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Chair:  Lloyd McKenzieRobert Dieterle

Scribe: Dana Marcelonis
 

Attendees

Present

Name

Affiliation

  •  
IBC
  •  
Lloyd McKenzieGevity
  •  
Enablecare
  •  
Aaron Kohn
  •  
Duane WalkerBCBSM
  •  
Michael CabralCMS
  •  
Susan BellileAvaility
  •  
Susan LangfordBCBST
  •  
Sonja Ziegler
  •  
Peter Muir
  •  
Cambia
  •  
Ann GallagherOptum
  •  
Luis SayagoDacarba
  •  
Ralph Saint-PhardHealow
  •  
Interpro
  •  
Celia Bowen
  •  
Isaac VetterEpic
  •  
Dawn PerreaultBCBSM
  •  
Jeffrey DanfordAllscripts
  •  
Rachel E. Foerster
  •  
Seth ParadisHealow
  •  
Sheryl TurneyAnthem
  •  
Serafina Versaggi
  •  
Rohit ShindeeClinical Works
  •  
Pallavi TalekarScope Info Tech
  •  
Barbara AntunaAIM
  •  
Brandon RaabAnthem
  •  
Chris JohnsonBCBSAL
  •  
Clarissa WinchesterBCBSAL
  •  
Didi DavisSequoia Project

Present

Name

Affiliation

  •  

  •  
JPSys
  •  
Roland GamacheAHRQ/CEPI
  •  
Jeanie SmithBCBSFL
  •  
Jim St. ClairDinocrates Group
  •  
Durwin DayBCBSIL
  •  
Patrick HarenCigna
  •  
Anthem
  •  
Athenahealth
  •  
Katherine LuskChildrens
  •  
Laurie BurckhardtWPS Health Solutions
  •  
Manoj KumarGuidewell
  •  

  •  
Minil Mikkili
  •  
Scott M. RobertsonKP
  •  
David Kates
  •  
Sreenivas MallipeddiMCG
  •  
Thomas J. KesslerCMS
  •  
Eric ThomasIBC
  •  
Tony LittleOptum
  •  
Yolanda VillanovaCMS
  •  
TorQuailla Aultman
  •  
Brian PoteetBCBST
  •  
Brad Prentice
  •  
Heather KennedyBCBST
  •  
Jim TaylorTibco
  •  
Jodie ZellerhoffCambia
  •  
Labcorp
  •  
Nick RadovUHC
  •  
Mary Kay McDanielCognosante
  •  
Joseph QuinnOptum
  •  
Julia Chan
  •  

  •  
BCBSM
  •  
Marianna SinghCAQH
  •  
Neeraja
  •  
Unknown User (yvonneltrevino)Cambia


Minutes Approved as Presented 


This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."


Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



CRD Implementation Guide Link

http://hl7.org/fhir/us/davinci-crd/2019May/



Ballot Comment Triage/Review

#22232

  • http://hl7.org/fhir/us/davinci-crd/2019May/hooks.html#configuration-options

  • Revisiting this issue with Lloyd on the phone
  • Configurability would allow providers to choose what they see and what they don't - this was intended as a mechanism to allow configurability
  • Does the EHR auto-determine these configurations? Is this part of an individual clinician profile that they specify when they want something? How would the provider specify this?
    • Is it just as valuable to put this on the service and not the client?
    • How do you put a checkbox on the service?
  • Trying to reduce the number of clicks for providers
  • Would like to highlight the importance of information provided back from CRD being useful/valuable to justify the interrupation to the clinician's flow
  • CDS Hooks guidance is that if there isn't guidance, then you don't return a card at all
  • CDS service needs to determine if the information it has is worthwhile enough to be displayed in the clinical workflow
  • Need to indicate this portion of the configurability section is 'experimental' 
  • Configuration option could be managed on provider by provider basis, or managed by administrative functions for the client
  • Will some of this workflow be handled by provider's backend administrative staff?
  • CRD has potential to be one of the first/most active users of hooks in a number of EHRs - payers have a lot of information they can provide back to add value, but could also add a lot of noise - there's going to need to be a degree of configurability
    • This is a proposed approach, but don't know how it's going to work
    • Intent is to tell folks to expect there's going to need to be configurability
    • Something to be refined over time as we learn more

#22233

  • List of configuration options is relatively undefined - we have examples instead of a defined list of what the options should be (because we don't have a lot of implementation experience yet)
  • Intent is if configurability proves to be useful, then future versions of the CRD spec would standardize the list of configuration options over time as we gain more experience
    • We're not in a place to standardize that list right now

#22234

  • Questionnaire comes with a Task saying 'please fill out' and a copy of the Questionnaire - both of these are created in the EHR
    • Task won't already exist because it's specific to the order being created
    • The Questionnaire may already exist, and doesn't need to be created again if it does
  • Why can't CRD service query CDS client's FHIR service to determine if Questionnaire resource exists?
    • Prefetch is only necessary if you can't check in advance, but think it will be necessary for certain payers
  • Capability that exists in the EHR rather than SMART on FHIR app?
    • EHRs will have capability to fill out certain questionnaires
    • EHRs will have capability of launching generic SMART apps that can do more complex questionnaires
    • Won't necessarily have a SMART app for every questionnaire
  • We're saying that some CRD services can't RESTfully query for FHIR resources -it's  equally true that some CRD clients don't support FHIR Questionnaire resource
    • In order to achieve interoperability, there will be additional capabilities that need to be added on payer and provider side
    • This is not a technical limitation, but a regulatory one that payer may not be permitted to RESTfully query for FHIR resources
      • What's the restriction on queries/ questionnaires?
        • Issue we discussed was always about PHI and not about queries
        • Reasonable solution would be to query something as long as not PHI
      • In EHR repository of questionnaires is a shared repository for all users - Provider A might be completing an order, they get back a card saying fill out questionnaire and user didn't click on card yet. Provider B is doing the same kind of order, and they get the request to complete the same questionnaire. 
        • Questionnaires are not patient-specific - QuestionnaireResponses are patient-specific
        • Execution of the card that creates the Task and the Questionnaire is asyncronous

ManagementNext agendaBallot comment triage/review continued
 Adjournment
Adjourned at 1pm ET

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Supporting Document

Minute Approval


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