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Chair: Mark Scrimshire

ScribePooja Babbrah

 

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
  •  
Sequoia
  •  
InterSystems
  •  
BCBS IL
  •  
Allscripts
  •  
Cambia Health
  •  
Enablecare
  •  
David DodgeCambia Health
  •  
Rachel Foerster & Associates
  •  
Howard FollisJuxly
  •  
Reliant Medical Group
  •  
Lantana Consulting
  •  
SureScripts
  •  

  •  
Blue Cross Blue Shield Association
  •  
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
  •  
onyxhealth.io
  •  
NewWave
  •  
ZeOmega
  •  
Anne Marie SmithNCQA
  •  
InterSystems
  •  
UHC
  •  
Casenet
  •  
Cigna
  •  
HealthLX
  •  
Independence Blue Cross
  •  
Joel WalkerHealthLX
  •  
Holly WeeksRegence
  •  
BCBS AL
  •  
Darrell Woelk
  •  
Cambia
  •  
Brent Woodman
  •  
Diameter Health
  •  
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
  •  
Centene
  •  
Veradigm
  •  
Kenneth Foster
  •  
Cigna
  •  
Christopher StehnoCorepoint Health
  •  

Neena Dakua


  •  
MD Partners
  •  
Joe Miller
  •  
Gevity
  •  
Thomas GrannanAzuba
  •  
Mike SabinMedica
  •  
Clay Rogers
  •  
Thomas GrannanAzuba
  •  
Matthew Hoesch
  •  
Vijaya ShivgandUPMC
  •  
Lauri ShockArkansas Blue Cross Blue Shield
  •  
Zanub MalikUPMC
  •  
Vishnu
  •  
Erin GosneyHumana
  •  
Summer DumanRegence
  •  
Sonya MayOptum
  •  
MITRE
  •  
POCP
  •  
MA Health Data
  •  

  •  

  •  
Colin Barry
  •  
Anoop Mohemmed
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
  •  
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
  •  
Avality
  •  

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
  •  

  •  
MITRE
  •  
Rutika
  •  
Ashley H. MaplesExpress Scripts
  •  
Brody BrodockAllscripts
  •  
Michael BrodyCME Online
  •  
Theressa BaumannBCBS AL
  •  
Mona ChandrapaleClinicalWorks
  •  
Optum
  •  
Aakash DeliwalaeClinicalWorks
  •  
Mayo
  •  
Eddy Hernandez-NievesEpic
  •  
Shaheer
  •  
Stanley Nachimson
  •  
Anthony SmithUNC Health
  •  
Howard Cohen
  •  
Minaei BehnazFDA
  •  
BCBSA
  •  
Shilesh Nairgdit
  •  
NewWave
  •  
MaxMD
  •  
BC Idaho
  •  
Edward CastagnaAltarum
  •  
Andrea KentCoverMyMeds
  •  
Carrie Denny
  •  
Kim Pham
  •  
Celine LefebvreAMA
  •  
Edifecs
  •  
Josh LambUPMC
  •  
Keya ShahCasenet
  •  
Gevity
  •  
MITRE
  •  
Mrugen MehtaeClinicalWorks
  •  
Revathi Jayakumuar
  •  
Supriya
  •  
Bapi Behera
  •  
Matt DyerVyne
  •  
Sree Vijetha VegiC-HIT
  •  
BCBSA
  •  
Rich BlochLumedic
  •  
Cigna
  •  
Michael Kim

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



PDex



Provider Directory 
  • Update on value sets, code sets


Discussion: 

  • Cardinality of Practitioner Role will change back (clerical error)
  • Discussion from last week: How to represent virtual services - there is a general agreement to extending location resource.  
  • There was an additional discussion on extension to Healthcare Services - types are virtual and physical.  Some discussion on additional backbone, but group can not remember and it wasn't captured in the notes.  Brief discussion on Mobiles. 
    • Group agreed this should be represented in physical. If there are any backbone elements that need to be included, reach out to Bob or Saul  
  • NewPatients discussion: Have only one extension.  Coding would be a Yes or No.  There Would be an additional accepting conditional field.  Could also qualify from network. Also - have an additional string.
    • Decision: Combine 4 values.  If no constraint characteristics to not be presented - If any concerns - send Bob or Saul an email.


PDEX Provenance

Preview to identify potential downstream information sharing by payers.

Work in Progress: Provenance for PDex-2020-06-03.xlsx 

PDex Provenance Scope:

The purpose of Provenance

Provenance of a resource is a record that describes entities and processes involved in producing and delivering or otherwise influencing that resource. Provenance provides a critical foundation for assessing authenticity, enabling trust, and allowing reproducibility

US Core has implemented a Provenance profile. The purpose of the profile is to cover:

the minimal (basic) information to support lineage of information. 


Payer Data Exchange Objectives for Provenance 

As payers exchange information with each other, with providers and with third party applications using PDex it is important that provenance is provided. The benefits to the Payer community in providing accompanying provenance resources are:

  • Identifying the payer as the “transmitter” and not the author of the majority of the information they provide
  • Enabling downstream users of the information to understand the source of the data when comparing information from different sources. 
  • Recording how claims information was received and, if relevant, converted to FHIR. 
  • As more healthcare organizations use and exchange information via FHIR more provenance records will be exchanged. Payers shall preserve and pass on provenance resources when exchanging FHIR records received from other sources.


What Provenance is NOT attempting to do

The Provenance resource is NOT attempting to trace every step of a claim’s journey from the originating provider to the payer.

As more provenance records are exchanged with information via FHIR it will be the sum of those provenance records that will provide the “chain of trust/confidence” and not the responsibility of a single organization to manage and assert the lineage of the information’s journey from originator to final recipient.

  

Discussion:

  • Need to make sure we are only making factual statements in the guide.


CARIN CPCDS to US Core Mapping

Discussion:

  • Questions regarding CARIN Alliance BB / FM discussion around provider and practice earlier this week.  Some confusion around this as it relates to provider.
    • Question - what does a payer do if they don't have the provider information to return.   
    • Suggestion - there needs to be list of situations and recommended placement of provider in all of those situations. 


Latest draft CARIN CPCDS Mapping document: CARIN Mapping to FHIR interim 2020 0513.xlsx

DRAFT - PDEX US Core Mapping from CPCDS source: ResourceMappingUSCoreCPCDS-2020-05-29-v26.xlsx



Next Agenda

 Adjournment

Adjourned at 


Outline Reference

Supporting Document

Minute Approval
Meeting Presentation 4/10/20
PDex Companion GuidesPDex IG Companion Guide List
Plan-Net Feedback DeckPlan-Net PDEX 041020_v1_notes.pptx



Action items

 



1 Comment

  1. I appreciate the PDex Provenance Scope statement.  In particular, "FHIR it will be the sum of those provenance records that will provide the “chain of trust/confidence” and not the responsibility of a single organization to manage and assert the lineage of the information’s journey from originator to final recipient.'  This is the perfect use case for Federated Provenance, as described in PSAF Volume 3, Federated Provenance: presents a general conceptual overview of what defines resource lifecycle events and associated provenance events, and what is needed to process, share, and leverage that provenance data for resource trustworthiness decisions (i.e., “fitness for use” decisions by resource recipients). Volume 3 passed normative ballot in February 2020.  It includes as PDex like use case where a chain of provenance instances are discoverable in a Federated Provenance Store, which could be a solution for the ability of any authorized entity to track provenance related to a specific PDex transaction/transformation.  Seems ripe for a Connectathon demonstration.