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Out of band discussion on projects using Medications List

  • Brett Esler
  • Danielle Bancroft
  • Dusica Bojicic
  • Richard Townley-O'Neill
  • Grahame Grieve


Agenda

  • Discuss plans for common advice on medications list types and implementation
  • Project scope of Interest
    • FRED IT projects and scope of completed work 
    • Agency lists in documents (Shared Health, Discharge Summary, Event Summary)
    • Oridashi current medications list; prescription history list
  • Types to discuss of list and attributes of those lists
    • Current medications (GP)
    • Current medications (Discharge)
    • Ceased medication (Discharge)
    • Relevant medications (Event Summary)
    • Prescribing history (GP/Dispense?)
    • Reconciled (Review?)
  • Appropriate List.mode and List.status usage
  • Change records
    • List.entry used for change record 
    • Change type vocabulary - agency work
    • Proposed List.entry.extension - change-description - detailed change text statement
  • Preadopt use of PractitionerRole as STU3 extension
  • Suggest invariant - make sure entry.flag matches MedicationStatement.status

Discussion

FRED

  • FRED MedsList/MedsReconcillation all transactions
    • Prescription exchange ERX/Medisecure
    • Opt-out MedView (Austin Health/Peninsula)
    • Prescriber/Dispenser can manage this list
    • Include OTC list
    • Source of the information 
    • Community pharmacy
    • Point in time record of reconciled list
    • Single instance of each medication
  • MyHR Discharge Summary is accessible
  • Storing 
    • List, MedicationStatement (contained Medication)
    • List of MedicationRequest
    • List of MedicationDispense
  • Reconciled as the Current Medications List
    • Hospital - admission/discharge review
    • Community - medications check, home medicine review
  • Declaration of context - info on the reconcilation; reasons; risks - QuestionnaireResponse ; extension on List resource
  • Withheld date range 
  • Clinical Intervention (change record) - QuestionnaireResponse

Agency

  • Proposed use in documents
  • Base AU common proposal
  • Change vocabulary common exchange proposal



List Types

  • Types of list can affect the allowed content in the list
  • Provenance used for the source detail
  • Medication List Types

    Type 1
    • Process Medication Reconciliation -Hospital: Admission/Discharge;  Pharmacist/Nurse: RMMR / MMR (regular/diabetes) / Pharmacist: HMR 
    • List of MedicationStatement (complete)
    • Active and Ceased meds
    • No restriction on MedicationStatement
    • Includes change detail

Type 2

    • GP comprehensive meds summary / Record Transfer
    • List of MedicationStatement (complete)
    • No restriction on MedicationStatement
    • Active and Ceased meds
    • no change detail

Type 3

    • SHS current meds
    • List of MedicationStatement (complete)
    • Active meds
    • no change detail

Type 4

    • Event Summary Meds / Discharge Summary (as one list)
    • List of MedicationStatement (pertinent)
    • Includes change detail
    • Active and Ceased meds


  • Work to do: How to handle draft record - discussion point on how to address this
  • Work to do: Representation of Declaration of Context in detail (common reconciliation content)
  • Work to do: Use of Provenance with medication lists
  • Work to do: Withheld date range
  • BE: summarise list types discussion
  • BE: AU Base Medication List general purpose
  • BE: add the text change extension as agency proposed
  • BE: publish draft of change status vocabulary (look at definitions - simplify) - Packing Patient Medication Profile (PMP) definitions (source also)

  • Who to involve: FRED, Oridashi, Agency, Webster, Cerner and others 




 


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