Chair: Mark Scrimshire
Scribe: Vanessa Candelora
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."
Minutes Approved as Presented
Meeting Minutes from Discussion
|Decision Link(if not child)|
|Management||Review ANSI Anti-Trust Policy|
Moved to Supporting section below!
|Today||2021 CMS HL7® FHIR® Connectathon|
No review today, will review next week.
|mustSupport elements aren't complete|
|Review FAQ Proposed Responses|
Reviewed the proposed response for 019 and the response from CMS.
Rob and Bob discussion to clarify available values. Rob - what is in the provider taxonomy for pharmacy are like retail: Clinics, mail order, compound, etc. It seems to be more like "can I get it while I'm there or will I get it by mail?" info. Makes sense.
Finalized (no one objected)
|Open for Implementer Questions|
Recent Implementer Questions:
There is no requirement to exchange the PDex Formulary as part of the mandate for Jan 2022, it is specific to USCDI data. PDex Formulary is an open API.
2. From Payers stand point of view, do we need to build a web portal or a 3rd party app so that a member directed payer data exchange can happen? Please let us know. Based on my understanding after reading the PDEX specification, I felt that Payers need to build a web portal for exchanging payer data. Is my understanding correct?
Short answer: we cannot answer today. Some context on the two schools of thought in discussion as of now:
A - this is part of a b2b transaction, so should be able to use business to business relationships and membermatch for which they want to exchange info.
B - The member should go have to authenticate in the old plan to consent to have their data shared with the new plan. Treat it like a payer app to authenticate.
There are pros and cons to each approach: HIPAA and consent, scope and realistic, burden to patient - If no portal, what is the process?
3. Provenance: Let us say Payer A got a bundle of resources after doing Patient/$everything on a members data from Payer B. And the Bundle contains let us say 10 claims, 1 coverage, 25 observations, 3 conditions etc. all originated at Payer B. Then, we need to send one provenance record for the Bundle and one for each resource type inside the bundle. Is my understanding correct?
Unclear from question Payer A vs. Payer B as new or old. We walk the workflow.
For 1/1/2022 you only need USCDI to comply with reg. and you will get a transmission of who sent the bundle (not the origin). e.g. Origin might be "I got this observation from St. J's Hospital in a CDA." That could be included in the bundle. If you want to package it up to a new payer.
If you know the orgin (St. J) you'll want to include. You'll also want to include the transmitter info if you are getting the data from a previous payer and passing it to a new payer. So, in that likely scenario, provenance records would be for each:
Note: If I make a request Patient/$everything, it may not come with provenance, unless they ask for it. If payers want to protect themselves they should be asking for the provenance records as well - see notes below on this and we will also add more FAQ language to advise.
4. In case the Payer is just a transmitter of data from one payer to another, then do we need to create just one Transmitter Provenance record or one transmitter provenance record for each resource type inside bundle? Please explain provenance scenarios with some examples for clarity.
See #3. The provenance record relates to everything in the bundle. Provenance can have multiple targets. You could get many that apply for one resource or many resources. Rule for provenance is that it's one provenance for the event.
It's unlikely that a payer is only transmitting the records from the prior payer to the next payer, that implies that the current payer would have 0 activity for a year for the payer. More likely, you've had info from yourself and from the prior payer. Transmitter will be you, but the details of each of the records will be where it came from and should be passed along in provenance as well.
You'll provide provenance for the bundle and you'll provide provenance for all the other sources you have data from.
Discussion related to #3 and #4:
If the Payer does a $everything, does it include the already created provenance for a particular resource? Unknown.
You have to do a reverseinclude of provenance to get it...
Definition of $patient everything is a little loose, it does say they "should" include provenance.
$patienteverything is not actually a search.
Expectation of USCORE is that you'd return the last organization that touched it. If you have provenance for the record that you are including everything for, you should include it.
IG does require a provenance for the bundle that says "Hi, I'm Payer x and I'm the transmitter" also... all should read the IG and we will provide FAQ guidance here.
Summary - let's add this the the FAQ page: If you use $everything, you should get the provenance, if not, you can't do a reverse include, you would need to query them separately. Payers should on a $everything include any existing provenance records.
One final Question: On payer to payer exchange, what is the expected response time? Payer App would expect to be synchronous with the request. If B2B (Payer to Payer), the pended regulation said within 24hours, but it's hard to answer until we know how we are going to solve it.
2021 CMS HL7® FHIR® Connectathon Overview of Track
Review FAQ Proposed Responses
Adjourned at 12:42pm EST.
|PDex Companion Guides|
|CARIN CPCDS to US Core Mapping|
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
|PDex - US Core |
Source PowerPoint: PDEXandUSCoreRelationship.pptx
|Da Vinci is seeking answers to open questions and clarifications needed on the implementation and operational needs of the upcoming CMS Patient Directed API Rules.|
Find initial questions and corresponding answers shared from our colleagues at CMS here
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!
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
- David Hill-Look in the coverage resource and Medication Knowledge to designate where you would include a Formulary ID.
- David Hill Create ticket for updating the definition column on the 7.26.1
- David Hill- add the second ticket referenced to the FAQ 0017 question.
- Mark Scrimshire- Add FAQ for $everything and provenance guidance - 6/11 convo today.
Attendees - 32
Intepro Solutions Rakesh Mathew Daniel Lilavois Patricia R Harbin Shalabh Gautam Kamaraj Kaliaperumal, Carefirst Bhanu Vemuri Narasimha Murthy Accenture Google Cloud Healthcare Maggie Mellon Courtney Bland
Present Name Affiliation CMS BCBST Deepthi Reddy Mettle Solutions Allscripts Eric Sullivan Inovalon MITRE India Duncan Optum Availity Susan Lestina AHA Bob Bowman CAQH Thomas Kessler CMS Patrick Edwards Briana Barnes Scope Info Tech Kishore Metla Mettle Solutions John Donnelly Lorraine Doo CMS Melanie Jones CMS Rim Cothren Yolanda Villanova CMS Manoj Kumar BCBSFL MITRE Srinivas Konchada Centene Corporation Sheryl Turney Anthem Helina Gebremariam Mike Novales BCBSIL Ric Light Humana Ann Gallagher Optum Chris Klesges Mitre Adam Gronsky Health Fidelity CaseNet Anthem CMS eClinicalWorks Healow Interfaceware Mark Rucci Spectramedix Anthem Cindy Monarch BCBSM Michael Kim Jim Catan Accenture BCBSA Jia Chen Robert Dieterle Jeff Eastman Ernestine Cooper Jason Teeple CIGNA Lloyd McKenzie Mary Winter Rachel E. Foerster Tom Grannan Azuba Tony Benson BCBS AL Independence BC Henry Archibong Inovalon HL7 Consultant Abdul Sattar Anirudh Choudhary Todd Biske ESI Darrell Woelk Doug Stoss Rick Lisseveld Aegis LakshminarayananSaravanan Laurie Burckhardt WPS Health Plan Kevin Lynch Inovalon Joseph Minieri MITRE Durwin Day BCBS IL Pamela West Ravi Thakkar Aetna UO Aetna Swati Nanda Aetna CVS Health Cyrus Kevin MITRE Fred Harmon Ready Computing Blue Cross NC Michael Ryan NCQA HealthSparq CVS/Aetna Dorothy Lee NCQA Khoa Nguyen Suma Addagadde BCBSNC Caitlyn Campi FL Blue Diane Bengtson Sean Mahoney MITRE Balaji Richard Lisseveld Shanna Hartman CMS Kevin Day Edifecs Sai Bagewadi Cognizant Kechia Scott Kerri Wing Krithika Kumar Accenture Don Zacharia Evernorth Pamela Maklari Cognizant @David Bradsher BenMedica @DJ Gallagher @Follis @Nidhi @Emily Lozada
Patricia R Harbin
Google Cloud Healthcare
Chris Johnson Independent Health Scott M. Robertson David Clowers Anthony Omosule Accenture
Present Name Affiliation Nancy Spector AMA Bruce Wilkinson BenMedica Avality BCBSAL MCG ONC Surescripts NCPDP Anupam Thakur BCBSFL Jonathan Hutchins BCBST Anthem Sunitha Godavarthi Christopher Gracon Labcorp James Derrickson Intersystems Cognizant Neetha Joseph Cognizant Kaiser Permanente MITRE Rutika Express Scripts Brody Brodock Allscripts Michael Brody CME Online Theressa Baumann BCBS AL Mona Chandrapal eClinicalWorks Optum Aakash Deliwala eClinicalWorks Mayo Epic Shaheer Stanley Nachimson Anthony Smith UNC Health Howard Cohen Minaei Behnaz FDA BCBSA Shilesh Nair gdit NewWave MaxMD BC Idaho Edward Castagna Altarum Andrea Kent CoverMyMeds Carrie Denny Kim Pham Celine Lefebvre AMA Edifecs Josh Lamb UPMC Keya Shah Casenet Gevity MITRE Mrugen Mehta eClinicalWorks Revathi Jayakumuar Supriya Bapi Bhera Matt Dyer Vyne Sree Vijetha Vegi C-HIT BCBSA Rich Bloch Lumedic Cigna Paul Knapp Ron Urwongse CAQH Anand Raghavan HealthLX Ezequiel Morales Cigna Evernorth Frank McKinney Hanna ? Brett Rauschke Carolyn McKinney Clarissa Winchester BCBS AL JC HealthShare Exchange (HSX) River Wong Rob McClure MD Partners Ronald Wampler CVS Health Aetna Derrick Woolridge Beata Ferraiz Ed Donaldson Consultant with Humana Julie Burgoon Mark Neumuth Aetna Raj Sankuratri Aetna Dr. Cheryl D. Lohman Germantown, MD | Family Physician Barbara Valeno Eshaa Dhall eclinicalworks Angie Brandon Bryan Briegal ACP Beatrice Thompson CVS Health Hema Srinivasa Kristin Ashby Aetna Nag Sanivarapu Abhishek Pandey Shailesh Prabhu Travis Hendrix Dr. First Zakir Guler Jason VanderJagt edifecs Erika Wagner Shamil Nizamov Michael Robinson Christopher Marchand Chris Busch Nathaniel Hosenpud Christopher Roedocker SKYGEN Jeff Brown Evernorth Sid Nehal Amin Amit Cudykier C45214 Noah Lincoff Yukta Bellani Evernorth/Cigna Brian Schoonover Optum Tone Southerland OneRecord @Ram Optum @Callie Phillips Kat Sobel
Scott M. Robertson