2023-01-09 National Directory Meeting

Greg Meyer

Joseph Shook 

2023-01-05 National Directory Meeting

Project Page: National Healthcare Directory

Project Scope Statement: National Healthcare Directory PSS

Implementation Guides:

• CI Build: http://build.fhir.org/ig/HL7/fhir-us-ndh/branches/master/index.html
  • Note: 3 IGs have been combined into a single IG
• Balloted Versions:
  • http://hl7.org/fhir/us/directory-query/2022Sep/
  • http://hl7.org/fhir/us/directory-exchange/2022Sep/
  • http://hl7.org/fhir/us/directory-attestation/2022Sep/

Connectathon: 2023- 01 FAST National Directory of Healthcare & Da Vinci Plan Net

Zulip Channel: https://chat.fhir.org/#narrow/stream/283066-united-states.2Fnational.20directory

Predecessor work that this effort builds upon:

• • VHDir Implementation Guide
  • ONC Healthcare Directory initiative
  • Da Vinci PDex Plan Net Implementation Guide

Sept 2022 Ballot Cycle Milestones

Tentative: May 2023 Ballot Cycle Milestones

Save the Date! January HL7 Working Group Meeting & Connectathon

• Connectathon: January 14-15, 2023 (2023 - 01 Connectathon 32)
• Work Group Meeting: January 16-20, 2023

• Location: Hilton Lake Las Vegas Resort and Spa, Henderson, NV (In-Person)

• Registration now open! 
• FAST Infrastructure Track Kick-off and Implementer Prep Calls will be held Jan 6th at 11:00 AM ET
  • Zoom Meeting: https://hl7-org.zoom.us/j/95475044278?pwd=OGJIMWRIUGxyTjZzU3J4djhVZG9kdz09

CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P)

• Federal Register (officially published 12/13/22)
• Fact Sheet
• Comment period closes 3/13/2023

This proposed regulation cover areas like Patient Access API, Payer to Payer Exchange, Handling Prior Authorization, etc.

Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard Proposed Rule (CMS-0053-P)

• Federal Register (published on 12/21/22)
• Comments due 3/21/23

This is the long awaited attachments rule from the Division of National Standards. It contains follow on requirements in the Accountable Care Act that mandated that CMS establish a standard for exchange of attachments compatible with HIPAA transactions. 

Ming identified gaps in extensions: http://build.fhir.org/ig/HL7/fhir-us-ndh/branches/ming1/index.html. Bob and Ming discussed in an attempt to reconcile outstanding issues with consolidated IG (underlying and associated standards) 

• NDH Digital Certificate - digital certificate as an overall collection of types of uses; didn't carry this forward to IG. Defined specific places where you would record digital certificate for exchange. Reintroduced this with 3 uses (authentication of individual/org, assign certificate, provide digital cert) to whatever CA is to extend digital certificate. Put digital certificate back in with 3 uses, externalize expiration date. Easy determination if certificate is going to expire. Does not replay certificate in endpoint resource
• Care Team: Annotation to add organization through role vs. individual. 
• New patient profile - characteristic of new patient but 'accepting new patients' extensions has 1 more element. Accepting new patients conditioned by what network they are part of, characteristics was e.g., age range, diagnosis, general spectrum of qualifications. However, other items in qualifications that could be conditioned by the network (e.g., accepting family members) so we left characteristic inside 'accepting new patients'. Combining them into 1 extension allows flexibility inside the network or network standalone. 
• New set of profiles, less constrained set of exchange resources 
  • RL: concern re: should this be in a separate IG predicated off of Base, will need to see how it's laid out and test it out; RD: require metadata profile data - will always know what profile it was based on
  • MD: Last Update: should be 0..1; RD: need to go back and restore the old Base profiles to add updated extensions
• LN's question re: endpoint and mimetype and payload type (discussion planned for Wednesday Q1 HL7 WG meeting) - JL will be there, LN can interact via chat during the meeting. Ticket https://jira.hl7.org/browse/FHIR-39617 MD worked this up against endpoint resource because Patient Administration and Zulip about this step to inform our work (will not be on R5).