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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
  •  
Laurie BurckhardtWPS Health Solutions
  •  
Lindee ChinEdifecs
  •  
Independence Blue Cross
  •  
Allscripts
  •  
Regence
  •  
Didi DavisSequioa
  •  
InterSystems
  •  
BCBS IL
  •  
Allscripts
  •  
Cambia Health
  •  
Enable Care
  •  
David DodgeCambia Health
  •  
CAQH 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
  •  
Optum
  •  
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
  •  

  •  

  •  
YuriyHealthLX
  •  
Stephen MacVicarMITRE
  •  
Anna MeisheidCMS
  •  
Epic
  •  
Paul Knapp
  •  
Dave FosterEdifecs
  •  
John FeloExpress Scripts
  •  
Ken Lord
  •  
Roland GamacheAHRQ
  •  
Epic
  •  
Jennifer Joe
  •  
Stephen McVicarMitre
  •  
Joe HamiltonUnity Point
  •  
Matthew FloresAdvent Advisory Group
  •  
Providence
  •  

  •  
EMR Direct
  •  
Barbara WoodPNC
  •  
Eshaa DhalleClinicalWorks
  •  
Katherine RuizUNC Health
  •  
Zach Heath
PresentNameAffiliation
  •  
Tibco
  •  
Aim Specialty Health
  •  
Christy Dodson
  •  
BCBSM
  •  
Allscripts
  •  
BCBSFL
  •  
BCBSM
  •  
CMS
  •  
Mike HurleyBRYJ Healthcare
  •  

  •  
Tori WillowsWellcare
  •  

  •  
Nandini GangulyEMDI - Scope Info Tech
  •  
Moxe Health
  •  
Jim McKinleyMedicaid Alabama
  •  
BCBST
  •  
Bart CarlsonAzuba
  •  
Deepthi ReddyMettle Solutions
  •  
Allscripts
  •  
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
  •  
Availity
  •  
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 KonchadaCentene Corporation
  •  
Sheryl TurneyAnthem
  •  
Helina Gebremariam
  •  
Mike NovalesBCBSIL
  •  
Ric LightHumana
  •  
Ann GallagherOptum
  •  
Chris KlesgesMitre
  •  
Adam GronskyHealth Fidelity
  •  
CaseNet
  •  
Anthem
  •  
CMS
  •  
eClinicalWorks
  •  
Healow
  •  
Interfaceware
  •  
Mark RucciSpectramedix
  •  
Carie HammondAEGIS
  •  
Anthem
  •  
Cindy MonarchBCBSM
  •  
ONC
  •  
Dawn PerreaultBCBSM
  •  
Kyle ZumsteinAvaility
  •  
Nancy SpectorAMA
  •  
Bruce WilkinsonBenmedica
  •  
Cara BarryAvality
  •  

Chris Johnson

BCBSAL
  •  
Duane WalkerBCBSM
  •  

  •  
Greg LindenLinden Tech Advisors
  •  
Mario JarrinChange Healthcare
  •  
Megan Smith-HallingsheadRegence
  •  
Patrice KuppeSurescripts
  •  

  •  
MCG
  •  
ONC
  •  
Surescripts
  •  
NCPDP
  •  
Anupam ThakurBCBSFL
  •  
Jonathan HutchinsBCBST
  •  
Anthem
  •  
Sunitha Godavarthi
  •  
Christopher GraconIndependent Health
  •  
Labcorp
  •  

  •  
James DerricksonIntersystems
  •  
Douglas DeShazoCognizant
  •  
Neetha JosephCognizant
  •  

  •  
Terry MayMitre
  •  
Rutika
  •  
Ashley H. MaplesExpress Scripts
  •  
Brody BrodockAllscripts
  •  
Michael BrodyCME Online
  •  
Theressa BaumannBCBS AL
  •  
Mona ChandrapaleClinicalWorks
  •  
Optum
  •  
Aakash DeliwalaeClinicalWorks
  •  
Mayo
  •  
Eddy NievesEpic
  •  
Shaheer
  •  
Stanley Nachimson

Create Decision from template

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



Connectathon Links

Connectathon being planned for December in Philadelphia at IBC - December 3rd -4th 



Links to PDex FHIR Guides and Code

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

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/

PDex IG Companion Guide - Laboratory Reporting Resources



PDex Formulary Ballot Reconciliation/ IG Updates

Balloted Formulary IG: http://hl7.org/fhir/us/Davinci-drug-formulary/Jun2019

  • Going through process to withdraw negative comments
  • Implementation Guide has been updated


PDex Directory IG Update

Directory IG: http://build.fhir.org/ig/HL7/davinci-pdex-plan-net/

  • Approval from Financial Management workgroup to go into early ballot
    • Sign up ends October 24th
    • Voting starts October 25th 
  • Out for eApproval with FMG
  • Going for TSC approval on Monday


PDex Ballot Comment Review
Group.                                  Count
_Typo26

Fit-For-Teleconference

8
None99
Ready-For-Vote54
Grand Total187


For Review - In-Person:

ID SummaryDetailsConsensus
23149,
23155,
23157,
23285,
23287,
23230,
23234,
23236,
23238,
23242,
23228,
23248,
23250,
23266,
23279,
23232,
23260

Ready For Vote

#23155

  • Persuasive

#23157

  • Content that is common across IGs will be moved to HRex and referenced
  • Persuasive

#23222

  • Need to use terms consistently across IG
  • Should move definition to HRex because we have this in multiple IGs

#23226

  • Refer to resolution for #23222

#23228

  • Remove 'whereas'

#23232

  • Intent is to only support R4 across other Da Vinci IGs, so this issue is no longer relevant
  • Not Persuasive

#23234

  • Broken link needs to be fixed

#23236, 23238, 23242 - links to be fixed

#23240

  • IG requires OAuth 2.0 as defined in SMART on FHIR framework for communication with a 3rd party app, so this comment is not correct
  • Clarify the paragraph in the IG
  • IG covers 3 scenarios:
    • 3rd party app
    • Provider using CDS Hooks to get information - scope gets granted based on access to the payer's data
    • Payer to Payer exchange
  • Not Persuasive with Mod

#23248

  • Change "Identifiers" to "Ids"
  • Persuasive

#23250

  • US Core dictates required fields in this case - we didn't create a new profile
  • If you use data absent extension, does that meet any conformance check? It's valid within the methodology, but not necessarily within the tools?
  • Optional (don't need to populate anything - 0..) vs. Required (need to populate something, but if don't have data you need to supply a reason why you don't have it - greater than 0..) vs. Mandatory (you have to supply the information)
  • Need to define what Must Support means for every Da Vinci IG
    • May want to put it in HRex and point to it from other IGs
    • Need to be explicit
  • How is any of this going to be enforced?
  • Leveraging US Core wherever possible - should we leverage the Must Support definition from US Core? 
    • Make this clear in the HRex IG
    • In many places US Core has marked fields as Required that would be inappropriate in payer situations (as opposed to clinical)
  • Defer this issue and discuss offline - implications across Da Vinci IGs
  • May also need to revisit cardinalities

23133Did I interpret 42 CFR Part 2 correctly in the Summary? - PDex #1

 Submitted by: Alberto Llanes  (Anthem)On behalf of:  (alberto.llanes@anthem.com)Existing Wording: When a Member is authorizing sharing of the Member Health History with another Health Plan or a Third Party Application via the OAuth 2.0 protocol the Health Plan that is operating the API MAY offer the Member an option to restrict the sharing of sensitive informationProposed Wording: When a Member is authorizing sharing of the Member Health History with another Health Plan or a Third Party Application via the OAuth 2.0 protocol the Health Plan that is operating the API MAY offer the Member an option to allow the sharing of sensitive information---Comment:Affirmative with Question was my vote. My question is, did I interpret 42 CFR Part 2 correctly in the Summary to the right? I don't want to case a negative vote on the entire ballot as as I'm sure my question will draw a correct response from the reviewers. Thank you.The default to the best of my knowledge is that sensitive information is restricted per 42 CFR Part 2 requiring explicit permission to share. The wording in this IG states that the payer may allow the option to restrict which is already the default case. The implication is that it would be shared otherwise.---Summary:Did I interpret 42 CFR Part 2 correctly in the Summary?

Robert Dieterlewill reach out to obtain SAMHSA input re: what is required
23153Difficult to navigate guide - PDex #11 Submitted by: Brett Marquard  On behalf of:  (brett@waveoneassociates.com)Existing Wording: N/AProposed Wording: N/A---Comment:The navigation of this IG is quite difficult -- it feel like a PDF with 'next page' buttons to get to the next page. I suggest reworking content into a 'guidance page' with links on side. See CDS hooks, US Core, other large guides---Summary:Difficult to navigate guide
23159Hidden Implementation Requirements - PDex #14 Submitted by: Brett Marquard  On behalf of:  (brett@waveoneassociates.com)Existing Wording: N/AProposed Wording: N/A---Comment:It seemed a bit strange to find conformance requirements on this page -- Isn't HREX supposed to define the framework? Should these be worked into the Capability Statement? Please change page heading, or move to a place where it's clear an implementer will find these requirements.---Summary:Hidden Implementation Requirements
231611Include defintion for extension - PDex #15 Submitted by: Brett Marquard  On behalf of:  (brett@waveoneassociates.com)Existing Wording: N/AProposed Wording: N/A---Comment:This extension doesn't include any description or examples. CQL, SQL, google query?---Summary:Include defintion for extension
23297Fix "The member authorizing the sharing of their information." - PDex #104 Submitted by: Kenneth Rubin  (US Department of Veterans Affairs)On behalf of: Kathleen Connor (kathleen_connor@comcast.net)Existing Wording: Provider requested Provider-Health Plan Exchange using CDS-Hooks and SMART-on-FHIR As a minimum the Health Plan’s FHIR API SHALL limit returned results to the records that are related to the Patient/Member that is:•The subject of the Provider query.•The member authorizing the sharing of their information.---Comment:RE "The member authorizing the sharing of their information."Wrt the definition of HIPAA treatment @https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html“Treatment” generally means the provision, coordination, or management of health care and related services among health care providers or by a health care provider with a third party, consultation between health care providers regarding a patient, or the referral of a patient from one health care provider to another"my understanding was that according to this IG, when a provider requests information from a payer (a 3rd party) about a patient who is the payer's Member, no authorization is required.  Please clarify why "The member authorizing the sharing of their information" is a criteria for permitting disclosure" so that readers understand the policy requirements.---Summary:Fix "The member authorizing the sharing of their information."
23310Appreciate well defined use cases - PDex #117Submitted by: Kenneth Rubin  (US Department of Veterans Affairs)On behalf of: Kathleen Connor (kathleen_connor@comcast.net)Existing Wording: There are two Provider/Clinician workflow examples:    First Visit with new Provider    Return visit with new ProviderProposed Wording: There are two Provider/Clinician workflow examples:    First Visit with new Provider    Return visit with new ProviderAssumption: Supported Provider/Clinician workflow meet the HIPAA treatment, payment, and operations purposes per https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html---Comment:Appreciate well defined use cases. Would like to limit use cases to situations which meet the HIPAA treatment, payment, operations definitions to ensure that use cases that don't meet these definitions are assumed to be prohibited. See https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html---Summary:Appreciate well defined use cases
23220The intention of including the EOB in the diagram is unclear - PDex #64 Submitted by: Kenneth Rubin  (US Department of Veterans Affairs)On behalf of: Paul Knapp (paul.knapp@bookzurman.com)---Comment:The intention of including the EOB in the diagram is unclear. The EOB is not the direct result of the adjudication, then Claim Response The EOB is a patient focused, not provider focused, resource which pulls together the majority of the Claim and ClaimResponse information for the purpose of informing the patient.Adding the ClaimResponse to the diagram would clarify the roles and contents of the respective resources. However neither ClaimResponse nor EOB contain or contribute net-new clinical information to the Patient's health record so their inclusion in the diagram as drawn is unclear. Either a box should be drawn araound hte EOB or ClaimResponse and EOB to indicate that they do not contribute clinical content or they should be removed from the diagram.---Summary:The intention of including the EOB in the diagram is unclear
23244The Da Vinci Documentation Templates and Rules Implementation Guide (DTR-IG) doesn't exist, therefore either remove this or refer to the guide in the future state and provide a link, if required, to something with content. - PDex #76 Submitted by: Kenneth Rubin  (US Department of Veterans Affairs)On behalf of: Paul Knapp (paul.knapp@bookzurman.com)Existing Wording: The Da Vinci Documentation Templates and Rules Implementation Guide (DTR-IG) provides additional guidance and expectations …---Comment:The Da Vinci Documentation Templates and Rules Implementation Guide (DTR-IG) doesn't exist, therefore either remove this or refer to the guide in the future state and provide a link, if required, to something with content.---Summary:The Da Vinci Documentation Templates and Rules Implementation Guide (DTR-IG) doesn't exist, therefore either remove this or refer to the guide in the future state and provide a link, if required, to something with content.

For Review: NOT In-Person:

IDSummaryDetailsConsensus
23401,
23145,
23139,
23143,
23147,
23151,
22872,
22860,
22864,
22873,
22874,
22876,
22859,
22865,
22858,
22861,
22862,
22863,
22866,
22868,
22869,
22870,
22871,
23197,
23206,
23212,
23218,
22821,
23374,
22819,
23413,
23405,
23319,
23318,
23322,
23323,
23325.

Ready-For-Vote





 Adjournment

Adjourned at


Supporting Documents

Outline Reference

Supporting Document

Minute Approval
Connectathon Kick Off Presentation

Connectathon Presentation.pptx and recording

PDex Companion GuidesPDex IG Companion Guide List





Action items

  •