2022-11-15 PIE WG Meeting Agenda

Antitrust Statement

Professional Associations, such as HL7, which bring together competing entities are subject to strict 
scrutiny under applicable antitrust laws. HL7 recognizes that the antitrust laws were enacted to promote 
fairness in competition and, as such, supports laws against monopoly and restraints of trade and their 
enforcement. Each individual participating in HL7 meetings and conferences, regardless of venue, is 
responsible for knowing the contents of and adhering to the HL7 Antitrust Policy as stated in §05.01 of 
the Governance and Operations Manual (GOM).

Approved by consent

New Proposals andPSS for revi/ew - PIE comments or interest

CDex Update - new use case  FHIR-38241

https://hackmd.io/2VIO8mEdSSO6h12ZLqgNeA?view

Bob share new use case Questionnaire and Questionnaire Response

Discussion: 

Bob:  Why can’t we as part of CDex Work around attachments go beyond requesting a document with a LOINC code?  Why don’t we do something that would allow us to ask for specific information and not just the entire document?  Discussed and decided that in addition to what they have done with attachment portion of CDex which basically allows it to be replacement for 277/278/275 to develop capability for the payer to ask for specific information and get it returned.  Already support the concept of a questionnaire and response as part of Burden Reduction as part of PAS as an attachment, so request could be a questionnaire that needs to be completed. Request could be prepopulated through 21^st Century Cures Act API or ask for an attestation.  This capability could apply to CDex in general and not just to attachments.  Could make it look exactly as it does when it is being done through CRD.  Advantage is that there would be standard way to execute a questionnaire, CQL and access APIs and apply it to attachments.

Stanley:  Thought the purpose of LOINC was to allow the health plan to ask a specific question and get a specific answer.  Don’t understand the difference between the questionnaire and the set of LOINC codes.

Robert:  LOINC codes are tied to specific documents with specific content.  Everything is predetermined in LOINC.  Doesn’t allow for attestations. Not taking away ability to just ask for LOINC codes; adding other capabilities by taking advantage of FHIR questionnaires.

Stanley:  Don’t understand value and difference in what is being proposed.

Robert:  Allow computable elements to be exchanged and not just a PDF. 

Chris:  Also a subset of LOINC called the HIPAA tab that is a portrayal of documents. Payers can only request the documents, not the individual LOINC codes.

Christol…Don’t want to have providers to include everything.  Could send a questionnaire which would allow questionnaire response with all the elements.

Robert:  Tie attachments into work of BR, that would allow providers and payers to implement underlying technology one time.  Intent is to get this written up and test during Connectathon in January and publish as part of the CDex implementation guide.  Trying to expand payer and provider capability to exchange exactly the information that is necessary.  Already have FHIR APIs, CQL, and questionnaires.  Want to take advantage of that out of the attachment side.

Mike Denison:  Curious as to what providers may think about payer being able to ask anything they believe they need instead of just standardized set of data. 

Robert:  Keep in mind that provider has ultimate control over what they submit. 

Mike:  Can ask for CCDA which may contain info that is irrelevant.  Now can have questionnaires that ask for specific things that are necessary. 

Stanley:  Initial idea of attachment standard is to limit content as well as format.  Want to make sure interaction is structured and not chatty when it comes to request for information. 

Mike:  Number of times entire medical record is sent is a problem.  Anytime can limit info would be beneficial. 

CDEX call is on WED at 2pm.  If WG members want to join and learn you’re welcome to join. 

Updates:

1. January Ballot now open for participation until Dec 8th
2. HL7 January Connectathon and WGM registration open.  Early Bird until Dec 16th

https://hl7.force.com/LightningMemberPortal/s/lt-event?id=a1Y7V00000X9AvZUAV&utm_source=HL7%20Members%20Large%20List%20Verified%20October%202022&utm_campaign=0ebcffb881-EMAIL_CAMPAIGN_2017_02_17_COPY_01&utm_medium=email&utm_term=0_b69c5222fc-0ebcffb881-56418632#/Connectathon

• Ballots are now open after being delayed. Quite a few ballots have been released for review.  December 8 is closing date for comments.  Also, announcement that HL7 early bird registration for January Connectathon is open.  Early bird is until Dec. 16.

This is a request for your structured HL7-related responses to an NCVHS Request for Comment (RFC) in advance of the body’s scheduled January 18-19, 2023 full meeting.  HL7 is anticipated to testify. The event focus is listed below and the NCVHS Request for Comment (RFC) published in the Federal Register can be found at:  

https://www.federalregister.gov/documents/2022/11/01/2022-23678/national-committee-on-vital-and-health-statistics-meeting-and-rfc  

Note, the NCVHS submission deadline in response to their Request for Comment is December 15, 2022, well in advance of the January hearing. Therefore, your HL7 comments on this are due to me at tgerber@hl7.org by December 8. Attached here is a response template to make responding easier and streamlined.  

A complete list of questions listed in the RFC is available at: https://ncvhs.hhs.gov/​January-2023-Standards-Subcommittee-Hearing-Public-Comment-Guidelines. 

Click here for the template - Call for Comments - NCVHS X12 and CAQH CORE Proposals

Covered the first 5 X12 Claims/Remit questions and drafted responses.  We will roll to next weeks meeting and begin a #6.

This document is houses under Documentation/Presentations:

https://confluence.hl7.org/download/attachments/34440405/NCVHS%20Request%20for%20Comment%20%20X12%20and%20CAQH%20CORE%2011-15-2022%20PIE%20WG%281%29.docx?api=v2

• HL7 asked for help with X12 and CHQH core for proposals they gave to NCVHS. Comments will be published.  Christol has some feedback already and opened the existing document for review by the WG.
• Cost Analysis: First question regarding cost analysis and X12 updating to the version 820 claims and remittance advice transactions. Costs depend on approach.  Multiple versions vs. big bang approach will affect costs.  X12 indicated they would make recommendations in sequenced manner.  Problem now is that we will have multiple versions to deal with.  May be premature to develop impact cost analysis until NPRM.  Most will hold off until NPRM.  Way too early to do detailed analysis.  Cost analysis will hinge on versions and if industry must support multiple versions at once. Also, there are multiple other developments that will affect priority. Will hold off until NPRM to do cost analysis.  Industry is highly regulated and it needs predicable, scalable, known process for standards updates to move forward.  May be 5 years for rule making then 2 years implementation before can realize benefits of new standards and the length of time affects cost.  Also, question about how long the NPRM will allow for updates.
• Operational Impact: Same general answer for question regarding operational impact.  Too early in the process to get involved until we know more.  Standards organizations are best to justify changes.
• XML Schema: Shouldn’t limit to XML standard.  Some Da Vinci IGs specify use of JSON only.  Should not limit organization’s choice as to which syntax to use. Need to check with systems staff as to potential impact of using other syntaxes.  If multiple syntaxes allowed, they should be semantically interoperable.
• FHIR Crosswalks: How FHIR Crosswalks would apply to HIPAA claims and remittance transaction standards: Utility is unclear until the crosswalks are built and tested. Unsure of utility of FHIR crosswalks for claims and remit. Also, what about transactions that don’t move forward to 8020?  Transactions are being updated annually.  Regardless of update cycle, need to maintain semantic interoperability if there are multiple versions and multiple standards are allowed.
• Unique Device Identifier: Part of USCDI.  There is space on EHRs that allows for sharing of data and tracking recalls.  Valuable to have.  Pilot tests show relatively easy to collect and send on a transaction.   Others may disagree with Stanley.