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Gaps in Care Zoom Link

2020-05 Zoom Info for Each Track

Important Connectathon Time Schedules at a glance

Start Time May 13th (Wed): 4pm  - 7pm ETMay 14th (Thur): 9am - 7pm ETMay 15th (Fri): 9am - 6:30pm ET
9am ET


  • HL7 Morning Annoucement (9am - 9:15 am)
  • ET HL7 Session: Intro to FHIR (9:15am)
  • Tutorial: Beginning FHIR Shorthand

HL7 Morning Annoucement (9am - 9:15 am)

Gaps in Care Zoom (starts at 9:15am ET - 6pm ET)

10am ET
  • Synthea (Breakout) - tool to generate patient data for eCQM testing

11:30 am ET
  • HL7 Session: FHIR Testing & Tools (11:30am ET)

12:30 ET

Gaps In Care Track  - Da Vinci Kick Off (Demo RI endpoints, test data, Postman, etc.)

Recording coming ...

Gaps in Care Track Status Check/Demo (12:30 am - 1:30pm ET)
1pm ET
  • Tutorial: Advanced FHIR Shorthand

4pm ETHL7 Connectathon Kick Off
Clinical Reasoning Demo - Da Vinci Track Demo (4:00pm ET) 
4:30pm ET
Gaps In Care Track - Da Vinci Sync-up Gaps In Care Demo - Da Vinci Track Demo (4:30pm ET)
5pm ETDa Vinci Connectathon Kick Off

6pm ET


Gaps In Care Track Kick Off

Recording


HL7 Connectathon Wrap Up (6pm - 6:30pm ET) 

HL7  GotoWebinar

Submitting WG/Project/Implementer Group: 

Clinical Qualitly Information (CQI) Work Group

DaVinci Gaps in Care Project

Justification and Objectives: 

A “Gap In Care” is defined as a discrepancy between recommended best practices and the services that are provided and documented. 

The purpose of the Gaps in Care Connectathon track is to develop reference implementation and test $care-gaps operation for the care gaps use cases 

Goals/Scope:

Run the $care-gap operation for the targeted use cases and get expected results.

This track will use R4 version of FHIR

Clinical input requested (if any)

Clinical review of the input parameters for generating the Care Gaps report and expected results in the payload.

Related tracks

This track is a part of the larger Da Vinci Program.

2020-05 Clinical Reasoning

2020-05 Bulk Data Track

2020-05 Da Vinci Risk Based Contracts Member Attribution List

Track Lead

Yan Heras (yan.heras@optimumehealth.com)

Expected participants

  • Dynamic Content Group
  • Optum
  • Mettle Solutions

Track Orientation

An initial track orientation webinar will be hosted on April 16th, 2020 during the regular Da Vinci Gaps in Care weekly meeting  on Thursday 2pm ET- 3pm ET. See Gaps in Care Confluence page for meeting information. 

Additional track information with more technical details will be further provided on the regular Da Vinci Gaps In Care weekly meeting in the coming weeks leading to the Connectathon. 

System Roles

Client: 

Server: 

Scenarios

Sequence Diagram (a Group of patients)
 
Sequence Diagram (a single patient)

Care Gap Scenario: ($care-gaps)

This is the Reference Implementation server endpoint for Gaps in Care to call the $care-gaps operation - 

          (Measures loaded to the r4 sandbox are specified based on FHIR 4.0.0  and are using the CQL 1.4 Translator.)

Updates on 5/14/2020
Repo: https://github.com/DBCG/davinci-gic.git

ReadMe: https://github.com/DBCG/davinci-gic/blob/master/README.md

The Gaps in Care branch cqf-ruler:  https://github.com/DBCG/cqf-ruler.git, the davinci_gic branch

Automatically building a container at: contentgroup/cqf-ruler:gic

That updates our sandbox with a manual click. (Rob Renolds' note: I did said click so our sandbox has been updated with the fixed Ruler; and ran the _refresh script in our IG (which is pointed at our sandbox)

Working implementation: https://gic-sandbox.alphora.com/cqf-ruler-r4/fhir/Measure/$care-gaps?periodStart=2019-01-01&periodEnd=2019-12-31&topic=57024-2&patient=numer-EXM124-FHIR4.

Gaps In Care use cases confluence page

Bundle that is returned by the Gaps In Care $care-gaps operation

Targeted Use Cases for the Connectathon:

Please see Gaps In Care $care-gaps Operation and Profiles for definitions of the In Parameters and Out Parameter. 


Use Case

Pre-conditions

In Parameters

Out Parameter

Bonus PointBonus Point
1

As a practitioner, get all gaps for a patient

Server knows the patient  

Server has measure data for the patient

  • periodStart:   1/1/2019
  • periodEnd:     12/31/2019
  • providerOrganization: n/a
  • subject:           a specific patient  (provided by the server) 
  • topic:               n/a
  • program:         n/a
  • measure:         n/a
  • practitioner:    n/a
  • status:             n/a  (default is all gaps: open and closed)    

return

0..* bundle where each bundle is a document bundle where the 1st entry is composition followed by one MeasureReport for each measure where the patient has a gap (open and closed)

Run the $care-gaps operation for open gaps only

  • periodStart:   1/1/2019
  • periodEnd:     12/31/2019
  • providerOrganization: n/a
  • subject:           a specific patient  (provided by the server) 
  • topic:               n/a
  • program:         n/a
  • measure:         n/a
  • practitioner:    n/a
  • status:             open-gaps

Run the $care-gaps operation for a specific measure

  • periodStart:   1/1/2019
  • periodEnd:     12/31/2019
  • providerOrganization: n/a
  • subject:           a specific patient  (provided by the server) 
  • topic:               n/a
  • program:         n/a
  • measure:         colorectal screening measure
  • practitioner:    n/a
  • status:             open-gaps
2

As a practitioner, get all gaps for all patients that are on my schedule tomorrow.

Server knows the patients  (a Group of patients) and provides them.   

Server has measure data for the Group of patients.

  • periodStart:   1/1/2019
  • periodEnd:     12/31/2019
  • providerOrganization: n/a
  • subject:           a Group of patients  (provided by the server) 
  • topic:               n/a
  • program:         n/a
  • measure:         n/a
  • practitioner:    n/a
  • status:             n/a  (default is all gaps: open and closed)  

return

0..* bundle where each bundle is a document bundle where the 1st entry is composition followed by one MeasureReport for each measure where the patient has a gap

Run the $care-gaps operation for open gaps only

  • periodStart:   1/1/2019
  • periodEnd:     12/31/2019
  • providerOrganization: n/a
  • subject:           a Group of patients  (provided by the server) 
  • topic:               n/a
  • program:         n/a
  • measure:         n/a
  • practitioner:    n/a
  • status:            open-gaps  

Run the $care-gaps operation for a specific measure

  • periodStart:   1/1/2019
  • periodEnd:     12/31/2019
  • providerOrganization: n/a
  • subject:           a Group of patients  (provided by the server) 
  • topic:               n/a
  • program:         n/a
  • measure:         colorectal screening measure
  • practitioner:    n/a
  • status:             open-gaps
3As a care manager, get all gaps for patients in my organization.

Server knows the patients for the organization and provides them. 

Server has measure data for all patients of the organization.

  • periodStart:   1/1/2019
  • periodEnd:     12/31/2019
  • providerOrganization: my_organization_TIN
  • subject:            n/a
  • topic:               n/a
  • program:         n/a
  • measure:         n/a
  • practitioner:    n/a
  • status:             n/a  (default is all gaps: open and closed)  

return

0..* bundle where each bundle is a document bundle where the 1st entry is composition followed by one MeasureReport for each measure where the patient has a gap

Run the $care-gaps operation for open gaps only

  • periodStart:   1/1/2019
  • periodEnd:     12/31/2019
  • providerOrganization: my_organization_TIN
  • subject:            n/a
  • topic:               n/a
  • program:         n/a
  • measure:         n/a
  • practitioner:    n/a
  • status:            open-gaps 

Run the $care-gaps operation for a specific measure

  • periodStart:   1/1/2019
  • periodEnd:     12/31/2019
  • providerOrganization: my_organization_TIN
  • subject:            n/a
  • topic:               n/a
  • program:         n/a
  • measure:         colorectal screening measure
  • practitioner:    n/a
  • status:             open-gaps

Relevant Resources/Profiles:

Test Data:

Issue Tracker

Gaps in Care Operation Issue Tracker

Track Report-Out

Gaps In Care Report Out document

Con Man App  Look for Da Vinci Gaps in Care Track on the left navigation bar

Security and Privacy Considerations

The scenarios and reference implementations here run using open (i.e. unsecured) connections. Systems SHALL NOT use PHI in any form, or data derived directly from PHI.

Other Documentation:

Gaps In Care Supporting Materials

Gaps In Care $care-gaps Operation and Profiles

https://github.com/DBCG/cqf-ruler/wiki/Care-Gap-Report-Walkthrough

Track Debrief

May 21st Gaps in Care weekly call at 2pm ET (see meeting details on Gaps In Care & Information)


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