Short Description

Continue the testing of the Implementation Guides, as well as Reference and vendor Implementations for electronic Prior Authorization Da Vinci (CRD + DTR + PAS) IGs

Long Description

Our Goal is to test CRD/DTR/PAS interoperability with as many interested parties as possible. e.g. EHR vendors, Providers, Payers, and others. The Da Vinci Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Auth Support (PAS) Implementation Guides (IGs) together support an integrated workflow to enable automated submission of required documentation and/or prior authorization from EHR and payer systems respectively. The use of these IGs is likely to be mandated as part of regulation. We have had past connectathon testing of CRD, DTR, and PAS. This track will ensure that the IGs work appropriately, independently, as well as in concert.

Each of the use cases (IGs) represented in the Burden Reduction track has four specific areas in which everyone is encouraged to test.  Focus for these areas has been determined as beneficial for the advancement of the designs through directed testing.  They are...

CRD:

DTR:

    • Launch and use of Adaptive Forms 
    • Launch process from CRD (initial, deferred, relaunch)
    • Launch process from CDex with task context and return QR to CDex
    • Capture source of information (CQL, modified, manual) with user 

PAS:


Type

Test Implementation Guides (IG) and Reference Implementations (RI)

Track Lead(s)

Jeff Brown (jeff.brown@lantanagroup.com) 

Specification Information

CRD - https://build.fhir.org/ig/HL7/davinci-crd 
DTR - http://build.fhir.org/ig/HL7/davinci-dtr 
PAS - http://build.fhir.org/ig/HL7/davinci-pas 

Reference Implementations

CRD - https://crd.davinci.hl7.org  
DTR - https://dtr.davinci.hl7.org   
PAS - https://prior-auth.davinci.hl7.org    

Call for participants

EHR vendors, Providers, payers, and other HIT related vendors

Zulip streams

CRD - https://chat.fhir.org/#narrow/stream/180803-Da-Vinci.20CRD/topic/Connectathons
DTR - https://chat.fhir.org/#narrow/stream/197320-Da-Vinci.20DTR/topic/Connectathons
PAS - https://chat.fhir.org/#narrow/stream/208874-Da-Vinci.20PAS/topic/Connectathons

Track Kick-Off Call

Friday August 25th 12:00 pm ET

Recording: https://hl7-org.zoom.us/rec/share/Z0PvIdM-Vc9HyRsZ11tKa9x0rfa_39trursaye1oNyTmozWxHsjGFtSWMgX6uJHa.ggQGbObjP5ym5Ur_?startTime=1692979423000

Slides:

Track Prerequisites

Knowledge of US Core (https://www.hl7.org/fhir/us/core/)

Technologies leveraged by the Burden Reduction use cases, such as the FHIR R5 Subscriptions Backport, CDS Hooks, and SMART on FHIR 

See underlying technologies/background page of Burden Reduction constituent Implementation Guides: 

ConMan Information

 

Connectathon Example (January 2023)

Testing:

System roles:

    • Healthcare Provider / EHR

 In this role, a provider wishes to discover the documentation requirements for Home Oxygen Therapy as well as have a template pre-populated to satisfy documentation requirements.

 It is expected that the provider will be able to:

        • Invoke CRD via CDS Hooks
        • Populate the hook request with necessary demographic, payer and requested service information or have a FHIR server that will respond to queries for the information
        • Handle the response of the CRD CDS Hooks Cards 
        • It is expected, that they will be able to launch a SMART on FHIR application using the EHR launch sequence
        • The SMART on FHIR app will collect information from the EHR using the template/rules returned from the payer system


    • Healthcare Payer

 In this role, the payer examines the request for Documentation Templates and Rules (DTR) and responds appropriately. This could be viewed as the server part of the transaction.

 It is expected that participants in this role will:

        • Provide a server that implements the CDS Hooks specified in the CRD IG
        • Provide a FHIR Questionnaire that details the information requirements for the "order-sign" scenario
        • Provide a FHIR Library that contains CQL with rules to extract the information needed by the Questionnaire from the EHR's FHIR server

Note:  If needed participants should install the Reference Implementations (RI) in advance as this process can be time consuming. See Track Preparation for details. 

Participants

If your organization intends to bring technology to this connectathon, please add yourself to this list and comment on each component. If your artifacts are available publicly, please add a URL. Otherwise, participants will contact the organizational POC for this information.


Organization

Point of Contact 

Clinical Scenario

CRD ClientCDS EndpointDTR App

Questionnaire

Resource 

CQL

Script

FHIR

Test Data

CQL Execution

Approach

PAS

App

PAS Subscriptions

PAS Additional documentation request


Maturity

Organization

Name

  • Name + email

e.g. CPAP, Knee surgery, MRI Immunologic drug

(Note if you are working with other participant(s) on specific scenario and/or exchanges)

Do you have a CRD client (calling into CDS Hooks)Do you have a CDS endpoint to use with CRDDo you have a DTR App?Do you have a Questionnaire resource? Is it adaptive?Do you have a CQL script for the scenario?Do you have test patients in a sharable FHIR bundleHow is your CQL executed? Javascript, CQL Engine, other?Do you have a PAS App?Support subscriptions conformant with Subscriptions R5 Backport IG?Able to request additional documentation leveraging CDex to launch DTR?

0. Building components for scenario

  1. All components built and being tested internally.
  2. Components and successfully tested - via Logica sandbox or other environment.
  3. Ready to test with other participants.
  4. Ready to test with EHR. 

Deloitte

Jay Rajendran

(jayrajendran@deloitte.com)














Edifecs

Brian Poteet

(brian.poteet@edifecs.com)

Artem Sopin

(artem.sopin@edifecs.com)



Yes
YesYes
Yes


3

Epic

Kyle Johnsen

(kjohnsen@epic.com)


partial support: order-sign ServiceRequests, system action filing, deferred DTR launch.

working on appointment-book and MedicationRequest












HIKE HEALTH

Rakesh Mathew

rakesh@hike.health 

Dinil AD

dinil@hike.health 

CPAP Device Request
YesYesYesYesYesYesYesYesNo3

Infor

Brian Lind

(brian.lind@infor.com)














Mesh Health

Portia Thurmond 

(portia@meshhealthsolutions.com)

Raghu Iyer

(raghu@meshhealthsolutions.com)

Home OxygenYesYesYesYes, not adaptiveYesNoJava EngineYesNoNo2

Mettle Solutions LLC

Sreekanth Puram

(sreekanth.puram@mettles.com)














MITRE

Andy Gregorowicz

(andrewg@mitre.org)

Robi Scalfani

(rscalfani@mitre.org)

Joyce Quach

(jquach@mitre.org)


NoYes
Yes





1

Nucural

Vishnu Yarmaneni

(vishnu@nucural.com)














Palmetto GBA

Richard Abercrombie (richard.abercrombie@palmettogbaservices.com)

Gregg Johnson (gregg.johnson@palmettogba.com)

Kevin Prince (kevin.prince@palmettogbaservices.com)














Smile Digital Health

Tom Kakanowski

(tom.kakanowski@smiledigitalhealth.com)

David Chisholm

Brenin Rhodes














Health Gorilla

Nick Radov (nradov@healthgorilla.com)


crd-request-generator










eHealth Exchange

Scott R

Mike Yakanich (myakanich@ehealthExchange.org)

Bill Howard

(bhoward@ehealthexchange.org)

Any FHIR data exchange. We act as an intermediary and proxy FHIR traffic between a requestor and responder within our network.









FHIr proxy capabilities are in-use in PRD today

Testing Roles:

Scenario/Name/Use case

Provider/

EMR System

Payer 

CRD

client

CRD

CDS system

DTR Operation system
(DTR API) Questionnaire

DTR App system

PAS

Bundle creator

PAS

Intermediary

PAS

Payer

Epic + MeshEpicMeshEpicMeshMeshMesh


Epic + Mettle + EvernorthEpicEvernorthEpicEvernorthEvernorthMettle


Epic + Smile + PalmettoEpicPalmettoEpicSmilePalmettoSmile


Epic + EdifecsEpicTest payerEpic

Edifecs

(PA)

Edifecs

(PA SoF)

Edifecs

(PA SoF)

Edifecs

(PA SoF)

Edifecs

(PA)

Test payer
Epic + MITREEpicCMSEpicMITRE




Epic + Mettle + CMS (MFFS) 

Blepharoplasty

EpicCMS(MFFS)EPICCMS CMSMettle


Nucural + Mettle + CMS (MFFS) 

Blepharoplasty

NucuralCMS(MFFS)NucuralCMSCMSMettleNucuralCMSCMS MACs
HIKE + EpicEPICHIKE (HPP)EPICHIKEHIKEHIKEHIKEHIKEHIKE