Short Description | A Da Vinci combined Track that covers the Drug Formulary and Provider/Pharmacy Directory Guides that address the CMS Patient Access API requirements of the Interoperability rule, including the Formulary STU2 balloted version (adding bulk data) and Plan Net STU Update (1.1.0) of the implementation guides |
Long Description | This Da Vinci track brings together the Drug Formulary and Plan-Net IGs that are cited by CMS to enable payers to comply with the Patient Access API rule. For payers this is an opportunity to test out their APIs with reference applications. For Consumer applications this is an opportunity to connect with payers and test your apps against the Drug Formulary and Plan-Net Patient Access APIs. |
Type | Implementation Guide |
Submitting Work Group/Project/Accelerator/Affiliate/Implementer Group | This track is organized by the HL7 Da Vinci Accelerator Project. The IGs are managed through the Financial Management and Pharmacy Work Groups |
Track Lead(s) | Corey Spears, and Sean Mahoney |
Track Lead Email(s) | cspears@mitre.org smahoney@mitre.org |
Related Tracks | 2022-05 CARIN IG For Blue Button® Track 2022-05 Da Vinci Payer Data Exchange (PDex STU2 inc. Payer-to-Payer) |
FHIR Version | FHIR R4 |
Specification(s) this track uses | US Core STU3 3.1.1 DaVinci Payer Data Exchange (PDex) US Drug Formulary STU 1.1 http://hl7.org/fhir/us/davinci-drug-formulary/STU1.1/ DaVinci Payer Data Exchange (PDex) US Drug Formulary STU 2.0 ballot + bulk data (https://build.fhir.org/ig/HL7/davinci-pdex-formulary/branches/bulk-draft/) DaVinci PDEX Plan Net STU1 1.0 (http://hl7.org/fhir/us/davinci-pdex-plan-net/) DaVinci PDEX Plan Net STU1 1.1.0 Update (https://build.fhir.org/ig/HL7/davinci-pdex-plan-net/branches/usCore/) |
Artifacts of focus | Plannet (Practitioner, Organization, Location), Formulary (PayerInsurancePlan, Formulary, FormularyItem, FormularyDrug) |
Expected participants | Payers, Technology Vendors and Consumer Application Developers MITRE IBM Edifecs |
Zulip stream | https://chat.fhir.org/#narrow/stream/215616-Da-Vinci.2FDrug.20Formulary.20Connectathon https://chat.fhir.org/#narrow/stream/207606-Da-Vinci.2Fplan-net-connectathon |
| Track Kickoff | |
Track Details | System roles: Payer FHIR API with member Authentication via SMART-on-FHIR App Launch Framework Payer Open API for Provider-Directory API Consumer App that can request access for member-mediated exchange via SMART-on-FHIR App Launch Framework All testers are recommended to preparer the Connectathon in advance. A Reference Server will be available, as will reference applications. Preparation of suitable coordinated test data across claims, clinical and reference resources is recommended. Role 1 Name: Referential consistency Scenarios Consumer App to connect to Patient Access API and Provider-Directory API and be able to reference Practitioner information from claim into the provider-directory provided by the same payer. Scenario Step 1 Name Action:
Precondition: Success Criteria:
Success Criteria: Bonus point: If Payer API configuration can demonstrate successful integration between data sources served up by independent FHIR Servers. e.g. Medical data and PBM data on separate servers and business logic is in effect to connect data related to a single member across the servers. TestScript(s): Touchstone scripts are available for each IG Security and Privacy Considerations: Patient Access API is protected by SMART-on-FHIR App Launch Framework (OpenID Connect/OAuth2.0 protocols). Bulk Data Scenario Action:
Formulary IG Postman Collection (for testing with Postman): 20220111 - Formulary IG Review.pdf |
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