2023-05-19 Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meeting

Single meeting on Fridays from 1:00-2:00 PM ET

Zoom Meeting https://hl7-org.zoom.us/j/92482555863?pwd=TWQzVENNeStqeEpVTHdicGM2cGdMQT09 

Next PlanNet Discussion:

• Friday, June 9th at 1:30 PM ET (during this meeting)

Now Available! Da Vinci In Action Interactive - Implementations To Date

A tracker to share general implementation progress across Da Vinci and the community. All listings are voluntary. Two goals for this tool:

1. Develop a picture of the progress of early adopters by Da Vinci membership (for Da Vinci leadership); and 
2. Create clarity for FHIR community, those who are in active development, ready for partners, and want to share contacts with wider community.

Upcoming CMS HL7 FHIR Connectathon (Virtual Testing Event)

Join developers, programmers, technology experts, analysts, and CMS colleagues to learn about and test emerging Fast Healthcare Interoperability Resources (FHIR) Application Programming Interfaces (APIs) and supporting FHIR Implementation Guides (IGs) at the 2023 CMS and HL7 FHIR Connectathon.

• July 18 - 20, 2023 from 9:00 am - 5:00 PM ET
• Register by June 30, 2023
• CMS 2023 - 07 FHIR Connectathon 4

• Made good progress working with CARIN to refine profiles to support request for non-financial profile. The data would be presentable through provider API. 
• Provenance was another topic of focus to describe where FHIR data came from. A profile in PDex today so rather than CARIN reinventing, they will refer to documentation in the PDex IG. 
• Casey noted they participated in the prior auth/ Burden Reduction track. 
• Some of the work related to CRD Hooks will relate to provider API - plan to leverage work done by Member Attribution which has data export function, and driven by member resource. Payers should be able to develop list of attributed members based on their own claim history as evidenced by treatment relationship with given provider. Work under BR with appointment hook and encounter start could be used as a trigger into member attribution group resource to update attributed member list or a provider in real time.  Some interesting cross over between Burden Reduction and PDex (for provider API).
• Section in formulary that supports bulk export of formulary data, using the $export capability to export formulary. PlanNet may also include in its next iteration. This is an area we hope to test (the bulk export).
• Wendy noted that there are scripts going through QA process related to this piece. 
• If an export for PlanNet, plans updating on a monthly/weekly basis. What would happen if we canned an export file - could be more efficient for plans. 
• Sure, for formulary, provider directory, etc. Things that are reasonably static. Benefits of efficiency with pre-canned response versus on demand. 

• Regarding consent workflows and executing consent policies; if we have a resource that contains protected data and member has chosen to exclude from the transfer. Is it best practice to redact whole resource or do it inline? Any guidance on this? 
• Not aware of any best practice but may be something out there. Be careful if doing redaction at the field level. What can be inferred from the record. Best approach is to redact the record.
• Also have to consider that you may have to redact any reference to it. Payer to payer punted the whole thing because there is only one consent.
• Interoperability rule indicated you could exclude sensitive data, which is defined at state level. 
• On member match, we have not specified in the IG how the match works. Can we assume that a member identifier will be supplied?
• Depends on what you mean by a member identifier. Goes back to original conversations that payers had at very first CMS Connectathon. The information is some demographics and minimal information from the coverage card.

12:05:52 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:

Today's Agenda: https://confluence.hl7.org/pages/viewpage.action?pageId=161081389

12:06:11 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:

Registration page for the CMS Connectathon: https://www.eventbrite.com/e/centers-for-medicare-and-medicaid-services-and-hl7-fhir-connectathon-tickets-627386478847

12:09:47 From  Wendy Gereke (AEGIS.net)  to  Everyone:

Can you please repeat what is targeted for testing for Formulary during CMS Conn?

12:49:01 From  Mark S (Onyx/PDex)  to  Everyone:

https://jira.hl7.org/browse/FHIR-40985

PDex IG Companion Guide List

PDex IG Companion Guide - Laboratory Reporting Resources

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

For questions, reach out to us on Zulip:

• PDex: https://chat.fhir.org/#narrow/stream/235286-Da-Vinci.20PDex/topic/Implementers
• Plan Net: https://chat.fhir.org/#narrow/stream/229922-Da.2BVinci.2BPDex.2BPlan-Net
• Formulary: https://chat.fhir.org/#narrow/stream/197730-Da-Vinci.20PDex.20Drug.20Formulary

Formulary - Searching by DrugName.docx

Recording of Formulary Tickets for STU 1.1.0 Overview

IQVIA

Elevance

Malcolm McRoberts

Manish Agarwal

Tulsi