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Chair:  Ulrike Merrick

Scribe: Dana Marcelonis
 

Attendees


Present

Name

Affiliation

  •  
Enablecare
  •  
Viet NguyenStratametrics
  •  
Ulrike MerrickVernetzt, LLC 
  •  
Anupam ThakurBCBSFL
  •  
Corey SpearsInfor
  •  
BCBSAL
  •  
Casenet
  •  
Holly WeeksRegence
  •  
Jeffrey DanfordAllscripts
  •  
Joseph QuinnOptum
  •  
Laurie BurckhardtWPS Health Solutions
  •  
Lindee ChinEdifecs
  •  
Lisa R. NelsonMaxMD
  •  
Linda MichaelsenOptum
  •  
Mark TaylorReady Computing
  •  
Peter Muir
  •  
Rajesh GodavarthiMCG Health
  •  
Samir JainReady Computing
  •  
Sreenivas MallipeddiMCG Health
  •  
Susan BellileAvaility
  •  
Susan LangfordBCBST
  •  
Tony BensonBCBSAL
  •  
Yan WangMaxMD
  •  
Jeanie SmithBCBSFL
  •  
Rachel E. FoersterRachel Foerster & Associates
  •  
Mary Kay McDanielCognosante
  •  
Greg LindenLinden Tech Advisors
  •  
Eric Haas
  •  
Anthem
  •  
Dawn PerreaultBCBSM
  •  
Jennell Stewart
  •  
Kat RuizUNC Health
  •  
Michael GouldIBC
  •  
Tony Laurie
  •  
Karen L. ZapataAnthem
  •  
Ann GallagherOptum
  •  
eClinical Works
  •  
Frank HoneVeradigm
  •  
BCBS AL
  •  
Lynn PerrineLantana
  •  
Nancy BeavinHumana
  •  
Providence
  •  
Ralph Saint-PhardHealow
  •  
Serafina Versaggi
  •  
Seth ParadisHealow
  •  
Sheryl TurneyAnthem
  •  
Todd Johnson
  •  
Julie MaasEMR Direct
  •  
Duane WalkerBCBSM
  •  
Epic
  •  
Jennifer CurryRegence
  •  
Regence
  •  
David DeGandiCambia
  •  
Cigna
  •  
Kate ReesCambia
  •  
TIBCO
  •  
UHC
  •  
Ric LIghtHumana
  •  
TorQuailla AultmanNC.gov
  •  
Chris JohnsonBCBS AL
  •  
Cigna
  •  
Anna MeisheidCMS
  •  
Gino Canessa
  •  

  •  
Scott StueweDirect Trust
  •  
HealthLX
  •  
HealthLX
  •  

  •  

  •  
Tracy M. FitzgibbonRegence
  •  
Jordan StoreyRegence
  •  
Jonas
  •  
Kayla SuaProvidence
  •  
EMR Direct
  •  
Sasha Volkov
  •  

  •  
Providence
  •  

  •  
Roland GamacheAHRQ
  •  

  •  
Rim Cothren
  •  
Eric SullivanInnovalon
  •  
Jason
  •  

  •  
Michelle Hunt
  •  
Dacarba
  •  
Cedars-Sinai
  •  
Rob WilmotCerner
  •  

  •  
Lubka Dagorova
  •  
Pinki Patel
  •  
Nandini GangulyScope Info Tech
  •  
BCBSM
  •  
AEGIS
  •  
BCBSM
  •  

  •  
Aakash DeliwalaeClinicalWorks
  •  
Christopher GraconIndependent Health
  •  
JPSys
  •  
Cigna
  •  
Labcorp
  •  
Cigna
  •  
Melissa GaffneyAvaility
  •  
Andrea KentCoverMyMeds
  •  
Regence
  •  
Centene
  •  
Judy Williamson
  •  
Joshua LambUPMC
  •  
Edward CastagnaAltarum
  •  
Howard CohenCentene
  •  
Mario Jarrin HurtadoChange Healthcare
  •  
Justin SappBCBS IL
  •  
Roderick HewittCentene
  •  

  •  
CoverMyMeds
  •  
Michelle BarryAvaility
  •  

  •  
Sahlem KahrakaCentene
  •  
Sarabjit
  •  
Sonja ZieglerOptum
  •  
Microsoft
  •  
Interpro
  •  
Mary WinterPrime West
  •  
Jeff MarlowPrime West
  •  
AMA
  •  
Michael Fausulo
  •  
Clay Rogers
  •  
Tammy BanksProvidence St. Joseph
  •  
Jay Robertson
  •  
Epic
  •  

  •  
AMA
  •  

  •  
Heather McComasAMA
  •  
Cigna
  •  
CMS
  •  
Vassil PeytchevEpic
  •  

  •  

  •  
Matt ReidAMA
  •  
Molly Malavey

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



Ballot and Connectathon Schedule
  • February 2020 ballot cycle is complete
  • Ballot Reconciliation starting in February 2020


HL7 Virtual Connectathon

HL7 Virtual Connectathon - May 13-15



Update on adding the transfer use case

In response to CMS guidance and rule, created Tracker FHIR-26909  to add Transfer Use Case  to the IG

  • 2 scenarios that aligned with CMS Rule
    • If patient is in emergency room and then becomes an inpatient - how do systems handle? Discharge from ER or admit to hospital, or Transfer to hospital?
      • Vendors indicated 50/50
    • When patient is discharged, if they're discharged to another facility that's part of the same system (e.g., hospital vs. inpatient rehab also owned by same health system)  Is it a discharge/admit, or a transfer?
      • Mixed
  • CMS rule would require us to capture that transfer activity that happens
  • Similar for Observation - that sometimes turns into an inpatient stay
    • Different organizations handle differently
    • Sometimes due to ED having a different Tax ID - would be a discharge from ED and an admit to inpatient


Ballot Comment Review
  • Block vote #4 was sent to InM listserv last week, on agenda Thursday, April 23rd at 3-4pm ET

Issue key Summary (Reporter) Proposed disposition

  1. J#26201 open loop process1 (klsalzman) Not Persuasive with Modification
    • If there's an alert, it should be for some reason - there should be an action needed
    • If it's going to be unsolicited, then there needs to be a way to deal with it in an automated way so there's no lingering patient safety or quality issues
    • Assuming that some kind of out of band agreement has been made up front that recipient agrees to receive notifications for their patients being admitted/discharged
    • Is there a way to identify that something is critical and it needs to be addressed?  Risk mitigation
    • Recipeint would need to implement filters/rules on their side to determine what's important to them
    • It's 'open loop' in the sense that there's no mechanism for responding to a Notification
    • Chat comment from Ray Duncan: "This is a real issue. The organization can agree to receive the alerts, but at least in Epic, the user does not have that much personalized control over their inbasket. Some people look at the inbasket, some ignore it, and the messages just pile up."
    • Chat comment from Matt Reid: "Just a point of clarification, it's the CMS rule, not the ONC rule that discusses ADT and hospital CoP."

    • Team to discuss offline to see if risk mitigation statements might be added to IG
  2. J#26133 Future Potencial Scenarios to be ballotted? (celine_lefebvre) Persuasive with Modification
    • No plan to publish additional use cases in this IG
    • Add a statement to the IG that additional use cases would be included in supplementeal non-balloted documents, similar to C-CDA examples taskforce has created, or in use case-specific implementation guides
  3. J#26132 Unsolicted notifications should be limited to defined use cases and triggers (celine_lefebvre) Persuasive with Modification
    • Triggers are out of scope in the sense that the sender is going to define the rules for how a notification gets triggered
    • This IG is defining that there are notifications being triggered for admits and discharges
    • Is there an intent for an entity or a community (HL7) to create a value set of codes that represent admit and discharge, or is the expectation that it would be an agreement between physician and the hospital?
      • IG includes Event Type Code value set - right now it's very granular and defines different types of admits and discharges
        • Previous ballot comments asked to make this less granular
      • For Notifications that use this IG, there is a specified value set, so you can't just make up your own
    • Recipient would look for event code, for example "notification-admit", to determine if it's an alert they're interested in
    • Workflow consideration to be added to IG? Acknowledgement to implementer to consult with health system, physician, end-user, etc. and establish some kind of a triage process
      • Don't typically go into implementation details like that in the IG
    • Assuming recipient has some kind of user interface to present these notifications to end-users - we're not trying to define the user-interface
    • Is there an assumption that the recipient has to subscribe to certain kinds of alerts and their respective codes?
      • No, there is no subscription included in this IG
      • This is an unsolicited notification - so recipient receives full pipeline of notifications and then filters based on what's important to them - there's a way to filter based on Event Code

Will need to continue discussion to review the following issues in future calls:

  1. J#26200 open loop process (klsalzman) ****
  2. J#26199 Message Bundles2 (klsalzman) Considered - No action required
  3. J#26175 Reliable Delivery heading does not discuss the topic. (ginocanessa) Persuasive with Modification
  4. J#26131 Need to reference Da Vinci Guiding Principles soemwhere in IG that is consistent across all other Da Vinci ballots (celine_lefebvre) Persuasive with Modification
  5. J#26130 Shoud not have two ways of doing something. (celine_lefebvre) Persuasive with Modification
  6. J#26129 How is the intermediary going to determine what to remove1? (celine_lefebvre) Persuasive with Modification
  7. J#26127 add link (celine_lefebvre) Persuasive with Modification
  8. J#26126 add versions (celine_lefebvre) Not Persuasive with Modification
  9. J#26125 do not require providers to include nullflavors (celine_lefebvre) Not Persuasive
  10. J#26124 Providers should not be required to provide the precise reason for missing data (celine_lefebvre) Not Persuasive
  11. J#26122 fix typo (celine_lefebvre) ****
  12. J#26121 Is there a possibility for manual review so that sensitive data is not shared? (celine_lefebvre) Persuasive with Modification
  13. J#26119 Multiple ways to create a message is not ideal (celine_lefebvre) Persuasive with Modification
  14. J#26118 Protection of sensitive data? (celine_lefebvre) Not Persuasive
  15. J#26117 Contract agreement to establish triggering event (celine_lefebvre) Persuasive
  16. J#26116 Many things create encounters from Admission Discharge Scenarios (celine_lefebvre) Persuasive with Modification
  17. J#26115 Triggers should not be out of scope (celine_lefebvre) Persuasive with Modification
  18. J#26114 Add Guiding Primciples to IG (celine_lefebvre) Persuasive with Modification

ManagementNext AgendaBallot comment review continued
Adjournment
Adjourned at 1:01pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval
Meeting PPT PresentationDa Vinci Presentation 20200422Alerts-Notification.pptx





Action items


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