2022 - 09 Da Vinci Payer Data Exchange (PDex) Post-STU2 Update and Formulary

Kick-off call will take place on 9/9/2022 during the regular 2:00 PM ET PDex/Formulary Workgroup call; 

Meeting recording: https://hl7-org.zoom.us/rec/share/CQ_BgP_oO3T-gkd6VNFmYiI1CyIjsoJkCBgf8SS03golHI7R5OZc-dT1M7cjCxQ.pLtQR2tF4-5_PG1R 

Use Case 1 - Payer-to-Payer

System roles:

• Payer acting as Server

• Payer acting as Client

Payers will need to register an mTLS endpoint into a GitHub repository to enable mTLS endpoint discovery.

Role 1 Name: Establish mTLS connection

Scenarios:

Payer1 will search for Payer2 in mTLS endpoint repository

Payer1 will request connection with Payer2

Payer2 will lookup  Payer1 in mTLS endpoint repository to confirm legitimate request

Payer2 will reciprocate connection back to Payer1 to establish mTLS connectivity. 

Scenario Step 1 Name

Action:

Payer1 and Payer2 successfully connect via mTLS

Precondition: Success Criteria: 

• Payer1 successfully makes a request to OAuth2.0 Dynamic Client Registration Protocol endpoint and relieves client credentials that enable a $member-match operation to be requested.

Success Criteria:  

Payer1 reaches $member-match operation with valid client credentials issued by DCRP endpoint via mTLS connection.

Bonus point:

Successful $member-match operation

TestScript(s):

TBD

Security and Privacy Considerations:

• mTLS will be established to enable access to OAuth2.0 DCRP endpoint.

Use Case 2 - Payer Provider (Provisional)

System roles:

• Payer acting as Server

• Provider acting as Client

Providers will need to be registered with Payer with appropriate User level credentials to access the required FHIR APIs and Operations

Role 1 Name: Get Patient info for Current Patient Roster

Scenarios:

• Provider will submit a list of patients to Payer to retrieve patient clinical data
• Provider will submit a list of patients to Payer to retrieve data for Patients since a previous download date
• Payer will validate list to ensure all members are attributed to Provider

Precondition: Success Criteria: 

• Provider successfully downloads data from Payer for a group of members/patients using bulk async protocols

Bonus point:

• Provider successfully downloads a subset of members from their attributed list
• Payer and Provider successfully negotiate updates to attributed member list(s)

TestScript(s):

TBD

Security and Privacy Considerations:

• TBD

Use Case 3 - Formulary Bulk Export

System roles:

• Payer/PBM acting as Server

• Third-Party App acting as Client

Role 1 Name: Server 

Server provides $export operation to enable one or more Formularies to be exported.

Role 2 Name: Client

Client makes $export request to download formulary.

Da Vinci Formulary STU2 RI with Bulk.postman_collection.json