Chair: Mark Scrimshire

ScribeVanessa Candelora

 

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ManagementReview ANSI Anti-Trust Policy



Call Structure & Name Changes



Implementer Resources

See Supporting section below!


TodayDa Vinci Testing Event October 26-27, 2021

Click here for details. Reach out to the lead if you are interested. 

This is purely testing and very targeted, no education. 


Formulary - testing the whole IG with relationship changes, but also specific testing needs: 

  • Testing QuantityLimitDetail extension
  • More robust (real world scenario) search testing

Plan Net:

  • Testing more than the previous "snapshot" of active providers, need to test the status and active dates for providers getting added and ended (contract periods.) to support enrollment period changes and the CAA requirement for notification of changes within 48hours. 

PDex: 

  • B2B for Payer to Payer
  • The EOB format for Prior Authorization status and information in PDex. 




PDex Focus for testing. Dental and Vision Discussion. 

Updated focus for Payer to Payer on the B2b Approach and the moved the Dental and Vision changes out (less urgent and may not be needed)

May look at holding off on the mapping for Dental and Vision as it sounds like regulation on this may be later next year or beyond so we have time to focus on other priorities. 

Mark to reach out to Corey: Is there something unique in Dental and Vision that would have an impact on USCDI? Does the way CARIN is representing CPCDS warrant any changes needed in PDex? 







Formulary STU Update Progress update

See Recording of Formulary Tickets for STU 1.1.0 Overview

Stage for people to review:  https://build.fhir.org/ig/HL7/davinci-pdex-formulary/branches/stu-update-1.1/ 

  1. Formulary – STU Update - Approved by FMG on 10/1 (DaVinci Formulary IG Publication Request)
  2. Target for Publication completion this month.


PDex 

Recording of PDex Provenance Discussion 10/1/2021

https://miro.com/app/board/o9J_lxZlj_w=/

Provenance - Mark Scrimshire share progress on the additional example for when the data is received from one payer with provenance and shared with another payer. Also update the description in the profile's provenance.

First draft of expanded Provenance Examples have been incorporated into the STU Update main branch: http://build.fhir.org/ig/HL7/davinci-epdx/PDexProvenance.html#example-provenance-records


Discussion: 

The receiving payer will end up re-writing the records received from payer 1 and maintain the integrity.  If they don't retain the bundle as a whole and break it down, then they need to re-write the translator record. 

so, when they go to send it to the next payer, they can say "Here's my data and here's a bunch of data that came from payer 1."

Question: What do we do with the prior payer Patient ID? 

For the Payer 2, the example assumes that you will write a patient record, and then pull info from previous plan, but not overwrite your own record with the new one.  You may want to add the patient record into your own with your own Master Patient ID and add the previous payer patient id as an additional id within the patient record. 

Concern with adding the Master patient ID, we are changing it. So we are essentially the assembler and thus references will change to point to our systems. 

What other options are there?

  • Store Patient and link it into your master patient record. Use link element on Patient to say that this individual is "the same as"  
    • messy with multiple records. 
    • would still need to include all of their data with that master ID. 


Homework for everyone - review examples and recommend improvements: http://build.fhir.org/ig/HL7/davinci-epdx/PDexProvenance.html#example-provenance-records





Cross PDex IGs Bulk data approach discussion

Last week we said: Summarize the system version of the $export command across all three IGs. Leaves the Authentication and Auth out, just to show how you could Download.  (e.g. PDex is at the patient level. 


Exploring two approaches:

  1. PDex – This needs to use the $everything operation as in   /Patient/{ID}/$everything  with the _type parameter that names all of the required resources used by the IG since everything is scoped by the Patient
  2. Formulary and Plan-Net – I think these can both refer to the $export operation - https://hl7.org/fhir/uv/bulkdata/export/index.html#endpoint---system-level-export The IG’s could add a requirement to explicitly name the resources that are profiled in the respective IG.













As needed:



PlanNet/Directory

Focused on V2 (See Agendas for 2pm ET call)



FormularyFocused on V2 (See Agendas for 2pm ET call)

New Implementer Support / Questions








Chat: 









Next Week

Listen to my feedback on Provenance examples

Implementer Support Questions from Zulip, if any.



 Adjournment

Adjourned at 12:40pm ET






Outline Reference

Supporting Document

Minute Approval
PDex Companion Guides

PDex IG Companion Guide List

PDex IG Companion Guide - Laboratory Reporting Resources

CARIN CPCDS to US Core Mapping

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

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

  • Links to Published IGs
Other Links:

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:

Formulary STU 1.1.0 Overview

Formulary - Searching by DrugName.docx

Recording of Formulary Tickets for STU 1.1.0 Overview

Recording of PDex Provenance Discussion 10/1/2021Recording of PDex Provenance Discussion 10/1/2021

Action items

  •  Mark Scrimshire - Next Step to add an example for when the data is received from one payer with provenance and shared with another payer. Also update the description in the provenance in the profile.   Want this done for the STU Update, will work on it next week. 
  • Mark Scrimshire , David Hill , Corey Spears  - Summarize the system version of the $export command across all three IGs. Leaves the Authentication and AUth out, just to show how you could Download.  (e.g. PDex is at the patient level.  10/8 - Discussion in Process. 
  • Mark Scrimshire reach out to Corey: Is there something unique in Dental and Vision that would have an impact on USCDI? Does the way CARIN is representing CPCDS warrant any changes needed in PDex? 

Attendees - 20

PresentNameAffiliation
PresentNameAffiliation
  •  
Onyx
  •  
Yukta BellaniEvernorth/Cigna
  •  


  •  
Gevity
  •  
MITRE
  •  
Alex Kontur 
  •  
HealthLX
  •  

  •  
MITRE
  •  
Bryan Briegel 
  •  


  •  
Chris Johnson 
  •  


  •  

  •  
Evernorth
  •  
Chetana Suresh IBC




  •  
Jim Denyer IBC
  •  


  •  
Dave Shekar 
  •  
Mettle Solutions
  •  
Ezequiel Morales Evernorth/Cigna
  •  
Rachel E. Foerster

  •  
Todd GrinawayCBC
  •  
Versaggi Consultant
  •  
James Derrickson
  •  
BCBST
  •  
Jason Brito
  •  
Tom GrannanAzuba
  •  
Jason Teeple 
  •  
Vanessa CandeloraPOCP, Da Vinci PMO
  •  
Kat CobelNCQA
  •  
Joel Hansen



  •  
 Mark Neumuth 
  •  
United
  •  
Michael RyanNCQA
  •  
@joe quinn

  •  
Rich Tallon
  •  
Jamie Stamps

  •  
 Ronald Wampler CVS Aetna Health
  •  
Sarah scott

  •  
Craig Knier Change Healthcare
  •  
Jeff Brown MITRE, FM Co-Chair
  •  
@Dustin R Nides