Pharm Tech Minutes 2011.10.05

To see the previous day's minutes go to: Pharm Tech Minutes 2011.10.04

IHE Pharmacy & HL7 Pharmacy Joint Meeting

Attendees

• Brandstätter, Jürgen (CodeWerk Software Services and Development GmbH, co-chair IHE)
• Canu, Nicolas (Association Réseau Phast - Phast)
• Cocchiglia, Arianna (Arsenal.IT)
• Costa Teixeira, Jose (Agfa Healthcare)
• De Jong, Tom (Nova Pro, co-chair HL7 Pharmacy)
• Demarmels, Marco (Lake Griffin, LLC)
• Duteau, Jean-Henri (Gordon Point Informatics, HL7 Pharmacy)
• Estelrich, Ana (Association Réseau Phast - Phast)
• Gengler, Winfried (Epic)
• Géraud, Thierry (CareFusion)
• Gibaud, Isabelle (Syndicat Interhospitalier de Bretagne - SIB)
• Glover, Hugh (Bluewave Informatics, co-chair HL7 Pharmacy)
• Hatem, John (Oracle, HL7 Pharmacy)
• James, Julie (Bluewave Informatics, HL7 Pharmacy)
• Koelewijn, Gert (Nictiz, HL7 Pharmacy)
• Lefebvre, Nicolas (INRIA)
• Letellier, Simon (EAHP)
• Liot, Pierre (Haute Autorité de Santé - HAS)
• Mohammad, Mirojane (Haute Autorité de Santé - HAS)
• Peters, Melva (Gordon Point Informatics, co-chair HL7 Pharmacy)
• Poiseau, Eric (INRIA)
• Rica, Charles (ASIP Santé)
• Robberecht, Marc (Agfa Healthcare)
• Robertson, Scott (Kaiser Permanente, HL7 Pharmacy)
• Rodrigues, Orlando (Glintt - Heatlhcare Solutions, S.A)
• Soley, Richard (OMG)
• Sprenger, Michiel (Nictiz)
• Surugue, Jacqueline (EAHP)
• Tzimis, Leonidas (EAHP)
• Zalunardo, Luca (Arsenal.IT)

By WebEx:

• Bourquard, Karima (IN-SYSTEM)
• Peytchev, Vassil (Epic)

End of the day before meeting

• Review the date milestones for the next cycle

• places for the next f2f meetings
• opportunities to have a f2f meeting in the USA
• define dates to finish the cycle to be ready for the EU Connectathon
• plan to be ready for a US Connectathon, in 2013 ?

• Review of the CP

• define 2 types of CP :

• Change / Addition
• Maintenance

• make it easier to be reviwed in the ballot

Introductions, ambitions and timelines

Presentation of IHE Pharmacy

Jürgen : young domain, young working group, first profiles in Pharmacy last year.

General lines of the roadmap includes cross domain activity foreseen to be increased due to overlapping borderlines and complying to IHE Governance requirements.

Presentation of HL7 Pharmacy

Tom : HL7 25 years, resulting in HL7 v2 as the most used standard in hospitals. HL7 Headquarters in Michigan US, international scope. Technical steering committee, 40 Working Groups, some of them like Patient care with 6 cochairs. (Most groups have 2 co chairs, 3 in Pharmacy). Importants points :

• Ballot packages
• Implementation technology specifications

See: http://www.hl7.org

All healthcare domains represented, based on healthcare sectors, but there is another domain CDA, which is just a methodology to structure the data, and is the most successful standard group, very popular as it should be implemented in all groups. Also Common Product Model, a overarching model, which is standardization within the standards.

Medication Documentation/Profile

Introductions

Tom de Jong's presentation:

The medication documentation or (virtual) medication profile.

Nictiz: HL7 v3.

AORTA in NL is an uncentralized system (only id not data are known by the central system)

Work with Dispense query and Dispense query response.

It is the responsibility of the data host to make the data retrievable 24/24h.

2 reasons for the data capture :

• controlling (prescribing / dispensing)
• observing (asking 'current' state)

3 dimensions of a "Virtual EHR":

• Care provider (GP ...)
• Concern (pharmacy, laboratory ...)
• Care activity (tracking ...)

-> Mandatory data elements for a medication survey.

-> Medication orders are "request to dispense", but sometimes it don't need dispense (already in stock).

"Care information broker"

4 profiles combining building blocks

1. Administrations referred to dispenses, referred to prescription
2. Prescriptions updates : changes doses / stop
3. Dispense (OTC medication) / administration
4. Administration (medication already in stock)

Julie James' Presentation

Abstract of her PhD thesis, describing a comprehensive medication profile

Requirements for :

1. Clinical care
2. Public health
3. Drug discovery and development

Medication profile: content? Location and length of storage, queries, ways information is retrieved and the structure under which they are reported

Discussion

Medication statement

System job to choose what display

provide the record

How to visualize complex data ?

Distributed systems or others solutions all must be supported.

define a request according to an "administration effective period" Depend of the clinical context ?

• acute disease
• chronic disease

• Different flavours for "current" medication ?
• What kind of queries ?
• With parameters ?
• Minimum of essential things (quick answer for emergency purpose)?
• How to deal with dosages ?

• IHE focus on process, HL7 on the design

• Common understanding, good balance, good hope for good progress together.

Supply chain

Thierry Geraud

summarizes the work done so far on the white paper on the supply chain:

• consideration focusing of the organisation behind, including stock availability and inventory.

• The scope must be defined clearly : supply chain of the medications inside the hospitals, with and without automated systems

• How is it medication related ?
• Need more USE CASES.

• Workitems will be restarted based on the use cases (particular supplies for patients).

• Prepare workitems for the next cycle.

• Centralized or decentralized systems as well as controlled drugs (narcotics).

Question on the version of HL7 to be used:

• V2, but in the near future,V3?

Infusion administrations

for "smart pumps" or normal device, well define in HL7 v2.

Both messages (Observations and administration) for pump devices with PCD.

Define Work items in a piece of paper : follow the process

Smart pump are just slaves – the dosage calculation according to patient’s weight should be done somewhere else.

Some already existing pumps are able to adjust on biological tests.

Infusion rate: when it varies, could each variation be considered as one administration?

Expression of substitution

• in the prescription, the prescriber indicates the way it can be substituted
• dispenser indicates the substitution operated

“In regards to today's discussion about substitution, the main reason why the EPSOS-proposed way of representation the permission to substitution is incorrect is that the RIM has constrained the Observation code to come from a specific value set and the ActClass codes can not be found in that value set.  So SUBST simply can't be put in the Observation.code attribute if the desire is to have a RIM-correct model.  The alternative that you have in the document with the component relationship to a SPLY that has a subject SUBST class would be the proper RIM-correct way of representing substitution.”

The CP-PHARM-019 will now close the open issue concerning substitution by changing to the correct structure.

Workflow management

2 TCons were set up on XDW with HL7 Pharmacy, ITI & PHARM A CP on XDW shall be approved in this cycle.

1. How the workflow is trigger ?

• Start & stop , but how is it trigger ?
• Elements of notification (optional element) are usable as trigger elements.

2. Business rules for the community manager

2 queries :

• Find prescriptions ready to validate
• Find prescriptions ready to dispense

IHE restrain, put constraints, and it can be a difficulty to be adopted.

Explicit rules to specify what are the Business architecture.

Optionality of pharmaceutical advice (change must be done) feedback loop in place : discussion between pharmacist & GP.

Business rules are linked to legislation of each country (best practices). Each content profile is neutral and real life.

HL7: different, this is a role, if you query, this is the way you have to do. HL7 is building a tool.

Nicolas quoted the «  cadre d’interopérabilité publié par l’ASIP

Roadmap planning HL7 – IHE

Productive, energetic meeting, synchronise once of twice a year just to be sure we stay aligned,

Fill the gap ...

• glossary HL7,
• glossary health informatics glossary,
• shared definition of terms,
• glossary IHE.

Agree on common wording , stay in peer to peer contacts. HL7 ballot package is available online but it's not normative. Repository of use cases ?

HL7 IHE

Application Role = Actor

Interaction = Transaction