2021-06-25 PDex Meeting

• 2021 CMS HL7® FHIR® Connectathon - July 20-22, 2021, registration ends July 1st, 2021
  • Information and Registration here (it's free): http://www.hl7.org/events/cms/
  • Confluence page: CMS 2021 - 07 Connectathon 2

Patient Cost Transparency Use Case- Kick off public call June 25th, 2021

Fridays at 11AM Eastern- here for call details, confluence page here

Kick off call started this week. Use case will mainly covering the price transparency rules for hospital and CAA. 

Join on Fridays. Use case will impact all providers/payers. 

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.

Discussion-

• perhaps start with practitioner role as resource
• look at the examples in the IG, as one has been provided to find specialty, provider service, organization
• not one place to start for all searches but there are examples available to help start with
• be useful to be at the CMS connectathon and join the directory to test it
• could use one search string and use underscore to look through additional profiles
• underscore filter can be used but not widely supported
• underscore grasp mechanism can be better but less widely supported
• best answer- probably can't, you lose constraints and brackets in search parameters
  • is this responsibility land to the server or the application?
  • suggest to have them attend the connectathon

Context: the NPRM identifies a requirement for payers to share the active and in process authorizations with members, providers and other payers. 

We're looking to exchange claim response, figure out accumulators, and how to identify the clinical data specific to the authorization.

Let's talk about the elements from PCDE that are relevant to help meet this need. 

Change to calls going forward - we will use the former PCDE 2pm ET call time to drive the work to support the next version (HL7's STU2) of PDex, Formulary and Plan Net. Will update to weekly as well. The PDex call at 12noon ET will remain as is for Implementer Support and updates to existing version. 

Update 6/25/21-

Put a list of enhancement together to add between now and January 22 Ballot, include updates for formulary. Enhance shopping experience and make it searier for formulary to be implemented

Enhance Plan Net to include phone number and possibly looking at bulk data

Enhance of PDex to see if we can include PA information, have data available to member, to payer and to next payer when member moved.

Will using the current PCDE public call to start working sessions on the building the enhancements. 

This call will be used to continue to build implementation IG and help answers questions on the STU1.

Next steps- have this ready by December to enter January ballot. Intent is to ballot new section only. Tentative date of publication for STU2 if able, end of April 22.

Review Formulary Tickets

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