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Present

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Affiliation

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Mitre
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George BierOptum
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BCBS AL
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Rush
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Matthew ByrneOptum
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Rush
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Cerner
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Anthem
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Allscripts
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InterSystems
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Allscripts
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Mitre
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Cambia Health
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Cerner
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Enable Care
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Optum
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Aegis
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BCBS FL
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InterSystems
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Anthem
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Mitre
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Allscripts
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Optum
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Jackie HardisonHumana
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Cigna
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Claudia HartmanHighmark Health
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Mark HinghamAnthem
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Optum
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Sheljina Ibrahim KuttyAnthem
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Allscripts
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Point of Care Partners
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Edifecs
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Mitre
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InterSystems
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Anthem
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Tso LukeOptum
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Point of Care Partners
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Optum
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Cognosante
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Optum
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Humana
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Stratametrics
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Casenet
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Allscripts
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Optum
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Optum
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InterSystems
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C SimeoneOptum
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Jeanie SmithBCBS FL
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InterSystems
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Veradigm
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CMS
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Casenet
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Independence Blue Cross
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Anthem
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CentriHealth
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CaseNet
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India DuncanOptum
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Jason Cassidy
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Optum
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Gevity
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Tracy McCutcheonKPMG
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Rashmi MenonKMHP
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Mario JarrinChange healthcare
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AMA
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Ann GallagherOptum
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Megan Smith-HallingsheadRegence
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Regence
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Anthony SmithUNC Health
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Optum
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  •   
Jennifer Joe
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Texas Health
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Cigna
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Labcorp
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Cigna
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Matt DyerVyne
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Barbara Kramer-ZarinsMITRE
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Centene
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Barbara WoodPNC
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Greta HoneycuttCoverMyMeds
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BCBSA
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MITRE
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Keya ShahCasenet
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Rich Bloch
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Interpro
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Lauri Shock
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Andrew JohnsonNational Decision Support
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MITRE
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Mark FlemingChange Healthcare
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eClinicalWorks
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Prathima
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Rachel Foerster & Associates
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Heather McComasAMA
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Megan RileyMITRE
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Summer DumanRegence
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Michelle BarryAvaility
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Chris Cera
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Michael FasuloRegence
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Mettle
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Lauree Marshall
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Uma Kandasamy
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Mina RasisExpress Scripts
  •   
Harmanpreet Singh



Column


PresentNameAffiliation
  •   
Peter MuirESAC
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Ryanne LaurenceOHSU
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Mitre
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CMS
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Aim Specialty Health
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Christy DodsonMCG
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Tibco
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Rajesh Godavarthi
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Santosh
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Tom Hartman
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Tori WillowsWellcare
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Alise WidmerLumeris
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Bart CarlsonAzuba
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David BruinsmaColonial Med
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Deepthi ReddyMettle Solutions
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Danny BrennanMA Health Data
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Patrick Edwards
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Cambia Health
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CMS
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Pallavi TalekarScope Info Tech
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Rajesh GarlapatiRush
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Susan BellileAvaility
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BCBST
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Ralph Saint-Phard
  •   
Kristi CushmanOHSU
  •   
Briana BarnesScope Info Tech
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Didi DavisSequoia Project
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Sreekanth PuramMettle Solutions
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Duane WalkerBCBSM
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EMDI Team
  •   
David HillMitre
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BCBS AL
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Nandini GangulyEMDI
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  •   
Rajesh GodavarthiMCG Health
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Rim Cothren
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Donna CampbellBCBSIL
  •   
Joanna GaskillLumeris
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Edifecs
  •   
Michael CabralCMS
  •   
Sudhir NairAnthem
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Saul KaravitzMitre
  •   
Dawn PerreaultBCBSM
  •   
Brent WoodmanBCBSM
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Yolanda VillanovaCMS
  •   
Deryl Lam
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Edifecs
  •   
Karen TottCMS
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MITRE
  •   
Dacarba
  •   
Carradora
  •   
Rachel Goldstein
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Ric LightHumana
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eClinicalWorks
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Healow
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Wanda Govan-JenkinsHHS
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Cindy MonarchBCBSM
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Edward Yurcisin
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Humana
  •   
Hibah QudsiMitre
  •   
Nancy SpectorAMA
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Patrick Leblanc
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Anupam ThakurBCBSFL
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MCG
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Chris KlesgesMitre
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BCBSA
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Gregory MagazuCaseNet
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Isaac VetterEpic
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Kat RuizUNC Health
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Laura Bright
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Humana
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Roland Gamache
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Katherine LuskChildrens
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Anthem
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  •   
Chris JohnsonBCBS AL
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Jim AdamsonArkansas Blue Cross
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Carry Denny
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Infor
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Anna MeisheidCMS
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Celine LefebvreAMA
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Eshaa DhalleClinicalWorks
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BCBSM
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Express Scripts
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Sandhya
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Christopher GraconIndependent Health
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Candice TitusCrisp Health
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Mariana SinghCAQH
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BC Idaho
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Shilesh NairGdit
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UHC
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Tammy BanksProvidence St. Joseph
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Bob HarringtonAllscripts
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Vishnu
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DanielleSutter Health
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MITRE
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Sonya MayOptum
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Molly MalaveyAMA
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Guidewell
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Angela BublikRegence
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eClinicalWorks
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Advocate Health
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Arsal HussainiAccenture
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Allen Saunders
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Steve Ruszkowski
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  •   
Beth Connor
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Thomas KesslerCMS
  •  
Daniel C





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Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy




Links

DTR IG: http://hl7.org/fhir/us/davinci-dtr/2019May/

Reference Implementation: https://github.com/HL7-DaVinci/dtr 



Reminder: Call Structure & Name Changes
  1. Burden Reduction (CRD/DTR/PAS) Implementer Support Call - Wednesday, DTR time slot (11at ET)
  2. Burden Reduction (CRD/DTR/PAS) Supplemental Examples Call - Friday, PAS time slot (3pm ET)
  3. Burden Reduction (CRD/DTR/PAS) IG Updates/Future Requirements - call to be scheduled, Mondays at 1pm ET


HL7 Patient Access API Testing Event - Aug 17-192020-08 Patient Access API Testing Event

HL7 FHIR Connectathon - Sept 9-11

2020-09 Connectathon 25

2020-09 Da Vinci CRD / DTR / PAS

  • Kick-off planned for next week once we have more details regarding the tool being used during the event


Implementer Questions (CRD/DTR/PAS)
  • Launch parameters
    • Submitted change request to CDS Hooks to better expose mechanism (not currently well documented)
    • When you pass back CARD intended to launch SMART app, mechanism to provide an extra parameter
      • Parameter gets communicated to auth service, which then passes it along as part of authentication process to SMART on FHIR app
      • JSON can contain anything - app context
      • Could include JWT, could include same info that was used to launch the hook, etc.
      • CRD spec doesn't specify what needs to be in there because it's specific to the SMART app
    • If we have generic SMART apps, what would it need - not payer specific
      • Hook service needs to know what the app wants; hook service will be 'tuned' to specific app
      • Specific SMART app and generic SMART app would need same thing - define what we want in the apps to test out in Connectathon and get it into spec?
    • Need to pass the following info:
      • Context passed to CDS endpoint
      • Access token/ JWT
      • URL to go get data (CQL, Questionnaire)
      • Need to create an example of what the above would look like in the JSON/payload
    • Assumptions:
      • Payers talking to multiple EHRs with their own capabilities - need to standardize interaction
      • Developers of the app and service not communicating necessarily
      • Providers could choose to work with 'generic' SMART app that interacts with multiple different payers
    • Can't use a CARD to launch a native capability (e.g., application module) with CDS Hooks
    • Payer does not necessarily know what SMART app is being launched?
      • They have to
      • This changes paradigm of 'generic' app
      • No ability to pass back CARD that says launch 'some' app and you don't know which one
    • Connectathon - need to test:
      • Test app launch context components and structure
        • Test that we can pass the context, access token, and URL
      • Payer CDS service pass back CARD with a URL that 'somehow' indicates specific SMART app OR launch whatever your generic functionality is
    • Need to add 'floor' model in the CRD IG
    • Need to figure out how to do the app launch - URL translations in EHR?
    • When invoking hook service, EHR could declare they have a generic app in advance and provide launch URL for that app
      • EHR would need to add custom extension to launch
      • Hook service shouldn't care what kind of apps could be launched


  • Post Sree's list of questions to Confluence
  • Guidance on CQL/ how it is evaluated - can implementer choose not to implement CQL?
    • Do we want to leave it to app to decide how to execute/evaluate, or provide more guidance?
    • Several approaches: 
      • EHR might have CQL evaluation engine locally
      • Launch within application via Javascript to run CQL
        • Can be slow
      • Application could have CQL evaluation API or someone could provide the API
        • Disasdvantage - network traffic (back and forth between EHR prior to doing the evaluation) 
    • Good option to have it local to application
    • Depending on how CQL is written, could call on other libraries
      • App would have to embed all the CQL scripts or access via CQL evaluation engine to other libraries needed to execute
      • Data Requirements in FHIR Library resource
        • Is this mandatory?
        • MITRE RI has defined these Data Requirements - instead of making FHIR calls during evaluation stage, doing it as pre-fetch
        • If using CQL service, this will be an issue
        • If we don't make it mandatory, just need to check that implementations work on Javascript side
        • Sreekanth Puram to write up options that we can test
    • Generic app would need access to CQL evaluation engine and all the value sets - how to make available?
    • Specific apps - evaluation services, libraries, etc. - app would define for itself
    • DEQM - CQF Ruler with library - open source code used to build services
      • Architected to run on provider side vs. DTR application pointing to evaluation endpoint
    • FHIR Questionnaire and CQL Questionnaire done by same group?
      • Yes, payer or payer's vendor who defines what goes into Questionnaire


  • Alternative paths/delegation
    • If you don't have all the info needed at time that DTR was launched, need to 'save' and potentially delegate to someone else to complete
    • There is guidance in IG, but implementation is EHR-specific
    • Save app context and re-launch SMART app - where does this get saved and how does it get re-launched
    • What does app need to pass back to EHR so it knows
    • Discuss next week with Larry Decelles



Next Agenda
  • Discuss question re: delegation: saving app context and re-launching SMART app - where does this get saved, how does it get re-launched, and what does app need to pass back to EHR so it knows
  • Additional implementer questions

 Adjournment
Adjourned at at 11:58am ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval
Draft list of supplemental examples (from 7/8 call)

Potential Examples:

  1. DME – O2
  2. Specialty Med – CodeX is interested in this topic
  3. Diagnostic Imaging – Head MRI, MRA
  4. Lab – Genetic test –
  5. Referral – Occupational Therapy or prosthetics – Example -
  6. Hospital admission - Pneumonia
  7. Home Health Services - eg.g Wound care
  8. Surgery – Arthroplasty (Total hip/knee replacement)
  9. CRD - Types of information/CARDS returned
  10. DTR - collect data and return it directly to payer - what does request look like, how to return it
    • RI demonstrates sending to PAS and sending to another endpoint
    • Extension on Questionnaire re: where response is supposed to be sent?
      • Not currently addressed in IG - Larry Decellesto add tracker to DTR
      • Sending to payer automatically (to same place request came from) in RI
  11. DTR - scenario where Questionnaire not posted directly, but keep it on file via EHR, or include it with prior auth submission or claim submission
    • IG worded like this, but need explicit instruction with respect to the Questionnaire - how do you ask for it and how do you respond
    • Larry Decelles to add to same tracker noted above
  12. DTR - Task workflow
    • Provider orders MRI, provider requirement is to attach Xray but someone else needs to do that - suspend order, send to someone else to complete (attach Xray) and submit - "to do" item put into a queue and/or assigned
    • Once CARD is received, does it matter who works it?
      • Within EMRs, don't yet have process for external agents/orgs (e.g., payers) to inject tasks
      • Task comes back and isn't assigned to anybody (i.e., no expectation that payer would assign it to someone) - whomever creates order has option to assign to someone else's task list, or leave unassigned and some other process defines who picks it up to complete

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