Stream: implementers
Topic: License or Permits resource
Paul Barry (Aug 15 2017 at 00:17):
What fhir resource would best represent a License or Permit?
Grahame Grieve (Aug 15 2017 at 00:25):
to do what?
Paul Barry (Aug 15 2017 at 00:48):
to do what?
To hold data about a DAPIs permit
Paul Barry (Aug 15 2017 at 00:49):
to do what?
It needs to have a reference to a patient and or practitioner
Grahame Grieve (Aug 15 2017 at 01:01):
isn't this a coverage?
Paul Barry (Aug 15 2017 at 01:05):
isn't this a coverage?
Coverage seem to be more about the financials. This is a permit to prescribe or dispense controlled drugs
https://www.health.act.gov.au/sites/default/files//Fact%20sheet%20FAQ_0.pdf
Contract maybe?
Grahame Grieve (Aug 15 2017 at 01:11):
then perhaps, yes. @Paul Knapp might have an opinion
Grahame Grieve (Aug 15 2017 at 01:11):
or @John Hatem @Scott Robertson @Melva Peters from Pharmacy
Melva Peters (Aug 15 2017 at 02:09):
We have had similar requests in the past to add a permit number on a MedicationRequest - which includes the authorization a prescriber has to prescribe a certain drug or type of drugs. Is this what you are looking for? The ability for a prescriber to include his/her authorization or permit when prescribing? If so, I think you should add a tracker item so pharmacy can re-consider. If it is a way to request authorization (as in the application), I don't think we have anything like this.
Paul Barry (Aug 15 2017 at 02:12):
We have had similar requests in the past to add a permit number on a MedicationRequest - which includes the authorization a prescriber has to prescribe a certain drug or type of drugs. Is this what you are looking for? The ability for a prescriber to include his/her authorization or permit when prescribing? If so, I think you should add a tracker item so pharmacy can re-consider. If it is a way to request authorization (as in the application), I don't think we have anything like this.
From the requirements we are seeing the permit should be an entity that is related to either a patient or a practitoner rather then an instance of a MedicationRequest. The permit itself will have workflow in the system where by a regulator can activate the permit
Grahame Grieve (Aug 15 2017 at 02:13):
I think both things are needed for the overall workflow
Paul Barry (Aug 15 2017 at 02:14):
I think both things are needed for the overall workflow
Yes I believe they may also be reference in MedicationDispense or MedicationRequest
Richard Townley-O'Neill (Aug 15 2017 at 04:07):
In our pre-FHIR model, practitioners has a data group called Entitlements(The entitlement or right of a participant to act in a given capacity (as defined by Entitlement Type) within a healthcare context.) with attributes identifier, type and period-of-validity. It is what we would have used.
There does not seem to be a suitable place for this in FHIR.
Grahame Grieve (Aug 15 2017 at 04:40):
it overlaps with Practitioner.qualifications. And you should clarify that 'we' in that sentence is the Australian national program
John Hatem (Aug 15 2017 at 10:31):
In the US, we call this the DEA number ( as in: DEA number (DEA Registration Number) is a number assigned to a health care provider (such as a medical practitioner, optometrist, pharmacist, dentist, or veterinarian) by the U.S. Drug Enforcement Administration allowing them to write prescriptions for controlled substances.). I agree this number is associated with the prescriber, not the Medication Request itself. When the Medication Request is the source for a formal prescription, it is often expected to include the DEA number for the prescriber in the order. Since we Reference the Practitioner as an author of the prescription. I had expected that Practitioner would have a place for the DEA number - maybe via the Qualification structure, or something like that structure.
Grahame Grieve (Aug 15 2017 at 12:31):
I think that here in Australia, you must nominate an explicit permission number on the request - it's not the same thing. But I'll defer to Paul
Lloyd McKenzie (Aug 15 2017 at 14:01):
Wouldn't you also need to have the ordering provider name and phone number or address on the request? I suspect it would still be handled through a Practitioner reference in FHIR.
Scott Robertson (Aug 15 2017 at 16:34):
I agree with @Melva Peters : please add your requirements as a tracker item.
In the US, generally, a medication order must indicate the prescriber, address, phone, and license or DEA (DEA required if the medication is a "controlled substance"). These are generally considered characteristics of the prescriber, i.e., they are always the same for that prescriber (sometimes location specific).
That's the simple case. There can be additional requirements. There are a few products where a specific (federal) authorization is required (not recalling if it is specific to the prescriber, patient, or both). There are also REMS (risk management programs) where each prescription must tie back to documentation that the prescriber, patient, and sometimes pharmacist have received specific education and enrollment in the program.
One could argue that the "additional requirements" are not in the 80%. However, the FDA has proposed that ALL opioid prescriptions be covered in REMS program ... that will certainly will fall into the 80%
Paul Barry (Aug 15 2017 at 21:28):
I agree with @Melva Peters : please add your requirements as a tracker item.
In the US, generally, a medication order must indicate the prescriber, address, phone, and license or DEA (DEA required if the medication is a "controlled substance"). These are generally considered characteristics of the prescriber, i.e., they are always the same for that prescriber (sometimes location specific).
That's the simple case. There can be additional requirements. There are a few products where a specific (federal) authorization is required (not recalling if it is specific to the prescriber, patient, or both). There are also REMS (risk management programs) where each prescription must tie back to documentation that the prescriber, patient, and sometimes pharmacist have received specific education and enrollment in the program.
One could argue that the "additional requirements" are not in the 80%. However, the FDA has proposed that ALL opioid prescriptions be covered in REMS program ... that will certainly will fall into the 80%
Our requirements are quite solution specific with little detail around the business scenarios they are trying to accomodate - we are pressing for more information. But from what I see you have described the exact scenarios we are trying to accomodate including your "additional requirements"
Paul Knapp (Aug 15 2017 at 22:38):
Yes, you wouldn't use Coverage as that provides insurance/assurance program identifiers.
Typically providers have an identifier for each category of service they are permitted (scope of practice) to perform and usually must list which on is applicable in a given data exchange.
A license is typically an annual reaffirmation of the right to practice that scope, as issued by a registrar - given that HL7 has not generally been used in provider licensing systems we don't have a content model, in FHIR (CDA, V3 or V2) to my knowledge which captures the license details.
Usually we capture that a person is licenced as a ZZZZZ by registrar AAAAA for period BBBBB but don't record the specific instance of a licence.
Jose Costa Teixeira (Aug 17 2017 at 15:56):
We should cover different levels: Besides per practitioner or institution, the permit may also be workflow instance.
In some countries, for some kinds of requests, a unique number is issued per request. This means "once this prescription has this unique number, then it can be dispensed".
Last updated: Apr 12 2022 at 19:14 UTC
