Patient-centric Medication List Management and Office Visit Reconciliation (Jira PSS-2571)

The project is to extend the EHR and PHR functional models specific to patient-centric medication list management and scheduled outpatient (office) visit medication reconciliation. An outgrowth of the HL7 EHR WG - Reducing Clinician Burden Project, the intent is to support FHIR-based, vendor agnostic applications that enable patients to more easily and accurately document medications as taken at home. The project anticipates an emphasize patient engagement strategies, where the patient (and their caregivers) are integral to managing the medication list on an ongoing basis - between and during office-based patient encounters with their clinician. This strategy promotes a holistic, encompassing approach to supporting patient health and provisioning healthcare services.

There are two primary project deliverables:

Deliverable 1: The EHR-S FM-based functional profile will focus on developing specifications for 3 core functions:

1) FHIR endpoint to serve up a patient's most recent active medication list

2) FHIR endpoint to ingest a patient-authored medication list

3) disambiguation that compares and highlights differences between the ingested list and the EHR list to facilitate validation and updating of the EHR patient medication list

Deliverable 2:

The PHR-S FM-based functional profile will focus on developing specifications focusing on 7 core functions:

1) retrieval of the active medication list from EHR systems via FHIR

2) retrieval of the pharmacy dispensed medication list from pharmacy systems via FHIR or API

3) disambiguation for comparing and highlighting differences among the last patient generated list, the EHR list, and the dispensed medication list

4) requirements for the patient-facing interface (including confirm, update / edit, add, remove, annotate, and refill request)

5) requirements for PHR medication list management utility outputs (for both patient and clinicians)

6) requirements for encrypted local and PHR-based storage with version control of the patient-generated medication list

7) utility to generate a FHIR payload for ingestion by EHR systems

The EHR and PHR functional profiles will specify functional requirements aligned with data flows and workflows, based on prototypic use case scenario narratives. Each scenario breaks down into event steps. Scenario analysis specifies for each event step:

• Actor(s)

• Actor role(s)

• Event description: Action(s) taken during this event

• Inputs: data required to undertake Action(s)

• Outputs: data resulting from Actions taken

• EHR/PHR/HIT system functions necessary to support Action taken

Actors may be humans, software, or device. Inputs and outputs (data requirements) will be linked to corresponding FHIR resources and elements.

The project focuses on developing an Informative Document for balloting. A second (future) phase is anticipated - development of a FHIR Outpatient Medication Reconciliation Implementation Guide.