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Chair:  Larry Decelles

Scribe: Dana Marcelonis


Attendees

Present

Name

Affiliation

  •  
Mitre
  •  
George BierOptum
  •  
BCBS AL
  •  
Rush
  •  
Matthew ByrneOptum
  •  
Rush
  •  
Cerner
  •  
Anthem
  •  
Allscripts
  •  
InterSystems
  •  
Allscripts
  •  
Mitre
  •  
Cambia Health
  •  
Cerner
  •  
Enable Care
  •  
Optum
  •  
Aegis
  •  
BCBS FL
  •  
InterSystems
  •  
Anthem
  •  
Mitre
  •  
Allscripts
  •  
Optum
  •  
Jackie HardisonHumana
  •  
Cigna
  •  
Claudia HartmanHighmark Health
  •  
Mark HinghamAnthem
  •  
Optum
  •  
Sheljina Ibrahim KuttyAnthem
  •  
Allscripts
  •  
Point of Care Partners
  •  
Edifecs
  •  
Mitre
  •  
InterSystems
  •  
Anthem
  •  
Tso LukeOptum
  •  
Point of Care Partners
  •  
Optum
  •  
Cognosante
  •  
Optum
  •  
Humana
  •  
Stratametrics
  •  
Casenet
  •  
Allscripts
  •  
Optum
  •  
Optum
  •  
InterSystems
  •  
C SimeoneOptum
  •  
Jeanie SmithBCBS FL
  •  
InterSystems
  •  
Veradigm
  •  
CMS
  •  
Casenet
  •  
Independence Blue Cross
  •  
Anthem
  •  
CentriHealth
  •  
CaseNet
  •  
India DuncanOptum
  •  
Jason Cassidy
  •  
Optum
  •  
Gevity
  •  
Tracy McCutcheonKPMG
  •  
Rashmi MenonKMHP
  •  
Mario JarrinChange healthcare
  •  

  •  
AMA
  •  
Ann GallagherOptum
  •  
Megan Smith-HallingsheadRegence
  •  
Regence
  •  
Anthony SmithUNC Health
  •  
Optum
  •  

  •  

  •  
Jennifer Joe
  •  
Texas Health
  •  

  •  
Cigna
  •  
Labcorp
  •  
Cigna
  •  
Matt DyerVyne
  •  

  •  
Barbara Kramer-ZarinsMITRE
  •  
Centene
  •  
Barbara WoodPNC
  •  
Greta HoneycuttCoverMyMeds
  •  
BCBSA
  •  

  •  
MITRE
  •  
Keya ShahCasenet
  •  
Rich Bloch
  •  
Interpro
  •  
Lauri Shock
  •  
Andrew JohnsonNational Decision Support
  •  
MITRE
  •  
Mark FlemingChange Healthcare
  •  
eClinicalWorks
  •  
Prathima
  •  
Rachel Foerster & Associates
  •  
Heather McComasAMA
  •  
Megan RileyMITRE
  •  
Summer DumanRegence
  •  
Michelle BarryAvaility
  •  
Chris Cera
  •  
Michael FasuloRegence
  •  
Mettle
  •  
Lauree Marshall
  •  
Uma Kandasamy
  •  
Mina RasisExpress Scripts
  •  
Harmanpreet Singh
PresentNameAffiliation
  •  
Peter MuirESAC
  •  

  •  
Ryanne LaurenceOHSU
  •  

  •  
Mitre
  •  
CMS
  •  
Aim Specialty Health
  •  
Christy DodsonMCG
  •  
Tibco
  •  

  •  
Rajesh Godavarthi
  •  
Santosh
  •  
Tom Hartman
  •  
Tori WillowsWellcare
  •  
Alise WidmerLumeris
  •  
Bart CarlsonAzuba
  •  
David BruinsmaColonial Med
  •  
Deepthi ReddyMettle Solutions
  •  
Danny BrennanMA Health Data
  •  
Patrick Edwards
  •  

  •  
Cambia Health
  •  
CMS
  •  
Pallavi TalekarScope Info Tech
  •  
Rajesh GarlapatiRush
  •  
Susan BellileAvaility
  •  
BCBST
  •  
Ralph Saint-Phard
  •  
Kristi CushmanOHSU
  •  
Briana BarnesScope Info Tech
  •  
Didi DavisSequoia Project
  •  
Sreekanth PuramMettle Solutions
  •  
Duane WalkerBCBSM
  •  
EMDI Team
  •  
David HillMitre
  •  
BCBS AL
  •  
Nandini GangulyEMDI
  •  

  •  
Rajesh GodavarthiMCG Health
  •  
Rim Cothren
  •  
Donna CampbellBCBSIL
  •  
Joanna GaskillLumeris
  •  
Edifecs
  •  
Michael CabralCMS
  •  
Sudhir NairAnthem
  •  
Saul KaravitzMitre
  •  
Dawn PerreaultBCBSM
  •  
Brent WoodmanBCBSM
  •  
Yolanda VillanovaCMS
  •  
Deryl Lam
  •  
Edifecs
  •  
Karen TottCMS
  •  
MITRE
  •  
Dacarba
  •  
Carradora
  •  
Rachel Goldstein
  •  
Ric LightHumana
  •  
eClinicalWorks
  •  
Healow
  •  
Wanda Govan-JenkinsHHS
  •  
Cindy MonarchBCBSM
  •  
Edward Yurcisin
  •  
Humana
  •  
Hibah QudsiMitre
  •  
Nancy SpectorAMA
  •  
Patrick Leblanc
  •  
Anupam ThakurBCBSFL
  •  
MCG
  •  
Chris KlesgesMitre
  •  
BCBSA
  •  
Gregory MagazuCaseNet
  •  
Isaac VetterEpic
  •  
Kat RuizUNC Health
  •  
Laura Bright
  •  
Humana
  •  
Roland Gamache
  •  
Katherine LuskChildrens
  •  
Anthem
  •  

  •  
Chris JohnsonBCBS AL
  •  
Jim AdamsonArkansas Blue Cross
  •  
Carry Denny
  •  
Infor
  •  

  •  
Anna MeisheidCMS
  •  
Celine LefebvreAMA
  •  
Eshaa DhalleClinicalWorks
  •  
BCBSM
  •  
Express Scripts
  •  
Sandhya
  •  
Christopher GraconIndependent Health
  •  
Candice TitusCrisp Health
  •  
Mariana SinghCAQH
  •  
BC Idaho
  •  
Shilesh NairGdit
  •  

  •  

  •  

  •  
UHC
  •  
Tammy BanksProvidence St. Joseph
  •  
Bob HarringtonAllscripts
  •  
Vishnu
  •  
DanielleSutter Health
  •  
MITRE
  •  
Sonya MayOptum
  •  
Molly MalaveyAMA
  •  
Guidewell
  •  
Angela BublikRegence
  •  
eClinicalWorks
  •  
Advocate Health
  •  
Arsal HussainiAccenture
  •  
Allen Saunders
  •  
Steve Ruszkowski
  •  

  •  
Beth Connor
  •  
Thomas KesslerCMS
  •  
Daniel C


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Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy




Links

DTR IG: http://hl7.org/fhir/us/davinci-dtr/2019May/

Reference Implementation: https://github.com/HL7-DaVinci/dtr 



Reminder: Call Structure & Name Changes
  1. Burden Reduction (CRD/DTR/PAS) Implementer Support Call - Wednesday, DTR time slot (11at ET)
  2. Burden Reduction (CRD/DTR/PAS) Supplemental Examples Call - Friday, PAS time slot (3pm ET)
  3. Burden Reduction (CRD/DTR/PAS) IG Updates/Future Requirements - call to be scheduled, Mondays at 1pm ET


HL7 Patient Access API Testing Event - Aug 17-192020-08 Patient Access API Testing Event

HL7 FHIR Connectathon - Sept 9-11

2020-09 Connectathon 25

2020-09 Da Vinci CRD / DTR / PAS

  • Kick-off planned for next week once we have more details regarding the tool being used during the event


Implementer Questions (CRD/DTR/PAS)
  • Launch parameters
    • Submitted change request to CDS Hooks to better expose mechanism (not currently well documented)
    • When you pass back CARD intended to launch SMART app, mechanism to provide an extra parameter
      • Parameter gets communicated to auth service, which then passes it along as part of authentication process to SMART on FHIR app
      • JSON can contain anything - app context
      • Could include JWT, could include same info that was used to launch the hook, etc.
      • CRD spec doesn't specify what needs to be in there because it's specific to the SMART app
    • If we have generic SMART apps, what would it need - not payer specific
      • Hook service needs to know what the app wants; hook service will be 'tuned' to specific app
      • Specific SMART app and generic SMART app would need same thing - define what we want in the apps to test out in Connectathon and get it into spec?
    • Need to pass the following info:
      • Context passed to CDS endpoint
      • Access token/ JWT
      • URL to go get data (CQL, Questionnaire)
      • Need to create an example of what the above would look like in the JSON/payload
    • Assumptions:
      • Payers talking to multiple EHRs with their own capabilities - need to standardize interaction
      • Developers of the app and service not communicating necessarily
      • Providers could choose to work with 'generic' SMART app that interacts with multiple different payers
    • Can't use a CARD to launch a native capability (e.g., application module) with CDS Hooks
    • Payer does not necessarily know what SMART app is being launched?
      • They have to
      • This changes paradigm of 'generic' app
      • No ability to pass back CARD that says launch 'some' app and you don't know which one
    • Connectathon - need to test:
      • Test app launch context components and structure
        • Test that we can pass the context, access token, and URL
      • Payer CDS service pass back CARD with a URL that 'somehow' indicates specific SMART app OR launch whatever your generic functionality is
    • Need to add 'floor' model in the CRD IG
    • Need to figure out how to do the app launch - URL translations in EHR?
    • When invoking hook service, EHR could declare they have a generic app in advance and provide launch URL for that app
      • EHR would need to add custom extension to launch
      • Hook service shouldn't care what kind of apps could be launched


  • Post Sree's list of questions to Confluence
  • Guidance on CQL/ how it is evaluated - can implementer choose not to implement CQL?
    • Do we want to leave it to app to decide how to execute/evaluate, or provide more guidance?
    • Several approaches: 
      • EHR might have CQL evaluation engine locally
      • Launch within application via Javascript to run CQL
        • Can be slow
      • Application could have CQL evaluation API or someone could provide the API
        • Disasdvantage - network traffic (back and forth between EHR prior to doing the evaluation) 
    • Good option to have it local to application
    • Depending on how CQL is written, could call on other libraries
      • App would have to embed all the CQL scripts or access via CQL evaluation engine to other libraries needed to execute
      • Data Requirements in FHIR Library resource
        • Is this mandatory?
        • MITRE RI has defined these Data Requirements - instead of making FHIR calls during evaluation stage, doing it as pre-fetch
        • If using CQL service, this will be an issue
        • If we don't make it mandatory, just need to check that implementations work on Javascript side
        • Sreekanth Puram to write up options that we can test
    • Generic app would need access to CQL evaluation engine and all the value sets - how to make available?
    • Specific apps - evaluation services, libraries, etc. - app would define for itself
    • DEQM - CQF Ruler with library - open source code used to build services
      • Architected to run on provider side vs. DTR application pointing to evaluation endpoint
    • FHIR Questionnaire and CQL Questionnaire done by same group?
      • Yes, payer or payer's vendor who defines what goes into Questionnaire


  • Alternative paths/delegation
    • If you don't have all the info needed at time that DTR was launched, need to 'save' and potentially delegate to someone else to complete
    • There is guidance in IG, but implementation is EHR-specific
    • Save app context and re-launch SMART app - where does this get saved and how does it get re-launched
    • What does app need to pass back to EHR so it knows
    • Discuss next week with Larry Decelles



Next Agenda
  • Discuss question re: delegation: saving app context and re-launching SMART app - where does this get saved, how does it get re-launched, and what does app need to pass back to EHR so it knows
  • Additional implementer questions

 Adjournment
Adjourned at 11:58am ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval
Draft list of supplemental examples (from 7/8 call)

Potential Examples:

  1. DME – O2
  2. Specialty Med – CodeX is interested in this topic
  3. Diagnostic Imaging – Head MRI, MRA
  4. Lab – Genetic test –
  5. Referral – Occupational Therapy or prosthetics – Example -
  6. Hospital admission - Pneumonia
  7. Home Health Services - eg.g Wound care
  8. Surgery – Arthroplasty (Total hip/knee replacement)
  9. CRD - Types of information/CARDS returned
  10. DTR - collect data and return it directly to payer - what does request look like, how to return it
    • RI demonstrates sending to PAS and sending to another endpoint
    • Extension on Questionnaire re: where response is supposed to be sent?
      • Not currently addressed in IG - Larry Decellesto add tracker to DTR
      • Sending to payer automatically (to same place request came from) in RI
  11. DTR - scenario where Questionnaire not posted directly, but keep it on file via EHR, or include it with prior auth submission or claim submission
    • IG worded like this, but need explicit instruction with respect to the Questionnaire - how do you ask for it and how do you respond
    • Larry Decelles to add to same tracker noted above
  12. DTR - Task workflow
    • Provider orders MRI, provider requirement is to attach Xray but someone else needs to do that - suspend order, send to someone else to complete (attach Xray) and submit - "to do" item put into a queue and/or assigned
    • Once CARD is received, does it matter who works it?
      • Within EMRs, don't yet have process for external agents/orgs (e.g., payers) to inject tasks
      • Task comes back and isn't assigned to anybody (i.e., no expectation that payer would assign it to someone) - whomever creates order has option to assign to someone else's task list, or leave unassigned and some other process defines who picks it up to complete


Action items

  •