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Chair:  Larry Decelles

Scribe: Phung Matthews


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Minutes Approved as Presented 


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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


Da Vinci Education Implementation Event

October 27-29, 2020

Registration is open- invite you to participate

Register here



Discussion: When should Attestation be used in the DTR 

What type of data should be allow to Attest to:

  • Attestation of being in the record should be there
  • Attesting to something the knowledge that the provider has but may not be in the medical records
  • No document is being attached with the attestation at this time
    • Is attestation enough or requires medical records as supporting documentation
    • If we can attach supporting documents then should 
    • CQL or questionnaire should indicate whether supporting documents are required
    • Leave it to payer policy to determine if attestation is enough or supporting documents is required

Bob reviewing IG and may need to be updated.




MCG presentation- Da Vinci Burden Reduction

Sreenivas Mallipeddi

CRD/DTR/PAS Testing proposal (follow up from Connectathon)

  • Propose multi-participant approach to testing components/roles of the guides at Connectathon
  • Bring multi-participants and multiple roles together to see if we can use the guides seamlessly
    • could we have multiple CDS services?
    • agree on context- able to use questionnaire and CQL from others?
  • Capabilities- indicate who has the capabilities for which roles 
  • May require more planning and interactions between collaborations for next Connectathon
    • Several scenarios can be used - ie SMART on FHIR app from other participants such as Mettles
  • Next steps-
    • Have focus meetings with MITRE and METTLES to discuss capabilities on use case- what are possible challenges?
      • Endpoint URLs, PA scenario artifacts (example patient data, questionnaire), CQL library
      • weekly "scrum" calls to identify blockers, get updates 
    • Start Zulip chat for continuous communication
    • Document what capabilities each group can do and what artifacts will be shared
    • Discuss the roles involvement from provider and payer view as interoperability 
    • Identify additional participants for testing along with their capabilities
    • EHR involvement also recommended
    • Start confluence page for participants to add their capabilities and artifacts


Implementer Questions (CRD/DTR/PAS)

Is there an expectation that each payer should have its own SMART on FHIR app?

  • Bob- should not be an expectation of having own SMART on FHIR app. However, the application used by a provider should be able to interact with majority of payers they participate in. 

Next Agenda



 Adjournment
Adjourned at 11:58PM

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

  •  Big Takeaway is needing more examples in the supplemental Guide: checking drug benefits vs. medical benefits and Price Transparency in CRD - Bob and Melanie


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
  •  
Optum
  •  
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
  •  

  •  
AEGIS
  •  
Ezequiel Morales

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
  •  
CaseNet
  •  
Epic
  •  
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
  •  

  •  
Thomas Grannan
  •  
Meryl BloomrosenPremier Inc
  •  
Phung Matthews