Chair:   Robert Dieterle Jean Duteau Mary Kay McDaniel 

Scribe: Crystal Kallem 


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Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
Management

Review ANSI Anti-Trust Policy





Call Structure

  1. Burden Reduction (CRD and DTR) - Wednesday at 11am ET

  2. Burden Reduction (PAS) - Thursday at 4pm ET 
  3. Burden Reduction (DTR) - Friday at 3pm ET 

Zulip: https://chat.fhir.org/#narrow/stream/259713-DaVinci-Burden.20Reduction.20interoperability 

Alternative slot for Friday meetings


Announcements / Housekeeping

Planning Da Vinci IG implementation testing?

Learn More here: Open Testing Tools - Build and Validate with Touchstone

Office Hours on 1st & 3rd Thursday of each Month at 4:00pm ET

Next Touchstone Office Hour session is on Feb 2nd

CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P)




Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard Proposed Rule (CMS-0053-P)




January Work Group Meeting & Connectathon Debrief

  • With regard to PAS piece, had Infor involved using subscriptions. It wasn't compliant with R4 Backport IG, but still a great success.
  • AS: Question about additional information submit - understanding that there is no way to submit additional information through a FHIR channel. How do you deliver this? Are there thoughts on extending the specification to think about a more synthesized way to do that? 
  • LM: The intent is to use the CDex IG for supplemental requests for data and attachments submission. 
  • AS: Thank you, this is what I wanted to hear. Discussed with Bob and Eric, and tested with Eric. It's possible that this method of transport may be restricted by regulation. Is it legal to use CDex to attach 275 to be compliant with the mandate? 
  • BD: Don't know what will happen with the attachments rule. There are three poss8ibilities: 1) it will be delayed or withdrawn based on recommendations that there are alternatives that are close; 2) it could get reduced in scope to only claims attachments, in which case it would allow for PA, 3) goes forward as is, which will have an impact. Will have to see where it lands. Working with a number of groups to coordinate a response to the NPMR. Implementation requirement is 2 years post final rule, which is 2.5-3 years from now. We  will recommend #1 or #2. 

Ballot Reconciliation - PAS

Tickets flagged for discussion

T Key Summary Assignee Reporter P Status Resolution Created Updated Due
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32 tickets left to review; getting closer to the end.

There are six (6) technical Corrections; two (2) others are marked as TCs but they are actually change requests.

FHIR-36425 - Getting issue details... STATUS and  FHIR-36428 - Getting issue details... STATUS

  • Two related tickets.
  • This is a question. Proposed resolution answers the question. Resolution marked Considered - Question Answered. 
  • Related to her other ticket: notes there are four different profile; the bundles are explicit and there is nothing wrong with doing this. 
  • She points out that the profiles are similar and better to combine
  • Remember trying abstract profiles and ran into snags; but would like to propose as a disposition that we will try to do this. 
  • BD: How many differences are there? 
  • JD: Two
  • BD: Of the two that are similar, are they a rationale sibling of the other? Yes. Can 0..* be the base and the clone the other one?
  • JD:  Yes
  • MD: Based all of this on the 5010. Do we want to look at making this adjustment in the move to the 6020. 
  • BD: The final rule will be at least 6 months and implementation date 2 years after that. We have plenty of time to update this IG. 
  • MK: Will the profile name change impact all of the mappings? 
  • JD/BD: No
  • Will not be changing the constraints on search/request/response. Will expend best effort to create abstract profiles for bundle. 
  • Tickets marked ready for vote

FHIR-39728 - Getting issue details... STATUS

  • BD: I thought we had guidance for this.
  • MK:  Went round and round about this and the problem is nobody is using it today so no real strong understanding. If you read LOINC, a modifier is nothing more than another LOINC code. You can't tell the difference. 
  • AB: Everything is correct. The segment has 12 fields and you do watever you want with it. The LOINC code that follows is associated with Dx. Each field builds upon each other and requires that you process it. 
  • CC: The question is not mapping the PAS response into the 278. Maybe all we have to worry about is mapping 278 in. We have a lot of LOINC codes. 
  • JD: Maybe there is no way to put structure around this. 
  • MK: And everything is pushed to item on FHIR side. In the 5010, there is a limit on number you can have. We have opened that up but will all show up in service lines.
  • BD: Given that LOINC has a discrete list of modifier codes, have a hard time saying we can't tell what is a modifier. 
  • MK: The mapping in the middle is having trouble determining if it's a modifier or not. In the mapping rules, you are assuming that there is someone in the middle that opens up the list. 
  • BD: You can automate this entirely. Understand that the mapping process is an entirely different challenge. 
  • JD: We still need the contentModifier but the value set needs to be changed to adjust the codes that are children of the LOINC attachment modifier list.
  • Ticket marked ready for vote

FHIR-40259 - Getting issue details... STATUS

  • Keeping the two extensions and will clarify that it is within the context of identifiers, and updating the descriptions.
  • Ticket marked ready for vote

FHIR-36581 - Getting issue details... STATUS

  • Was a technical correction. Adjusted to a change request. Comment is persuasive. 
  • Ticket marked ready for vote.

FHIR-36238 - Getting issue details... STATUS

  • Will define the terms that we are using. Comment persuasive. 
  • Ticket marked ready for vote. 

Follow-up from past weeks


Ballot Reconciliation - CRD and DTR
  • CRD and DTR: Happening on Wednesdays at 11am ET
  • DTR: Happening on Fridays at 3pm ET 


Chat Comments


15:02:00 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    Today's Agenda: https://confluence.hl7.org/pages/viewpage.action?pageId=154993697
15:15:02 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    https://jira.hl7.org/browse/FHIR-36425
15:19:12 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    Related ticket: https://jira.hl7.org/browse/FHIR-36428
15:22:08 From  Tom Kakanowski (Smile)  to  Everyone:
    IMO, from an implementation perspective, that model would be very helpful (ie abstract ancestor profile)
15:26:58 From  James Bound (Cognizant)  to  Everyone:
    This is probably the dumbest question I am going to ask today but when is this expected to be in production at a Health Plan / EMR integrated into a process that speaks to a health plan?
15:27:06 From  James Bound (Cognizant)  to  Everyone:
    The entire PAS spec?
15:27:55 From  Tom Kakanowski (Smile)  to  Everyone:
    2+ years from now
15:28:20 From  James Bound (Cognizant)  to  Everyone:
    Ok, the average implementation for these types of processes that I have seen at any health plan averages about one year.
15:28:38 From  James Bound (Cognizant)  to  Everyone:
    So 1.5 years from now it would have to be fully baked.
15:29:59 From  Tom Kakanowski (Smile)  to  Everyone:
    Proabbly more like 2, but in principle yes
15:30:21 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    https://jira.hl7.org/browse/FHIR-39728
15:31:11 From  James Bound (Cognizant)  to  Everyone:
    My thought is when this spec is finalized probably looking at six months to a year to get it ready from that date and then one year plus for a health plan to put it into production.
15:31:20 From  James Bound (Cognizant)  to  Everyone:
    Concerned we don't have that much time to make these types of decisions.
15:37:30 From  Tom Kakanowski (Smile)  to  Everyone:
    Given cardinality, how are individual modifiers linked back to their diagnosis code?
15:43:04 From  Kyle Johnsen (Epic)  to  Everyone:
    attachment modifiers- https://loinc.org/29488-4/
15:52:30 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    https://jira.hl7.org/browse/FHIR-40259
15:57:32 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    https://jira.hl7.org/browse/FHIR-36581
15:58:18 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    https://jira.hl7.org/browse/FHIR-36238


Next Agenda




Adjournment
Adjourned at 5:00 PM ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval
Implementer Questions (CRD/DTR/PAS)


Da Vinci Implementer Support Page

Zulip Streams:

PAS is https://chat.fhir.org/#narrow/stream/208874-Da-Vinci.20PAS
CRD is https://chat.fhir.org/#narrow/stream/180803-Da-Vinci.20CRD
DTR is https://chat.fhir.org/#narrow/stream/197320-Da-Vinci.20DTR

Call to All Implementers: Please come with your questions!

1) Add your question in the Zulip Stream listed above in advance of the call and tag Vanessa CandeloraRobert Dieterle and the IG lead.

We learn as a community and iterate on the IGs through real world experience, so your contributions are welcome!

STU Published IG Links
PAS Supplemental Guide

PAS Supplemental Guide

Ballot and Community Feedback Tracking (JIRA) Da Vinci Coverage Requirements Discovery (CRD) STU Balloting Dashboard
Da Vinci Documentation Templates and Rules (DTR) STU Balloting Dashboard
Da Vinci Prior Authorization Support (PAS) STU Balloting Dashboard
Burden Reduction History/Background


Action items

  •  

Attendees -  


Present

Name

Affiliation


PresentNameAffiliation
PresentNameAffiliation
  •  
POCP, Da Vinci PMO
  •  
Sreekanth PuramMettle Solutions
  •  
Cognizant
  •  

Jeff Brown

Lantana
  •  
MITRE
  •  
Change
  •  
Enable Care
  •  
MITRE
  •  
Chetana SureshIBC
  •  
MITRE
  •  
Anna Taylor

  •  

  •  
Smile CDR
  •  
Christopher GraconIndependent Health
  •  
Jean Duteau 
  •  
Gevity
  •  
Smitha HarishMettle Solutions
  •  
Mallik NimmagaddaMCG
  •  
RFA, CAQH CORE
  •  
EverNorth
  •  
Farheen Khalileclinicalworks
  •  
HL7 FM
  •  
Thomson KuhnACP
  •  
Ricky ZouCognizant
  •  
eClinicalWorks
  •  
Jessica CzulewiczCMS
  •  
Nicholas Volker
  •  
AMA
  •  
HeathEPIC
  •  
John Donnelly
  •  
Heather McComasAMA
  •  
Tibco
  •  
Joyce Quach MITRE
  •  
Meg RileyMITRE
  •  
Optum
  •  
MaxMD
  •  
Susan Bellile Availity
  •  
Sahil MalhotraMITRE
  •  
Kristina McCann
  •  
BCBST
  •  
Beth ConnorCMS
  •  
Christina DexterCognizant
  •  
Michelle BarryAvaility
  •  
Sean O'QuinnCerner
  •  
Tim McNeil Surescripts
  •  
Yolanda Liu MITRE
  •  
CMS
  •  
Gary Dickinson 
  •  
Thomas Grannan

  •  
Rajesh GodavarthiMCG Health
  •  
Robi ScalfaniMITRE
  •  
Marivie Lanter

  •  
Jim Denyer IBC
  •  
United Healthcare
  •  


  •  
Rob Brull Infor
  •  
Bryan Briegel IBM Watson Health
  •  
Mettle
  •  
Katie RussellCovermymeds
  •  
David DeGandi Cambia
  •  


  •  
Versaggi Consulting
  •  
David DelanoMHDC
  •  
Amanda MerrittZeOmega
  •  
Philip MaherCerner
  •  
Don Rucker
  •  

Dawn Duchek

Trizetto Provider Solutions
  •  
Mark

  •  

  •  
@Dorrie Speckman

  •  
Multi-Care ConnectedCare
  •  
@Kyle JohnsenEpic
  •  
Deb ConklinMedical Mutual, X12
  •  
Chris Johnson BCBSAL
  •  
@Brian LindInfor
  •  
Molly Reese AMA
  •  
Julie King Cognizant
  •  
Alyson BroxtonCognizant
  •  
Vassil Peytchev Epic
  •  
Amol Vyas Cambia Health
  •  
Epic
  •  
Optum
  •  
Wanda Govan-JenkinsOS/ONC
  •  
AHA
  •  
AHA
  •  
Zach Robin MITRE
  •  
Yukta BellaniEvernorth
  •  
Jason TeepleEvernorth
  •  
Phung Matthews3M
  •  
Sheljina IbrahimAnthem
  •  
Epic
  •  
Ryan BussellCohere Health
  •  
Diederik Muylwyk 

Smile CDR

  •  
Fred Switzer Epic
  •  
Christopher BustardCohere Health




  •  


  •  


  •  
@KDeviCore/ Evernorth
  •  
 Anup MahansariaSg3





  •  
@Anushe AlySmile CDR
  •  
@Tamilka Bevels

  •  
Melvin

  •  
Kristal Vines CMS, CPI, PCG
  •  
Marc WilliamseviCore
  •  
Heather TrimbleEvernorth/eviCore
  •  
@Balaji NarayananOnyx
  •  
SW

  •  
VA (Federal Electronic Health Record Management)
  •  
MaryKay McDaniel
  •  
Jeff DanfordAltera Digital Health
  •  
Kassie MintesnotLantana
  •  
Chris Cioffi Elevance Health
  •  
Vic ChandlerCognizant
  •  
Andrew KirnerAvaility
  •  
Andrew BarbieriEpic
  •  
Yan Heras 

  •  
Brian PoteetEdifects
  •  
Carie HammondAEGIS
  •  
Bhargav VajarAvaility
  •  
Neha

  •  
Bhanu VemuriBlue Cross NC
  •  
Miriam

  •  
Ddesai

  •  
AnushreeSmile Digital Health
  •  
Thao MichaelsSmile Digital Health
  •  
Daniel VargasLantana
  •  
Brandon StewartLantana
  •  
Demetrio Herrera

  •  
Jaspreet Kaur

  •  
Shamil NizamovSmile Digital Health
  •  
DinakarInfor
  •  
Rick Duffy

  •  
Don Quackenbush
  •  
Sofya KreimanOpala
  •  
Portia Thurmond

  •  
Ankit Kumar Agarwal
  •  
Laureta ExezoborSmile Digital Health
  •  
Scott Ogden

  •  
Nikki Henck
  •  
Michael Gould ZeOmega
  •  
Tom KakanoswkiSmile Digital Health
  •  
Amar NagarsurkarSmile Digital Health
  •  
Gregg JohnsonBCBSSC
  •  
Artem SopinEdifecs