Minutes - Medication WG 2020-03-17

Attendees

• Jan Lenie, Farmaflux, working for Recip-e, has worked on Pilot medication scheme
• Annemieke Vergauwe, Cerner, pharmacist, responsible for medicinal databases, follows up on recipe and vitalink
• Jens Penny, IT project lead at UZ Leuven, implementation medication scheme in- & outside hospital
• Tom Henkens, APB, responsible for medication databases, contact for software vendors
• Richard Francken, Cerner Benelux, responsible for business development & ehealth interoperability
• Will Van Norel, Cerner Benelux, Cerner market strategist, potential product development needs
• Robin Bosman, eHealth Platform
• Karlien Erauw, Agoria, secretary of HL7 Belgium/Belgian eHealth standardisation group within sectoral standardisation operator Agoria-ICT
• Jose Costa Teixeira, eHealth consultant working for several institutions in Belgium, chairing this session

Agenda

• Roll call
• Present HL7 Belgium, its working groups & structure
• Discussion: Identifying short term & midterm deliverables
• Check if all stakeholders are present, engage other stakeholders
• Next meeting schedule

Presenting HL7 Belgium

José initiates the discussion to propose topics (which can be anything, for example medication scheme, vaccination, medication shortages...) Idea for this meeting is to create a backlog of work items for the group.

Discussion: Short and mid-term deliverables

• Richard: Standardisation in context of semantic interoperability so that Cerner knows how and what to implement
• Concept of medication scheme
  • Effort to standardize in vitalink with KMEHR, is not sufficient for UZ Leuven, how can IHE & HL7 standards help to standardize the concept of medication scheme
• Jan Lenie: dispensations in pharmaceutical pilots & needs to translate them from Khmer to FHIR, posology
• Tom Henkens: electronic prescription, GFDPD : each one of us has its own std, with little & bigger differences that give problems upon exchange with other parties (pharmacies is different than GP’s & hospitals), unidoses in hospitals, pharmacist works with packages – definitions & scope is important
• Jens Penny: explore way to implement Khmer in FHIR, translate also into snomed ct, important to how we define medication (unidoses vs packages)- by transformation we can come to the same thing – dispensation records
• Richard: topics are related to each other – is there already a std for the BE market what medication is, HL7 & IHE can work closely together – make a profile for the BE market how to std this – how to deliver medication overview for the pt in 1 way
• Will: How does this relate to VIDIS?
• Robin: they talk about this, looking at the as-is medication scheme, enough people to be aware what is live in the field and the problems that are now in the field. For now, it is not a priority for them, they first want to evolve the as-is medication scheme. But they do talk about something in FHIR in the future.
• Jose: what about prescription, is related to semantic interoperability – prescription is from 1 party to 1 other party = not our immediate scope. We do need semantic interoperability
• Tom: there is a decent std, the national code, it is although not implement everywhere in the same way
• Note that Medication scheme is different than the patient record
• Jens: frequencies & timings as part of the medication scheme – also part of the dispensation
• Will: what standards are used ? there are proprietary codes. Goal to move it forward as int’l std.
• Jose: There is a EU project: Unicom, successor of open-Medicine project (which pointed to the technical solution of identifying medications across countries, based on IDMP and standard attributes).

Possible topics

• Semantic interoperability (product codes)
  • Complex
  • There is a nat’l code in Belgium as in each other country, EU code, GS1 code… we’ll have to make sense out of it
  • We could make some conversions, how will this look like
    • Where do we get these codes?
    • Active substance – but pharmacies want product code
    • How do we share data across parties?
    • There is semantic + content
    • How do we sync data? as we don’t want to share spreadsheets or pdf files
• Medication scheme
  • Exists in KMEHR
  • Cannot be done in a couple of weeks nor months
  • There are several flavours of medication lists, have all their downsides
  • Whatever we do will be a significant change, will have to be put in a roadmap
• Dispensation record
  • Will also need semantic interop but should not overlap
  • Do we want to work on FHIR record for pharmacies ? Jan confirms – vidis project wants to give the dispensation in a format that the point can read so it is a work item
  • Jose: seems not too difficult – transactional needs are not too complex

Available information and resources

• Semantic interoperability / Product Catalogs:
  • FHIR activities ongoing still
  • Other standards e.g. ISO 19256 high level requirements for Medicinal Product Dictionaries
  • openMedicine project – open-medicine.eu : about how to use IDMP attributes to identify medication across countries
  • Most likely, there will never be one code for all countries. Legal constraints are different. Lots of content to standardize, but it is possible to standardize.
  • Formulary/catalog of products – on IHE work items

• Dispense
  • 19293 ISO std Health Informatics - Requirements for a record of the dispense of a medicinal product (ISO/TS 19293:2018)
  • If the topics coincide, IHE Belgium can work with IHE int’l and align early

• Medication Scheme – on the roadmap of several groups (including IHE as a Medication Record)
  • Medication scheme is on the roadmap
  • We can start to work on our functional needs
    • Jens: vidis wants prescription in their patients portal. This may mean:
    • What is prescribed
    • What is dispensed
    • What is taken by the patient
  • Recipe works: based on KMEHR – std is the same as for the medication scheme – look at what works and what doesn’t
  • Pathology is nice in a structured way, is kind of ok in text when it comes for dispensation but not at all for the medication scheme
  • Jose: What is the place of a dispense in a medication scheme? dispensation can be used as source for the medication schema
  • Jens: medication is a superset/can contain a lot more, it is easier to start with dispensations, make FHIR profile on this & check how it corresponds with e.g. Snomed
  • Need for functional descriptions (data models and use cases): for maintenance and matching to between Kmehr and FHIR – it cannot be done if we don’t agree on the meaning
  • Recipe uses SAM database, has its own terminology, are not related to Snomed etc – is this information publicly available ? we have to check what we know abt this topic : http://www.samportal.be/nl/sam

• Overall
  • Cerner: prefers to have connections with int’l projects ; Belgium market: there are already some challenges – BE codes, KMEHR, partly Snomed implemented – how can we use the IHE methods to have a int’l IHE profile & have BE implementations
    • Jose remarks that translation to BE market, can be simple or complex - needs analysis and this is what this group can prepare

Information available

• eHealth Suisse
• Dutch ZIBs
• Current datasets in Belgium
• ISO standards: ISO/TS 19293:2018, ISO/TS 19256:2016, ISO/TS 19844:2018, ISO 17523:2014, IDMP...
• Belgian SAM is based on NHS medication model. British had one prevailing vendor (First Databank)
• NCPDP is US, collects pharmacy standards, are not open standard, they are also doing some initiatives on HL7 FHIR - we can check how they are
• A lot on medication catalogs is new (vendors have their own std, not standards-based interoperability), only in 2018 HL7 started on it
• Z-index is organization of its own, Richard will share contact person : https://www.z-index.nl/english
• https://www.nictiz.nl/programmas/medicatieproces/

Action Items

• Collect the info that is already out there on the topics
  • What do we know about the topics in Belgium & outside Belgium + compare with existing initiatives

• List topics that are candidates for backlog – José
• Collect information available – José & Karlien
• Look at code standards for medication – all
• Official Roadmap: will align strategically with governments (but that will not block us) - TBD
• Bring input and start planning work on transactions, content and terminologies + dispensation + medication scheme – by all as from next meeting