Short Description

Test the Da Vinci Risk Adjustment Implementation Guide 

Long Description

Continue the testing of the Da Vinci Risk Adjustment Implementation Guide.  

  • Testing the $report operation input parameters/return and the profiles specified in the IG

     

  • Testing a proof of concept scenario which uses CQL logics to specify inclusion and exclusion criteria for an example HCC and generates risk adjustment coding gap report for the example HCC

Type

Test an implementation guide

Submitting Work Group/Project/Accelerator/Affiliate/Implementer Group  

Clinical Quality Information (CQI)/DaVinci Project

Track Lead(s)

Yan Heras

Track Lead Email(s)

yan.heras@optimumehealth.com

Related Tracks

N/A

FHIR Version

FHIR R4

Specification(s) this track uses

STU1: http://hl7.org/fhir/us/davinci-ra/

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

(Draft STU2 Branch will be merged to CI Build: http://build.fhir.org/ig/HL7/davinci-ra/branches/Draft-STU2-Branch/index.html)

Artifacts of focus

FHIR Resources:

Operation: $report

Profiles: 

Expected participants

Novillus
Optum
United Healthcare
Alphora

Zulip stream

https://chat.fhir.org/#narrow/stream/311469-Da-Vinci.20Risk.20Adjustment/topic/Connectathon

Track Implementers Connection Call

Meeting Recording: https://hl7-org.zoom.us/rec/share/Fnd6b9RRdPsq33qQGknJ-7CZB0P0VvfQG5-WCz5EuQR57PY8-Uyi9iHRlAXaZAUD.NzxIMxJVUkVo95En

Meeting Minutes:2022-06-16 Risk Adjustment Use Case Meeting/CMS Connectathon Track Implementers Connection Call - Da Vinci - Confluence

June 16th, 3pm ET (during the regular weekly DaVinci Risk Adjustment call time)

Join Zoom Meeting: https://hl7-org.zoom.us/j/97235158298?pwd=bktQdkV4Y3BqL3A3ek83UU92STlpUT09

Meeting ID: 972 3515 8298 / Passcode: 418967

Presentation Slides

Recording:  https://hl7-org.zoom.us/rec/share/CyaU_Xw5_-lTo_aTSXi8r9GIIHaOG9qk0Cxq9adR443B9irGc4nbsc1YJwB9KxEa.IboGzZpqAULKkGep / Access Passcode: RiskAdjustment@0616

Track Details

System roles:

  • Client - A system requesting risk adjustment coding reports using the $report operation.
  • Server- A system receiving the request for for retrieving the risk adjustment coding gap reports using the $report operation..

Scenarios

Get Scenario to test the Parameters

  • Action: For each of the test cases for parameters, a Client calls the $report operation to the Server with input parameters specified in the test case. Depending on the input parameters received, Server either returns Risk Adjustment Coding Gap MeasureReport or OperationOutcome. 
  • Precondition: Server has a number of pre-generated risk adjustment coding gaps reports that support $report operation input parameters and the test cases specified
  • Success Criteria: The Client receives expected results as specified in each of the test cases. 
  • Security and Privacy Considerations: The scenarios and reference implementations here run using open (i.e. unsecured) connections. Systems SHALL NOT use PHI in any form, or data derived directly from PHI.

GET Scenario to test the Results

  • Action: For each of the test cases for results, a Client calls the $report operation to the Server. Server returns appropriate results. 
  • Precondition: Server has a number of pre-generated risk adjustment coding gaps reports that support $report operation input parameters and the test cases specified
  • Success Criteria: The Client receives expected results as specified in the test case. Results are examined in detail to ensure, for example, MeasureReport is constructed correctly with correct data elements and evaluatedResources. 
  • Security and Privacy Considerations: The scenarios and reference implementations here run using open (i.e. unsecured) connections. Systems SHALL NOT use PHI in any form, or data derived directly from PHI.

Proof of Concept Scenario

  • Use HCC189 "Amputation Status, Lower Limb/Amputation Complications" as an example HCC
  • Use CQL to specify HCC189 inclusion and exclusion criteria
  • Run a prototype $risk-adjustment operation which evaluates the CQL for HCC189 and generates risk adjustment coding gap report

Reference Implementation End Point: https://cloud.alphora.com/sandbox/r4/ra/fhir/ (NEW end point)

There will be two separate instances of Risk Adjustment validator set up in Touchstone. One points to the STU1 IG and another points to the Draft STU 2 branch of the IG. 

Test Scripts: https://touchstone.aegis.net/touchstone/testdefinitions

      • All test scripts are located in: /FHIRSandbox/DaVinci/FHIR4-0-1-RA
      • The test cases for Parameters are located in: /FHIRSandbox/DaVinci/FHIR4-0-1-RA/01-RAReport/04-RA-ReportParameters
      • The test cases for results are located in: /FHIRSandbox/DaVinci/FHIR4-0-1-RA/01-RAReport/05-RA-ReportResults

Document Testing Results: all testing results will be documented in the Connectathon Manager: 

Test Plan: https://confluence.hl7.org/display/DVP/%24report+Test+Plan+Template