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Submitting WG/Project/Implementer Group

Financial Management WG / DaVinci

Track Resources

General CMS Connectathon Participant Information:

Justification and Objectives

This project defines a FHIR interface to a directory of a health insurer’s in-network providers and pharmacies for patients/consumers. The PDEX Plan-Net Implementation Guide was recently ballotted for STU and comments are currently being addressed and resolved.

Note: The Connectathon will use the STU1 ballot version of the IG, not the Continuous Integration build.

The objectives of the hackathon are:

  • Test and gather feedback on the design and implementation feasibility of the PDEX Plan-Net model and its FHIR Implementation Guide to drive ballot reconciliation.
  • Identify areas of improvement and expansion of the PDEX Plan-Net model to future use cases.
  • Foster mindshare and innovation ideas on potential applications using the PDEX Plan-Net

This track will use the R4 version of FHIR.

Related tracks

Da Vinci PDex

Da Vinci PDex Formulary

Proposed Track Lead

Saul Kravitz (saul@mitre.org).

David Hill  (dwhill@mitre.org). 

Participants: (Please add your name/organization)

  • Praneeta Pappula (Aetna)
  • Aziz Khalmukhamedov (Cigna)
  • Anand Rakshe (Aetna)
  • Ricky (1uphealth)
  • Shaheer AbdulKareem (Healthsparq/Cambia)

Track Orientation

The track kickoff presentation from 11/15 can be seen here:

Zulip Channel: https://chat.fhir.org/#narrow/stream/207606-DaVinci.2Fplan-net-connectathon

System Roles

Local Requester (Client)

An application that can query a FHIR server implementing the Plan-net IG in support of provider or consumer use cases.

Available Clients

...

Short Description

How would you describe this track to promote participation?  What's your two-sentence elevator pitch?  (Avoid acronyms)


Long Description

This project defines a FHIR interface to a directory of a health insurer’s in-network providers and pharmacies for patients/consumers. The PDEX Plan-Net Implementation Guide was recently ballotted for STU and comments are currently being addressed and resolved.

Note: The Connectathon will use the STU1 ballot version of the IG, not the Continuous Integration build.

The objectives are:

  • Test and gather feedback on the design and implementation feasibility of the PDEX Plan-Net model and its FHIR Implementation Guide to drive ballot reconciliation.
  • Identify areas of improvement and expansion of the PDEX Plan-Net model to future use cases.
  • Foster mindshare and innovation ideas on potential applications using the PDEX Plan-Net


Type

Pick one:

  • Test the design of a Resource/set of Resources
  • Test an Implementation Guide
  • Test a FHIR-associated specification
  • Educate on the use of a FHIR technology/IG


Submitting WG/Project/Implementer Group

Financial Management WG / DaVinci

Proposed Track Lead

Saul Kravitz (saul@mitre.org).

David Hill  (dwhill@mitre.org). 

Related tracks

Da Vinci PDex

Da Vinci PDex Formulary

This track will use the R4 version of FHIR.

Specification(s) this track uses

Please provide version-specific (ballot, connectathon or official release) hyperlinks to the FHIR IG or other specifications implementers of this track will follow.  If the relevant version does not exist yet, describe what it *will* be.  (Hyperlink to actual version should be present no later than 1 month prior to connectathon.)


Artifacts of focus

Provide links to the resources, profiles or other key artifacts that will be a focus for the connectathon


Clinical input requested (if any)

Does your track have a need for input from the clinical community?  If so, what are the needs?


Patient input requested (if any)

Does your track have a need for input from the patient/care-giver community?  If so, what are the needs?

Expected Participants:

  • Praneeta Pappula (Aetna)
  • Aziz Khalmukhamedov (Cigna)
  • Anand Rakshe (Aetna)
  • Ricky (1uphealth)
  • Shaheer AbdulKareem (Healthsparq/Cambia)

Zulip stream: https://chat.fhir.org/#narrow/stream/207606-DaVinci.2Fplan-net-connectathon

Identify the stream on http://chat.fhir.org that will be used to coordinate among participants, both prior to and during the connectathon (Mandatory)

Track Orientation

Provide information about the date & time at which a webinar will be hosted to share further participation information about this track.  (Mandatory)

System Roles

Local Requester (Client)

An application that can query a FHIR server implementing the Plan-net IG in support of provider or consumer use cases.

Available Clients

Payer Directory (aka Plan-net) (Server)

A server that makes provider data available.

Available Servers

Reference Implementation:  https://davinci-plan-net-

...

ri.logicahealth.org/fhir

  • Authentication/Authorization: 
  •   
  • none
  • This
  • web-client has been tested with the reference server described below, and allows browsing of the loaded resources, and support for scenarios 10a and 10b described below.

Payer Directory (aka Plan-net) (Server)

A server that makes provider data available.

Available Servers

Reference Implementation:  https://davinci-plan-net-ri.logicahealth.org/fhir

  • Authentication/Authorization:  none
  • This is a HAPI server with an interceptor that supports the 'near' query on Location resources.
  • The dataset is an extended version of relevant data from the VhDir demo implementation that includes pharmacies.

...

  • is a HAPI server with an interceptor that supports the 'near' query on Location resources.
  • The dataset is an extended version of relevant data from the VhDir demo implementation that includes pharmacies.

IBM FHIR Server:  https://cthon24.wh-fhir.dev.cloud.ibm.com/basic

...

...

  • Find all the organizations and providers that are members of the "State of Connecticut HMO" Network (id "plannet-network-HPID110000").

Organizations

{{url}}/OrganizationAffiliation?network=plannet-network-HPID110000&_include=OrganizationAffiliation:participating-organization

Providers

{{url}}/PractitionerRole?network=plannet-network-HPID110000&_include=PractitionerRole:practitioner

TestScript(s)

...

  • HMO" Network (id "plannet-network-HPID110000").

Organizations

{{url}}/OrganizationAffiliation?network=plannet-network-HPID110000&_include=OrganizationAffiliation:participating-organization

Providers

{{url}}/PractitionerRole?network=plannet-network-HPID110000&_include=PractitionerRole:practitioner

TestScript(s)

Touchstone Tests are found at: Touchstone_DaVinci_PDex_PlanNet_Scripts

Please create a Touchstone user account (free) associated to the DaVinci organization if you have not already in order to run your systems through the test scripts.

Security and Privacy Considerations

No security or privacy considerations.   Data is not patient-related.


Track Resources

...

Please create a Touchstone user account (free) associated to the DaVinci organization if you have not already in order to run your systems through the test scripts.

Security and Privacy Considerations

No security or privacy considerations.   Data is not patient-related.

Track overview

Short Description

Long Description

Type

  • Test the design of a Resource/set of Resources
  • Test an Implementation Guide
  • Test a FHIR-associated specification
  • Educate on the use of a FHIR technology/IG

...