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Do not launch ANY of the links while your are in create or edit mode. There is a good chance all of your work will be gone.

Template Usage Information:

  1. Project Name and ID

Enter the name of the project here: Risk Based Contract Member Identification

Project ID: 1517

Complete this section for all “Direct to Normative” ballot projects and when a project proceeds from “Informative to Normative” or “STU to Normative”.

Forward PSS to the TSC (via; this triggers American National Standards Institute (ANSI) Project Initiation Notification (PINS) submission.


TSC Notification:  Informative/STU to Normative 


- or -                     Direct to Normative (no STU) (includes reaffirmations)       


Identify ISO, IEC or ISO/IEC standard to be adopted in text box below

Enter info here if an ISO, IEC, or ISO/IEC Standard is to be adopted as an American National Standard; Enter the designation of the standard(s) to be adopted:

Includes text from ISO, IEC or ISO/IEC standard: Check here if this standard includes excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption.




Select the unit of measure used in the standard; if no measurements are in the standard, select N/A









Investigative Project (aka PSS-Lite)

Date : 

Check this box when the project is investigative or exploratory in nature, which allows limited project scope definition. Sections 1-Project Name, 2-Sponsoring Group(s)/Project Team, 3a-Project Scope, 3b-Project Need, 3e-Project Objectives/Deliverables/Target Dates, 3i-Project Document Repository, 6b-[Realm, if known], and 6d-[applicable Approval Dates] are required for Investigative Project. Investigative Project specific instructions are highlighted in yellow. An investigative project must advance in two WGM cycles, requiring a full scope statement. Otherwise the project will be closed.

2. Sponsoring Group(s) / Project Team

2.a. Primary Sponsor/Work Group

Primary Sponsor/Work Group
(1 (And Only 1) Allowed)

Financial Management

2.b. Co-sponsor Work Group(s)

Co-sponsor Work Group(s):

(Enter co-sponsor approval dates in Section 6.d Project Approval Dates)


Indicate the level of involvement that the co-sponsor will have for this project:
X Request formal content review prior to ballotWGMs
X Request periodic project updates. Specify periodWGMs

 Other Involvement. Specify details here: 

2.c. Project Team

All names should have confirmed their role in the project prior to submission to the TSC.

Project facilitator (1Mandatory)Robert Dieterle, Viet Nguyen

Other interested parties and their roles

Viet Nguyen and Lloyd McKenzie (technical FHIR support)

Multi-disciplinary project team (recommended)

     Modeling facilitator

Lloyd McKenzie

     Publishing facilitator

Paul Knapp

     Vocabulary facilitator

Viet Nguyen

     Domain expert rep

Lenel James, Robert Dieterle,

     Business requirement analyst

Christol Green, Mary Kay McDaniel, Linda Michaelsen, Nick Radov, Amit Shah, Mary Lynn Bushman, Durwin Day

     Conformance facilitator (for IG projects)

Lloyd McKenzie

     Other facilitators (SOA, etc)

Implementers (2Mandatory for STU projects)

FHIR Project Note: The implementer requirement will be handled by the “balloting” project.  Therefore work groups do not fill out the above section.  However, feel free to list implementers specific to your work group’s resources if you know of any.

1) BCBS Michigan

2) United Healthcare

3) BCBS Florida
4) Humana

3. Project Definition

3.a. Project Scope

This PSS will enable Payers and Provider to exchange information that identifies members of a patient population associated with particular risk based contract. The solution needs to define a simple, reliable, exchange method for payers and providers to synchronize data from practice management and EHRs, and to enable providers and payer organization to validate enrollment in Value-Based Care (VBC) programs at the point of care and for population level program management. The information that will be exchanged should be sufficient to identify a specific existing patient for inclusion in a risk based contract or create such a patient in the PM/EHR if the patient does already exist and the PM/EHR has the capability.

Workflow will be defined to initiate the exchange process automatically (e.g. CDS Hooks) or via an explicitly triggered request.

This PSS builds on the HRex implementation guide for the automated exchange of information between a payer and provider using standard profiles and constraints on existing exchange methods.

This project will reference, where possible the "standards" defined by the Health Record exchange (HRex) Library/Framework Implementation Guide which in turn will utilize prior work from Argonaut, US Core and QI Core effort for FHIR DSTU2, STU3, and R4 where appropriate. The following diagram depicts the anticipated scope of the HRex Library/Framework IG.

The ultimate goal is to support the accurate and timely exchange of risk based contact member information between payers and providers to facilitate VBC programs.

The project team plans to work with existing FHIR artifacts where possible. If changes are necessary, the project team will work with the responsible Work Group to review and implement (via tracker items or new PSS) any necessary enhancements to base FHIR resources, extensions, and/or profiles.

As part of the ongoing updates and enhancements, the project will generalize the member attribution list so that it can be used for other DaVinci initiatives including Gaps In Care, DEQM, Risk Adjustment etc. As part of the generalization the following capabilities will be added or modified

  • Change the name from atr-group to atr-patient-list
  • Allow the creation of a patient list by either the payer (producer) or the provider (consumer)
  • Allow the modification of the patient list subject to agreements between producers and consumers
    • Add a member (patient) to the list
    • Remove a member (patient) from the list.
  • Add ability to retrieve data using Bulk API beyond the member attribution list for the different use cases.

As part of the above changes, we are collaborating with other DaVinci initiatives and the Argonaut program to ensure the generalized patient list meets the various use cases.

3.b. Project Need

Providers and Payers need to easily and accurately identify members of a patient population associated with particular risk based contract. The solution needs to define a simple, reliable, exchange method for payers and providers to synchronize data from practice management and EHRs, and to enable providers and payer organization to validate enrollment in VBC programs at the point of care and for population level program management.

This PSS builds on the HRex implementation guide for the automation exchange of information between a payer and provider using standard profiles and constraints on existing exchange methods.

Currently, no FHIR implementation guide exists to standardize the method of exchanging risk based contract member lists between payers and providers. This implementation guide will provide a standard for adoption by both providers and payers to support VBC attribution.

The proposed changes are being performed to support the following different use cases

  • Use patient lists as a generalized capability so that it can be used for DEQM, Gaps In Care, List of Patients with appointments etc.
  • The generalized patient lists can be used in a “for population” mode for different use cases in the future:
  • Creation and Modification of the list is required for programs such as CMS Data At Point of Care (DPC) use case where the consumer creates the list and then modifies the list as needed to add and remove members.

3.c. Security Risks

Will this project produce executable(s), for example, schemas, transforms, style sheets, executable program, etc.  If so the project must review and document security risks. Refer to the Cookbook for Security Considerations for additional guidance, including sample spreadsheets that may be used to conduct the security risk assessment. 





3.d. External Drivers

Risk Based Contracts

3.e. Project Objectives / Deliverables / Target Dates

Within each row, enter the explicit work product(s) / objective(s).  Indicate their target date at the right in WGM/Ballot Cycle format.  Include the project end date as the last objective (for standards projects, the end date will be the projected ANSI approval date). 

Target Date(in WGM or ballot cycle format, e.g.

‘2017 Sept WGM’ or

‘2017 Jan Ballot’)

Standard For Trial Use (First Ballot Cycle)

2019 September Ballot

Complete STU Reconciliation

2020 January

Request STU Publication

2020 January WGM

Submit for STU 2 Ballot (Second Ballot Cycle)

2023 Jan Ballot

Complete STU 2 Reconciliation

2023 May

Request STU 2 Publication

2023 June

STU 2 Period

2023 Sept -2025 May

Submit for Normative Ballot

2025 May Ballot

Complete Normative Reconciliation

2025 Sept WGM

Submit Publication Request

2025 Oct

Project End Date (all objectives have been met)

2025 Dec

3.f.   Common Names / Keywords / Aliases

Da Vinci, Attribution, Risk Based Contract Members

3.g. Lineage


3.h. Project Dependencies

Health Record Exchange Library/Framework

3.i.   HL7-Managed Project Document Repository Location

Projects must adhere to the TSC's guidelines (which were approved on 2016-04-04 and summarized in Appendix A).

A template to create a Project Page on the HL7 Wiki is available at:

Enter the SPECIFIC URL of the HL7-MANAGED SITE where supporting project documents, deliverables, ballot reconciliation work and other project information will be kept

3.j.   Backwards Compatibility

Are the items being produced by this project backward compatible?






If you check 'Yes' please indicate the earliest prior release and/or version to which the compatibility applies:

For V3, are you using the current data types? 

(Refer to TSC position statement on new projects using R2B for more information on the current V3 data types)






If you check no, please explain the reason:

If desired, enter additional information regarding Backwards Compatibility.

3.k. External Vocabularies

Will this project include/reference external vocabularies?






If Yes, please enter the vocabularies: HCPCS, SNOMED, CPT, ICD, RxNorm, LOINC

4. Products (check all that apply)

Arden Syntax

V2 Messages – Administrative

Clinical Information Modeling Initiative (CIMI)

V2 Messages - Clinical

Clinical Context Object Workgroup (CCOW)

V2 Messages - Departmental

Domain Analysis Model (DAM)

V2 Messages – Infrastructure

Electronic Health Record (EHR) Functional Profile

V3 Domain Information Model (DIM / DMIM)


FHIR Extensions

V3 Documents – Administrative (e.g. SPL)


FHIR Implementation Guide (enter FHIR product version below)

V3 Documents – Clinical (e.g. CDA)


FHIR Profiles (enter FHIR product version below)

V3 Documents - Knowledge


FHIR Resources

V3 Foundation – RIM

Guidance (e.g. Companion Guide, Cookbook, etc)

V3 Foundation – Vocab Domains & Value Sets

Logical Model

V3 Messages - Administrative

New/Modified/HL7 Policy/Procedure/Process

V3 Messages - Clinical

New Product Definition (please define below)

V3 Messages - Departmental

New Product Family (please define below)

V3 Messages - Infrastructure

Non Product Project - (Educ. Marketing, Elec. Services, etc.)

V3 Rules - GELLO

White Paper

V3 Services – Java Services (ITS Work Group)

Creating/Using a tool not listed in the HL7 Tool Inventory

V3 Services – Web Services (SOA)

If you checked New Product Definition or New Product Family, please define below:

For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?


5. Project Intent (check all that apply)

Create new standard

Supplement to a current standard

Revise current standard (see text box below)


Implementation Guide (IG) will be created/modified

Reaffirmation of a standard

Project is adopting/endorsing an externally developed IG:

New/Modified HL7 Policy/Procedure/Process

Specify external organization in Sec. 6 below;

Externally developed IG is to be (select one):

White Paper (select one):

Adopted  - OR -



Balloted Informative OR

Non-balloted WG White Paper

N/A  (Project not directly related to an HL7 Standard)

If revising a current standard, indicate the following:

-    Name of the standard being revised:
-    Date it was published (or request for publication, or ANSI designation date)
-    Rationale for revision
-    The relationship between the new standard and the current standard (is it designed to replace the current standard, a supplement to the current standard, etc.)

5.a. Ballot Type (check all that apply)

Comment (aka Comment-Only)

Joint Ballot (with other SDOs)


N/A  (project won’t go through ballot)


STU to Normative     - OR -

Normative (no STU)

If necessary, add any additional ballot information here.  If artifacts will be jointly balloted with other SDOs, list the other groups.

5.b. Joint Copyright

Check this box if you will be pursuing a joint copyright.  Note that when this box is checked, a Joint Copyright Letter of Agreement must be submitted to the TSC in order for the PSS to receive TSC approval.

Joint Copyrighted Material will be produced?




6. Project Logistics

6.a. External Project Collaboration

Include SDOs or other external entities you are collaborating with, including government agencies as well as any industry outreach.  Indicate the nature and status of the Memorandum of Understanding (MOU) if applicable.

For projects that have some of their content already developed:

How much content for this project is already developed?


Was the content externally developed ? :


Da Vinci

Is this a hosted (externally funded) project?  (not asking for amount just if funded)




6.b. Realm


- OR -


Realm Specific


Check here if this standard balloted or was previously approved as realm specific standard


Includes vocabulary and profiles that are specific to the US healthcare system

Support US Healthcare workflows

6.c. Stakeholders / Vendors / Providers

This section must be completed for projects containing items expected to be ANSI approved, as it is an ANSI requirement for all ballots








Clinical and Public Health Laboratories




Clinical and Public Health Laboratories


Immunization Registries




Emergency Services


Quality Reporting Agencies




Local and State Departments of Health


Regulatory Agency


Health Care IT


Medical Imaging Service


Standards Development Organizations (SDOs)


Clinical Decision Support Systems


Healthcare Institutions (hospitals, long term care, home care, mental health)






Other (specify in text box below)


Other (specify in text box below)








Other (specify below)







Other:  Federal Healthcare Agencies (e.g. CMS), Providers (e.g. Physicians)

6.d. Project Approval Dates

Click here to go to HL7 Project Scope Statement Instructions#Appendix A for more information regarding this section.
Approvals are by simple majority vote of the approving body

Sponsoring Work Group Approval Date: 

FM WG Approval Date

Updated PSS approval date: 2022-04-26

(Original PSS approval date: 2019-03-12)

Administrative review – in parallel with Work Group Approval

Co-Sponsor Group Approval Date

PIE WG Approval Date

Updated PSS approval date: 2022-05-11

(Original PSS approval date: 2019-03-12)

CIMI Projects: CIMI Management Group

CIMI MG Approval Date


CDA Projects: CDA Management Group

CDA MG Approval Date


FHIR Projects: FHIR Management Group

FMG Approval Date


V2/Publishing Projects: V2 Management Group

V2 MG Approval Date


US Realm Projects: US Realm Steering Committee Approval
(Email WG approved PSS to:

USRSC Approval Date


Affiliate Specific Projects: Affiliate Approval Date

Affiliate Approval Date


Submit PSS to Steering Division after all of the above approvals are received

Steering Division (of Primary Sponsor WG) Approval Date:

SD Approval Date CCYY-MM-DD


Last PBS Metrics Score:





PBS Metrics Reviewed? (required for SD Approval if not green)



ARB and Steering Division approval may be in parallel

Architectural Review Board Approval Date:

(required for externally developed content)

ARB Approval Date


TSC Approval

If applicable, TSC has received a Joint Copyright/Distribution Agreement (containing the verbiage outlined within the SOU),
signed by both parties.




Technical Steering Committee Approval Date:
(Email SD WG approved PSS to:

TSC Approval Date