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Chair:  Mark Scrimshire 

Scribe: Dana Marcelonis

 

Attendees

Present

Name

Affiliation

  •  
SureScripts
  •  
Regence
  •  
Optum
  •  
Michael BaillieUHC
  •  
Humana
  •  
BCBS AL
  •  
Rush
  •  
SureScripts
  •  
Rush
  •  
Cerner
  •  
Laura BurckhardtWPS Health Solutions
  •  
Lindee ChinEdifecs
  •  
Independence Blue Cross
  •  
Allscripts
  •  
Regence
  •  
Didi DavisSequioa
  •  
InterSystems
  •  
BCBS IL
  •  
Allscripts
  •  
Cambia Health
  •  
Enable Care
  •  
David DodgeCambia Health
  •  
Rachel E. FoersterCAQH Core
  •  
Howard FollisJuxly
  •  
Reliant Medical Group
  •  
Lantana Consulting
  •  
SureScripts
  •  

  •  
Independence Blue Cross
  •  
GunjitZeOmega
  •  
Kenneth Hall
  •  
NCQA
  •  
Optum
  •  
Jackie HardisonHumana
  •  
Cigna
  •  
HealthLX
  •  
ZeOmega
  •  
BCBSA
  •  
Point of Care Partners
  •  
Edifecs
  •  
Heather KennedyBCBST
  •  
Edifecs
  •  
Sathaya KrishnasamyAnthem
  •  
BCBS AL
  •  
Stephen LaneSutter Health
  •  
InterSystems
  •  
Anthem
  •  
Luis MaasEMR Direct
  •  
Erin MajderBCBS IL
  •  
Point of Care Partners
  •  
Cognosante
  •  
BCBS AL
  •  
Lloyd McKenzieGevity
  •  
Optum
  •  
Humana
  •  
MaxMD
  •  
Stratametrics
  •  
Sean ParsonsBCBS OK
  •  
Scott Parsons
  •  
BCBS AL
  •  
Allscripts
  •  
HealthLx
  •  
Joe QuinnOptum
  •  
Optum
  •  
Regence
  •  
InterSystems
  •  
NewWave
  •  
NewWave
  •  
ZeOmega
  •  
Anne Marie SmithNCQA
  •  
InterSystems
  •  
UHC
  •  
Casenet
  •  
Cigna
  •  
HealthLX
  •  
Independence Blue Cross
  •  
Joel WalkerHealthLX
  •  
Holly WeeksRegence
  •  
BCBS AL
  •  
Darrell Woelk
  •  
Cambia
  •  
Brent Woodman
  •  
Anthem
  •  
Cambia
  •  
NewWave
  •  
Edifecs
  •  

  •  

PresentNameAffiliation
  •  
Tibco
  •  
Barbara AntunaAim Specialty Health
  •  
Christy Dodson
  •  
Danny
  •  
Evan CurrieBCBSM
  •  
Grace StambaughAllscripts
  •  
Jeanie SmithBCBSFL
  •  
Jim St. Clair
  •  
John BialowiczBCBSM
  •  
Melanie Combs-DyerCMS
  •  
Mike HurleyBRYJ Healthcare
  •  

  •  
Tori WillowsWellcare
  •  

  •  
EDMI Team
  •  
Beth Sprars
  •  
Nandini GangulyEMDI - Scope Info Tech
  •  
EMDI Team
  •  
Moxe Health
  •  
Jim McKinleyMedicaid Alabama
  •  
Raj
  •  
Ray WilkersonScope Info Tech
  •  
BCBST
  •  
Chris VanWaters
  •  
Bart CarlsonAzuba
  •  
Deepthi ReddyMettle Solutions
  •  
Emma JonesAllscripts
  •  
Eric SullivanInovalon
  •  
David Hill Mitre
  •  
Pallavi TalekarScope Info Tech
  •  
Ralph Saint-PhardHealow
  •  
Scott SwihartSumma Health
  •  
India DuncanOptum
  •  
Jason CassidyMoxe Health
  •  
Praveer MathurWellcare
  •  
Megan Soccorso

Cigna

  •  
Prashanth GolcandaLumeris
  •  
Rajesh Godavarthi
  •  
Susan BellileAvaility
  •  
Susan LestinaAHA
  •  
Bob BowmanCAQH
  •  
Thomas KesslerCMS
  •  
Patrick Edwards
  •  
Briana BarnesScope Info Tech
  •  
Kishore MetlaMettle Solutions
  •  
John DonnellyInterpro
  •  
Lorraine DooCMS
  •  
Melanie JonesCMS
  •  
Rim Cothren
  •  
Yolanda VillanovaCMS
  •  
Kathleen Connor
  •  
Manoj KumarBCBSFL
  •  
Saul KravitzMitre
  •  
Srinivas Konchada
  •  
Sheryl TurneyAnthem
  •  
Helina Gebremariam
  •  
Mike NovalesBCBSIL
  •  
Ric LightHumana
  •  
Ann GallagherOptum
  •  
Chris KlesgesMitre
  •  
Adam GronskyHealth Fidelity
  •  
Gregory MagazuCaseNet
  •  
Mary L. BushmanAnthem
  •  
Michael CabralCMS
  •  
Rohit ShindeeClinicalWorks
  •  
Seth ParadisHealow
  •  
Trevor HiltonInterfaceware
  •  
Mark RucciSpectramedix
  •  
Carie HammondAEGIS
  •  
Christol GreenAnthem
  •  
Cindy MonarchBCBSM
  •  
Daniel ChaputONC
  •  
Dawn PerreaultBCBSM
  •  
Kyle ZumsteinAvaility
  •  
Nancy SpectorAMA
  •  
Bruce WilkinsonBenmedica
  •  
Cara BarryAvality
  •  
Chris JohnsonBCBSAL
  •  
Duane WalkerBCBSM
  •  
Galen Mulrooney
  •  
Greg LindenLinden Tech Advisors
  •  
Mario JarrinChange Healthcare
  •  
Megan Smith-HallingsheadRegence
  •  
Patrice KuppeSurescripts
  •  
Peter Muir
  •  
Sreenivas MallipeddiMCG
  •  
Alex KonturONC
  •  
Surescripts
  •  
Margaret WeikerNCPDP

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Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy



Links

PDex Updates

Preparation for submission on May 19, 2019

  • Continuous integration build is currently broken - working with Lantana to fix issues
  • Adding MedicationDispense resource - defines what has been issued as a prescription to a patient
    • CARIN Alliance is also using this resource to display this information
    • Minimizing extra work for payers to publish this information if it's aligned across initiatives
  • Adding section regarding data mapping - section 3.6
    • Leveraging work done by CMS Blue Button and the CARIN Alliance for data mapping
    • Aiming for consistent FHIR mapping from payer source systems/data
    • Tables identify data descriptor (e.g., patient ID, DOB, etc.) and FHIR resource and subsidiary element within resource to populate data
    • Link is inclucded so if there's an entry in the CMS Blue Button 2.0, you'll be able to pull up a field definition
  • Expanded upon data provenance
    • Declare data chain of custody, and actions taken upon the data
    • If health plans receive data from another source, they need to retain the provenance records and update with any actions they take upon the data when they share with others
  • Added Patient-everything operation
    • Allows you to pull the entire patient record
    • Creates a bundle without any paging
    • Allows payers to create a bundle where a member has authorized them to share via an alternative transport method (e.g., secure FTP, Direct, etc.)
    • NPRM requirement for member-directed data exchange between payers, talks about the original payer pushing the data
      • Recommendation is that this is changed to require new payer to pull data, but we are covering it in case it does not get changed
    • This operation references bulk data formats
  • PDex is included in early ballot - STU
    • Ballot signup starts May 21
    • Ballot voting starts June 21
  • Tested Scenario 1 during HL7 Montreal Connectathon
  • Jacksonville Connectathon - May 29-30
    • Focusing on additional scenarios
    • Mitre and HealthLX will be publishing code to GitHub repositories for the scenarios we'll be testing


PDex Formulary Update
  • IG PDex-Formulary Implementation Guide
  • Initial IG content due May 19
  • Mitre developing Formulary IG and Reference Implementation
    • Will use MedicationKnowledge, and based off of CMS QHP Formulary
    • Compile into HAPI FHIR server
    • Working with Pharmacy Workgroup
    • Currently working through issues re: US Core medication codes
  • How does this work relate to NCPDP?
    • Addressing NPRM requirement to provide access to Part D formulary via FHIR API
    • Using current CMS requirements for reporting formulary for qualified health plans as the base
    • Leveraging some work Mitre has done
    • Reconcile this with NCPDP work on formulary and real-time benefits check
    • For May 19 IG deadline, trying to keep this as simple as possible
    • Between then and June 6, can add features that align with NCPDP


PDex Plan Network Directory Update
  • Ability for member to access a health plan's provider directory, including pharmacy directory
  • Validated Healthcare Directory Implementation Guide is the basis for this Implementation Guide
  • Currently reviewing giude, and removing content that does not apply to our requirements - making local directory information available to end-users
    • Exluding validation, restriction, care team, endpoint
    • Some extensions will be removed


Links to PDex FHIR Guides and Code

PDex IG:  https://trifolia-fhir.lantanagroup.com/implementation-guide/davinci-pdex
PDex Plan-Net IG: https://trifolia-fhir.lantanagroup.com/implementation-guide/4y9cKSGi
PDex Formulary IG: https://trifolia-fhir.lantanagroup.com/implementation-guide/pP0jnkBf
 

The Github repositories:
PDex IG: https://github.com/HL7/davinci-epdx
PDex Plan-Net IG: https://github.com/HL7/davinci-pdex-plan-net
PDex Formulary IG: https://github.com/HL7/davinci-pdex-formulary

The connection between Trifolia and the Github repositories is a manual push.

However the web hooks are in place to publish from GitHub to build.fhir.org automatically. The Continuous Integration Builds for the guides are here:

PDex IG: http://build.fhir.org/ig/HL7/davinci-epdx/
PDex Plan-Net IG: http://build.fhir.org/ig/HL7/davinci-pdex-plan-net/
PDex Formulary IG: http://build.fhir.org/ig/HL7/davinci-pdex-formulary/


ManagementNext agenda

 Adjournment
Adjourned at 12:43pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Action items

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