Pharm Tech Minutes 2013.03.01

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  • Call to Order/Roll Call
  • Stephen Chu
  • Jacqueline Surugue
  • Jürgen Brandstätter
  • Michael Tan
  • Jose Costa Teixera

Jürgen reports on the Austrian e-Medication project status

  • Administration recording is required
  • Use-case of recording drug-substitution and vacation administration events
  • Other use-cases already known and queued for phase 2: Chemo-Therapy medication administration, etc.
  • This requires the project the creation of a "Medication Administration" Content specification
  • This will be done by Jürgen

  • Questions out of the project to the group
  • Filtering issue 1: Cut the resulting medication list to specific date ranges?
  • Is that still an "unreconciled medication list". Yes, still an unreconsiled medication list
  • But the query parameters SHALL be set by the client! Defaults (e.g. last 3 months) are ok but shall also be applied by the client. However they should be made KNOWN to the user.
  • If the system has business rules for constraints for query parameters this is ok.
  • Advanced implications
  • The Austria project requires the following constraints: The date range allowed varies on the "role" of the user (Physicians see maximum the last year, other less). In general medication is available no longer than one year then it has to be deleted by law.
  • So it can happen, that a query with parameter "last 6 months" returns just records of the last "2 weeks" due to those constraints. This is potential dangerous if not made known to the user.
  • Solution: "Effective" query parameters shall be included in the returned result to ensure clinical safety?

  • Filtering issue 2: Cut the resulting medication list according to a calculated "range, which says if it's still reasonable that the patient still takes the medication OR at least has some of this medication left". If this threshold is passed it will be filtered out of the resulting list.
  • Example:
  • Client asks for the medication list
  • System collects this list completely (e.g. 105 dispenses for the last year)
  • Then this list is filtered, by calculating "range, which says if it's still reasonable that the patient still takes the medication or has this medication in its hands" and all those items will be removed.
  • Calculation rules: dosage vs. package size, example: Query will be set at Dec 1st, 2012 and figures out a dispense issued at Jan 1st, 2012 of a package of 30 pills, which the patient shall take 3 per day. In this case the patient would have been taken the last pill at Feb 1st, 2012 (which is 10 months ago). Thus this is "outdated" it will be filtered out of the list.
  • It remains a list of the few items, which are "likely" that the patient still takes or has at home
  • Statements of the group
  • Is such a filtering is a kind of "reconciliation"?
  • No, server-side business rules applied as such are not falling under the "reconciliation" process.
  • If that is clinical dangerous or not is another question
  • Netherlands have tried such approaches
  • Failed because it's not relyable and clinical unsafe
  • They have not been implemented
  • Those rule is conflicting with other business rules
  • The group definitely NOT recommeds to apply a filtering, because of it's unreliable, clinical unsafe and further implications like "mixed record in the list, the one properly calculated to be in, the other ones not able to be calculated because of missing dosing information)
  • The group recommends that if such a filtering is done it should be done at the client side, otherwise the returned unreconsiled medication list has omissions which may be clinical important
  • Also "outdated" medication taken e.g. 3 months ago may be of interest for the prescribing user

  • Filtering issue 3: Regarding to the content of an item in this list
  • If the "content" of the items in the list is filtered does that cause a problem? Does "raw data" mean "unreduced raw data"?
  • Austrian example: The package information is not needed in the medication list and is left away at each item
  • Stephen: This can not be done always, because package information might be the only information to determine the dosage
  • Netherlands: Dispense records is on "trademark" level
  • Statements of the group:
  • If it's metadata -> no problem
  • If it's clinical data -> should not be reduced
  • Discussion will be continued next time

New document: Medication Documents definitions

New action items

  • New action item: Jürgen: A "New Work-item proposal" will be prepared until Treviso meeting
  • New action item: Jürgen: A "Draft profile" will be prepared until Treviso meeting
  • New action item: Jürgen: A "Change proposal on CMPD introducing a Administration actor" will be prepared until Treviso meeting

Next TCon

Date will be determined by Doodle

Pharmacy Technical Committee