2021-07-02 Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meeting

Call Structure & Name Changes

• Friday 12noon ET - Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meetings
• Friday 2pm ET - Payer Data Exchange (PDex/Formulary/PlanNet) Version 2 Meetings (formerly the PCDE call)

Payer Data Exchange (PDex/Formulary/PlanNet) Confluence space

• Individual pages for each IG
• Space for separate meeting minutes

• 2021 CMS HL7® FHIR® Connectathon - July 20-22, 2021
  • Confluence page: CMS 2021 - 07 Connectathon 2
  • Complete the HL7 Pre Connectathon Survey to designate which track you want to participate in.
  • Attend the Participant Information Session on Thursday, July 8th at 4:00 PM ET.
  • Friday 7/9 (12noon ET) - Payer to Payer and Patient Access API Kick Off Orientation will be held on this call

Patient Cost Transparency Use Case- Kicked off June 25th, 2021 Fridays at 11AM Eastern - See HL7 Calendar and PCT confluence page here

For Kickoff slide deck and recording, click here

Use Case #1: Need to develop an Advanced Search feature that may require to perform search across profiles e.g. single search that involves search using parameters such as Provider’s Name, Specialty, Health Plan, Spoken Language, Zip code or City/State and Gender.

Issue/Challenge: I this case I could not figure out a single profile that can be used to perform this search. Similarly, we cannot perform search in multiple steps (searching the search result) as this will be too complex plus will not work with pagination provided via FHIR server.

We did have some discussion about this in our core team, but some of this is really up to the third party app.  We encourage the person that asked to join these meetings and how you are joining us at the CMS Connectathon! 

Open Forum for additional questions

Are we going to make a statement on where the translation will occur?  Something that is similar, brand, generic, and representation.  Idea that I have a phrase / string text vs. RXNorm identifier is seperate. 

It would be help to make a decision of who is responsible for doing that. Through this process someone could figure out that the drug is on the formualry.  text matching and the generic to brand transformation.  

Strong in generic form, then the clinical drug name is in []

• who is responsible for determining the text matching with misspelling - the oxy methalone vs. searching for the generic. 

We are syaing "Server will provide this in your search"  the Patient likely wont have all the information and the strengths and the RX Norm representation of the Form (oral tablet) but this could be different if not RXNorm.  

Now, search parameter for DrugName is displayed as follows:

Search on ingredient, then use the API to get all the strengths for that ingredient.  Multi-ingredient drugs

Problems to solve:

1) If I'm searching on drug name, what is the test I need to provide to find what I'm looking for,.

2) If I'm searching on Brand, should I expect to get results for generics as well and vice versa.  

• It's possible to do this, it takes a service to understand the APIs.  Misspellings, wild card searches, etc. would be part of the services.
• Also, Alternates to be offered is another thing you have in the Formulary.  Required. 

I have a known RX Representation of a drug, then the formulary can give alternatives.  This discussion is around getting the Rx Representation and what comes back if 

eg, Valium is a brand name for the drug diazepam, can search for either. 

Using ingredients should get us far in terms of the formulary response. 

Next Step: Corey will go back and look at wording. 

Every single drug in RxNorm has a SCD.

There are no SCDs that don't also have the "generic" name in the US. 

Then, if it's branded, it also needs to be represented by the branded, if it's in the formulary. 

Branded form you might get could change over time. All generics are represented by different drugs. 

Let's say - Patient is looking for Brand name, but he PBM doesn't have it on formulary only the generic. 

If they search for the brand name, what's the expectation.   

Generics vs. therapeutic equivalent is a big question.  Biologics gets really complex.  

Find an Example with multiple brands, one generic representation.  Corey to work with Rob to find one and they write out want to do with combinations. 

One idea: Diazepam is available under the following different brand names: Valium, Diastat, and Diastat AcuDial.

What are all the variants that you'd want to display.

The pharmaceutical industry and regs should provide the guidance of what should come back with (substitution, translate to generic to brand is on formulary, multi-ingredient), the standard just needs to support it.  

Response needs to be therapeutically appropriate in the context of the pharmaceutical response.  Responsibility to disclose.  The clinical appropriateness of the response is on the pharmacutical side not on the standard side.  

Look into this: Name of the form - eg oral tablet vs oral pill - getting the right form brings issues.  

12:56 PM
Michael Gould to Everyone

Link to pubmed article that may help with multiple brands: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737992/

12:57 PM
Michael Gould to Everyone

May have some examples that we could use

12:58 PM
Michael Gould to Everyone

Article is from 2013 so not sure if examples are still relevant

In the coming weeks, we'll begin reviewing open JIRA Trackers that may help implementers.

PDex IG Companion Guide List

PDex IG Companion Guide - Laboratory Reporting Resources

Latest draft CARIN CPCDS Mapping document: CARIN Mapping to FHIR interim 2020 0818 v2.xlsx

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

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

• Links to Published IGs

• PDex STU 1.0.0
• Plan Net STU 1.0.0
• Formulary - STU 1.0.1

Implementer Resources

Da Vinci Implementer Support Page 

Implementers can take advantage of tools: See the Reference links on the Payer Data Exchange (PDex) page to access links for Reference Implementations, sandboxes, test scripts, and more!

Da Vinci PDex for Patient Access API Frequently Asked Questions (FAQs)

CMS Final Rule Questions and Answers log

ONC FAST National Healthcare Directory (including end points) solution page that includes links to everything (solution doc, Connectathon, HL7 workgroup, etc.): https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/National+Healthcare+Directory