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Section

Attendees

Column


Present

Name

Affiliation

  •   
SureScripts
  •   
Regence
  •   
Optum
  •   
Michael BaillieUHC
  •   
Humana
  •   
BCBS AL
  •   
Rush
  •   
SureScripts
  •   
Rush
  •   
Cerner
  •   
Laurie BurckhardtWPS Health Solutions
  •   
Lindee ChinEdifecs
  •   
Independence Blue Cross
  •   
Allscripts
  •   
Regence
  •   
Didi DavisSequioa
  •   
InterSystems
  •   
BCBS IL
  •   
Allscripts
  •   
Cambia Health
  •   
Enable Care
  •   
David DodgeCambia Health
  •   
CAQH Core
  •   
Howard FollisJuxly
  •   
Reliant Medical Group
  •   
Lantana Consulting
  •   
SureScripts
  •   

  •   
Independence Blue Cross
  •   
GunjitZeOmega
  •   
Kenneth Hall
  •   
NCQA
  •   
Optum
  •   
Jackie HardisonHumana
  •   
Cigna
  •   
HealthLX
  •   
ZeOmega
  •   
BCBSA
  •   
Point of Care Partners
  •   
Edifecs
  •   
Heather KennedyBCBST
  •   
Edifecs
  •   
Sathaya KrishnasamyAnthem
  •   
BCBS AL
  •   
Stephen LaneSutter Health
  •   
InterSystems
  •   
Anthem
  •   
Luis MaasEMR Direct
  •   
Erin MajderBCBS IL
  •   
Point of Care Partners
  •   
Cognosante
  •   
BCBS AL
  •   
Lloyd McKenzieGevity
  •   
Optum
  •   
Humana
  •   
MaxMD
  •   
Stratametrics
  •   
Sean ParsonsBCBS OK
  •   
Scott Parsons
  •   
BCBS AL
  •   
Allscripts
  •   
HealthLx
  •   
Optum
  •   
Optum
  •   
Regence
  •   
InterSystems
  •   
NewWave
  •   
NewWave
  •   
ZeOmega
  •   
Anne Marie SmithNCQA
  •   
InterSystems
  •   
UHC
  •   
Casenet
  •   
Cigna
  •   
HealthLX
  •   
Independence Blue Cross
  •   
Joel WalkerHealthLX
  •   
Holly WeeksRegence
  •   
BCBS AL
  •   
Darrell Woelk
  •   
Cambia
  •   
Brent Woodman
  •   
Diameter Health
  •   
Cambia
  •   
NewWave
  •   
Edifecs
  •   

  •   

  •   
YuriyHealthLX
  •   
Stephen MacVicarMITRE
  •   
Anna MeisheidCMS
  •   
Epic
  •   
Paul Knapp
  •   
Dave FosterEdifecs
  •   
John FeloExpress Scripts
  •   
Ken Lord
  •   
Roland GamacheAHRQ
  •   
Epic
  •   
Jennifer Joe
  •   
Stephen McVicarMitre
  •   
Joe HamiltonUnity Point
  •   
Matthew FloresAdvent Advisory Group
  •   
Providence
  •   

  •   
EMR Direct
  •   
Barbara WoodPNC
  •   
Eshaa DhalleClinicalWorks
  •   
Katherine RuizUNC Health
  •   
Zach Heath
  •   
Centene
  •   
Veradigm
  •   
Kenneth Foster
  •   
Cigna
  •   
Christopher StehnoCorepoint Health
  •   

Neena Dakua


  •   
MD Partners
  •   
Joe Miller
  •   
Gevity



Column


PresentNameAffiliation
  •   
Tibco
  •   
Aim Specialty Health
  •   
Christy Dodson
  •   
BCBSM
  •   
Allscripts
  •   
BCBSFL
  •   
BCBSM
  •   
CMS
  •   
Mike HurleyBRYJ Healthcare
  •   

  •   
Tori WillowsWellcare
  •   

  •   
Nandini GangulyEMDI - Scope Info Tech
  •   
Moxe Health
  •   
Jim McKinleyMedicaid Alabama
  •   
BCBST
  •   
Bart CarlsonAzuba
  •   
Deepthi ReddyMettle Solutions
  •   
Allscripts
  •   
Eric SullivanInovalon
  •   
David Hill MITRE
  •   
Pallavi TalekarScope Info Tech
  •   
Ralph Saint-PhardHealow
  •   
Scott SwihartSumma Health
  •   
India DuncanOptum
  •   
Jason CassidyMoxe Health
  •   
Praveer MathurWellcare
  •   
Megan Soccorso

Cigna

  •   
Prashanth GolcandaLumeris
  •   
Rajesh Godavarthi
  •   
Availity
  •   
Susan LestinaAHA
  •   
Bob BowmanCAQH
  •   
Thomas KesslerCMS
  •   
Patrick Edwards
  •   
Briana BarnesScope Info Tech
  •   
Kishore MetlaMettle Solutions
  •   
John DonnellyInterpro
  •   
Lorraine DooCMS
  •   
Melanie JonesCMS
  •   
Rim Cothren
  •   
Yolanda VillanovaCMS
  •   
Kathleen Connor
  •   
Manoj KumarBCBSFL
  •   
Saul KravitzMITRE
  •   
Srinivas KonchadaCentene Corporation
  •   
Sheryl TurneyAnthem
  •   
Helina Gebremariam
  •   
Mike NovalesBCBSIL
  •   
Ric LightHumana
  •   
Ann GallagherOptum
  •   
Chris KlesgesMitre
  •   
Adam GronskyHealth Fidelity
  •   
CaseNet
  •   
Anthem
  •   
CMS
  •   
eClinicalWorks
  •   
Healow
  •   
Interfaceware
  •   
Mark RucciSpectramedix
  •   
Carie HammondAEGIS
  •   
Anthem
  •   
Cindy MonarchBCBSM
  •   
ONC
  •   
Dawn PerreaultBCBSM
  •   
Kyle ZumsteinAvaility
  •   
Nancy SpectorAMA
  •   
Bruce WilkinsonBenmedica
  •   
Cara BarryAvality
  •   

Chris Johnson

BCBSAL
  •   
Duane WalkerBCBSM
  •   

  •   
Greg LindenLinden Tech Advisors
  •   
Mario JarrinChange Healthcare
  •   
Megan Smith-HallingsheadRegence
  •   
Patrice KuppeSurescripts
  •   

  •   
MCG
  •   
ONC
  •   
Surescripts
  •   
NCPDP
  •   
Anupam ThakurBCBSFL
  •   
Jonathan HutchinsBCBST
  •   
Anthem
  •   
Sunitha Godavarthi
  •   
Christopher GraconIndependent Health
  •   
Labcorp
  •   

  •   
James DerricksonIntersystems
  •   
Douglas DeShazoCognizant
  •   
Neetha JosephCognizant
  •   

  •   
May TerryMITRE
  •   
Rutika
  •   
Ashley H. MaplesExpress Scripts
  •   
Brody BrodockAllscripts
  •   
Michael BrodyCME Online
  •   
Theressa BaumannBCBS AL
  •   
Mona ChandrapaleClinicalWorks
  •   
Optum
  •   
Aakash DeliwalaeClinicalWorks
  •   
Mayo
  •   
Eddy NievesEpic
  •   
Shaheer
  •   
Stanley Nachimson
  •   
Anthony SmithUNC Health
  •   
Howard Cohen
  •   
Minaei BehnazFDA
  •   
BCBSA
  •   
Shilesh Nairgdit
  •   
NewWave
  •   
MaxMD
  •   
BC Idaho
  •   
Edward CastagnaAltarum
  •   
Andrea KentCoverMyMeds
  •   
Carrie Denny
  •   
Kim Pham
  •   
Celine LefebvreAMA
  •   
Edifecs
  •   
Josh Lamb
  •   
Keya ShahCasenet
  •   
Gevity
  •  
MITRE
  •  
Mrugen MehtaeClinicalWorks
  •  
Revathi Jayakumuar
  •  
Supriya



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PDex Provider Directory Ballot Comment Review (Saul Kravitz)

  • US Core PractitionerRole is over-constrained for Provider Directory purposes
    • Provider Directory IG has been built - every place we can use US Core, we did
    • Where US Core hadn't weighed in with a profile, it was based on R4
    • Instead of profiling US Core PractitionerRole, could profile R4 base profile, but include all the constraints from US Core that it can, and not include the ones that it can't
      • Constraint examples:
        • US Core constrained the reference to the Practitioner to be required, whereas in the base resource it's optional
          • Sometimes PractitionerRole represents group or hospital, and not a person; therefore making it required doesn't work for this use case
        • Healthcare provider taxonomy cited in US Core PractitionerRole - would need to extend it or replace it
    • Concern that deviating from US Core would cause trouble for EHRs, though Provider Directory IG is not straight US Core, they're already going to need to learn a new profile
  • If we adopt all the constraints from US Core that we can, and skip the ones that we can't, what's the impact?
    • We shouldn't point to a profile that says something we don't want it to say
    • We should provide feedback on it
    • Trying to use US Core as much as possible because we know there's EHR/implementer agreement to support it
    • Payers need the right profile and the right data set
    • Rule is for payers to provide this data to member via 3rd party apps
    • The IG already diverges from US Core, is there additional impact if it diverges further?
    • Seems cleaner to start from base R4
  • Group agrees to start from base R4 profile, and circle back to US Core to raise the issue so that it can be addressed in R5
  • This addresses a number of ballot comments - Saul Kravitzwill provide proposed resolutions for each of those issues and bring back to the group for review


PDex Ballot Comment Review (Mark Scrimshire)

Review in-person comments from Kathleen Connor

FHIR-23313

  • Security labels
  • Proposing a claraification that we're relying on US Core for the majority of the profiles, so this IG is following the requirements defined in the US Core security section - those requirements extend to HRex/this IG
    • US Core doesn't address security labels in any real way
    • Start looking at work Security workgroup is doing 
    • Wouldn't we need to enhance the Security section of US Core?
    • Trying to stay inline with US Core instead of imposing additional requirements on top of it
    • Security is not a focal point of US Core, it's more clinical
  • Issue needs additional follow up

FHIR-23312

  • Need to wait and see what comes down the pike with TEFCA and NPRM
  • Providers would like to know that it was patient generated data
  • Future IG would need to be updated to reflect regulatory requirements when they come out
  • If there's no regulatory requirements now, and implementer community doesn't feel like it's not a requirement right now, we wouldn't include in the IG at this time
    • Have payers, EHRs said this is a requirement?
      • Reluctant to enforce the industry as a whole to require something that's an unknown
      • First round make it a SHOULD, and as we learn more make it a SHALL in the next version
      • Some may require and others won't
    • Payer/provider liability if they don't have Provenance information
    • If don't know where the data came from, payer likely won't store it at all because data can't be confirmed
    • Reality is that data sharing is happening now with X12, V2, and they don't have any Provenance capability 
      • That's usually point to point, and in FHIR world there will be multiple stopping points
      • There are multiple stops occuring now as well
  • Little industry experience in sourcing Provenance - thus a SHOULD as we learn more
  • Purpose of IG is to enable greater exchange of this information - if not going to require Provenance, should at least have a statement in IG re: expectation of someone receiving this information
    • What should recipient assume if don't receive Provenance
    • Receiver knows the data was received from the source, but they don't know where the source got it from (because the source system doesn't know, or it's not able to tell me)
    • Won't have complete Provenance chains for decades
    • Nobody is required to implement this IG - if they're going to implement it, why can't it be a SHALL?
      • If payers can't use information without having provenance, then we could make it a SHALL, but payers haven't said this - payers just don't know yet
    • Payer receiving tons of clinical data, sending it to thousands of providers without provenance today - in how many situations has the information been unreliable and caused a false diagnosis?  To date, payer has not received any feedback indicating this has occurred
    • Default assumption is that receiver will treat the data as 'real' - patient safety is at risk if it's false
  • Work with Kathleen to create a paragraph in the IG that describes the issues covered in this conversation - the issues that should be considered by senders and receivers when Provenance is not sent or received - this would be an acceptable resolution to this issue 

FHIR-23311

  • Change from "screen" to "process" - there may be situations where this is done by calling into a help desk - trying to leave it open

FHIR-23309

  • PDex team developing Provenance examples based on payer experience
  • Revised Provenance profile will be incorporated into HRex IG to be shared with other Da Vinci IGs
  • Work to be shared with Security workgroup
  • Concerned with having a way to indicate where it came from and how it came there - came out of CDA, V2 transaction, a claim - not that it just came from Dr. Smith, but that it came from Dr. Smith via...
    • FHIR resource has a target - does it need any constraints?
    • Think it's a value set issue
    • Need to talk to payers to confirm this is an issue
    • Suggest making this a work item (CR) for Security workgroup
  • FHIR-23304, 23305, 23307 are related to this one- Mark Scrimshirewill update 

FHIR-23301



Next Agenda

Continue ballot comment review


 Adjournment

Adjourned

at 

at 12:59 pm ET



Outline Reference

Supporting Document

Minute Approval
PDex Companion GuidesPDex IG Companion Guide List




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