2021-05-21 PDex Meeting

Link to the Read Out Mark shared today: HL7 FHIR Connectathon 27 Report Out.docx.pdf

Any questions?  

BB: Can we add Formulary ID into any of the FHIR resources?

Looking at the group level, where can I get the Formulary ID to group by tiers and group formularies?  From BPM, want to tell which formulary the medication is.  They have the tier info for the medication, but how do they say "which formulary does it belong to"  e.g. returning Tylenol.

Drug tier extension has a drug tier ID and Type.

Currently, we group things by coverageplan and coveragetier. can group a set of alternatives.

They are grouping the formulary - managed at a higher level than the coverage plan.  The plan has a formulary.  Inside the formulary, there are drugs. 

The assumption is that for each formulary API there is one formulary. 

DB: typically you'll have a great than 1 ratio with multiple cost structures, 2 formulary's and 20 coverage plan codes.  They are just repeating. no method for showing they share a given formulary. you don't need the list in pdf anymore. 

It's not built to show that two plans share a single formulary. 

Recommendation to add a value into Medication Knowledge that says this drug comes from this formulary.  The downstream use case is for providing alternatives. 

-Need a value that is shared across multiple data classes.  

there is no method to make a search based on this ID, so unless you shape the API query, the ID isn't serving a purpose other than back end - unless you are wanting to make different queries - 

In the scenario where they are looking for Alternatives, don't need member. E.g. Zocore is being requested, has alternatives like drug a and drug b.  The ID isn't used by the consumer nor is it available for search. why push it across the wire?  Should this be a back end system data setup to allow for sharing the return. Then the entry array, if you query the coverageplan, you get back the list of all the drugs on the formulary and each of those drugs could have a list of alternatives. 

Next Step: David Hill Look in the coverage resource and designate where you would include a Formulary ID. Coverage in member specific. Coverage Plan is not tied to a particular patient, it's a list of drugs covered by that plan. 

Note these are difference:

• Coverage under PDex
• Coverage Plan in Formulary.

BP: Request to also look at adding to Medication Knowledge in addition to Coverage Plan. 

Question 2: DB - Codeable concept, take the display and concatenate the code value with a description  (CARIN Blue Button EOB IG use the definition element instead of the :long.... 

Go to the Drug Tier Code system, binding

(Note: Definition column not populated is an error - create ticket)

Formulary Ticket updates

PDex Formulary JIRA Tracker Dashboard

Lloyd added some more tickets (see dashboard recent additions in the top right:17 Remaining Issues for Review 

Implementer Support

Review FAQ Proposed Responses  

Cancelled on 5/28/21 due to WGM. See you on 6/4

PDex IG Companion Guide List

PDex IG Companion Guide - Laboratory Reporting Resources

Latest draft CARIN CPCDS Mapping document: CARIN Mapping to FHIR interim 2020 0818 v2.xlsx

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

Find initial questions and corresponding answers shared from our colleagues at CMS here

• Links to Published IGs

• PDex STU 1.0.0
• Plan Net STU 1.0.0
• Formulary - STU 1.0.1

Implementer Resources

Da Vinci Implementer Support Page

Implementers can take advantage of tools: See the Reference links on the Payer Data Exchange (PDex) page to access links for Reference Implementations, sandboxes, test scripts, and more!

Da Vinci PDex for Patient Access API Frequently Asked Questions (FAQs)

CMS Final Rule Questions and Answers log

ONC FAST National Healthcare Directory (including end points) solution page that includes links to everything (solution doc, Connectathon, HL7 workgroup, etc.): https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/National+Healthcare+Directory