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Chair:  Dr.Nita Thingalayaand Dr. Julia Skapik

Scribe: Dana Marcelonis
 

Attendees

Present

Name

Affiliation

  •  
Robert DieterleEnablecare
  •  
Stratametrics
  •  
Nita ThingalayaIBC
  •  
Cambia Health Solutions
  •  
Gregory MagazuCaseNet
  •  
Jeanie SmithBCBSFL
  •  
Corey SpearsInfor
  •  
Optum
  •  
Ashley SteddingCMS
  •  
Barbara AntunaAIM Specialty Health/ Anthem
  •  
Mary Kay McDanielCognosante
  •  
Michael GouldIBC
  •  
Laurie BurckhardtWPS Health Systems
  •  
Serafina Versaggi
  •  
Sreenivas MallipeddiMCG Health
  •  
Susan BellileAvaility
  •  
Susan LangfordBCBST
  •  
BCBSAL
  •  
Tracey McCutcheonKPMG
  •  
Dawn PerreaultBCBSM
  •  
CMS
  •  
Anupam ThakurBCBS FL
  •  
Anthem
  •  
Allscripts
  •  
BCBSM
  •  
Chris JohnsonBCBSAL
  •  
MITRE
  •  
ZeOmega
  •  

  •  

  •  
Cigna
  •  
eClinicalWorks
  •  
Jim TaylorTibco

Present

Name

Affiliation

  •  
John BialowiczBCBSM
  •  
Nandini GangulyScope Info Tech/ EMDI
  •  
Peter Muir
  •  
CAQH
  •  
Pallavi TalekarScope Info Tech
  •  
Kelly TaylorCMS
  •  
Karen L. ZapataAnthem
  •  
Brandon RaabAnthem
  •  
Cindy MonarchBCBSM
  •  
Michael CabralCMS
  •  
Nick RadovUHC
  •  
Epic
  •  
James Derrickson
  •  
Laurie WoodromeLabcorp
  •  
Ric LightHumana
  •  
Harvey KuangExpress Scripts
  •  
BCBS AL
  •  
Gevity
  •  
Julia ChanCW Global Consult
  •  
Ken Lord
  •  
Edifecs
  •  

  •  
Roland Gamache
  •  
Alberto S. LlanesAnthem
  •  
Mark ScrimshireNew Wave
  •  
EMR Direct
  •  
Patrick MurtaHumana
  •  
Ranjith KandurAnthem
  •  
Mitre
  •  
Joe Minieri
  •  
Dave Foster
  •  
Providence
  •  
Betty SullivanAllscripts
  •  

  •  
June Bronnert
  •  
Cynthia GinsburgCMS
  •  
Eshaa DhalleClinicalWorks


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


ManagementBallot and Connectathon Schedule

Ballot Comment Review
  • Terminology issue that was discussed last week will be addressed across Da Vinci IGs
    • We're getting stakeholder input and will bring an update back to the group next week

#24590

  • Should Provenance be addressed in this IG?
    • When passing info from one payer to another, do we have a need/expectation for also sharing where the records came from
    • Payer responsible for the decision they make, but not responsible for data that originally came from provider
  • Payers should provide Provenance for the data included in this document
  • Payers do want to know where the data came from
  • PDex states that if you receive Provenance, should also carry it forward and if generating stuff, you should create Provenance
    • Even if payer didn't receive Provenance, they could indicate where they received it from
  • Persuasive with mod

#24750

  • Virtual Connectathon question - looked at IG examples - should there be more guidance re: what should appear in text section to be used as human readable view on treatment plan?
    • What do people need to see in a human readable section?
      • Attachments wouldn't be in the human readable section
      • Pull content from care plan, care team, etc.?
  • All Da Vinci IGs should provide guidance
  • Persuasive

#24752

  • Title fields need to be clearer - what is document and section title to contain?
    • Would it be appropriate to include patient identifiers in title?
    • We have explicit references to date and patient, so it would be duplicative
  • Do we need to allow flexibility in language? Always English in US?
    • It will be English 99% of the time, but should allow flexibility
  • If we need flexibility, then we can't make it a fixed value, we can provide guidance
  • Title to include "Coverage Decision Exchange Document (patient name, date)"
  • Mark section.title as 1..1 must support and include suggested language
  • Persuasive

#24753

  • Patient identifiers
    • Mark Scrimshireprovided proposal to Viet Nguyen re: Coverage resource to be included in HRex
    • PCDE points to Coverage (this is where payer-assigned identifiers should be included)
    • Add a usage note that primary identification of the individual is expected to happen through Coverage resource, not through the information in the Patient resource
    • General guidance in the US to not use SSN as patient identifier - do we need to consider adding this?
      • If we're pointing to Coverage as mechanism for identifying, that should preclude the use of SSN
      • Up until the recent change for CMS, Medicare was, and some Medicaid plans are still using SSN as the Member ID
      • Even if it was previously used as an identifier, some payers are filtering it out of their clinical systems
      • This kind of guidance would need to go in US Core because we don't have a Da Vinci specifc profile
      • Nick Radov will put in a tracker for US Core and see what they think
  • Persuasive

#24758

  • Goals would only be present if transmitted directly from the provider with other treatment plan information, or if payer is managing patient via care management program
  • Should we be using terminology to describe this?
    • Federal government perspective - any additional constraints on goals aren't helpful becaues most goals should be patient-centric - e.g., while there are SNOMED codes that say 'patient able to walk a mile' the general guidance is that it's not necessary to use coded items in the goals field
  • Expectation is that you don't need to send goals, and if somebody sends goals, you're allowed to drop them on the floor
  • Federal guidance says that if you have goals, you should send them if you have them
  • Care Plan - organizational structure for each single treatment (reason for treatment, what it is, and status of treatment)
    • If you receive a Continuity of Care Document indicating that a patient is on a particular treatment, would you expect to receive the goals for that from the prior payer if they have them?
      • No - if it was done, it would be a nice to have because every payer is going to have their own goals
      • No, we would make up our own goals - it would be a nice to have
  • Hold this one for input from the community - payers will ask their teams if this is of value to them

ManagementNext agenda

Ballot comment review continued


 Adjournment

Adjourned at 2:57pm ET


Supporting Documents


Action items


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