CeRx 4.4.0 C01.21 Get Patient Medication Summary - Last Dispense Pickup and Processing Date

This was discussed at the last HL7 Community call and it was proposed that SupplyEventLastProcessed be added to the Medication Prescription Summary Query Response payload. SupplyEventLastProcessed would include both effectiveTime and Quantity attributes so one could capture information about the last time and quantity processed.

Call participants appeared to be supportive of the approach, but as most on the call were not CeRx implementers I wanted to present the proposed approach to this community. At this point, a formal RFC has not been created as we would need to have a better understanding of commitment to implement prior to formalizing this change.

OK. I understand. How do others using CeRx feel about the proposal?

The current message returns both the last Pickup date and the last Dispense date, but it returns them both within the same parent element and this makes it appear as though the two values are from the same record (and in many cases they are). But in reality the two values can come from two different records and as a result you can get a message back that would have a last Dispense date that is greater then the last Pickup date (indicating that you currently have a dispense in process). The request is to separate these two values into two different parent elements so that we can provide the summary info about the two different events (last Dispense, and last Pickup) as it appears that this information is important to the pharmacists reviewing the information.

Isn't the intent of the medication summary to return information about prescriptions that have been dispensed? It would seem to me C01.25 Get Medication Profile Generic Query would be the more appropriate transaction to use if you want to know about dispenses that are still in process.

Based on a request from the Nova Scotia DIS Program, there was a change implemented to the transaction C01.21 Get Patient Medication Summary in CeRx 4.4.0.

The Medication Summary response message was adjusted based on the information in the following request to Infoway

informs.infoway-inforoute.ca/browse/HL-213.

Here is a summary of the changes that were implemented in CeRx 4.4:

• Request that the C01.21 message have the First Dispensed Date and Last Dispensed Date have their datatype change from IVL.HIGH to IVL, the names from Dispensed Date changed to Dispensed Processing and Pickup Dates, and provide implementation guidance to indicate when a dispense will be included in the message.

• Add Implementation Note: "The LOW end of the IVL will contain the processing date & the HIGH end will contain the pick-up date."

Upon implementation of the attribute, it was discovered that this change in CeRx 4.4 did not fully address the primary reason for the request by Nova Scotia.

From the original request, the following was noted by the NS DIS Program:

“Based on consultation with the Nova Scotia pharmacy system vendors, it has been identified that the query response for this transaction includes the Dispense Pickup Date for the last dispense but excludes the Dispense Processing Date for the last dispense. Providing the Dispense Processing Date for the last dispense would be very beneficial for users”

The Nova Scotia DIS Program is requesting separate attributes to be created within the message to support the ability to send separate Last Dispense Date and Last Pickup Date information.

The attributes are described as follows:
1. Last Dispense Processing Date
• Low value – the date of the last dispense
• High value – the date the dispense indicated in the low value was picked up (if the dispense was picked up)

2. Last Dispense Pick Up Date
• Low value – the date of the dispense corresponding to the high value in this attribute
• High value – the date the last time a dispense was picked up

The following examples demonstrate the expected behavior of the attributes.

There are three dispenses on a patient’s DIS profile for a prescription order.

Example 1
Rx1, Dispense Date, Pickup Date
Dispense 1, January 1, 2016, January 2, 2016
Dispense 2, February 1, 2016, February 2, 2016
Dispense 3, March 1, 2016, no pickup

In the Query response, the behavior is expected to be:
1. Last Dispense Processing Date
• Low value – the date of the last dispense (March 1, 2016)
• High value – the date the dispense indicated in the low value, was picked up - (No value as the low value was not picked up)

2. Last Dispense Pick Up Date
• Low value – the date of the dispense corresponding to the high value in this attribute (February 1, 2016)
• High value – the date the last time a dispense was picked up (February 2, 2016)

Example 2
There are three dispenses on a patient’s DIS profile for a prescription order.

Rx1, Dispense Date, Pickup Date
Dispense 1, January 1, 2016, January 2, 2016
Dispense 2, February 1, 2016, February 2, 2016
Dispense 3, March 1, 2016, March 2, 2106

In the Query response, the behavior is expected to be:
1. Last Dispense Processing Date
• Low value – the date of the last dispense (March 1, 2016)
• High value – the date the dispense indicated in the low value, was picked up - (March 2, 2016)

2. Last Dispense Pick Up Date
• Low value – the date of the dispense corresponding to the high value in this attribute (March 1, 2016)
• High value – the date the last time a dispense was picked up (March 2, 2016)

We suggest creating a new element fullfillement6, similar to fufillment2, that would contain the information identified above as “Last Dispense Processing Date”.

fullfillement6 will be located at this location:

PORX_IN060260CA/controlActEvent/subject/combinedMedicationRequest/component3/supplyRequest/component/supplyRequestItem/fulfillment6

fullfillement2 description should be modified to reference supply event pickup event.


Thanks