2021-06-18 PDex Meeting

• 2021 CMS HL7® FHIR® Connectathon - July 20-22, 2021
  • Information and Registration here (it's free): http://www.hl7.org/events/cms/
  • Confluence page: CMS 2021 - 07 Connectathon 2

FHIR-32718 - Getting issue details... STATUS  - If there is a mis-spelling from the search.  Not found is more important than a non-formulary and non-covered. Difference between misspelling vs. real drug but not on formulary. 

Is there a master list of drugs provided someone that we could return the "not found" vs. others? 

RxNorm dataset - would the consumer of the data have a list above and beyond the RxNorm data set? 

• RM: Does not see that the issue raised (while cvalid) is a formulary issue.  It's the responsibility of that app.  Formulate the query that makes sense for the app.  We are not aware of a list that goes beyond RxNorm. Also, the NDCs that don't have RxNorms can also be covered, but for another day. 
• There may be additional hoops to get default coverage for others. 
• Add the expectation that it's the app's responsibility to validate that it's a real drug. Then, the response was that 
• Which string should you send when the expectation is an RxNorm code.  Sender should go to RxNorm, use the right value, and then the response can say "no, it's not on formulary" 
• If it's a null set of a real drug, it is not on formulary.  
• I.e. the general form, not the branded form
• For the formulary drug profile, there is the representation of brand and generic in the GUI. 
• Clarify what we expect both sides of the query when we allow for both branded and non-branded representation of drugs.  
• If you get a query for a branded query, what is expected.
• Does it support returning multiple matches to a given drug name query?
  • Medication Knowledge: Get

There is a fetch for a specific resource (single)

So that null is expected to be interpreted as non on formulary as opposed to a bad query - not persuasive with mod

Additional Issue: To form a valid query into the system, there is some validation for the user interaction.  the samples provided for PDex formulary.  They use the formulary drug v3000 sample. the way the display name is encoded is n the way RXNorm doe sit.  The prescriptible synonym not the name.  Should they use the name or the 

Corey will add a tracker about addressing the multiple names -   -  https://www.hl7.org/fhir/rxnorm.html  to ask for clarity on what to display for the proper data in RxNorm.  Need to add clarity on what string we expect people to be searching.   Rx Nav and RxNorm - there are a few names. 

Rob M note: All of this is going to change at some point - the content of using x with FHIR is under the purview that are going to change inside of HL7. It needs to be improved and done.   Rob agrees that every IG should point back to these pages (i.e. RxNorm IG)

Now under the rule, it's an option for the 

Need new Tracker Items:

1) For proper names for display 

2) expected returns with regards to allowance for both brand and non-brand search matches.  

Reviewed:  FHIR-32724 - Getting issue details... STATUS

likely an edge case - formulary for a member (the reg) is likely to have one drug plan.  If there was two regulated plans, offered by the same payers, by the same API. you could potentially get this issue, but seems like an obscure edge case. 

Agreed: Non Persuasive: Would be handled by the back end business ruels.  Asummptio is that for this scenario the abck end would pick one, combine them for jteires, would present one formulary.  have their own back end logic for picking one, tiering, etc.  

FHIR-31037 - Getting issue details... STATUS  Discussed and reviewed.  Pursuasive with Mod. 

Added drafts from last week, still work in progress.  

Finalized #20. 

Use Case #1: Need to develop an Advanced Search feature that may require to perform search across profiles e.g. single search that involves search using parameters such as Provider’s Name, Specialty, Health Plan, Spoken Language, Zip code or City/State and Gender.

Issue/Challenge: I this case I could not figure out a single profile that can be used to perform this search. Similarly, we cannot perform search in multiple steps (searching the search result) as this will be too complex plus will not work with pagination provided via FHIR server.

Issue/Challenge: I this case I could not figure out a single profile that can be used to perform this search. Similarly, we cannot perform search in multiple steps (searching the search result) as this will be too complex plus will not work with pagination provided via FHIR server.

Review FAQ Proposed Responses 

Review Formulary Tickets:  FHIR-31683 - Getting issue details... STATUS and  FHIR-31684 - Getting issue details... STATUS

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