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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 ZieglerOptum
  •  
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
  •  
Sequoia Project
  •  
Rachel Goldstein
  •  
KasiCambia
  •  
Bob Thompson
  •  
Sushmita Kumari

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
  •  
Cambia
  •  
Anthem
  •  
AMA
  •  
Bas van den HeuvelPhilips


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
  • 8 issues left to be reviewed
  • 19 items in block vote (not including 8 to be reviewed)
  • Send them out for block vote today to be voted on next week in HL7 workgroup
  • Ken has 5 issues - reviewed via email, and 4 can be moved into the block vote

#22197 

  • Constraining reference display?
    • Reference that points to another URL, can have a display element to incude a brief description
    • Dates are important - e.g., a particular test was done within the past 6 months
    • Why are dates being discussed as PHI?
      • If you have a date and a test type, could resolve back to patient - only if you already have access to the whole medical record
    • PHI vs. non-PHI
      • In most cases commercial payers would need PHI, but non-PHI is available as option
      • CMS/Medicaid would be non-PHI
      • Non-PHI option
        • Coverage period, payer, coverage active/inactive, coverage type
        • Member ID and Plan ID are NOT included
        • Consider adding Group ID and Plan ID
          • Can have multiple groups under a plan - plan will look at the group and apply appropriate rules
    • Group agrees that dates need to be included and are not pointing back to PHI
    • Identifier would not be unique to a patient's coverage - it uniquely identifies the coverage
    • Needs to be discussed with Ken in a future call

#22155 and #22164

#22154

  • If have an EHR that supports Configuration, but there's nothing there, that's ok
  • If EHR doesn't support Configuration, then they get the default behavior

#22177

  • Launching an app to do 'what if' scenarios
    • There are no draft orders to pass, nothing to update
    • When CRD passes back CARDS to substitute this order, or fill out this other questionnaire, etc. there's no expectation that the SMART app would support executing those things - it's a read only for the clinician to say that if you ordered something like this, the system would tell you to do this instead
    • SMART app isn't going to do any writing
    • Can update specification to make this clear
  • Bas van den Heuvelagrees with proposed resolution/withdraws issue

#22185

  • As you are typing in order for new medication, lab, etc. the hook is firing continuously
  • If service has info to provide, then that appears down at the bottom - e.g., once you pick patient and medication, before you select dose, then CARD would be displayed
    • Previous advice might no longer be valid once user enters additional information
    • ID is on CARD so that if you're presenting different information, CARD ID would be different - EHR could use this to realize that something different needs to be presented
    • Up to EHR to make that determination
  • Existing CDS Hooks spec doesn't have a CARD ID
    • There is no way to know if information has changed
    • EHR has no way to manage them then to keep displaying them because they have no way of knowing if they're the same or different - no way to suppress
    • CRD spec needs an assumption on how this works
    • EHR can store CARD content, so it could tell if it has seen the particular text/link/SMART app before - would work on basis of comparing content
    • Additional specification needed in CDS Hooks or CRD spec
  • Means by which EHR decides to suppress CARDs is up to the EHR, it's not specific to CRD
    • CRD is not telling EHRs that there is a specific way to behave
    • EHR invokes the hook as many times as it makes sense depending upon how it manages user data entry
    • EHR has ability to suppress CARDs displayed based on their own business practices, user dismising a CARD, user reviewing data - different EHRs may behave in different ways
  • Make it explicit in the CRD spec that if every time you call CDS Hooks that you replace the CARDS previously displayed with the new CARDs - don't hold onto CARDS across calls
    • Each hook is distinct - when move from draft order hook to signed order hook, throw away draft CARDS when you do the signed CARDS
    • 3 order-related hooks are the only ones that are related to each other - review, select, and sign - the rest are distinct
    • Consider multiple hooks in same 'family'
  • Bas van den Heuvel and Lloyd McKenzie will discuss offline via email and bring back to group next week

ManagementNext agenda

 Adjournment
Adjourned at 1:06pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Action items


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