2021-07-23 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)

Is now set for 9/13-9/15

FQA

Did not get to review it this week due to the CMS Connecthaton

Readout Recording from today

• Connectathon Track pages. 

  • CMS2021-07 Patient Access API - Payer Data Exchange IG (including Formulary)
  • CMS2021-07 Payer to Payer Data Exchange - Payer Data Exchange IG
  • CMS2021-07 Provider Directory - Da Vinci Plan Net

CMS Connectathon CConMan: http://conman.clinfhir.com/connectathon.html?event=cms

Last 3 days at CMS Connectathons. approximately 1200 participants and PDex was well represented. 

Monday- have session with CMS, presenting payer to payer exchange. Tuesday- overview of IG and RI and testing. Wednesday- over the payer to payer exchanges. Thursday- deep dive on the RI and testing on suite of PDex test scripts. Focus on CMS mandate for 7/1/21. 

Feedback was positive. About 90 participants at this specific track.

Provider directory- had questions from providers, had some via chat and zulip. Lots of interest in the implementation of the provider directory and questions on how locations search works. Discussion from other implementators on how to do it on their end. 

Formulary- on education of the IG, had about 83 participants. Several questions came up on formulary and identifiers of plans (which there are no standards from but mostly left to the organization). Concern that this may be difficult to implement. Question on the border of the IG, not including med list. Query to search for drugs that are part of the formulary and not specific to what they are taking. Other means of doing it with EHR by US Core.  Number of comments in testing as many were observers (showing RI). 

• Had questions from one participants that is being looked at, may have good information for STU2 version.

Number of persons wanting to know how to get more involved in the HL7 process. 

Benefit of CMS connectathon, that it was able to reach a wider audience. 

In terms of testing- let testing on Patient Access API session but had interacting on the the provider directory. Many people were new on how to interact with FHIR server and how to make a query. Last day of testing had more participants and interactions. The member matching query had some pass and some fails. 

Many great questions on the zoom chat. May be ideal to get that transcript. 

CARIN Alliance panel made an announcement to have a directory, lightweight solution, maintain a list found in Github that anyone can submit to , as a way to start the discovery process. Crowd source endpoints for third party to connect. 

https://carinfhirdirectory.com/

Is a survey monkey that pulls it into a file and placed into GitHub. 

Tone Southerland (OneRecord)

heres the github: https://github.com/onerecord/carinfhirdirectory

(Note- not endorsing CARIN but provide available options)

Consumer side- a lot of items that can be reused from the Payer to Payer and Patient Access API. How can we reuse the Patient Acess API for the payer to payer. May be great to add for the Sept connecthaton. From payer perspective- you have done the heavy lift of identifying the US Core data and converting it to FHIR. Only certain payers are involved in the payer to payer exchange, not across industry. Best to use the Patient Access API for it than build a whole new system. 

Bob- had ONC FAST directory- working on a national directory, looking at Pdex directory. 

• What is current thinking around Payer to Payer?

Bob- biggest issue is related to HIPAA and consent. API -member goes through a portal and gets a token to get the information exchange. Limitations that small number of people have portal accounts. 

Have asked CMS questions. Is this more toward an operation issues? Is attesting to new plan to have data moved sufficient for consent? 

• Has anyone standardize the exchange?

Use the PDex clinical API from the Patient Access API. Requirement is USCDI not entire Patient Access API. 

• How do we round up payers to be interoperable? 

Because the CMS mandate did not specify using a API but have guidance that API is encouraged. The payers involved in the payer to payer exchange requirement are also required to be compliant with the Patient Access API. CMS points to USCDI and USCore. 

Patient Access API is required to incorporate data into the patient profile. If building a FHIR repository and getting FHIR data, and may not need to add it to the infrasctructure. 

Take a look at the FAQ here.

If you have received the structure data and need to incorporate into the patient record. 

Tone Southerland (OneRecord) 

One reason payers are looking for simplified solutions for P2P (ie. S3 bucket/ftp) could be that the patient access api work is based on their well-known existing internal data model. Whereas incorporating new mappings is not light-weight work for some organizations. A step one could be to meet the bare bones of the reg, and adapt that solution later to incoporate the data into the payer's data model, and then it could be exported as part of the existing patient access api solution.

Mapping may be internal and external. 

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