Short Description

Testing the use of Member Attribution STU2 candidate IG focusing on the davinci-data-export, member-add, member-remove operations and the atr-group and davinici-patient-list functionality.

Long Description

The Connectathon will exercise the STU2 candidate Member Attribution  FHIR IG and validate:

  • Specific APIs proposed
    • Creation of Group
  • Specific Operations proposed
    • davinci-data-export
    • member-add
    • member-remove
  • Specific Data Structures proposed for representing the Member Attribution List. (Data Structures include Resources, profiles, valuesets, extensions)
    • davinci-patient-list
    • atr-group

This advances the concept of Group creation, Group discovery, Group management and Group exports for different use cases.

Type

Test an Implementation Guide

Related Tracks?

DEQM, RiskAdjustment, Pdex.

Call for participants

EHR vendors

Payers

ACOs 

Track Prerequisites

Bring either a client or a server (Consumer or a Producer).

Clients can also use POSTMAN tool.

Track Lead(s)

Nagesh Bashyam

David Degandi

Track Lead Email(s)

David.Degandi@cambiahealth.com;nagesh.bashyam@drajer.com 

Specification Information

Zulip stream

https://chat.fhir.org/#narrow/stream/214784-Da-Vinci.20ATR

Track Kick off Call

3pm ET on Wednesday, April 26, 2023

DV ATR May 2023 Connectathon Kick Off.mp4

Testing Scenario:

Role 1: Producer Role (Server)

  • System that will be responsible for creating the Member Attribution List
  • Server has to support the following resources 
    • Patient
    • Practitioner
    • PractitionerRole
    • Coverage
    • Organization
    • Group (atr-group)
    • Group (davinci-patient-list)
    • RelatedPerson (Optional)
  • APIs that would be required
    • Group/[id]/$davinci-data-export with the above resource types being extracted.  - STU2
    • Search/Read on Group resource (Phase 1 of the IG , already balloted, tested and published)
    • POST on GROUP - STU2
    • POST on PATIENT - STU2
    • POST on ORGANIZATION - STU2
    • POST on PRACTITIONER- STU2
    • Group/[id]/$add-member operation - STU2
    • Group/[id]/$remove-member operation - STU2
  • Effort Required: Few months if starting from scratch.

Role 2: Consumer Role (Client)

Effort Required: Can use POSTMAN if there is no client.

Will require a month if starting from scratch to develop a client.


Scenarios

Scenario 1: Consumer (Provider Organization) discovers the applicable Group Resource in Producers (Payer Organization) system

  • (Part of Phase 1 Implementations) 

Ability for a Provider organization to discover the Group Resource representing the Member Attribution List that is applicable to their specific organization.

For example, Multicare would like to know which Group Resource in Cambi'a System is applicable for their organization using the Contract Identifier or Settlement Entity Name

Pre-condition:

  • One of the following queries will be executed
    • Provider Organization knows the Settlement Entity Name or Contract Identifier

API: 

GET <Server Base URL>/Group?identifier=http://example.org/groups|12345

Success Criteria:

  • Receive Group Resource from the API call.


Scenario 2: Consumer (Provider Organization) Requests the Patient  List from the Producer (Payer Organization)

Ability for a Provider organization to request the full Patient List that is applicable to their specific organization. Note: The request has to be accepted by the Payer and eventually a Member Attribution List would be made available. This is an asynchronous request following Bulk Data IG specifications.

For example, Multicare would like to request the Member Attribution List from Cambia for a specific contract. 

Pre-condition: 

  • Provider Organization knows the specific Group Resource for the specific contract that represents the Member Attribution List.
  • The Group Id of the specific Group Resource that is applicable and was retrieved as part of Scenario 1

API

Group/[Group id]/$davinci-data-export with required parameters (sub-set of patients, subset of types, since parameter)

Success Criteria:

  • Request is accepted by the Payer and a Content Location is received as part of the Response. 


Scenario 3: Consumer polls the Content Location for Request Completion and Member Attribution List data location. 

  • (Part of Phase 1 Implementations) 

Ability for a Provider organization to poll the Content Location received as part of Scenario 2 to determine completion status of the Member Attribution List Request issued in Scenario 2 and once completed identify the location of the files that represent the Member Attribution List.

For example, Multicare would poll the content location received as part of the response in Scenario 2. 

Pre-condition: 

  • Provider Organization has requested the Member Attribution List which was accepted by the Payer.
  • Provider Organization has the URL for the Content Location where the request status can be polled.

API

GET <Content Location from Scenario 2 response>

Success Criteria:

  • Completion Status indicated by 200 HTTP code and the Response Body containing the URLs for the files representing the Member Attribution List.
  • There needs to be at least one URL for each of the resource types specified using the _type parameter in the Scenario 2. (

Patient, Practitioner, PractitionerRole, Organization, Location, Coverage, RelatedPerson)


Scenario 4: Consumer retrieves the files representing the Member Attribution List

  • (Part of Phase 1 Implementations) 

Ability for a Provider organization to retrieve each of the files that represent the Member Attribution List.

For example, Multicare retrieves each of the NDJSON files representing the Member Attribution List.

Pre-condition:

  • Provider Organization has the URLs to retrieve the files representing the Member Attribution List from the response indicating that the export request was completed.

API

GET <File URL for each Resource identified in Scenario 3 completion response>

Success Criteria:

  • Retrieve the NDJSON files for each of the following resources:
    • Patient, Practitioner, PractitionerRole, Organization, Location, Coverage, RelatedPerson


Scenario 5: Consumer creates PATIENT, PRACTITIONER and ORGANIZATION resources

  • (Part of Phase 2 Implementations) 

Ability for a Provider organization to create Patient, Practitioner and Organization resources to be used in the Group.

For example, a Provider organization planning to use CMS DPC system would create these resources before creating the Group.

Pre-condition:

  • Provider Organization has the URLs
  • Provider Organization has a treatment relationship with the Patient.

API

POST <BaseURL>/[Patient|Practitioner|Organization]

Success Criteria:

  • Verify that the resources have been created.


Scenario 6: Consumer creates Group resource

  • (Part of Phase 2 Implementations) 

Ability for a Provider organization to create Group resource.

For example, a Provider organization planning to use CMS DPC system would create a Group resource.

Pre-condition:

  • Provider Organization has the URLs
  • Provider Organization has a treatment relationship with the Patient.

API

POST <BaseURL>/[Group]

Success Criteria:

  • Verify that the resources have been created.


Scenario 7: Consumer modifies Group resource

  • (Part of Phase 2 Implementations) 

Ability for a Provider organization to add members to the  Group resource.

For example, a Provider organization planning to use CMS DPC system would create a Group resource and add members to the Group with whom they have a treatment relationship.

Pre-condition:

  • Provider Organization has the URLs
  • Provider Organization has a treatment relationship with the Patient.

API

POST <BaseURL>/Group/[id]/$member-add

Success Criteria:

  • Verify that the members have been added to the Group by retrieving the Group.


Scenario 8: Consumer modifies Group resource

  • (Part of Phase 2 Implementations) 

Ability for a Provider organization to remove members from the  Group resource.

For example, a Provider organization planning to use CMS DPC system would create a Group resource and add members to the Group with whom they have a treatment relationship, when the treatment relationship no longer exists the Provider Organization may remove the members from the Group.

Pre-condition:

  • Provider Organization has the URLs
  • Provider Organization has a treatment relationship with the Patient.

API

POST <BaseURL>/Group/[id]/$member-remove

Success Criteria:

  • Verify that the members have been removed from the Group by retrieving the Group.


TestScript(s)

  • Indicate any test scripts that will be used to help verify system behavior


TestScript(s)

  • Touchstone - DaVinci Member Attribution 4.0.1 - STU2 Folder


Security and Privacy Considerations

  • SMART on FHIR Backend Services Authorization is specified by the IG. However it is not required for Connectathon purposes this time around since this is the first time this IG is being