Pharmacy Work Group - Orlando s1

Pharmacy Working Group Meeting Minutes

San Antonio, TX January 19 – 23, 2014 Table of Contents a) Action List

b) c) Monday 19 January 2015 Q1 Attendees Name Organization Country Email Scott Robertson (Chair) Kaiser Permanente US [email protected] Hugh Glover Blue Wave Informatics UK [email protected] Julie James Blue Wave Informatics UK [email protected] John Hatem Oracle US [email protected] Melva Peters Gevity Consulting CAN [email protected] Nicolais Canu PHAST FR [email protected] Daniel Lamphear McKesson US [email protected] Frank McKinney US fm@frank Christof Gessner HL7 Germany DE christof@[email protected] Quorum Met: Y Agenda Topics Introductions Review and finalize WGM agenda Approve September 2014 WGM minutes Determine representatives to other meetings Assign roles for Pharmacy Quarters Hot Topics Conference call schedule Action List (if John available) Prep for meeting with SDWG reps Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Draft Minutes http://www.hl7.org/documentcenter/public/wg/medication/minutes/HL7%20Pharmacy%20WG %20Meeting%20Minutes%20-%20September%202014%20-%20Chicago%20-%20Draft.docx Minutes/Conclusions Reached Review of the agenda Changes made to the agenda on the Wiki Move action item list review to Wednesday Representatives to other Meetings Tuesday Q2 O&O – Julie will attend Wednesday Q2 EHR WG – Jean will attend Approval of the September 2014 WGM minutes Moved by John – seconded by Hugh to accept the minutes as circulated. CARRIED 7/0/0 Review of Hot Topics Action: Review and clean up hot topic list (Scott) Conference Call Schedule Will book teleconference for 60 minutes for weekly but will have a business meeting every 2 weeks. Second meeting will be held only if there is work to be done. Keep meeting at the same time. Next teleconference – February 2nd at 4pm Eastern Action: Melva will set up teleconferences and Wiki Prep for the SDWG meeting There are some action items coming forward from SDWG Action: John to work on spreadsheet Discussion of interests of new attendees Learning and interest in FHIR Oncology medications Review of examples for oncology medication orders to determine additional requirements for FHIR Cycle Length Dosing issues – can’t be represented d) Monday 19 January 2015 Q2 Attendees PHER meeting. John Hatem attended from Pharmacy Agenda Topics PHER FHIR resolutions General FHIR discussion by Ewout Kramer. Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached Open issues for PHER FHIR – 11 issues were discussed and all resolved. See gForge and filtered by PHER for status of these issues. Some of these issues were solved such that the current Immunization Resource is more closely aligned with Pharmacy Medication Administration resource. Ewout Kramer spoke about Project Argonaut generally and spoke about this US based effort to provide funding and resources to aid in getting DSTU 2 for FHIR out. EK stated that FHIR is going to use the security work done with SMART and incorporate that into FHIR. EK described the FHIR Clinical Connectathon and identified David Hay as the contact for reviewing and providing input into the next round of use cases for discussion next May. e) Monday 19 January 2015 Q3 Attendees Name Organization Country Email Brad Arnolt Cerner US [email protected] Charlie Mead Vidal Group [email protected] Christof Gessner HL7 Germany DE christof@[email protected] Frank McKinney US fm@frank Hugh Glover Blue Wave Informatics UK [email protected] Jae Woo Sin IHIS [email protected] Jean Duteau Duteau Design Can [email protected] John Hatem (chair) Oracle US [email protected] Matthew Graham Mayo Clinic US [email protected] Scott Robertson (scribe) Kaiser Permanente US [email protected] Quorum Met: Y Agenda Topics Update on MTM ballot & reconciliation (Scott) Update on Pharmacy Guidance - Endorsement Project (Scott) Pharmacy FHIR Work Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached Update on MTM ballot & reconciliation (Scott) MTM reconciliation complete (unsure if posted) Edits "done" but need examples and stylesheet (software issues) Action: confirm recon post and notice to ballotters (Scott) Action: finish examples; finish stylesheet (Scott) Update on Pharmacy Guidance - Endorsement Project (Scott) Pending Domain Experts Steering Division On target for this coming ballot cycle Action: confirm status of project with DESD (Scott) Action: push through TSC and ballot process (Scott) Pharmacy FHIR Work Pharmacy FHIR overview and walk-thru for newer attendees (John) All Pharmacy Resources were reviewed with the attendees. This generated discussion and feedback from the attendees. No new action items were generated from this discussion. f) Monday 19 January 2015 Q4 Attendees Name Organization Country Email Frank McKinney US fm@frank Hugh Glover (chair) Blue Wave Informatics UK [email protected] Rob Savage US [email protected] Jean Duteau CA [email protected] John Hatem (scribe) Oracle US [email protected] Matthew Graham Mayo Clinic US [email protected] Eric Larson CDC US [email protected] Katherine Duteau CA [email protected] Keith Willard SureScripts US [email protected] Tim McNeil SureScripts US [email protected] Joon Hyun Song IHIS [email protected] Jae Woo Sin IHIS [email protected] Do Yann Lee IHIS [email protected] Christof Gessner HL7 Germany De [email protected] Quorum Met: Y

Agenda Topics FHIR Pharmacy review of our issues Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached Jean Duteau is reviewing all open issues for Pharmacy FHIR as listed on gForge. Review results of discussions as documented by Jean Duteau in the gForge Pharmacy list of issues. All issues have been completed and the Motion was entered by Rob Savage to accept the solutions. Seconded by Tim McNeil. Vote was passed: 12 /0 /0 Jean Duteau is entering resolutions into gForge at the end of the quarter. And as time permits he is entering in FHIR changes to the Pharmacy Resources. g) Tuesday 20 January 2015 Q1 Attendees Name Organization Country Email Hugh Glover (scribe) Blue Wave Informatics UK [email protected] Jean Duteau CA [email protected] John Hatem (chair) Oracle US [email protected] Tim McNeil SureScripts US [email protected] Christof Gessner HL7 Germany De [email protected] Kai Heiman HL7 Germany De [email protected]

Quorum Met: Y Agenda Topics IHE profiles Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached CDA Templates in Europe and Generally Kai described some IHE involvement in pharmacy profiles and the consequent development of CDA profiles. IHE profile: Overarching condition based therapy plan – medication is part of this. ePSOS templates are available There are also some Polish and Lithuanian templates art - decor (http://art-decor.org) is used to document CD|A for many Eutropean projects. Kai walked through some examples. Action: Provide links for projects described (Kai) Kai is willing to help Pharmacy WG work on CDA templates. Christof asked about Pharmacy project to create CDA templates – we have a project for this which is currently on hold. Medication Statement would be the most appropriate starting point for this. Kai believes Medication Statement would take 2 days in an out of cycle meeting to prepare. Christof thinks that with a clear vision there could be a good attendance from Europe for a Paris meeting. h) Tuesday 20 January 2015 Q2 Attendees Name Organization Country Email John Hatem (chair) Oracle US [email protected] Hugh Glover (scribe) Blue Wave Informatics UK [email protected] Jean Duteau CA [email protected] Tim McNeil SureScripts US [email protected] Mike Marsh AAULD [email protected] Ashi Ravichandra Medfusion [email protected] Brady Keeler Medfusion [email protected] Jeffrey Ting Systems Made Simple [email protected] Nicolais Canu PHAST FR [email protected] Brad Arnott Cerner [email protected] Daniel Lanphear McKesson [email protected]

Quorum Met: Y Agenda Topics Meeting with FHIR Team Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached FHIR FHIR Tracker Items should be done and QA complete in 8 week’s time Argonaut Lloyd gave some background – Argonaut will deliver for the next ballot, but the output and mappings will be available before that. ACTION: Pharmacy should review the CCDA mappings when available if possible Consistency of resources John asked whether there is a process for achieving consistency. Not really – it’s a ballot function. FHIR WG New WG for FHIR core will be created to do some of the basic allocation and management. FHIR Comment Resolution Motion – add status field to Medication statement P:Duteau, S:McNeil Discussion: Add an unknown status? Conclusion not to add. Motion carried 10,0,0 i) Tuesday 20 January 2015 Q3 Attendees Name Organization Country Email John Hatem (scribe) Oracle US [email protected] Hugh Glover (chair) Blue Wave Informatics UK [email protected] Jean Duteau CA [email protected] Christof Gessner HL7 Germany De [email protected]

Quorum Met: Y Agenda Topics Pharmacy Webinar discussion Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached This discussion covered a review of the Pharmacy Overview document which described at a very high level the core Pharmacy constructs of Prescription/Medication Order, Medication Administration, Medication Dispense, Medication Statement and other healthcare processes where Pharmacy information is often used. This was a lead in to Hugh’s review of some of the presentation approaches/content he has provided. Hugh did work on an outline of the topics we should cover in our webinar, but did not distribute this material. Other areas covered in the Overview discussion: Architectures; Clinical Processes where pharmacy information is part of the process; Medication Knowledge e.g. FDB drug-drug checking, drug monographs, contraindications/indications; Medication Lists; Medication Supply Chain. These ideas were not discussed in depth, nor was there a discussion to include or leave these subjects out of a webinar. We agreed to continue the discussion on our weekly conference calls and identify specific action items during the call. Note that the list of attendees was lost and I need confirmation that Jean attended this quarter. I also believe that Christof G attended and another individual who I don’t have the name for. I am still looking for that list of attendees. j) Tuesday 20 January 2015 Q4 – Joint with PHER See meeting minutes from PHER k) Wednesday 21 January 2015 Q1 Attendees Name Organization Country Email John Hatem Oracle US [email protected] Melva Peters HL7 Canada CAN [email protected]

Quorum Met: No Agenda Topics Forward Planning Mission and Charter SWOT Work Group Health Metrics PBS Metrics Project Review 3 year plan Planning for May 2015 Work on agendas for upcoming teleconferences Action List (if John available) Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached No decisions were made due to lack of quorum SWOT was updated and will brought to a different quarter for review and approval 3 year plan was updated and will brought to a different quarter for review and approval Discussion of May 2015 WGM Webinar discussion may help drive some of what we can do for May 2015 WGM in quarters where we have participants from Europe l) Wednesday 21 January 2015 Q2 Attendees Name Organization Country Email John Hatem (scribe) Oracle US [email protected] Christof Gessner HL7 Germany DE [email protected] Michael Tan Nictiz NL [email protected] William Goossen NL [email protected] Melva Peters HL7 Canada CAN [email protected] Christian Hay GSA CH [email protected] Giorgio Cangioli HL7 Italy Italy [email protected] Julie James Blue Wave Informatics UK [email protected] Hugh Glover (scribe) Blue Wave Informatics UK [email protected] Jean Duteau Duteau Design CA [email protected] Catherine Chronaki HL7 Foundation GR [email protected] Quorum Met: Yes Agenda Topics ISO Updates eRx specification IHE Pharmacy OpenMedicine Project Review of ISO SKMT Pharmacy related terms and definitions Status of email threads Discussion of Out of Cycle Meeting in conjunction with HL7 WGM in Paris - May 2015 Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached ISO updates per Christian Hay. Christian presented ISO status including Road Map. (presentation (PPT) will be sent by Christian to Pharmacy WG). General discussion about how to most effectively provide comments to ISO regarding various ISO work products. Jean Duteau raised issues regarding how to effectively communicate issues. Christian asked Jean to contact him directly to identify an approach that will work. It was confirmed in discussion that the messaging work developed by HL7 Pharmacy WG for use by ISO has been dropped. They chose to use SPL approach. This is not new news, but just an affirmation of where we stand. Implementation guide work is being written by folks from FDA and Gunther. IHE Pharmacy report by Michael Tan Michael reviewed the current and planned work activity. Current primary project is on Medication distribution and supply. Driver is Jose. IHE catalogs links to MPD work – comment by Julie James. General statement, some of the IHE projects are still very abstract as noted by Michael Tan in his presentation. Pharmacy OOC in Paris Discuss plans and agenda. John H discussed the thoughts that came out of earlier Pharmacy WG discussion with Kai H and a suggestion to create a Medication Statement Universal template. It was suggested by Michael that this may not be possible in our 1 day OOC meeting in Paris. Michael did agree to discuss with this team and Melva and John agreed to evaluate whether we could accomplish this work in the actual HL7 Pharmacy WGM in Paris. Open Medicine Project update by Catherine Chronaki. Ask Catherine for the slides. Georgio discussed some of the issues that resulted in the creation of this project. Challenges in sharing medication information across cross-border country boundaries in Europe as seen in various epSOS projects. Goals were identified that related to finding practical deployment options. Georgio sent slides to Melva Peters Additional presentation by Christian Hay confirming and adding in more details and information about the Open Medicine project. General discussion about how to use IDMP content in the direct to patient care types of projects of which the Open Medicine is an example. m) Wednesday 21 January 2015 Q3 Attendees Name Organization Country Email Christof Gessner HL7 Germany DE [email protected] John Hatem (Chair) Oracle US [email protected] Wendy Huang Canada Health Infoway CAN [email protected] Melva Peters (Scribe) HL7 Canada CAN [email protected] Brett Marquard River Rock US [email protected] George Cole AllScripts US [email protected] Benjamin Flessner Epic US [email protected] Dave Parker DOD/VA US [email protected] Quorum Met: Y Agenda Topics CCDA mapping SDWG issues related to issues Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached CCDA Mapping If Pharmacy has started mappings, should share with Brett Action: Melva set up a meeting with Brett to review further - Complete Review of Pharmacy Use Case document Action: John to share the Pharmacy Use Case document with Brett Action: John to share the Pharmacy Overview document with Brett SubstanceAdministration FreeTextSig – proposal to create a new SubstanceAdministrationAct with only the text element supported – to be placed in an entryRelationship within the Medication Activity Could represent the text in a couple of ways – with text or with a reference Action: Brett to send examples to Pharmacy Action: Pharmacy to review with modeling facilitators Loading Dose Concerns raised about example that has been posted and has proposed that only free text will be supported n) Wednesday 21 January 2015 Q4 Attendees Name Organization Country Email Lisa Nelson Lantana US John Hatem (Chair) Oracle US [email protected] Wendy Huang Canada Health Infoway CAN [email protected] Melva Peters (Scribe) HL7 Canada CAN [email protected] Brett Marquard River Rock US [email protected] George Cole AllScripts US [email protected] Benjamin Flessner Epic US [email protected] Dave Parker DOD/VA US [email protected] Jean Duteau Duteau Design CAN [email protected] Kevin Shekleton Cerner CAN [email protected] Quorum Met: Y Agenda Topics Continued SDWG discussion Pharmacy FHIR Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached Discussion of Free Text Sig Moved to approve the medication status code states as per spreadsheet – Moved by Brent – seconded by Lisa. Carried (8/0/0) Discussion of Status Codes in CCDA – Moved to approve the medication status code states as per spreadsheet – Moved by Dave – seconded by Benjamin. Carried (8/0/0) Pharmacy FHIR Discussion of adding “batch” to the Medication Resource Moved by Jean – seconded by Melva – to add batch with lot number and expiration date – Carried (3/0/0) o) Thursday 22 January 2015 Q1 Attendees Name Organization Country Email John Hatem (chair) Oracle US [email protected] Scott Robertson (scribe) Kaiser Permanente US [email protected]

Quorum Met: No Agenda Topics Status of email threads Pharmacy Template Work Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached No formal meeting Reviewed pharmacy list email Many FHIR-related issues have been addressed with ongoing FHIR pharmacy work Expression of dose timing in FHIR remains an issue. Need to include better discussion and examples to illustrate simple and complex dosing instruction Need to confirm that relative use of MedicationStatement, MedicationPrescription and MedicationDispense is present in FHIR documentation Remaining issues closed or are being addressed with ongoing work p) Thursday 22 January 2015 Q2 Attendees Name Organization Country Email John Hatem (chair) Oracle US [email protected] Scott Robertson (scribe) Kaiser Permanente US [email protected] Melva Peters Gevity Consulting CA [email protected] Pharmacy HIT Shelly Spiro Collaborative US [email protected]

Quorum Met: Yes Agenda Topics Pharmacy Template work FHIR Use Cases Add: PSS for "Pharmacist EHR-System Functional Profile Release 2" Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda PSS Pharmacist Functional Profile 20150122.docm (on dropbox) Minutes/Conclusions Reached PSS for "Pharmacist EHR-System Functional Profile Release 2" Reviewed PSS, minor edits Noted that Steve Hufnagel will be presenting MedMangement and Immunization FHIR resources to project team. Action Item: follow up with Steve to ensure that his work on FHIR is reflective of Pharmacy FHIR work. Motion to accept PSS (Shelly) Request for regular updates. Will be added to Pharmacy WGM ongoing until complete Vote 4-0-0 FHIR Examples Need to decide what we want example for, rather than just random examples Reviewed current examples, brainstormed additional examples (see FHIR working documents) q) Thursday 22 January 2015 Q3 Attendees Name Organization Country Email Scott Robertson KP US [email protected] Pharmacy HIT Shelly Spiro Collaborative US [email protected]

Quorum Met: No Agenda Topics Pharmacy Template Work Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached No meeting due to lack of quorum r) Thursday 22 January 2015 Q4 Attendees Name Organization Country Email Melva Peters HL7 Canada Canada [email protected] John Hatem Oracle US [email protected]

Quorum Met: No Agenda Topics Pharmacy Templates Supporting Documents Agenda http://wiki.hl7.org/index.php?title=January_2015_Pharmacy_WGM_Agenda Minutes/Conclusions Reached No meeting due to lack of quorum