Stream: implementers
Topic: Patient's Pharmacy Preference
David Loney (Oct 14 2020 at 18:00):
Where do you prefer to include the patient's outpatient pharmacy of choice? Under Patient generalPractitioner? careTeam? Anywhere else?
Jens Villadsen (Oct 14 2020 at 18:02):
sounds like an extension on patient / person
Lloyd McKenzie (Oct 14 2020 at 21:06):
@Melva Peters
David Loney (Oct 14 2020 at 21:32):
Jens Villadsen said:
sounds like an extension on patient / person
Thank you Jens. Seems like necessary data for CPOE/ electronic Rx so we thought there must be some common way of transferring this information. Anyone else have thoughts?
Peter Jordan (Oct 14 2020 at 22:42):
I'd add MedicationRequest to that list as this preference can be related to an individual prescription (NZ implementation experience).
Melva Peters (Oct 15 2020 at 13:39):
You can use MedicationRequest.dispenseRequest.dispenser to identify the intended performer of the dispense of a specific MedicationRequest.
David Loney (Oct 15 2020 at 13:54):
Thank you Melva. This has seemed best practice for identifying the outpatient pharmacy the request is sent to. The difficulty we are having is automating the selection of the pharmacy from a patient preference. I did see a previous post stating they stored pharmacy preference in Patient -generalPractitioner. What we had hoped is for there to be a norm/widely accepted location so we could transmit and receive accurately. Anyone else have thoughts?
Lloyd McKenzie (Oct 15 2020 at 14:16):
You could capture it as part of CareTeam
Jose Costa Teixeira (Oct 15 2020 at 20:37):
Agree with CareTeam
Peter Jordan (Oct 15 2020 at 22:05):
From a practical perspective, I prefer Melva's suggestion to use MedicationRequest.dispenseRequest.dispenser. Current experience with our National e-Prescription Service is that this choice can be specific to an individual medication and/or whether the prescribing takes place virtually (nearest pharmacy to residency likely to be chosen) or at a healthcare facility (often pharmacy next door). Community Pharmacists as part of a Care Team is certainly desirable, particularly with complex patient medication regimes, but the world of community dispensing is moving beyond dedicated healthcare facilities to generic retail outlets.
Jose Costa Teixeira (Oct 15 2020 at 22:36):
There's a difference I think:
1 - Someone defines / knows that this patient, for any future requests, prefers "Pharmacie de la Ville"
2 - For one request, someone says "This request is to be dispensed at the Pharmacie de la Ville because we know that is what the patient prefers"
Jose Costa Teixeira (Oct 15 2020 at 22:37):
#2 is on an instance of a request, so it makes sense as a MedRequest.
My interpretation is that the question was for #1 (and i think careteam is the closest we have)
Jose Costa Teixeira (Oct 15 2020 at 22:38):
right @Peter Jordan ? does this separation make sense?
Peter Jordan (Oct 15 2020 at 23:32):
That makes sense @Jose Costa Teixeira , although the 2nd use case should also include where the patient has actually made that selection themselves (in NZ I can do that myself when requesting repeat scripts from a patient portal).
David Loney (Oct 16 2020 at 12:12):
Jose Costa Teixeira said:
There's a difference I think:
1 - Someone defines / knows that this patient, for any future requests, prefers "Pharmacie de la Ville"
2 - For one request, someone says "This request is to be dispensed at the Pharmacie de la Ville because we know that is what the patient prefers"
Excellent help. My takeaway is, there is not an accepted location to transmit the patient's preferred pharmacy information (a standard piece of information here in the NorthEast USA). Our system stores, at rest, in a FHIR resource style; we will store this information in either "Careteam" or "generalPractitioner". The information will travel within the medicationRequest; however, medication requests are transient, not resting, in our system. What I mean by this is, we would need to reference a previous medicationRequest in order to ascertain preferred pharmacy. In order for intake administrative staff to be able to update the patient's pharmacy preference, they will need to carry out this update within a resting resource. Even careTeam can be transient, can it not? as the careTeam changes with various conditions being tested or treated; therefore storing under the "Patient" resource, within generalPractitioner seems most reasonable to me.
If someone sees that I am running off the rails here, I would sure like to hear from you within this forum.
I am new to FHIR and eager to learn. Thanks to all who participated.
Jose Costa Teixeira (Oct 16 2020 at 12:36):
You are correct that prescriptions (being transactional data) is not the place to store this. You definitely don't want to have anyone peeking into prescriptions just "to see what is the pharmacy of choice".
Jose Costa Teixeira (Oct 16 2020 at 12:42):
Patient.generalPractitioner is "Patient's nominated primary care provider", but I don't know if putting a pharmacy there is a misuse.
A patient can have several CareTeams, so you can dedicate one of those teams for the Pharmacy.
You can for example have one profile for CareTeam called "PreferredPharmacyTeam" and make that part of your specification
David Loney (Oct 16 2020 at 13:09):
Jose Costa Teixeira said:
Patient.generalPractitioner is "Patient's nominated primary care provider", but I don't know if putting a pharmacy there is a misuse.
A patient can have several CareTeams, so you can dedicate one of those teams for the Pharmacy.
You can for example have one profile for CareTeam called "PreferredPharmacyTeam" and make that part of your specification
This makes sense
John Moehrke (Oct 16 2020 at 14:00):
I was assuming that Patient.generalPractitioner or some other element like it, would be the place for this. Hence why this is a 0..*, and why it includes Organization Resource references
John Moehrke (Oct 16 2020 at 14:00):
Of course Organization is not sufficient, as a Location is really the use-case
John Moehrke (Oct 16 2020 at 14:01):
I think this would be a good Change Request to be discussed by PA
Jose Costa Teixeira (Oct 16 2020 at 14:03):
Agree - at least to clarify the meaning of the field to make it clear if the above is a misuse or not
Vassil Peytchev (Oct 16 2020 at 14:22):
I don't think generalPractitioner is a place for a patient preference. The definition of the field is "Patient's nominated primary care provider". Overloading this meaning is not helpful for interoperability.
Jose Costa Teixeira (Oct 16 2020 at 16:35):
Hence the clarification needed.
Lloyd McKenzie (Oct 16 2020 at 16:47):
There'd been some discussion about using generalPractitioner. However, neither the name nor the definition seem to encompass "preferred pharmacy".
David Loney (Oct 16 2020 at 17:41):
Lloyd McKenzie said:
There'd been some discussion about using generalPractitioner. However, neither the name nor the definition seem to encompass "preferred pharmacy".
Lin Zhang (Oct 17 2020 at 09:19):
Do we need to consider patient preferences in a more generally manner? For instance, patient's food/meal preferences (maybe due to a religious reason).
Kevin Mayfield (Oct 18 2020 at 07:21):
I would echo @Lin Zhang comment. In English NHS we have used an extension for medicine preferences (we have three), together other preferences it is not siting well with Patient.
I'm leaning towards QuestionnaireResponse being more suitable.
Last updated: Apr 12 2022 at 19:14 UTC
