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                      PHISC - Pharmaceutical Coding Sub-committee Meeting

                    Minutes of Meeting held on Thursday, 28 April 2005 (14h00 – 16h00)

                    Old Mutual West Campus Business School, Jan Smuts Drive,
                                     Pinelands, Cape Town

Name                        Company            Title                  Telephone Number   E-mail Address

Lyn Hanmer                  MRC                Divisional Manager     021 938 0343

Wynand Erasmus              Medscheme          Business Analyst       011 391 3400
                                               Deputy Director                 ;
Dianne Phillips             NDoH               Procurement            012-312-3287

Ricardo Kettledas           NDoH               Chief Pharmacist       012-312-0345
Jakkie De Jager             NDoH               Codifier               012-312-0342

Suzanne Bornman             PSSA               Professional Officer   012-301-0850
                            Global Standards
                            1 South Africa     Global Standards                ;fiona.vanderlinde
Fiona Van Der LInde         (GS1 SA)           Executive              011-789-5777

Neil Andrews                Medi-Clinic        Systems Co-ordinator   021-943-6303
Roy Alger                   EPR                                       082 467 7378
                                               Coding Specialist
Anita Flemetakis            Discovery Health   Manager                011 529 5345

                                               Pharmacy Risk
Inez Naidu                  Discovery Health   Manager                011 529 1888

Margaret Sales              SAMHS (DoD)        Systems P O            012-482-2097

Sunelle Lubbe               Medi-Clinic        Code Co-ordinator      021-809-6777

                   1. Welcome
                      Lyn Hanmer, the PHISC chairlady opened the meeting and welcomed all attendees. All
                      attendees introduced themselves and their organisations.
                      The list of meeting documents were confirmed namely an agenda, minutes to meeting
                      held on 26 Jan 2005, PESA presentation slides (Keith Johnson and Dorinda De Jager)

2. Apologies
   Tony Odendaal
   Marita Van Rooyen
   Helen Kruger (MediKredit)
   Patrick Matshidze

3. Minutes of the previous meeting held on Thursday, 26 January 2005
    Page 3 paragraph 2: NISA to read NHISSA (National Health Information System
      South Africa)
    Pg 4 Paragraph 1: NISA to read NHISSA (National Health Information System South

4. A) Mission Statement
    AF suggested the following outline for a mission statement:
      To address the need for a national standard and uniform pharmaceutical coding
      system for the South African Healthcare industry that would cater for both the private
      and public healthcare sectors.

   B) Pharmaceutical Sub-committee objectives
      Key concepts:
    Communication, co-ordination, improved efficiency and accuracy
    Transparency
    Standard industry terminology
    Billing and cost effectiveness
    Non Proprietary pharmaceutical coding system for public and private sector access
    Pharmaceutical Risk Management, risk reporting, statistics and trend analysis
    Development of pharmaceutical coding crosswalks
    Integration with international pharmaceutical coding standards
    Determination of all links between the existing national pharmaceutical coding
      standards for existing products in South Africa

       AF to distribute the minutes to the team for comment on the mission statement and
       objectives. The team to finalize the objectives and the mission statement prior to the
       next meeting includes (by 24 June 2005 please):
      Wynand Erasmus
      Fiona Van der Linde
      Inez Naidu
      Dianne Phillips
       WE to co-ordinate in conjunction with AF.

5. Surgical Classification
    Definition of Surgicals:
   o AF made reference to the definition of medicines and medical devices in the
      Medicines and Related Substances Control Act 101 of 1965 that should be used as a
      reference to define the scope of surgicals being addressed. AF also mentioned that
      medical devices is a term broadly used to cover instruments, surgicals, prostheses
      and CAPEX as is standard practice in other countries. AF to confirm the scope of
      medical devices as per Act 101 definitions.
   o Medicines and Related Substances Control Act 101 of 1965 Definitions:

    Medical Device -
    Medicines and Related Substances Control Act 101 of 1965:
    „Medical device‟ means any instrument, appliance, material, machine, apparatus,
    implant or diagnostic reagent-
        a) used or purporting to be suitable for use or manufactured or sold for use in-
                i.  the diagnosis, treatment, mitigation, modification, monitoring or
                    prevention of disease, abnormal physical or mental states or the
                    symptoms thereof; or
               ii.  restoring, correcting or modifying any somatic or psychic or organic
                    function; or
              iii.  the diagnosis or prevention of pregnancy

           and which does not achieve its purpose through chemical, pharmacological,
           immunological or metabolic means in or on the human body but which may
           be assisted in its function by such means; or
        b) declared by the Minister by notice in the Gazette to be a medical device,

    and includes any part or an accessory of a medical device

    Medicines –
    Medicines and Related Substances Control Act 101 of 1965:
    „Medicine‟ means any substance or mixture of substances used or purporting to be
    suitable for use or manufactured or sold for use in-
        a) the diagnosis, treatment, mitigation, modification or prevention of disease,
             abnormal physical or mental state or the symptoms thereof in man; or
        b) restoring, correcting or modifying any somatic or psychic or organic function
             in man,

    and includes any veterinary medicine

o   DP: Question was raised as to the range of surgical products and medical devices
    that would be addressed within the scope of the Sub-committee meeting. RA said
    that historically PHISC looked at products that went through the pharmacy –
    medicines and surgicals. Consensus was reached that NAPPI coded items in the
    private sector and NSN coded items in the public sector would precedence over
    items that are not coded. Capital Equipment is accommodated for in tariff codes and
    may be addressed at a later stage. Diagnostic materials and Exceptions will be

   List of available/used Surgical Classifications:
o   Surgical Classification (MediKredit & Discovery Health)
         o It was agreed that MediKredit, having proprietorship over the surgical
             classification be represented at the PHISC Pharmaceutical Coding Sub-
             committee meeting as they are best positioned to comment on the structure,
             use, maintenance and accessibility of the Surgical Classification.
         o PHISC Pharmaceutical Coding Sub-committee to request a presentation of
             the Surgical Classification.
         o AF provided a brief overview of the Surgical Classification as this has been a
             joint venture with Discovery Health and MediKredit
o   UMDNS (Universal Medical Device Nomenclature System)
         o Developed and owned by ECRI (Emergency Care Research Institute)
         o ECRI classification did not cater for all NAPPI coded items and needed to be
             further customized for South Africa

         o   Margaret Sales from SAMHS confirmed that NSN coding is being utilized in the
             military for surgicals and was not aware of any grouping linked to these NSN codes
             as suggested by RA who will investigate further.
             First 4 digits of NSN is used to indicate the broader classification of the item e.g.
             6515 indicates Medical and Surgical Instruments, equipment, and supplies. JdJ and
             RK would assist AF with the explanatory detail behind the first 4 digits in addition to
             the ICN aspects related.
             MS agreed to represent the military at the Pharmaceutical Sub-Committee meetings
             and would also request someone from the procurement division of the military to
         o   Medi-Clinic and Medscheme confirmed that they only use NAPPI codes for surgicals
             for identification.
         o   EAN confirmed that sugicals are linked to EAN 13 coding but no intelligence.
         o   DoH National and provincial tenders use various coding systems which complicates
             the compilation of a standard surgical register. (DP: Tender is not always national
             and therefore products may not be coded)
             RA said that this scenario is also prevalent in academic institutions where a range of
             existing products are bought out and distributed outside of the mainstream. DP
             mentioned that pharmaceuticals and surgicals are dealt with separately when
             charged in provincial hospitals. Pharmaceuticals are not charged for unless scripted
             (RA). DP mentioned that the composition and the coding of the daily cost needs to
             be looked at vs. what is excluded. The coding and handling of prostheses in state
             hospitals would be investigated (RA and MS)
         o   DP mentioned a workshop for registration of medical devices has taken place. LH
             will follow up with N. Molai

      6. Crosswalks and pharmaceutical databases
         The PHISC Pharmaceutical Coding Sub-committee reached consensus that a standard
         format for Pharmaceutical coding, classifications and crosswalks be developed. This will
         be available and updated on the PHISC website. The format/framework should include
         the following information:
         1. Code/ Classification name
         2. Who uses it
         3. Developer
         4. Maintenance
         5. Code/ Classification structure
         6. Scope – what does it describe
         7. Ownership
         8. Proprietary or non proprietary
         9. Cost (i.e. if owned, what is the cost of maintaining it)
         10. Is pricing included/linked
         11. Examples of Code/ Classification
         12. Which database it is linked to
         13. Notes
         AF to prepare a table to include standard fields as defined above for stakeholders to

Code/ Classification/Crosswalk                     Stakeholder
NAPPI                                              MediKredit
NSN                                                NDoH       (incl Prostheses coding and
ICN                                                NDoH
UPFS                                               UPFS- DoH (incl Prostheses coding and
EAN                                                Fiona Van Der LInde

Surgical Classification                           MediKredit
WHO ATC                                           Refer to Draft document 26 Jan 2005
UMDNS                                             Anita Flemetakis
NAPPI – NSN                                       MediKredit and NDoH
NAPPI – EAN                                       PESA and GS1SA
NSN – EAN                                         GS1SA and NDoH
NAPPI – WHO ATC                                   MediKredit, Medscheme
NSN – WHO ATC                                     Management Sciences for Health (MSH) –
                                                  Jean-Pierre Sallet
Australia/ New Zealand coding                     MediHelp
Canada coding                                     Medscheme
UK and Scotland coding                            NDoH

            DP mentioned that JP Sallet has a database connecting ATC (used in E cape) to
             items on tender (NSN). DP has forwarded all PHISC Pharmaceutical Coding Sub-
             committee documents to JP. DP to provide AF with email address.
            RA mentioned that UCT maintains an Adverse Drug Reactions database which would
             be valuable to investigate to understand the coding and classifications within the
             database. ATC crosswalks may assist in ATC to NSN crosswalk. RA and DP will
            DP investigated MCC coding currently utilized for registration of new products and
             commented that there does not appear to be any fundamental basis for the structure
             and maintenance of these coding.
            Margaret Sales from SAMHS will investigate the coding used for prostheses. In
             addition MS will look at SAMHS representation for the PHISC Pharmaceutical Coding
            Jakkie de Jager to give AF different NSN categories with different items within each
            RK will comment on ICN
            AF asked hospital groups to provide information on the coding classifications they

     7. Feedback on PESA presentation
         Copies of the presentation were handed out at the PHISC Pharmaceutical Coding
           Sub-committee meeting.
         Suzanne Bornman provided feedback to the PESA presentation held on 12 April
           2005. Representation at the meeting included PSSA, PESA, MediKredit, DoH, Medi-
           Clinic, Discovery Health, Interpharm.
         The first presentation was given by Keith Johnson who provided a summary on the
           original objectives of PESA as well as PESA‟s progress to date.
         The second presentation was given by Dorinda De Jager who provided an overview
           on the PESA Product Price File. Dorinda De Jager can be emailed to obtain a login
           ID and password for access to the PESA Product Price File. SB noted that the
           NAPPI to EAN crosswalk is approximately 35% accurate. Buy in from manufacturers
           is needed to keep this crosswalk updated and accurate. RK mentioned that for buy
           in the manufacturers should be part of the PHISC Pharmaceutical Coding Sub-
           committee since. PMA, NAPM, IMS (IMSA) should therefore be included. (FvdL
           would compile a standard letter to be sent to PMA, NAPM, IMS for representation
           since she has had tremendous response from manufacturers with regard to a NAPPI
           EAN crosswalk). EAN would function as a conduit for PESA to obtain the EAN codes
           for NAPPI coded products.

      SB confirmed that PESA has contacted DoH with regards to DoH using the PESA
       Product Price file for SEP. Currently DoH makes use of the Blue Book (Blue Book is
       electronic). The Blue Book does not have a link to EAN
      LH suggested that PESA follow up with DoH with regard to their submission for DoH
       to use PESA Product Price for SEP
      RA raised the question as to what the difference between the PESA and MediKredit
       Product Price File is. SB will confirm what fields would be in the Public Domain. In
       addition the PESA Product Price File would be updated by manufacturers online
       using their login ID an password.
      RK mentioned that a minimum data set should be defined for information in the
       Public Domain. In addition Proprietary and Non Proprietary should be defined
      WE (Medscheme) confirmed that Medscheme has a NAPPI to WHO ATC crosswalk
       which they are working at making public domain

8. Applicability of ICD-10 implementation for Pharmacies
    The National Task Team for implementation of ICD-10 reached consensus to
      propose a delay for implementation of ICD10 coding to Pharmacies from 1 July 2005
      to 1 December 2005. Patrick Matshidze will present the proposal to CoMS after
      which a decision will be taken to accept or not accept the proposal. As soon as a
      decision has been taken, this will be communicated to the National Task Team for
      implementation of ICD-10.
    SB noted that Patrick Matshidze met with the Pharmacy Council where there was a
      discussion around granting blanket cover for all pharmacies, or whether individual
      pharmacies that cannot comply must individually ask for an extension of
      implementation. No final decision has been communicated as of yet.
    WE provided an overview of the Task Team committee as well as the representation.
    WE will provide AF with the internet link to the National Task Team for
      implementation of ICD-10.

9. Disclaimer agreement
    AF circulated a draft Disclaimer agreement to be used for the PHISC committee and
    Comments:
   o DP to look at WHO ATC Disclaimer agreement wording.
   o Wording “Not for gain” to be incorporated.
   o RA asked if something can be proprietary to PHISC if PHISC is not a legally
      constituted body.
    Draft disclaimer agreement will be presented at the main PHISC meeting for

10. General

      LH – attends the International Standards committee which has sub committees.
       Working group 6 is the Pharmacy and Medication working group. This working group
       is looking at Pharmaceutical terminology for medicines, specification of pharmacy
       medication record and how pharmaceutical products are represented. LH to send
       the documents to AF for distribution. The opportunity exists for member countries to
       contribute and have access to what other countries are producing. SA only
       developing committee as part of committee. SA has not been active.
      RA represents SA on HL7 Committee. Definition of HL7 pharmaceutical component
       of electronic health record is being addressed. RA to circulate and assimilate
       comments and put forward motions on behalf of PHISC
      Pharmaceutical Coding and Classification research has extended to include
       Australia, New Zealand, UK, Canada and USA

      PHISC website has been updated with all relevant Pharmaceutical Sub-committee
       meeting minutes and documents since 2004

11. Action points summarized

      Pharmaceutical Coding Sub-committee to finalize Mission Statement and objectives
      Disclaimer agreement to be distributed to PHISC members/ attendees for comment
       and input
      MediKredit to be contacted for a presentation on the Surgical Classification
      Crosswalks and pharmaceutical databases:
   o   MK to provide feedback at the next meeting on NAPPI to NSN crosswalk progress
   o   Stakeholders to provide information on pharmaceutical coding and classification in
       the standard format designed
   o   Feedback to be provided on the research on international coding systems (Australia
       & New Zealand, UK & Scotland, Canada) in the standard format designed.
   o   South African Military and RA to confirm the handling of prostheses
   o   South African Military to confirm if military groups NSN to any classification system
   o   NDoH (JdJ) to provide feedback on the NSN categories with different items within
       each category
   o   NDoH (RK) to provide information on ICN
   o   Hospital groups (Medi-Clinic) to provide feedback on the classification systems they
   o   JP Sallet to be contacted with regards to the ATC to NSN crosswalk
   o   RA and DP to investigate the UCT Adverse Drug Reactions Database
   o   SB to confirm which fields of the PESA Product Price File will be in the public domain
   o   SB to follow up on PESA‟s submission for DoH to use the PESA Product Price File
       for SEP
   o   WE to confirm if Medscheme‟s NAPPI to WHO ATC crosswalk will be in the public
      LH to follow up with N. Molai regarding the Workshop for registration of medical
      Definition of Proprietary and Non Proprietary

12. Next Pharmaceutical Coding Sub-committee meeting date and venue
     20 July 2005, 14H00-16H00 (Venue to be confirmed)

13. Closure
     LH thanked SAMHS for their representation. Pharmaceutical stakeholders present
       were thanked for their input. The meeting was summarized highlighting the action
       points that need to be followed through on before the next Pharmaceutical Coding
       Sub-Committee meeting


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