This page is part of the Pharmacist Care Plan FHIR IG (v0.2.0: STU 1 Draft) based on FHIR v3.1.0. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Use Cases

This implementation guide meets the need of four use cases unique to the pharmacy environment. Though the scope of the pilot testing focused on Use Case 4, the standard was designed to meet the needs for clinical data exchange in each of the cases described in this section.

Use Case 1: New condition for a patient at risk for a pulmonary embolism

The community pharmacist meets with the patient and the caregiver after a recent discharge from a hospital for a pulmonary embolism. The patient is diagnosed with hypertension and diabetes. The patient has been enrolled in a diabetes outpatient clinic and has now been referred to an anticoagulation outpatient clinic. The community pharmacist coordinates medication therapy management services (including reconciliation of medications, allergies and indications for medication use) with the primary care provider (PCP) and the diabetes and anticoagulation clinics and documents the patients medication-related goals. The pharmacy generates the Pharmacist Care Plan to share medication related goals and electronically delivers the Care Plan to the patient, the PCP, and the outpatient clinics for chronic care management and care coordination.

Use Case 2: Patient scheduled for a hip replacement

The pharmacist, under a collaborative practice agreement with the orthopedic surgeon, counsels the patient prior to the procedure to ensure there are no medication-related problems. After the surgery, the pharmacist coordinates medication-related goals with the patient pertaining to deep vein thrombosis risk and pain management.

The community pharmacist uses a health IT system to document patient care. The health IT system generates the Pharmacist Care Plan to share the medication related goals electronically with the patient, orthopedic surgeon, PCP, home health care agency, and the rehabilitation center for care coordination.

Use Case 3: Patient with behavioral health issues and multiple chronic diseases meets with a consultant pharmacist for the yearly comprehensive medication review to meet Medicare Part D MTM requirement

The pharmacist documents conflicting treatment strategies and medications. The pharmacist recommends strategies/alterations to existing treatment, development of a manageable medication schedule, patient education, and outcome follow-up.

The community pharmacist uses a health IT system to document patient care. The health IT system generates the Pharmacist Care Plan to share the medication related goals and strategies electronically with the patient, the psychiatrist, the outpatient psychiatric clinic, and the PCP or chronic care management and care coordination.

Use Case 4: Patient comes to the community pharmacy to pick up hydrocodone, which has been e-prescribed and complaints of constipation

The pharmacist reviews the state Prescription Drug Monitoring Program (PDMP) database and discovers that multiple physicians have treated the patient for pain. The pharmacist suspects the patient may have an opioid abuse condition. Through patient assessment using a validated nutrition screening tool, the pharmacist discovers the patient shows signs of potential malnutrition, has three chronic care conditions, complains of constipation, and has no PCP. The pharmacist performs comprehensive medication review and helps the patient identify a PCP.

The community pharmacist documents conflicting treatment strategies and medications including the need for naloxone. The pharmacist recommends strategies/alterations to existing treatment, pain management, development of a manageable medication schedule, nutritional counseling, patient education, and outcome follow-up.