIRMATION BALLOTS.....................................................................................................................................................5

ACTION: MELVA TO POST APPROVED MINUTES........................................................................5

ACTION: SCHEDULE TIME ON UPCOMING TELECONFERENCES FOR BALLOT RECONCILIATION...................................................................................................................................6

ACTION: REACH OUT TO CDS TO SEE IF THEY NEED A NEW TYPE FOR DISPENSEREQUEST.................................................................................................................................7

ACTION: 9087 CLARIFY MEDICATION ORDER CHANGES - TALK TO JOSE ABOUT THIS – IS IT STILL NEEDED AND WHY THIS IS SPECIFIC TO PHARMACY......................................7

ACTION: ADD NEW TRACKER ITEM TO CONSIDER IF BATCH/LOT SHOULD BE ON PRODUCT OR PACKAGE........................................................................................................................9

ACTION: ADD CLARIFYING TEXT REGARDING ITEM 12399...................................................10

ACTION: MICHELLE TO SEND E-MAIL RE ITEM 12394..............................................................11

ACTION: COME TO BACK TO TABLED ITEM 12395.....................................................................11

ACTION: ADD CLARIFYING TEXT RE ITEM 12393.......................................................................11

ACTION: TRACKER 12397 UPDATE DESCRIPTION/COMMENT FOR MEDICATION.INGREDIENT.(TEXT IN TRACKER).......................................................................14

ACTION: TRACKER 12391 UPDATE MEDICATION NARRATIVE TO BETTER DESCRIBE WHEN TO THE USE RESOURCE RATHER THAN THE CODE, AND ON APPROPRIATE USE OF USERSELECTED. (TEXT IN TRACKER)....................................................................................14

ACTION: TRACKER 10577 CREATE NEW ELEMENT MEDICATION.IMAGE (INFORMATION IN TRACKER)...........................................................................................................14

ACTION: TRACKER 10289 APPLY CHANGES ACROSS MEDICATION, MEDICATIONSTATEMENT, MEDICATIONDISPENSE, MEDICATIONADMINISTRATION (TEXT IN TRACKER)..............................................................................................................................14

ACTION: JOHN TO CONFIRM IF CATALOG MIGHT BE USED FOR OUR FORMULARY REQUIREMENTS.....................................................................................................................................17

ACTION: INVITE LORRAINE TO JOIN PHARMACY IN MADRID.............................................17

ACTION: INCLUDE AS AN AGENDA ITEM FOR MADRID DISCUSSION.................................17

ACTION: ADD TRACKER ITEMS FOR MEDICATIONDISPENSE AND MEDICATIONREQUEST........................................................................................................................17

ACTION: NEED TO REVIEW DEFINITIONS FOR MEDICATION ORDER..............................18

ACTION: POPULATE TEMPLATES WITH EXAMPLES – MELVA TO CONTACT KAI........18

ACTION: AGENDA TIME ON FEB 6 FOR REVIEW OF MEDICATIONSTATEMENT............18

ACTION: CREATE A NEW TRACKER ITEM FOR THE "MAINTENANCE DRUG INDICATOR" AND INCLUDE IN THE DISCUSSION AROUND FORMULARY.........................19

ACTION: MELVA TO FOLLOW-UP WITH JULIE ON HOW TO HANDLE BOSS...................19

ACTION: MICHAEL TO RAISE IN NAPLES AT NEXT IHE PHARMACY F2F.........................21

ACTION: JOHN WILL POST TO SVN................................................................................................21

ACTION: TRACKER 12468 NEEDS TO BE APPLIED.....................................................................24

ACTION:....................................................................................................................................................24

ACTION: TRACKER 12386 CHANGES NEED TO BE APPLIED...................................................25

Monday 16 January 2017 Q1Attendees

Name Organization Country EmailMelva Peters (Chair) Gevity Canada [email protected] Hatem US [email protected] Zhang Epic US [email protected] Robertson Kaiser Permanente US [email protected] McNeil SureScripts US [email protected] de Jong NovoPro NL [email protected] Glover Blue Wave UK [email protected]

Quorum Met: Yes

Agenda Topics Finalize Agenda Reps to other WGs Assign Roles for Quarters If we have new attendees, review

Overview of Pharmacy material - V2, V3, FHIR Overview of Template work

Hot Topics Approval of September 2016 WGM Minutes

Supporting Documents Agenda

http://wiki.hl7.org/index.php?title=January_2017_Pharmacy_WGM_Agenda September 2016 Minutes

Sept 2016 Draft Minutes

Minutes/Conclusions Reached Finalize Agenda

See updated version on Wiki Add Thursday - morning – presentation for Pharmacy during general sessions/lunch - complete

Reps to other WGs Do we need to send rep to EHR - ballot reconciliation for reaffirmation ballot? Passed – Scott will

coordinate with EHR for publishing Monday Q2 - Future of V3 - Tom Monday Q3 - Structured Docs - Rep only - Scott

CDA Product Family - All work groups that have developed or plan on developing CDA Related Standards/IG's are invited to send a representative to this meeting. There will be many work groups invited to participate, so send representatives only.

Tuesday Q2 - O&O - Rep only Tuesday Q4 - PHER - Rep only – John will talk to Joginder Thursday Q1 - Patient Care - Rep only - Scott

Joint meeting with SD, Pharm, LHS, CH, FHIR-I Topics: All things care plan, care coordination, Care Team.

Assign Roles for Quarters – see updated agenda on the Wiki Hot Topics

How do you create a snapshot of the patient’s medication list? Will discuss Wednesday Q3

http://www.hl7.org/documentcenter/public/wg/medication/minutes/HL7_Pharmacy_WG_Meeting_Minutes_-_Baltimore_September%202016_Final%20Draft.docx

http://wiki.hl7.org/index.php?title=January_2017_Pharmacy_WGM_Agenda

mailto:[email protected]





Approval of September 2016 WGM Minutes Motion by Scott to accept minutes – seconded by Tom – 5/1/0 Carried

Prep for Clinicians on FHIR Work through scenarios Entertain questions from attendees

Ballot Knowledge Base Query Reaffirmation EHR WG Functional profile Moved by Scott – seconded by John to approve publication of the Knowledge Base Query material

and Functional Profile – 6/0/0 Carried FHIR Tracker Items

GF#12470 - TR12470 Changes to attribute name and the values for the not taken – need to fix in the material

Action ItemsAction: confirm with Hans if there are any topics for O&O for Tuesday Q2 - completeAction: Scott to create publication requests for 2 reaffirmation ballotsAction: Melva to post approved minutes - complete

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12470&start=0


Name Organization Country EmailMelva Peters (Chair) Gevity CanadaJohn Hatem (Scribe) US [email protected] Zhang Epic US [email protected] Robertson Kaiser Permanente US [email protected] Miller Cerner US [email protected] Syed Cerner US [email protected] McNeil Surescripts US [email protected] Keegan POCP US [email protected] Schueth POCP US [email protected] Haas Healthedatainc US [email protected] Frierd Epic US [email protected] Met: Yes

Agenda Topics Prep for Clinicians on FHIR FHIR Tracker Items (TBD)

GF#12470 - TR12470

Minutes/Conclusions Reached Discussed GF # 12470.

Initial focus is on the not Taken use cases: A set uses is being created in a separate spreadsheet that lists the combinations of notTaken and Medication Statement status and Information Source.

See spreadsheet Motion: Jenni/ seconded Danielle: passed 11/0/0

US Realm Profiles (Brett and Eric will join in second half of quarter) Decision was to defer this to a conference call.

Action Items

Action: Schedule time on upcoming teleconferences for ballot reconciliation – complete

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12470&start=0








Name Organization Country EmailMelva Peters (Scribe) Gevity Canada [email protected] Hatem (Chair) US [email protected] Zhang Epic US [email protected] Bui [email protected]

Lindsay HoggleAcademy of Nutrition and Dietetics US [email protected]

Tom de Jong NovoPro NL [email protected] Syed Cerner US [email protected]

Quorum Met: Yes

Agenda Topics GF#7910 - TR7910 Discussion of whether we should create a DispenseRequest Type 12340 Clarify guidance for substance use 10097 Review Pharmacy Resources to identify which elements should be mandatory 10125 Remove the International Realm Pharmacy Extensions Profile from the FHIR build 7641 2015May core #932 - Look at moving extensions to core 9087 Clarify Medication Order changes



Minutes/Conclusions Reached GF#7910 - TR7910 – defer to when Michelle is here Discussion of whether we should create a DispenseRequest Type

Need to reach out to CDS to see if this is still required 12340 Clarify guidance for substance use

See Tracker for decision 10097 Review Pharmacy Resources to identify which elements should be mandatory

See Tracker for decision 10125 Remove the International Realm Pharmacy Extensions Profile from the FHIR build

Send note to CDS to indicate will be removing them 7641 2015May core #932 - Look at moving extensions to core

Link to 10125 9087 Clarify Medication Order changes

Talk to Jose about this – is it still needed and why this is specific to Pharmacy

Action Items

Action: Reach out to CDS to see if they need a new type for DispenseRequest - completeAction: 9087 Clarify Medication Order changes - Talk to Jose about this – is it still needed and why this is specific

to Pharmacy - complete







Monday 16 January 2017 Q4 Attendees

Name Organization Country EmailMelva Peters (Scribe) Gevity Canada [email protected] Hatem (Chair) US [email protected] Zhang Epic US [email protected] Bui [email protected]


Tom de Jong NovoPro NL [email protected] Syed Cerner US [email protected] McNeil SureScripts USScott Robertson Kaiser Permanente USQuorum Met: Yes

Agenda Topics Medication Resource Related Changes

12396 Medication package and product 12412 Need a better name for Medication.product 12398 Active and inactive medication ingredients 12399 Medication reference to more abstract Medication 12394 Medication product ingredients as Medications 12395 Basis of Strength Substance 12397 Medication open world semantics 12392 Inactive flag for Medication resources 12393 Medication resource manufacturer clarification 12391 Medication resource definitive versus descriptive code 10577 Adding image of the drug or medicine to Medication Resource 10389 Add guidance about whether to choose medication codeableConcept or reference to

medication if need to include lot number or batch 7562 2015May core #853 - Expand description and usage of Medication.code.display 8489 Medication related indicators - maintenance drug, over the counter 5827 Should medication have a status code?



Minutes/Conclusions Reached 12396 Medication package and product

Discussion – initial draft of wording Sub-group to work on changes to wording Consider whether batch/lot should be on product or package – add as a new tracker

12398 Active and inactive medication ingredients See tracker

12392 and 7290 – Status on a product See tracker

Action Items







Action: Add new tracker item to consider if batch/lot should be on product or package - complete

Tuesday 17 January 2017 – Q1Attendees

Name Organization Country EmailEric Haas US [email protected] Hatem US [email protected] Zhang Epic US [email protected] Miller Cerner US [email protected] Syed Cerner US [email protected] de Jong HL7 NL NL [email protected] Met: Yes

Agenda Topics 12399 Medication reference to more abstract Medication 12394 Medication product ingredients as Medications 12395 Basis of Strength Substance 12393 Medication resource manufacturer clarification



Minutes/Conclusions Reached 12399 Medication reference to more abstract Medication

There was some discussion about what a generic medication is (generic branded product vs. abstract product). A conclusion was reached that we would need a flexible mechanism to link from more specific medication instances to more abstract ones. The link would be a reference to the code of the more abstract medication. We looked at the V3 Medication CMET for inspiration but that certainly didn’t help. Then Michelle pointed out that we had this discussion before when we annotated the code attribute. It turned out that this was exactly what we were looking for, because the data type for code allows a mapping to equivalent or more abstract codes. We did decide to add some extra text later, to clarify the way code should be used to achieve the desired link between levels of abstraction.

Vote: Non-persuasive with Mod. Tom/Michelle 5-0-0. 12394 Medication product ingredients as Medications

Michelle will send an e-mail that captures some previous discussions related to this topic, to prevent us from rehashing the same arguments. Michelle’s recollection is that we did make a clear distinction after this prior discussion on when to use Medication and when to use Substance as an Ingredient.

12395 Basis of Strength Substance There was discussion about the intent of the question. The consensus was that he wants a way to

clarify whether the amount specified for the ingredient (i.e. strength as a ratio) was relative to another ingredient or relative to the final product. There would be a few possible solutions to this: - Add a reference to a substance (or medication) that the amount is relative to (usually the base). - Be explicit about the fact that the amount is always relative to the amount of the final product. - Leave it open and assume a receiving system/provider knows how to interpret the amount.We decided to table the issue until we have more specific pharmaceutical expertise present.

12393 Medication resource manufacturer clarification We will add some text to clarify that the manufacturer is intended to convey the legal entity that is

responsible for the manufacture of the medication (specifically not intended for the distributor) Vote: Non-persuasive with Mod. Tom/Daniel 5-0-0. Action: Add clarifying text.

Action Items


Action: Add clarifying text regarding item 12399.Action: Michelle to send e-mail re item 12394.Action: Come to back to tabled item 12395.Action: Add clarifying text re item 12393.

Tuesday 17 January 2017 – Joint with FHIRAttendees

Name Organization Country Email

Quorum Met:

Agenda Topics


Minutes/Conclusions Reached

Tuesday 17 January 2017 Q3 Attendees

Name Organization Country EmailJohn Hatem USA [email protected] Robertson Kaiser Permanente USA [email protected] Xhang Epic USA [email protected] McNeil Surescripts USA [email protected] Pickering Cerner USA [email protected] de Jong HL7 NL NL [email protected]

Quorum Met: Yes

Agenda Topics FHIR tracker items

12397 Medication open world semantics 12392 Inactive flag for Medication resources 12393 Medication resource manufacturer clarification 12391 Medication resource definitive versus descriptive code 10577 Adding image of the drug or medicine to Medication Resource 10389 Add guidance about whether to choose medication codeableConcept or reference to

medication if need to include lot number or batch 7562 2015May core #853 - Expand description and usage of Medication.code.display 8489 Medication related indicators - maintenance drug, over the counter 5827 Should medication have a status code?



Minutes/Conclusions Reached Tracker 12397 Medication open world semantics

(See tracker log) Created new description. M/S Tom/Kathy 'Persuasive' 5-0-0. Passed. ACTION: Needs to be applied

Tracker 12391 Medication resource definitive versus descriptive code (see tracker log) The use of the word "primary" is incorrect. revising comment to refer to

code.userSelected=T. included reference to text in the codedConcept datatype. M/S Tom/Kathy "not persuasive with mod" 5-0-0 Passed. ACTION: needs to be applied

10577 Adding image of the drug or medicine to Medication Resource (see also tracker log) Name: Medication.image type: attachment cardinality 0..1 Description: a photo or graphic representation of the medication. Note that image is only applicable

where the code represents a physical item (Amoxil 250mg capsule), not an abstract item (e.g. Amoxicillin 250mg)

M/S Daniel/Kathy "persuasive" 5-0-0 Passes. ACTION: needs to be applied 10389 Add guidance about whether to choose medication codeableConcept or reference to medication if

need to include lot number or batch (see tracker log) augmenting current comment. Adding specific example (e.g., if form or lot number,

then must use medication resource) Needs to apply to any medication.code choice: Medicaton, MedicationStatement,

MedicationDispense, Medication Administration. M/S Scott/Kathy 'persuasive' 5-0-0 passes. ACTION: needs to be applied to multiple resources



Action ItemsAction: Tracker 12397 Update description/comment for Medication.ingredient.(text in tracker)Action: Tracker 12391 Update Medication narrative to better describe when to the use resource rather than the code,

and on appropriate use of userSelected. (text in tracker) Action: Tracker 10577 Create new element Medication.image (information in tracker)Action: Tracker 10289 Apply changes across Medication, MedicationStatement, MedicationDispense,

MedicationAdministration (text in tracker)

Tuesday 17 January 2017 Q4 - Joint with PHERAttendees

Name Organization Country Email

Quorum Met:

Agenda Topics

MEETING WITH PHER IN Chula Vista Boardroom


Minutes/Conclusions Reached

Wednesday 18 January 2017 Q1Attendees

Name Organization Country EmailJohn Hatem (Chair) US [email protected] Peters (Scribe) Gevity Consulting CAN [email protected] Robertson Kaiser US [email protected] McNeil SureScripts US [email protected] Keegan POCP US [email protected] SpiroZabrina Gonzaga Lantana USCasey Thompson Lantana USAngelica Garcia Humana Transcend Insights US [email protected] Thompson NCPDP US [email protected] Williams Lantana US [email protected] Transcend Insights USDaniel Zhang Epic US [email protected] de Jong HL7 NL NL [email protected]

Quorum Met: Yes

Agenda Topics Update on Pharmacist Care Plan - Sue Thompson and Shelly Spiro (15 min) Schedule for Conference calls DMP M&C SWOT Forward Planning

Project Review Formulary PSS 3-year plan review

Action Item list review



Minutes/Conclusions Reached Update on Pharmacist Care Plan

Have identified implementers for the pilot – Community Care of North Carolina (payer) plus 6 pharmacy vendors

Being used as a tool for the value based model in the US PSS was presented 1 year ago ONC is the funding source for the Care Plan project CDA based Pharmacist Care Plan – based on CCDA R2.1 Care Plan Document Type Pharmacist Care Plan V1.0 by NCPDP Changes to PSS – Lantana is funding to lead modelling of templates; added new vendors; timelines

have changed – implementing Fall 2017. Draft standard to be completed before the end of January.








Balloting in September cycle for HL7 ONC High Impact Pilot – awarded to Lantana – purpose to establish a standard for pharmacist care

plants and to deploy the standard across the Community Pharmacy Enhanced Services Network (CPESN) – a project of Community Care of North Carolina

Question about modelling Intervention with medications – should medications be included in the Intervention section or just have the Intervention section refer to the Medication Section.

Schedule for Conference calls – keep DMP M&C SWOT Forward Planning

Project Review Formulary PSS – 3-year plan review Action Item list review

Analytics engine to support real time and batch processing Apply clinical measures – drug interactions, over use of medications Add tracker item for MedicationDispense – add link to DetectedIssue – new attribute 0..*

o Add “notDone” and notDoneReason” (would be a choice – of codeableConcept and reference to a DetectedIssue) – Jocelyn/Scott – 7/0/1

Add tracker item for MedicationRequest – add link to DetectedIssue – new attribute 0..* - – Melva/Tom – 7/0/1

Action ItemsAction: John to confirm if catalog might be used for our formulary requirementsAction: Invite Lorraine to join Pharmacy in MadridAction: Include as an agenda item for Madrid discussionAction: Add tracker items for MedicationDispense and MedicationRequest


Name Organization Country EmailJohn Hatem (Chair) US [email protected] Peters (Scribe) Gevity Consulting CAN [email protected] Robertson Kaiser US [email protected] McNeil SureScripts US [email protected] Keegan POCP US [email protected] de Jong HL7 NL NL [email protected] Zhang Epic US [email protected] Shafarman Shafarman Consulting US [email protected] Met: Yes

Agenda Topics Pharmacy Templates Work



Minutes/Conclusions Reached Templates – location art-décor.org – Medication on CDA

OID needed to be registered MedicationOrder – is completely defined

Recursive relationship to the MedicationOrder. Motion: We will unwrap this component relationship and include a substance administration parent and child. Scott – Kai – 6/0/2 Carried

Explicit details for parent/child: Motion: Melva/Scott – 6/0/2 - Carried If text information, will always be in - M the Parent All dosing is in the child(s) Parent – id, code, text, status, effectiveTime (use period- interval of timestamp), repeatNumber,

methodCode, approachSiteCode, route Child – doseQuantity, rateQuantity, dosecheckQuantity, maxDoseQuantity, administrationUnitCode

Effective times – will leave examples for Parent Effective times on child – will include the same examples as for the Parent

MedicationStatement Kai will start to work on MedStatement Will present on a teleconference – Plan for Feb 6 – will make a decision on whether to ballot

Action ItemsAction: Need to review definitions for Medication OrderAction: Populate templates with examples – Melva to contact KaiAction: Agenda time on Feb 6 for review of MedicationStatement





Name Organization Country EmailJohn Hatem US [email protected] Robertson Kaiser US [email protected] McNeil SureScripts US [email protected] Peters (Scribe) Gevity Consulting CAN [email protected] Zhang Epic US [email protected] de Jong HL7 NL NLQuorum Met: Yes

Agenda Topics Discussion of what a snapshot of a patient's medication list is FHIR Tracker Items



Minutes/Conclusions Reached Discussion of what a snapshot of a patient's medication list is FHIR Tracker Items – See FHIR tracker items for decisions/direction

TR7562 TR 8489:

Action: Create a new tracker item for the "maintenance drug Indicator" and include in the discussion around formulary.

TR 5290: TR 12395:

Action: Melva to follow-up with Julie on how to handle BoSS







Name Organization Country EmailJohn Hatem US [email protected] Robertson (Chair) Kaiser US [email protected] McNeil SureScripts US [email protected] Peters (Scribe) Gevity Consulting CAN [email protected] Zhang Epic US [email protected] Bui DOD/VA IPO US [email protected] Duteau Infoway CAN [email protected] de Jong HL7 NL NL [email protected] Visceglia NCCN US [email protected] Lamb NCCN US [email protected] Shapiro Quera US [email protected]

Quorum Met: Yes

Agenda Topics Overview of Infoway MedicationRequest profiles and extensions (Jean Duteau) - 30 minutes FHIR Tracker Items



Minutes/Conclusions Reached Overview of Infoway MedicationRequest profiles and extensions

Profiles on MedicationRequest, MedicationDispenses and on workflow (renewals and cancellations) MedicationRequest – 3 profiles – compound, coded medication and prescribable devices (have a

code) How do you create a snapshot of the patient’s medication list?

Work with material developed for ONC project and update documentation







Thursday 19 January 2017 Q1Attendees

Name Organization Country EmailJohn Hatem US [email protected] Peters (Scribe) Gevity Consulting CAN [email protected] Tan Nictiz NL [email protected] Zhang Epic US [email protected] de Jong HL7 NL NL [email protected] Syed Cerner USA [email protected]

Quorum Met: Yes

Agenda Topics Update from IHE Pharmacy (Michael Tan) General Session Pharmacy Presentation FHIR Tracker Items



Minutes/Conclusions Reached Update from IHE Pharmacy (Michael Tan)

Project on Mobile Medication Administration Registering medication administration in certain settings – elderly patients treated at home instead

of a nursing home; day care Use Case 1 – nurse travel from patient to patient residing at their own home. Activities are based on

a care plan. Medication administration is part of daily routine. Could be other activities Synchronization of workstation with a mobile app on a phone/tablet – need to synchronizing with

the two Open issues

Selection criteria of medication requests for the performer Scope now limited to reporting back medication administration – supplying medication

(dispense) is not the focus Unplanned administration of stocked medication must be possible (conditional usage: take in

case of fever) Medication not administered must be documented, including reason of deviation Non-prescribed medication (OTC) must be documented. Scanning of product barcode is part of

the workprofile Use Case 2 (future) – patient has to administer chemo therapy on his own. Complex dosage schema

with time schedule. App generates instructions for patient to consume medication Discussion of possible joint meeting with IHE Pharmacy – before MadridAction: Michael to raise in Naples at next IHE Pharmacy F2F General Session Pharmacy Presentation

Reviewed draft presentationAction: John will post to SVN FHIR Tracker Items

See GForge





Name Organization Country EmailJohn Hatem US [email protected] Peters (Scribe) Gevity Consulting CAN [email protected] NCCN USDaniel Zhang Epic US [email protected] de Jong HL7 NL NL [email protected] Syed Cerner USA [email protected] Lamb NCCNMichelle MillerJocelyn KeeganDanielle FriendScott Robertson Kaiser Permanente US [email protected] Met: Yes

Agenda Topics FHIR Tracker Items



Minutes/Conclusions Reached FHIR Tracker Items

See updates in Gforge





Name Organization Country EmailJohn Hatem (chair) US [email protected] Zhang Epic US [email protected] Robertson (scribe) Kaiser Permanente US [email protected] Visceglia NCCN US [email protected] Lamb NCCN US [email protected]

Quorum Met: Yes

Agenda Topics FHIR tracker items



Minutes/Conclusions Reached FHIR tracker 12468 –

See tracker item for official documentation John created spreadsheet to compare notTaken/notGiven and related Event elements Reviewed the related tracker item on renaming notTaken Also realized MedicationDispense should have notDone (notDispensed), e.g., too early, but not the

ReasonDispensed concept (why did we dispense the med doesn’t make sense) Looks like we have the concepts aligned

Changes to MedicationAdministration reasonGivenCodableConcept reasonGivenReference

Persuasive M/S Scott/Daniel 4-0-0 Mentioned by Mary V: Project in CDS for International Chemotherapy has been approved. We may be

asked about medication-related components, but no assignments at this time. FHIR Tracker 12386 Harmonization of MedicationDispense with Workflow event logical model

See tracker item for official documentation Difference/question: MedDisp.id is 0..1, event.id is 0..*. Is there a need to allow multiple

MedDisp.ids? maybe a dispense management application work with another automation system (IV robot, large scale pharmacy filling systems) would have an identifier from the management system and from the automation system? Agree to change to 0..*

Definition. In workflow, not in dispense. Doesn’t look like it is necessary. basedOn. In workflow, not in dispense. Supported in dispense as authorizingPrescription.

Maybe add to comments that this is equivalent to basedOn in the event logical model part of. In workflow, not in dispense. Makes sense for medications dispensed directly related to

a procedure, e.g., prep meds for colonoscopy. Statuses matches except for

stopped=aborted. Don’t change name Add preparation to MedDisp to track internal workflow, e.g., interaction between

“human” applications and robotic systems. Do not add Unknown to dispense

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12386








Add notDone to dispense. Changing patient to subject Adding context to reference encounters Occurance: align dispense with event logical model … discussion to continue in Q4

Action: Tracker 12468 needs to be applied


Name Organization Country EmailJohn Hatem (chair) US [email protected] Zhang Epic US [email protected] Robertson (scribe) Kaiser Permanente US [email protected]

Quorum Met: Yes

Agenda Topics FHIR Tracker items



Minutes/Conclusions Reached FHIR Tracker 12386 Harmonization of MedicationDispense with Workflow event logical model

See tracker item for official documentation … continued Dispenser kinds of elements to be replaced with performer structure from workflow. Allows to

track multiple potential performers (pharmacist, technician, robotic system) reasonCodeableConcept … doesn’t seem to apply to dispense. (we’re filling the dispense because

either the patient or doctor asked us to) already have notes in dispense John will wordsmith final statement, as summarized in his spreadsheet M/S Daniel/Scott 2-0-0 Passes

Action: Tracker 12386 changes need to be applied






Full list of attendeesName Organization Country EmailCasey Thompson Lantana USDaniel Zhang Epic US [email protected] Frierd Epic US [email protected] Haas Healthedatainc US [email protected] Glover HL7 UK UKJean Duteau Infoway CAN [email protected] Syed Cerner USA [email protected] Keegan POCP US [email protected] Hatem USA [email protected] Transcend Insights USKathy Pickering Cerner USA [email protected] Bui [email protected]


Mark Shafarman Shafarman Consulting US [email protected] Albitz Wolters Kluwer Health USA [email protected] Mary Visceglia NCCN US [email protected] Peters HL7 Canada Canada [email protected] Miller Cerner USA [email protected] Lamb NCCN US [email protected] Williams Lantana US [email protected] Robertson Kaiser Permanente US [email protected] Spiro Pharmacy HIT Collaborative USA [email protected] Thompson NCPDP USA [email protected] McNeil SureScripts USA [email protected] De Jong HL7 Netherlands Netherlands [email protected] Schueth Point of Care Partners USA [email protected] Yunwei Wang IMO US [email protected] Gonzaga Lantana US











