2020.07.29 Virtual IAT Track Agenda

Jean Duteau

HL7

Topic 1: Life and Death in C-CDA (specifically documentation of death, death reason and birth/pregnancy, but not at the same time for the same patient 😊 )

What problem are you trying to solve?
EHRs have historically approached C-CDA documents as tools in care transitions but increasingly they are used for secondary uses. Having a consistent way to document death and pregnancy helps with quality measurement, disease reporting (i.e. COVID-19) and research. Both death and pregnancy documentation issues observed in the real-world which could be improved.

What actions do you want attendees to do before or what samples or examples do you want them to bring to the session?
Just reviewing a few different templates from IGs and what they do in their systems (both C-CDA production/consumption)  

What actions are you expecting to happen as a result of your session?
Improved interoperability! Specifically we’ll have more consistent examples about these issues which currently inconsistently implemented.  

John D'Amore

Diameter Health

Topic 2: Payer Section in CCDA Documents

What problem are you trying to solve?

Alignment around how to send Payer data in this section.  Discussion of the remaining challenges – identifying the Payer, how to share additional payer identifiers like Group, RXBIN, RXPCN, etc.

What actions do you want attendees to do before or what samples or examples do you want them to bring to the session? 

Bring samples of how you currently populate the Payer section – specifically in these scenarios:

    Patient is the subscriber to the insurance

    Patient is the dependent on an insurance policy

    Patient has multiple insurances

    Patient is self pay

    Patient is a child and parent is paying

    BONUS points:  1. Patient has Medicare but they are not covering service provided, 2. Longitudinal CCD showing coverage for several encounters

What actions are you expecting to happen as a result of your session?  A) Unification of how payer data is shared in a CCD B) Recommended changes for template changes if needed C) Clarification on how we could clearly identify payers and identifiers

Linda Michaelsen

Optum

12:45pm - 1:30pm

Topic 3: Extending CDA to add more useful identifiers

What problem are you trying to solve?

Address current data provenance and matching problems. C-CDA document receivers can’t know the meaning of id elements in CDA documents without difficult (and often not feasible) OID discovery processes. 

What actions do you want attendees to do before or what samples or examples do you want them to bring to the session?

Familiarize themselves with how their current id usage works.  Review the value sets for identifier uses in FHIR and V2.

What actions are you expecting to happen as a result of your session?

Determine if there is support for requesting an update to the Companion Guide to add guidance on how to use the new extension that SDWG will be spearheading.  Suggest the use cases and examples would be most valuable to include when introducing its use in C-CDA documents. Show where consensus exists so that ONC can plan accordingly.

Jean Duteau

SDWG

1:45pm - 2:30pm

What problem are you trying to solve?

A number of pain points related to the intersection of querying for documents, dynamic generation of documents based on the state of data in the EHR/HIE, and consistency of formatting in the C-CDA. Important to note that my topic will reflect work that the Joint Carequality-CommonWell Content Workgroup has already done around lifecycle and versioning for encounter and patient summaries. 

What actions do you want attendees to do before or what samples or examples do you want them to bring to the session?

Bring document examples that reflect the issues identified or potential solutions.

What actions are you expecting to happen as a result of your session?

Generate support for additional relevant examples that would be further refined through examples task force to complete them.

Joe Lamy

Carequality/CommonWell

2:45pm - 3:30pm

What problem are you trying to solve?

When to differentiate the use of Clinical Note, Annotated Comment and Unstructured Document

What actions do you want attendees to do before or what samples or examples do you want them to bring to the session?

Collect and bring examples they have implemented or have come across.

Confirm your organization's intentions for consuming Note Activity content.

6) What actions are you expecting to happen as a result of your session?

Participants will be more informed about what type of content can be exchanged using the clinical notes templates.

Develop clear examples that show and explain when to use each: Clinical Note, Annotated Comment and Unstructured Document

Emma Jones

Allscripts

What problem are you trying to solve?  

It is currently unclear how to map C-CDA Author Participation data FHIR resources derived from C-CDA documents. 

What actions do you want attendees to do before or what samples or examples do you want them to bring to the session?

• Bring your current rules for producing and/or consuming C-CDA Author Particiaption and Performer Participation.
• Bring your current state mappings of C-CDA Author Particiaption & Provenance Author Participation to FHIR Resources.
• Find examples of C-CDA Author Particiaption that are less than desirable.
• Find examples of C-CDA entries that have multiple instances of Author Participation associated with them.
• Find examples of C-CDA documents that have multiple instances of Author Participation associated with them.

What actions are you expecting to happen as a result of your session?

• Evolve the proposals.
• Build consensus around best practices for mapping of C-CDA Author Participation & Provenance Author Participation to FHIR Resources. 
• Push for these proposals to inform a future Companion Guide update or additional C-CDA Examples

David Riddle

Cerner Corporation

Open Discussion

• Solidify next steps and plan for future C-CDA IATs

Jean Duteau

HL7