Stream: implementers
Topic: NCPDP 2017 to FHIR 4.0
Aron Dalentor (Jun 13 2019 at 17:34):
Hello, does anyone know how to map part of NCPDP related to signature within FHIR? When we search for available examples
(https://www.hl7.org/fhir/medication-mappings.html#script10.6
https://www.hl7.org/fhir/medicationrequest-mappings.html#script10.6),
much of the data is not mapped and the signature is absent at all.
Lloyd McKenzie (Jun 13 2019 at 17:41):
@Melva Peters @Scott Robertson
Scott Robertson (Jun 13 2019 at 18:23):
Yes, the mapping is incomplete. While SCRIPT 10.6 is in use today, as of 1/1/2020 SCRIPT 2017071 will be the version in use. The current effort is to get a comprehensive SCRIPT 2017071 to FHIR r4 mapping done. This will likely include a set of extensions for the SCRIPT content that does not map or is not added to the resources.
I assume your request is in terms of EPCS, the requirement for a digital signature or an indicator that of identity verification (a "Signed Prescription" per DEA regulation). SCRIPT 10.6 does not support digital signatures (although, you should look at FHIR Digital Signatures (https://www.hl7.org/fhir/signatures.html#6.1.2) if that is your intent. SCRIPT 10.6 uses <DrugCoverageStatusCode>="SI" to meet DEA requirements, and that could be sent as a local FHIR extension.
I'm interested in your business case. Do you have a system receiving eRx using FHIR?
Aron Dalentor (Jun 14 2019 at 10:06):
We've partnered with company that developed eRx system. They use NCPDP 2017071 and they didn't implement FHIR, but we do and want to integrate their system into ours. They will send to us messages in NCPDP and we want to convert it into FHIR R4 and retranslate to other systems as FHIR messages. We are especially concerned about sig because in NCPDP sig is presented very well compared to dosageInstruction in MedicationRequest resource in FHIR. We are not interested in controlled substances, our focus is oncology and chemotherapy medications. @Scott Robertson @Melva Peters
Brendan Keeler (Aug 18 2021 at 17:00):
This is an interesting thread. Has anyone done significant work on the NCPDP to FHIR mapping?
Lloyd McKenzie (Aug 18 2021 at 21:36):
@Scott Robertson would know if anyone has...
Scott Robertson (Aug 19 2021 at 05:33):
There are individuals interested in mapping between SCRIPT 2017071 and FHIR r4, but no coordinated effort that I am aware of. It will need a business/use case driver since non-inpatient eRx in the US is exclusively SCRIPT 2017071 - CMS names SCRIPT in the Part D regulations, and that drives the overall market.
Brendan Keeler (Aug 19 2021 at 06:02):
FHIR increasingly used in a storage capacity. A FHIR enabled pharmacy receives a NEWRX and wants to store it.
A prescriber retrieves medication history and wants to store to the FHIR server
Brendan Keeler (Aug 20 2021 at 19:20):
I imagine RXHISTORYRESPONSE would be MedicationStatement, but RXHISTORYREQUEST seems to map to two distinct FHIR calls (Patient search with demographics, MedicationStatement search with patient ID). Do people agree? Is there a way around that?
Brendan Keeler (Nov 19 2021 at 15:07):
Circling back on this - seems like it was done here: http://hl7.org/fhir/us/meds/2020Sep/pdmp.html#ncpdp-mappings-for-pdmp-request
I'm curious about the choice of MedicationDispense vs MedicationStatement
Lloyd McKenzie (Nov 19 2021 at 18:40):
NCPDP lives in the world of dispenses and prescriptions. Why would they use statement, which is more about summarization and tracking compliance?
Brendan Keeler (Nov 19 2021 at 20:13):
The med history response is a summary across all pharmacies and Pharmacy Benefit Managers.
Vassil Peytchev (Nov 19 2021 at 22:11):
The pharmacies know about dispenses, wouldn't that be the best resource type to use?
Brendan Keeler (Nov 19 2021 at 22:34):
Given it's a mixture of dispenses (pharmacies) and claims (PBMs), I'm conflicted. Here's MedicationStatement's explanation:
"This is a record of a medication being taken by a patient or that a medication has been given to a patient, where the record is the result of a report from the patient or another clinician, or derived from supporting information (for example, Claim, Observation or MedicationRequest). A medication statement is not a part of the prescribe->dispense->administer sequence but is a report that such a sequence (or at least a part of it) did take place, resulting in a belief that the patient has received a particular medication."
Lloyd McKenzie (Nov 22 2021 at 15:43):
MedicationDispense and Claims both allow conveying "what quantity of what was provided". MedicationStatement can't expose that. It lets you say "Patient is on X", but that's pretty much it. So we'd lose information NCPDP has if we did that.
Brendan Keeler (Nov 22 2021 at 18:59):
Gotcha. MedicationDispense it is
Last updated: Apr 12 2022 at 19:14 UTC
