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Chair:  Larry Decelles

Scribe: Dana Marcelonis


Attendees

Present

Name

Affiliation

  •  
Mitre
  •  
George BierOptum
  •  
BCBS AL
  •  
Rush
  •  
Matthew ByrneOptum
  •  
Rush
  •  
Cerner
  •  
Anthem
  •  
Allscripts
  •  
InterSystems
  •  
Allscripts
  •  
Mitre
  •  
Cambia Health
  •  
Cerner
  •  
Enable Care
  •  
Optum
  •  
Aegis
  •  
BCBS FL
  •  
InterSystems
  •  
Anthem
  •  
Mitre
  •  
Allscripts
  •  
Optum
  •  
Jackie HardisonHumana
  •  
Cigna
  •  
Claudia HartmanHighmark Health
  •  
Mark HinghamAnthem
  •  
Optum
  •  
Sheljina Ibrahim KuttyAnthem
  •  
Allscripts
  •  
Point of Care Partners
  •  
Edifecs
  •  
Mitre
  •  
InterSystems
  •  
Anthem
  •  
Tso LukeOptum
  •  
Point of Care Partners
  •  
Optum
  •  
Cognosante
  •  
Optum
  •  
Humana
  •  
Stratametrics
  •  
Casenet
  •  
Allscripts
  •  
Optum
  •  
Optum
  •  
InterSystems
  •  
C SimeoneOptum
  •  
Jeanie SmithBCBS FL
  •  
InterSystems
  •  
Veradigm
  •  
CMS
  •  
Casenet
  •  
Independence Blue Cross
  •  
Anthem
  •  
CentriHealth
  •  
CaseNet
  •  
India DuncanOptum
  •  
Jason Cassidy
  •  
Optum
  •  
Gevity
  •  
Tracy McCutcheonKPMG
  •  
Rashmi MenonKMHP
  •  
Mario JarrinChange healthcare
  •  

  •  
AMA
  •  
Ann GallagherOptum
  •  
Megan Smith-HallingsheadRegence
  •  
Regence
  •  
Anthony SmithUNC Health
  •  
Optum
  •  

  •  

  •  
Jennifer Joe
  •  
Texas Health
  •  

  •  
Cigna
  •  
Labcorp
  •  
Cigna
  •  
Matt Dyer-Vyne
  •  

  •  
Barbara Kramer-ZarinsMITRE
  •  
Centene
  •  
Barbara WoodPNC
  •  
Greta HoneycuttCoverMyMeds
  •  
BCBSA
  •  

  •  
Yunwei WangMITRE
PresentNameAffiliation
  •  
Peter MuirESAC
  •  

  •  
Ryanne LaurenceOHSU
  •  

  •  
Mitre
  •  
CMS
  •  
Aim Specialty Health
  •  
Christy DodsonMCG
  •  
Tibco
  •  

  •  
Rajesh Godavarthi
  •  
Santosh
  •  
Tom Hartman
  •  
Tori WillowsWellcare
  •  
Alise WidmerLumeris
  •  
Bart CarlsonAzuba
  •  
David BruinsmaColonial Med
  •  
Deepthi ReddyMettle Solutions
  •  
Danny BrennanMA Health Data
  •  
Patrick Edwards
  •  

  •  
Cambia Health
  •  
CMS
  •  
Pallavi TalekarScope Info Tech
  •  
Rajesh GarlapatiRush
  •  
Susan BellileAvaility
  •  
BCBST
  •  
Ralph Saint-Phard
  •  
Kristi CushmanOHSU
  •  
Briana BarnesScope Info Tech
  •  
Didi DavisSequoia Project
  •  
Sreekanth PuramMettle Solutions
  •  
Duane WalkerBCBSM
  •  
EMDI Team
  •  
David HillMitre
  •  
BCBS AL
  •  
Nandini GangulyEMDI
  •  

  •  
Rajesh GodavarthiMCG Health
  •  
Rim Cothren
  •  
Donna CampbellBCBSIL
  •  
Joanna GaskillLumeris
  •  
Edifecs
  •  
Michael CabralCMS
  •  
Sudhir NairAnthem
  •  
Saul KaravitzMitre
  •  
Dawn PerreaultBCBSM
  •  
Brent WoodmanBCBSM
  •  
Yolanda VillanovaCMS
  •  
Deryl Lam
  •  
Edifecs
  •  
Karen TottCMS
  •  
Mitre
  •  
Dacarba
  •  
Carradora
  •  
Rachel Goldstein
  •  
Ric LightHumana
  •  
eClinicalWorks
  •  
Healow
  •  
Wanda Govan-JenkinsHHS
  •  
Cindy MonarchBCBSM
  •  
Edward Yurcisin
  •  
Veradigm
  •  
Hibah QudsiMitre
  •  
Nancy SpectorAMA
  •  
Patrick Leblanc
  •  
Anupam ThakurBCBSFL
  •  
MCG
  •  
Chris KlesgesMitre
  •  
IBC
  •  
Gregory MagazuCaseNet
  •  
Isaac VetterEpic
  •  
Kat RuizUNC Health
  •  
Laura Bright
  •  
Humana
  •  
Roland Gamache
  •  
Katherine LuskChildrens
  •  
Anthem
  •  

  •  
Chris JohnsonBCBS AL
  •  
Jim AdamsonArkansas Blue Cross
  •  
Carry Denny
  •  
Infor
  •  

  •  
Anna MeisheidCMS
  •  
Celine LefebvreAMA
  •  
Eshaa DhalleClinicalWorks
  •  
BCBSM
  •  
Express Scripts
  •  
Sandhya
  •  
Christopher GraconIndependent Health
  •  
Candice TitusCrisp Health
  •  
Mariana SinghCAQH
  •  
BC Idaho
  •  
Shilesh NairGdit
  •  

  •  

  •  

  •  
UHC


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Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



Links

DTR IG: http://hl7.org/fhir/us/davinci-dtr/2019May/

Reference Implementation: https://github.com/HL7-DaVinci/dtr 



Connectathon

Philadelphia Connectathon Hosted by Independence Blue Cross - December 11-12, 2019

CMS HL7 Connectathon - January 2020 - January 7-8, 2020



Ballot Comment Review

FHIR-24714

  • Need to share authentication information that CDS service has with DTR app
  • Using EHR as pass through between CDS service and DTR app
  • There's no protection of that credential in app context or in the EHR
  • EHR doesn't want to know someone else's password to the payer's FHIR server
  • We don't have a way to authenticate to payer's server
  • We're not exchanging PHI with payer, just need CQL and questionnaire
  • Options
    1. Not preferred - DTR app doesn't need to authenticate to payer's FHIR server - publicly expose rules or whitelist some IPs in some cases
      1. Feedback that this approach won't be approved by InfoSec at payers
    2. Preferred - DTR to interact with payer FHIR API through OAuth credentials or SMART backend services spec
      1. Authenticate on behalf of DTR app, not the user in this case
    3. If user has credentials with payer, could do SMART standalone launch (not a likely scenario that user has credentials with payer)
    4. If DTR app is more tightly associated with payer's FHIR server, then maybe some unspecified security mechanism that we don't need to worry about in the spec because it's all one system (app/FHIR server)
    5. Federated trust model - DTR presents EHR issued access token to payer FHIR server, and FHIR server is able to validate that token is good because trust relationship exists
      1. If native EHR app, there is no SMART launch - EHR would be issuing a credential to itself to authenticate to someone else's server - not an acceptable approach
  • Recommendation: DTR shall authenticate against payer's FHIR server following SMART backend services specification and use OAuth
    • Enables a bunch of different workflows
    • Clearly communicates to the DTR app and payer FHIR server how security layer should work
    • SMART backend services is mature and likely going to be named by ONC in the rule, so will have wide applicability
  • Need to remove app context language from IG
  • Reed Gelzer chat comment:
    • Our SkinWoundAssessment template project has potential extension into the area you're reviewing.  Specifically, Anthem has a directive for PriorAuth data  requirements.    Translating that directive into a specification permits conformance testing of a given data object against that spec.    Conformance testing can be done in production, as we are demonstrating in the HL7 Connectathon series.
    • I would recommend a specific scenario to map this against, then review that with our SkinWoundAssessment project.

FHIR-24717

  • Duplicate of FHIR-24714

FHIR-24715

  • CDS Hooks spec refers to ability to share not-persisted resources as part of the CDS Hooks request - provide advice to clinician before they finish taking an action
  • If CDS service and SMART app have a business relationship (part of same entity, or acting on behalf of same entity) then CDS service should store off service request/contextual FHIR resources received as part of CDS hooks request and pass through simple identifier in app context field so that SMART on FHIR app can wuickly reference/look up that FHIR resource
  • In this case could there be different 'owners' of service and app
  • Update language to: The request resource created during the CRD workflow should be persisted in the EHR FHIR server for retrieval by the DTR application, if possible. This might, for example, be the ServiceRequest resource that is sent in the CDS hook to the CRD server. Additionally, a tight integration between the CRD service and the DTR application should enable the DTR app to access FHIR resources received by the CRD service that are not available from the EHR's FHIR server.

ManagementNext Agenda

No call next week, Wednesday, December 11 due to Philadelphia Connectathon


 Adjournment
Adjourned at 12pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Action items

  •