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Chair: Mark Scrimshire

ScribeVanessa Candelora

 

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Minutes Approved as Presented 



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This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."


Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



HL7 Da Vinci Education and FHIR Implementation Event

October 27-29, 2020

The Da Vinci Education & FHIR Implementation Event will focus on how the Implementation Guides (IGs) address the final rules, including burden reduction and quality measures

Open registration - click here



Implementer Support Questions (PDex, Formulary, Plan Net)
  • Dental and Vision. CARIN 
    • CMS and ONC Rule mandate is unclear, open question to them for clarification. 
  • Looking at B to B to C Connections.
    • e.g. Payer to PBMs/sub contracts to Patient
    • Encourage ESI to join this discussion (note anti-trust) to review what they are looking to build from a general standards approach. - 
      • Update per Jason Teeple - The Express Scripts Architect will be able to attend the 10/30 meeting to discuss B2B2C concepts.  He has agreed to make sure the conversation focuses on the standards and we do not discuss anything that would run into ANSI concerns
    • The PBMs may be thinking about things like, are they looking at FHIR APIs for Formulary, CPCDS, and Directory directly or are they passing through the payers, or others. Real-time data exchange?
    • Member Identity Resolution will be key here - passing JWT tokens - needing the info from the Payer and the PBM. 
  • Identifying Members across plans (Master Data Management)
    • Treated as one member record or multiple members due to multiple plan coverages rather than 1 account.
      • Scenarios: 
        • one individual has multiple plans of their own - primary and secondary Coverage
        • spousal arrangements coverage at the same time. 
        • coverage with medical, dental, and vision
      • All scenarios should be fine with having a separate patient record for each plan.
  • US Core element - Payers don't always have clinical status - sometimes they can get it from the claims, UM, etc.
    • Taking the condition from claim, don't always know if it;s active. 
    • It's a "MUST" support, so share when you have it.
    • Don't craft/paste it together.
    • Should we share a status that is a "this is my best guess" - No. It's not a requirement.
    • Could add an example to the "must" support guidance in PDex for this. 


PDex IG Links and Updates

Updated to 0.1.24 on build.fhir.orghttp://build.fhir.org/ig/HL7/davinci-epdx/index.html

Source code is here: https://github.com/HL7/davinci-epdx

  • 0.1.24 Updated US Core Patient, Hrex Coverage, US Core CareTeam, US Core Condition, PDex MedicationDispense, US Core Encounter, US Core Procedure to add mapping of CARIN-BB IG CPCDS fields to US Core/PDex Profiles. Fixed DiagnosticReport mapping of CCDA and X12 837 claim elements.

Spreadsheets used to support tables in PDEX IG:

ToDo:

  • Guidance on handling data received from Payer-to-Payer Exchange
  • Persona Page (question)
  • Create "What to Review" Guidance for FM

Mark Scrimshire - add Cardinality guidance to Condition (I believe)



Other discussion

Discussion around code sets used and how implementers will support. 

  • CARIN Mapping to FHIR interim 2020 0818 v2.xlsx - reviewed live the data elements mappings pulled over; CPCDS (EOBs or Patient Resources) to map into US Core conditions, procedures, encounters, etc. 
    • CPCDS (not x12)
  • May want to add the code sets that CPCDS points to within the IG. (Once it's ready) Mark Scrimshire
  • Won't be changes from US Core side that would impact here. 

Formulary - Dave Hill meeting with Pharmacy WG on Monday. Open questions for CMS, but Denise St. Clair may join the October event sessions to share CMS's feedback on the open questions related to security requirements. 



PDex Supplemental Guides

IG Publishing Updates 
  • Presentation of IG to FM and start of 1 week review - see FM DRAFT Agenda for 10/20 here. 
  • Follow up vote will be, in general 1 week later. Then, following approval vote, it will go through additional approvals with TSC, FMG, etc. and get published. 





 Adjournment

Adjourned at 1:00pm







Outline Reference

Supporting Document

Minute Approval
PDex Companion GuidesPDex IG Companion Guide List
CARIN CPCDS to US Core Mapping

Latest draft CARIN CPCDS Mapping document: CARIN Mapping to FHIR interim 2020 0513.xlsx

DRAFT - PDEX US Core Mapping from CPCDS source: ResourceMappingUSCoreCPCDS-2020-05-29-v26.xlsx

PDex - US Core
inter-relationship

Source PowerPoint: PDEXandUSCoreRelationship.pptx

Da Vinci is seeking answers to open questions and clarifications needed on the implementation and operational needs of the upcoming CMS Patient Directed API Rules.

Find initial questions and corresponding answers shared from our colleagues at CMS here


Action items

Attendees

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PresentNameAffiliation
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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
  •   
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
  •   

  •   
Manoj KumarBCBSFL
  •   
MITRE
  •   
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
  •   
Anthem
  •   
Cindy MonarchBCBSM
  •   
Michael Kim
  •   

  •   

  •   
Jim CatanAccenture
  •   

  •   

  •   
Jia Chen
  •   
Robert Dieterle
  •   
Jeff Eastman
  •   
Ernestine Cooper
  •   
Jason Teeple
  •   
Lloyd McKenzie
  •   
Mary Winter
  •   
Rachel E. Foerster
  •   
Tom Grannan
  •   
Tony BensonBCBS AL
  •   

Rakesh Mathew

Independence BC
  •   
Henry ArchibongInovalon
  •   

  •   
Abdul Sattar





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ONC
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Dawn PerreaultBCBSM
  •   
Kyle ZumsteinAvaility
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Nancy SpectorAMA
  •   
Bruce WilkinsonBenmedica
  •   
Avality
  •   

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
  •   
Cognizant
  •   
Neetha JosephCognizant
  •   

Scott M. Robertson

Kaiser Permanente
  •   
MITRE
  •   
Rutika
  •   
Express Scripts
  •   
Brody BrodockAllscripts
  •   
Michael BrodyCME Online
  •   
Theressa BaumannBCBS AL
  •   
Mona ChandrapaleClinicalWorks
  •   
Optum
  •   
Aakash DeliwalaeClinicalWorks
  •   
Mayo
  •   
Epic
  •   
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 LambUPMC
  •   
Keya ShahCasenet
  •   
Gevity
  •   
MITRE
  •   
Mrugen MehtaeClinicalWorks
  •   
Revathi Jayakumuar
  •   
Supriya
  •   
Bapi Bhera
  •   
Matt DyerVyne
  •   
Sree Vijetha VegiC-HIT
  •   
BCBSA
  •   
Rich BlochLumedic
  •   
Cigna
  •   
Paul Knapp
  •   
Pooja Babbrah
  •   

  •   
Ron UrwongseCAQH
  •   
Anand Raghavan

Inovalon

  •   
HealthLX
  •   

David Clowers


  •   
Ezequiel Morles
  •   
Frank McKinney
  •   
Hanna ?
  •   
Brett Rauschke
  •   
Carolyn McKinney
  •   
Clarissa Winchester
  •   
JC
  •   
HealthShare Exchange (HSX)
  •   
River Wong
  •   
Rob McClure
  •   
Ronald Wampler
  •   
Derrick Woolridge
  •   
Beata Ferraiz