Canadian FHIR Baseline Profiles - Due Diligence Review - PrescribeIT – December 18th, 2-3pm EST

Hi all,

Having received almost no attendees at this point (understanding there is a conflict with a Connectathon) we will be reconvening at our next bi-weekly occurrence (Jan 29th). Please consider the present CA Baseline / DDR session CANCELLED.

Thank you!

Attendees

Michael Savage
Sheridan Cook
Igor Sirkovich
Dean Matthews
Kenneth Sinn
Matthew Herbert
Piers Hollott
Rita Pyle
Shamil Nizamov
Thomas Zhou

Summary:
• Three DSTU2 PrescribeIT profiles (specs.prescribeit.ca/R3.0/erx/erx-index.html) reviewed against the R4 Canadian Baseline (build.fhir.org/ig/HL7-Canada/ca-baseline/branches/master/artifacts.html)
• 1 DDR issue resolved through relaxation of a mustSupport flag in the CA Baseline
• Recording of the meeting will be made available in the Infocentral: drive.google.com/file/d/1DlHh65Dcs2Xs253r5zYbdobPvqAvlitT/view?usp=sharing

Next Meeting:
• Review PrescribeIT extensions for MedicationDispense and confirm which ones are appropriate (still needed after shift to R4) for socialization in the CA Baseline
• Start on Practitioner and Organization profile comparisons for next meeting

Medication
• Medication.code:
o No DDR issues identified
o PrescribeIT includes a constraint on the CodeableConcept data type that is effectively the same as the baseline (if coding is used system and code must be present) but visualized differently - they also require code.text as 1..1 whereas the baseline is less restrictive uses the base cardinality (allowed since implementation guides are expected to be more constraining than the baseline which is use case agnostic)
• Medication.form is present in the baseline which uses R4 but in PrescribeIT (DSTU2 guide) it's known as product.form - both use the same bound valueSet (preferred in the baseline, extensible in PrescribeIT)
• Subject = patient in R4 - no issues
• Per the baseline goals, we'll be socializing but not requiring any of the extensions in the Medication profile from PrescribeIT
o Ext-medication-strength-description: important for any IGuide using CCDD since products at the first level don't include product strength in their concepts
Ext-medication-code-representative & Ext-medication-isActiveIngredient are also helpful to socialize if it's in use and other IGuide authors want to use it and not duplicate effort/extensions

MedicationDispense
• 1 DDR issue: Baseline overly prescriptive in flagging "whenHandedOver" as must support
o While it's clinically relevant and expected in repository use cases, not all systems are suspected to be able to support this element meaningfully today, particularly community labs
• Some community pharmacies might populate this field w/ the same value as whenPrepared - would cause integrity and meaningfulness issues if we require their Iguides to inherit the flag
o Relaxing mustSupport flag on whenHandedOver in CA baseline for now
• Given it's criticality for clinical use cases and the gap that exists in vendor support - this might be a good candidate for the more prescriptive CA Core

• medicationReference and medicationCodeableConcept in baseline, but reference not in PrescribeIT (only medicationCodeableConcept)
o PrescribeIT has context where medication reference may not be needed so they constrained to only codeableConcept

• Dispenser used in PrescribeIT (DSTU2 format) in R4 becomes Performer , can be repeating in the baseline
o Ext-reference-practitioner-org used in PrescribeIT to bridge the gap in DSTU2 needed to communicate organization in this context - won't be socialized into the Baseline since shift to R4 Performer resource bridges that gap.
o Other extensions reasonable to socialize

•dosageInstruction
o PrescribeIT much more prescriptive but not a concern from DDR perspective given the use case for prescribe has much more specific requirements than the use case agnostic baseline which has to also support use cases where not all information is fundamental to achieving the use case (i.e. citizen access, quality reporting, CDS hooks, etc.)

MedicationRequest
• No DDR issues identified
• Some non consequential differences due to versioning:
o PrescribeIT guide is currently in DSTU2 so the resource is named MedicationOrder (whereas Baseline is R4 and the resource name changes to Medication Request
o medicationRequest.reported is in Baseline, but not in PrescribeIT DSTU2 profile
• medicationRequest.medication is MS in CA Baseline, PrescribeIT doesn't have the parent element as must support but has a slice that is MS -> This is belived to be a difference in MS definitions between guides (common) and the result of the element already being required cardinality (1..1) in the base spec.

Thanks. I was trying to find it with the working group section.

dmatthews wrote: Where can I find a link to the calendar item so that i can attend?

You can find it on the main page, right side of infocentral.infoway-inforoute.ca/en/

Direct link to the calendar entry: infocentral.infoway-inforoute.ca/en/news-events/event-calendar/icalrepeat.detail/2020/12/18/3845/-/canadian-baseline-profiles-profile-stream-updates

Where can I find a link to the calendar item so that i can attend?

Hi all!

For the Friday Dec 18th agenda, we will be moving to the next Implementation Guide (PrescribeIT) as part of our Due Diligence Review. We will be comparing the profiles in common between the CA Baseline and PrescribeIT iGuides.

Thank you!