Pharm Tech Minutes 2012.07.23

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Medication Documentation discussion WebEx minutes


  • Tom de Jong (Nova Pro)
  • Simon Letellier (EAHP)
  • Jose Costa Teixeira (Agfa Healthcare)
  • Marco Demarmels (Lake Griffin), scribe
  • Rob Horn (Agfa Healthcare)
  • Stephen Chu (National E-Health Transition Authority (NEHTA))
  • Lynne Gilbertson (NCPDP) [connected few seconds]


  • Goal:
Clarify the scope of the Whitepaper and additional needed work;
find out how to allow collaboration between HL7 and IHE on the current IHE work package, and the "bottom-up" versus the "top-down" approaches.
  • Tom recaps the history of the MedDoc wp and the misunderstanding about the different tasks of the HL7 and IHE Pharmacy group regarding this wp. The confusion was about the task of HL7 Pharmacy. HL7 deals with the basic data structures ("bottom") and IHE with workflows ("use of data within a workflow"). At the HL7 WGM in San Antonio (Jan 12) the HL7 EHR-S workgroup got in contact with us and some assumed that the specification of a Pharmacy EHR functional profile is HL7's concern in the MedDoc wp ("top-down").
=> it is not so much about distributing the work between HL7 and IHE Pharmacy but rather about forming two approaches, in which people from both organizations may want to work.
  • Rob sees a third dimension "workflow" beside the top-down and the bottom-up dimensions and proposes that whatever is observable within a workflow be a building block which the bottom-up fraction is aiming at.
It is noted though, that the top-down approach (functional view) as well as the workflows depend very much on local rules, conventions and jurisdiction, whereas the building blocks (the data that we can collect from the Pharmacy workflows) do not depend on any local habits, and are generic.
  • Rob suggests that we start with examining what has been published by the IHE PCC committee with their notion of Medication Statements, Continuity of Care Documents and the like, in order to make sure that no wheels will be reinvented. If there is a need to adjust any of the PCC deliverables as a result of our work, it should rather be done through the CP mechanism: harmonize, not invalidate what is already there.
  • Jose notes that there are known gaps in the CDA Template used in PCC, e.g. it is assumed that any medication is exactly taken as prescribed. Infos on lack of compliance or altered intake schedule and the like cannot be captured currently. We need to suggest certain extensions.
  • Stephen: The top-down approach is about identifying the needed components which make up Medication Lists and all those other entities he had recently sent an expose about (see link to attachment below).
  • Jose: One group works on what info is needed. The other group works on how to build the available info elements The initial motivation for the wp was to see what info is available and not how it is used.
  • Stephen: The results of the top-down approach will have to undergo a reality check when they are applied to local and specific workflows.
  • Rob: We need to maintain a global perspective and avoid going into national specific requirements.
  • Stephen: If necessary, specific requirements may appear as extensions.
  • Jose: A restricted (global) top-down approach would probably be supported by the information elements found by the bottom-up approach.

conclusion: We want to work with two papers in mutual coordination.

  • one group (corresponds to the initial idea of the wp):
- what information elements can we collect from the ePrescribing/medication workflow
  • other group:
- Definition of medication information uses and needed information/data for those uses.

We need to keep both groups in sync.

  • Next step:
    • generate a formal description of scope for both work items (like a HL7 Project Scope Statement)
  • Who does what?
    • Jose will formulate the use and capture of information and the articulation between both approaches for bottom-up
    • Group will review

Stephen's recommendations

There are two approaches to requirement analysis and design – the top down and bottom up approaches.

The top down approach supports detailed analysis from the function requirement perspective, allowing the functional profiles (e.g. medication list, medication profile, medication record, etc) to be identified and clearly defined. It also allows for the data requirements to be identified and defined at high level sufficient for further decomposition into detailed data design and to be used for cross referencing; adequacy, accuracy reusability and consistency (AARC) checks on the bottom up approach.

The bottom up approach supports detailed analysis of data requirements from business/clinical activities and workflow perspectives (e.g. prescription, dispense, administration, etc). It allows the data constructs to be identified and defined to granular levels, together with the application of data types and terminology constraints where appropriate.

The two approaches are complementary in nature. They can be used to cross referencing and validating the analysis outcomes of each approach. The top down approach is also important for providing adequacy, accuracy, reusability, and consistency (AARC) checks on the bottom up approach. One approach should not be favoured to the detriment of the other.

Agreements reached at the end of the conference call include:

(1) There will be two IHE whitepapers on medication documentation – one focuses on the bottom up approach and one focuses on top down approach. The top down approach paper will focus on defining the functional profiles required for safe and effective patient medication management. The bottom up whitepaper will focus on detailed/granular data constructs that are used in the medication management activities/processes.
(2) The top down and bottom up whitepapers must complement each other; informs each other about any gaps (i.e. missing pieces) so that the gaps can be closed
(3) Realm, national, regional, institutional and individual clinician specific workflow perspectives/contexts are out-of-scope for these two whitepapers. They will only focus on globally or universally applicable context
(4) The scopes and boundaries of each whitepaper will need to be clearly defined. How the two white papers relate to each other and the boundaries overlap will also need to be defined. This scope and boundary definition will be the focus of a project scope statement document to be developed
(5) Leads:
(a) Jose will take the responsibility of drafting the project scope statement document with others contributing to refine and complete this document;
(b) Marco will take the lead to develop the top down approach whitepaper, using the medication documentation whitepaper as the starting point;
(c) Jose will take the lead in developing the bottom up approach whitepaper

I think we have reached good understanding and agreements on the issues that caused the lengthy debates. I believe that we have a workable solution to move forward.


eMedication Management Concepts & Definitions slidedeck - Stephen CHU - NEHTA - PDF file(907 Ko)