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Implementation GuideScenarios IncludedSponsoring Workgroup

Project Number

PSS LinkPSS StatusProject StatusReference ImplementationProject PageWorkgroup CallsStatus

Data Exchange for Quality Measures

v1 Medication Reconciliation Post Discharge

v2 Colorectal Cancer Screening and Venous Thromboembolism Prophylaxis Measures

Clinical Quality Information (CQI)1429

Approved

Balloted for STU2 in May 2019 

Ballot Reconciliation in WG


In planning to add additional patterns

GitHub - Use Case Reference Code

Data Exchange for Quality Measures (DEQM)YesActive

Coverage Requirements Discovery


Financial Management1515PSS for Coverage Requirements Discovery

Approved

Balloted for STU2 in May 2019 

Ballot Reconciliation in WG

CRD GitHub Repository

Coverage Requirements Discovery (CRD)YesActive
Documentation Templates and Payer Rules   
Clinical Decision Support1493PSS for Documentation Templates and RulesApproved

Balloted for STU1 in Sept 2019 

Ballot reconciliation in WG

DTR GitHub Repository

Documentation Templates and Payer Rules (DTR)YesActive
Health Record Exchange Framework (HRex)
Clinical Interoperability Council (CIC)1494PSS for eHealth Record Exchange (eHRx) FrameworkApproved

Balloted for STU1 in early Sept 2019 

Ballot reconciliation in WG

N/AHealth Record Exchange Framework (HRex)NoActive
Clinical Data Exchange (CDex)

Provider to Provider

Provider to Payer

Patient Care1495PSS for eClinical Data Exchange (eCDx)Approved

Balloted for STU1 in early Sept 2019 

Ballot reconciliation in WG

CDex Communication Response App

CDex Communication Request App

Clinical Data Exchange (CDex)YesActive
Payer Data Exchange (PDex)

Payer to Provider

Payer to Member

Payer to Payer

Financial Management1489PSS for Payer Data Exchange (PDex)Approved

Balloted for STU1 in early Sept 2019 

Ballot reconciliation in WG

PDex GitHub RepositoryPayer Data Exchange (PDex)YesActive
Payer Data Exchange (PDex): Formulary
Financial Management1489PSS for Payer Data Exchange (PDex)Approved as part of PDex

Balloted for STU1 in early Sept 2019 

Ballot reconciliation in WG

PDex Formulary GitHub RepositoryPayer Data Exchange (PDex)YesActive
Payer Data Exchange (PDex): Plan Network Directory
Financial Management1489PSS for Payer Data Exchange (PDex)Approved as part of PDexPlan to ballot for STU1 in Jan 2020 PDex Plan Network Directory GitHub RepositoryPayer Data Exchange (PDex)YesActive
Prior Authorization Support
Financial Management1490PSS for Prior-Authorization SupportApproved

Balloted for STU1 in Sept 2019 

Ballot reconciliation in WG

Prior Auth Support GitHub Repository

Prior Authorization SupportYesActive
Alerts: Notification (ADT), Transitions in Care, ER admit/discharge

Admit

Discharge

Clinical Decision Support1516PSS for AlertsApprovedPlan to ballot for STU1 in Jan 2020 

Alerts Sender

Alerts Receiver

Alerts/NotificationsYesActive
Payer - Payer Coverage Decision Exchange
Financial Management1515PSS for Payer Coverage Decision ExchangeApproved

Balloted for STU1 in Sept 2019 

Ballot reconciliation in WG

PCDE GitHub RepositoryPayer Coverage Decision ExchangeYesActive
Gaps in Care & Information
Clinical Quality Information (CQI)1427HL7 Project Scope Statement Gaps In Care.docxApproved



Discovery
Risk Based Contract Member Identification
Financial Management1517PSS for Risk Based Contract Member Identification (Updated)ApprovedPlan to ballot for STU1 in January 2020 
Risk Based Contract Member IdentificationYesActive
Performing Laboratory Reporting
Orders & Observations (O&O)






Planning
Chronic Illness Documentation for Risk Adjustment
Financial Management1513PSS for Chronic Illness Documentation for Risk AdjustmentApproved



Planning
Patient Cost Transparency
Financial Management1514PSS for Patient Cost TransparancyApproved



Planning
Health Record Exchange: Patient Data Exchange
Patient Care1518PSS for Patient Data Exchange for Value-Based CareApproved



Planning

GitHub - Use Case Reference Code







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