Stream: implementers
Topic: Pharmacy
Jayashree Surnar (May 11 2017 at 08:26):
hell all, which resorce is most suitabe to represent the pharmacy HealthCareService or Organization resource? and how to link the pharmacies and patient? any suggestions please.
Thank you.
Lloyd McKenzie (May 11 2017 at 09:21):
Pharmacy would typically be an Organization. HealthcareService would be used to indicate whether the pharmacy does compounding, immunizations, etc. Patient pharmacy is best linked through CareTeam
Jayashree Surnar (May 11 2017 at 11:00):
@Lloyd McKenzie , Thank you so much.
Angelica Garcia Gutierrez (May 15 2017 at 18:29):
Hello all, which field in the Claim resource may be used to record the pharmacy (organization) that dispense a given medication? For the purpose of recording pharmacy claim data.
David Cai (May 16 2017 at 00:22):
From reading the element description I think careTeam is where you can record the pharmacy.
Lloyd McKenzie (May 17 2017 at 15:31):
@Paul Knapp
Melva Peters (May 17 2017 at 19:55):
I would have thought it was claim.organization -they are responsible for the claim based on the dispense.
Paul Knapp (May 24 2017 at 12:47):
Melva is correct, claim.organization.
Angelica Garcia (Jan 17 2018 at 19:14):
Hello all, I am recording pharmacy information in the Organization resource. Part of the data that needs to be recorded is the NABP number or identifier. I couldn't find any code system that allows me to record this information. Would it be okay if I use the following as a system:?
Organization.identifier.system= 'https://nabp.pharmacy'
Organization.identifier.value= 2588068
Thanks
Lloyd McKenzie (Jan 18 2018 at 05:23):
You can submit a change request asking us to register that as the URI for that type of identifier system - ideally you'd give us more information about the number, who issues it, whether it's unique across time (i.e. do they re-use identifiers eventually), etc.
Bill Lush (Apr 10 2019 at 15:53):
In UK hospitals (not sure if it is the same in other parts of the world) once a drug has been prescribed there is a “Verification” step where a pharmacist reviews the prescription and verifies that the prescribed drug is suitable to prescribe. The verification takes into account if the drug is suitable to give for the patient’s conditions, and is suitable with the other drugs the patient is currently taking plus other checks. A request has been received from a system vendor that they would like to send/receive verification information. I was wondering if the Zulip community have had any experience of implementing “Verification” information or could share their views on:
1) Verification, in this context, is it a reasonable data item to be sharing between hospital ePMA systems and hospital Pharmacy Systems?
2) If so which FHIR resource should the information be sent in, e.g. MedicationRequest; MedicationDespense or another resource?
Lloyd McKenzie (Apr 10 2019 at 15:56):
@Melva Peters @Jean Duteau
Jose Costa Teixeira (Apr 10 2019 at 17:21):
@Bill Lush this is common. IHE calls it Pharmaceutical Advice because there was no ideal name. I call it "reviewed order". In some countries / settings, such validation is mandatory, in others this is not possible.
Jose Costa Teixeira (Apr 10 2019 at 17:21):
This is still a request
Lloyd McKenzie (Apr 10 2019 at 17:43):
It would typically be the filler order/encoded order - i.e. the representation on the pharmacy side that reflects the specific manufactured drug product selected, the detailed dosage instructions taking into account patient characteristics, etc. I suspect that it will most commonly be handled as the transition between a "draft" filler order and an "active" filler order.
John Silva (Apr 10 2019 at 21:06):
Yes, this concept has been around since V2 days -- see the diagram 4.16 "Pharmacy/Treatment Transaction Flow Diagram" that shows this and I believe the IHE HMW model has a similar diagram and workflow.
Mona O (Jun 21 2019 at 21:09):
Melva is correct, claim.organization.
Is the dispensing pharmacy under claim.provider or careTeam.provider? Also, can anyone distinguish how claim.facility which references location should be utilized? Per MedicationDispense resource the MedicationDispense.location description is "where the dispensed occurred" and within the boundaries and relationships for Location it states "Locations and Organizations are very closely related resources and can often be mixed/matched/confused. The Location is intended to describe the more physical structures managed/operated by an organization, whereas the Organization is intended to represent the more conceptual hierarchies, such as a ward". If I was looking to represent a specific Walgreens location should claim.provider or claim.careTeam.provider via organization be used and/or claim.facility via location be used?
Andy Stechishin (Jun 21 2019 at 23:05):
@Mona O I believe in your stated example that Walgreen's would be in the Claim.provider (referring to Organization) and the specific pharmacy location (if it was considered important) would be in the Claim.facility
Varvara (Aug 10 2019 at 21:30):
Hello all, I am mapping adjudicated pharmacy claims now, and it seems they are usually related to medication dispense, so shouldn't we have MedicationDispense reference in Claim/ ExplanationOfBenefit resources? Or where else do I put dispense-specific information such as partial/full fill or information about medication substitution ?
Andy Stechishin (Aug 10 2019 at 23:25):
@Varvara I think you would link the medication dispense in the supporting info
Varvara (Aug 12 2019 at 10:17):
Thank you , @Andy Stechishin ! Could you also suggest where to put In/Out of network info to identify if benefits provided were considered in or out of network ?
Michele Mottini (Aug 12 2019 at 13:20):
Pharmacy claims have the medication dispense details as one (and usually only) item within the claim (or ExplanationOfBenefit) itself - no separate MedicationDispense resource
Varvara (Aug 12 2019 at 15:07):
@Michele Mottini so you would put all dispense info such as DAW and fill type information into item.details ? I was using .item for drug code itself and details for any additional services billed such as dispense fee, but it seems that all dispense details fit nicely only MedicationDispense resource
Michele Mottini (Aug 12 2019 at 15:36):
There is no obvious link between Clam and MedicationDispense - although I guess you can put a reference to MedicationDispense in a supportingInfo valueReference - but that does not make it usable for _include for example
Michele Mottini (Aug 12 2019 at 15:37):
The only production data I am familiar with - CMS BlueButton - does not use MedicationDispense
Andy Stechishin (Aug 12 2019 at 16:06):
@Varvara you can indicate in/out of network amounts using the total attribute . The benefitBalance has an explicit indicator for in/out of network but this attribute is intended for the remaining amounts of coverage. There is not an explicit indicator at the item/detail/subDetail level to show in or out of network
Michele is correct, CMS does not have the MedicationDispense information associated with their claim information and therefore do not provide it as part of CMS BlueButton. Most of the dispensing information is available in the various attributes that are part of item/detail/subDetail however daysSupply is not and the FM work group is looking to add this as a standard extension.
Varvara (Aug 20 2019 at 20:01):
@Andy Stechishin @Michele Mottini thank you so much for the explanation. Pharmacy claims seems to be the most complicated for now:) Do you know any close-to-reality examples of pharmacy claims?
Michele Mottini (Aug 20 2019 at 21:21):
CMS BlueButton has plenty of those
Andy Stechishin (Aug 21 2019 at 00:03):
@Varvara there are also examples of pharmacy claims in the resource examples for Claim
Last updated: Apr 12 2022 at 19:14 UTC
