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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 DyerVyne
  •  

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

  •  
MITRE
  •  
Keya ShahCasenet
  •  
Rich Bloch
  •  
Interpro
  •  
Lauri Shock
  •  
Andrew JohnsonNational Decision Support
  •  
MITRE
  •  
Mark FlemingChange Healthcare
  •  
eClinicalWorks
  •  
Prathima
  •  
Rachel Foerster & Associates
  •  
Heather McComasAMA
  •  
Megan RileyMITRE
  •  
Summer DumanRegence
  •  
Michelle BarryAvaility
  •  
Chris Cera
  •  
Michael FasuloRegence
  •  
Mettle
  •  
Lauree Marshall
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
  •  
BCBSA
  •  
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
  •  
Tammy BanksProvidence St. Joseph
  •  
Bob HarringtonAllscripts
  •  
Vishnu
  •  
DanielleSutter Health
  •  
MITRE
  •  
Sonya MayOptum
  •  
Molly MalaveyAMA
  •  
Guidewell
  •  
Angela BublikRegence
  •  


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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 



CRD/DTR Implementation, IG Questions

Is there a scenario where the provider can send or ask for coverage requirements for more than one clinical order (e.g., 3 lab orders)?

  • Depending on what you're ordering, may have substantially different documentation requirements
  • Assuming you need to collect document, you'd have to be able to merge rule sets for 3 different orders - too big a leap to start with?
  • For first pass, perhaps constrain to only ask one question at a time - can ask them sequentially
  • When CDS Hooks gets triggered, it will send all outstanding orders
    • End user interface - sends full collection of orders, and the CARDS you get show up on bottom of screen as items you might want to know about - typically not associated with a particular tick box for what you're ordering... it's relevant to all the items you're ordering
    • Can return multiple CARDS - if you order 5 things, you could return 5 or 17 CARDS, for example
  • When CDS Hooks gets triggered, what does it mean it will send all outstanding orders?
    • When you're authoring orders, might be authoring more than one at same time (e.g., prescriptions, labs, imaging)
    • You can send all the draft orders or orders you're about to sign off on (not all orders that exist, just the ones you're working on right now)
    • Some orders don't go to the payer for authorization - would those be included?
      • Default is that all orders in the set being authored are sent to all CDS Services that are subscribed to that hook - within that, EHR can filter to avoid sending certain info to certain entities
      • Scenario: one order covered by payer, but another order seen as a prerequisite (e.g., if ordering drug, you also need to order a particular lab test)
        • EHR needs to determine what's appropriate to send and what's not


Will there be a scenario where we get a CARD back and there's no user intervention?

  • CRD starts with sending request with any pre-fetch, sending access token, having payer decide what needs to get done and send back CARD to do that (could result in nothing, textual info, link to PDF, link to rules for DTR and ability to spawn DTR or equivalent inside of EHR) - CRD is done at that point
  • At that point DTR gets rules form payer and asks you to verify this information - doesn't need to be something the user has to do manually - all the information could be collected automatically, and app would let provider know it's preparing to send something back to the payer, and allow provider to review it if they want to
    • Store in EHR, send back to payer, make it available for a prior authorization, etc.


Group reviewed and provided input re: Healow Diagnostic Imaging scenarios

  • Everything requires sending FHIR Prior Auth bundle - not allowed to just send 278
  • Not 278 generated directly from SMART App? Still doing claim $-submit and then translate to 278?
    • If EMR has capacity to make conversion happen on our own, end state is 278 - take data into FHIR resources, and then convert to 278
    • That defined PAS bundle, info necessary to populate 278 and the documentation, also needs to go as FHIR resources - whether it's in 275 binary segment or some separate path (since no attachments rule) - it needs to go to the payer
  • Any response that the provider has to make via Questionnaire also needs to be stored back in the EHR/medical record
  • Not expecting CARD to return Questionnaire, the CARD would return a link to the Questionnaire
  • Send Questionnaire, auto-populate it with the rules, and then if there's something missing you would request from provider
  • Question re: collecting responses and bundling them into PA - not everything you collect in the Questionnaire can't be populated in 278?
    • Everything that went into the Questionnaire, including resources that created answers in the Questionnaire, any documents you retrieved as document references - assembly of FHIR resources - that all goes into the PAS bundle
  • Think of Questionnaire as everything I need to know - not just what's missing - if it can be auto-populated via EHR API, then it's complete. If not, provider to fill in the rest.


Supplemental Examples - what do we need to develop?
  • Healow working on examples with Larry/MITRE team and will share with the group in 2 weeks
  • Need examples for various combinations of orders and determine what's included in current version vs. future:
    • Single
    • Multiples when only one requires a response
    • Multiples when each one requires a response
    • Requires going into DTR or some other process
  • Work with practicing clinicians to develop common high volume scenarios as it relates to DME, Diagnostics, Referrals (e.g., Home Health), Drugs Covered Under Medical Benefit
    • Order set - ordered commonly together, includes multiple orders
    • Multiple orders not grouped together in an order set
    • Orders not within an order set
  • Need examples of discrete reports - whether they be FHIR resource or document reference

Management
  • Reminder that Da Vinci calls are cancelled Friday, 7/3 due to holiday

Next Agenda


 Adjournment
Adjourned at 11:59pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Action items

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