Pharm Tech Minutes 2016.12.08
FHIR discussions
- Dispense vs SupplyDelivery to support "Nurse brings the medication to the patient and does not administer"
- Jose Asked this in Pharmacy - response was initially "doesn't seem like dispense" but when discussing with Workflow (incl. John H) there was an agreement that this would go back to being Dispense.
- Result: We expect this will be updated in the FHIR documentation
- Consequence: We need a status modifier to differentiate Dispensed from Delivered. This will surely be an extension. => IHE extension.
- How do we capture that the patient will have taken the medication the next day?
- We need to support "administered, but stated by patient" <-- medicationAdministration.performer? To be discussed.
- How to register in one system? (not our concern, since we are handling interoperability)
- How to communicate across systems? (that is what we will discuss)
Discussion: does the online/offline aspect change the resources to be used? No.
- Should we also document "while delivering, i DID NOT administer"?
- e.g. if the patient is feeling bad and will take it later --> This is not a dispense case anymore, this is a normal "non-administration" case.
Changes proposed to FHIR
12446 – should be done prior to 12379 and 12447. Renaming medicationRequest.stage to intent, to align with request logical model.
12379 – adding “instance-order” or “administration-instance” to the possible values for Intent. We need to differentiate a prescription from a MAR entry. This was largely debated, and the only thing missing is applying the solution that has been reached in workflow.
12447 – for the “intent” to work in real life, intent should be in the search criteria. Align with request model on this.
12439 – align with request logical model by providing a way to query “only the prescriptions / MAR entries assigned to me”. Add “intendedPerformer” to medicationRequest.
12439 – further align with model by providing a way to query not just a provider, but a provider type.