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Short Description

Test the Da Vinci Risk Adjustment Implementation Guide  

Long Description

Test the profiles and operations specified in the Da Vinci Risk Adjustment IG for the next ballot (STU 2)

  • Test operations: $ra.coding-gaps, $ra.remediate-coding-gaps, $ra.resolve-coding-gaps, $ra.evaluate-measure 
  • Test the profiles including Risk Adjustment Coding Gap Bundle, Risk Adjustment Coding Gap Composition, Risk Adjustment Coding Gap Clinical Evaluation DetectedIssue, and Risk Adjustment Coding Gap Original DetectedIssue
  • Test an end-to-end scenario 

Type

Test an Implementation Guide

Related Tracks?

Clinical Reasoning

Call for participants

Payers, providers, vendors

Track Prerequisites

Read the IG specifications

Create an account with Touchstone for testing using Touchstone test scripts 

Track Lead(s)

Yan Heras

Track Lead Email(s)

yan.heras@optimumehealth.com

Specification Information

https://build.fhir.org/ig/HL7/davinci-ra/

Zulip stream

https://chat.fhir.org/#narrow/stream/311469-Da-Vinci-Risk-Adjustment

Track Kick off Call

Recording: DaVinci Risk Adjustment Jan 2023 Connectathon Kickoff Call.mp4

SlidesRisk Adjustment Jan 2023 Connectathon Kick Off Call.pdf

December 15th, 2022, 4pm ET

System Roles

  • Payer   
  • Provider
  • Risk Adjustment Coder (Note that Risk Adjustment Coder could be either internal or 3rd party vendor contracted with Payer)

Testing Scenario:

Two breakout sessions scheduled on Saturday, Jan 14, 2023:

  • 2:00PM - 3:00PM breakout session at Grand Ballroom Salon 1
  • 4:00PM - 5:00PM breakout session at Grand Ballroom Salon 1

End to End Scenario

Step 1: Coding Gap Generation - (Payer)
Action

Payer calls $ra.coding-gaps operation to create a Risk Adjustment Coding Gap Bundle for a group of patients (use a group of one patient for this testing scenario to demonstrate group)

Preconditions

Payer Server is pre-populated with Risk Adjustment Coding Gap MeasureReport and resources for supporting evidence

Success Criteria             

returns: 

New RA Coding Gap Bundle
  Composition (status: preliminary)
    Original DetectedIssue (status: preliminary)
    Original Evidence
  RA MeasureReport

Step 2: Coding Gap Remediation  - (Provider request gap closure and invalidation)
SetupEnsure clean test environment

- <DELETE> [base]/Bundle?_timestamp=2022-11-27T11:42:12.848-07:00
- <DELETE> [base]/Bundle?_timestamp=2022-11-30T03:14:26.354+00:00
- <DELETE> [base]/Bundle?_timestamp=2022-11-30T03:16:18.198+00:00

Action

Provider calls $ra.remediate-coding-gaps operation to create a new Risk Adjustment Coding Gap Bundle                                                                                                       

Preconditions
  • Original Risk Adjustment Coding Gap Bundle is available on the Provider Server
  • Clinical Evaluation DetectedIssue and clinical evaluation evidence are available on the Provider Server
Success Criteria

returns 

New RA Coding Gap Bundle
  Existing Composition (status: preliminary)
    Existing Original DetectedIsssue (status: preliminary) - for gap closure request scenario
    Existing Original Evidence 

    Existing Original DetectedIsssue (status: preliminary)
    Existing Original Evidence 

    Existing RA MeasureReport

Add
    Clinical Evaluation DetectedIssue (status: preliminary)  - for gap closure request
    Clinical Evaluation Evidence

Bonus Point

Run Step 2 independently

    • Precondition: have a bundle available to Post that can run step 2 independently
Step 3: Coding Gap Approve Scenario  - (Risk Adjustment Coder)
SetupEnsure clean test environment:

- <DELETE> [base]/Bundle?_timestamp=2022-11-27T11:42:12.848-07:00
- <DELETE> [base]/Bundle?_timestamp=2022-11-30T03:14:26.354+00:00
- <DELETE> [base]/Bundle?_timestamp=2022-11-30T03:16:18.198+00:00

Action

Risk Adjustment Coder calls $ra.approve-coding-gaps operation to create a new Risk Adjustment Coding Gap Bundle                                                              

PreconditionsThe updated Risk Adjustment Coding Gap Bundle is available on the Risk Adjustment Coder Server
Success Criteria

returns:

New Risk Adjustment Coding Gap Bundle
  Existing Composition

  Existing Original DetectedIsssue (status: canceled) - for gap closure request scenario
    Existing Original Evidence 

    Existing Original DetectedIsssue (status: final)
    Existing Original Evidence 

  Existing MeasureReport

    Clinical Evaluation DetectedIssue (status: final) - for gap closure request
    Clinical Evaluation Evidence    

Set  DetectedIssue status to canceled/final

Bonus Point

Run Step 3 independently

    • Precondition: have a bundle available to Post that can run step 3 independently
Step 4: Coding Gap Resolution Scenario - (Payer)
SetupEnsure clean test environment:

- <DELETE> [base]/Bundle?_timestamp=2022-11-27T11:42:12.848-07:00
- <DELETE> [base]/Bundle?_timestamp=2022-11-30T03:14:26.354+00:00
- <DELETE> [base]/Bundle?_timestamp=2022-11-30T03:16:18.198+00:00
Action

Payer calls $ra.resolve-coding-gaps operation to created a new Risk Adjustment Coding Gap Bundle with the updated RA MeasureReport

PreconditionsThe updated Risk Adjustment Coding Gap Bundle is available on the Payer Server                                                                                                                           
Success Criteria

returns:

New Risk Adjustment Coding Gap Bundle
  Existing Composition (status: final)
  Updated RA MeasureReport

Include All
  Detected Issues (Original and Clinical Evaluation)
  Evidence (Original and Clinical Evaluation)

Set
  Composition status to final

Bonus Point

Run Step 4 independently

    • Precondition: have a bundle available to Post that can run step 4 independently

Test Scenarios:

https://docs.google.com/spreadsheets/d/1vcVp1KJH4_aERiwy7x-lARmYXR1JlcbniggPyQ6ZgGg/edit#gid=0


"Assisted" Generation Scenario - Risk Adjustment Coding Gap Report 


— — 

Reference Implementation End Points: 

Reference Implementation using cqf-ruler /HAPI

Novillus Risk Adjustment Server:  (require password to access)

Touchstone

There are two separate instances of Risk Adjustment validator set up in Touchstone. One points to the STU1 IG and another points to the CI Build which contains the STU2 content in development. 

Test Scriptshttps://touchstone.aegis.net/touchstone/testdefinitions

Test Plan:

Document Testing Results in the Connectathon Manager

Connectathon Manager: http://conman.clinfhir.com/connectathon.html?event=con32


stu2-b branch:

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