2021-08-04 CDex MeetingChair: Robert Dieterle

Scribe:  Vanessa Candelora 

Minutes Approved as Presented 

Agenda Topics

Agenda Outline

Agenda Item Meeting Minutes from Discussion Decision Link(if not child)

Management Review ANSI Anti-Trust Policy

LinksCDex Implementation Guide: http://build.fhir.org/ig/HL7/davinci-ecdx/ Source Code in GitHub:

CDex Communication Response AppCDex Communication Request App

HRex Sept Ballot IG: http://hl7.org/fhir/us/davinci-hrex/2020Sep/index.htmNote: 34 affirmatives of 35 approval threshold.

HL7 Connectathon 28 Sept 13-15

Registration is now available here

Early Bird registration August 16th and last day to register is August 30th. 

Implementer Support

Da Vinci Implementer Support Page

If you are an implementer and have questions, enter them on our chat.fhir zulip stream:   

https://chat.fhir.org/#narrow/stream/179283-Da-Vinci

https://chat.fhir.org/#narrow/stream/180805-Da-Vinci.20eCDx

Health Record Exchange Framework (parent IG) 

We want to land the payer-to-payer approach for member consent/authorization to incorporate into HRex. No discussion needed on this call today.

HRex JIRA Dashboard

JIRA Open Issues for review

This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."

1. 2. 3.

1. 2.

Today Discussion on adding "Unsolicited" Push of Data to CDEX 

Not in next published version, but in future (January 2022?) ballot.Use case limited to provider to payer as described in the PIE white paper. (Claims)Provider to provider push is out of scope.  FHIR referrals is still a WIP and this use case cannot process without it. 

Ideal restful way is to update the service request to have additional information in the context of the referral. So, are we not going to use the FHIR composition version of the CCDA? 

This could be all different formatsThe payload is less important, it's about the mechanism to create the association in the service request world.  Many use Messaging to update the referral/service Request. Can do it in pure REST, task, via operation. 

Confirm we can count on the EHR to have an Identifier, it's a lot easier. 

This is an Identifier assigned by the provider and it's provided by the provider.  

the payer would need something more (demographics) that just the Provider given identifier since that is not stored in their payer systems.Payer uses PWK code (wouldn't call this a claim number) but that is the identifier they would look for on an unsolicited attachment to tie to the claim. 

Right now, Argonaut is not supporting service request for task. There are 4-5 ways that a push could happen. 

Decision: no changes to assumptions above. 

It may well chose the operation that says, "here is the thing I want to link this to and here is the info." 1 to many. 

Link initially would be a claim Identifier (could also be a referral identifier)

parameters resource (collects stuff that is a bit more sophisticated than a bundle) to allow multiple arguments. 

It doesn't require the payer to come back and get data, you can push the entire data. 

Want a separate end point?

We are not saying "you must store this" - it's up to the recipient to decide what they store and where. There is a need to say "you must associate this data with this particular entity. "e.g. pathology report as an extra thing that wouldn't relate to the claim. have an end point to say here is the claims attachment and here's the end point to attach it to.  - feels like an operation would handle this well. Return would be a 200/201 "OK, I got it"

Fail: An operation outcome that says You don't have the operation, or I can't consume what you attached, etc.Success: attachment received and association made.

Recipient to decide what they store and whereThere wouldn't be a response for "hey I need more info" since it's unsolicited. Request for more would come back through the Prior Auth., Claim or Referral response process. 

Expectation is that this is being sent at the same time or before the claim. 

Next step: Eric, Bob, and Lloyd to hash out the operation offline. 

Bob and Susan - could look at PIE IG to see what is used for the Identifier.

EH Update: See page 22 of Guidance on Implementation of Standard Electronic Attachments for Healthcare Transactions November 2017

A critical part of the exchange of the Attachment is the ability to re-associate the Attachment with the initiating transaction. A unique identifier, Attachment Control Number, must be included to help match the Attachment from the provider to the request or the associated transaction (claim, referral or prior authorization).

When the Attachment is unsolicited, the Attachment Control Number is on both the associated transaction and the Attachment and is assigned by the Provider.

Created JIRA Tracker FHIR-33139

Signatures Robert Dieterle FHIR-26855  -  Signature requirements for Payers  (Next Step: Bob write up and share)Theme : Signatures - 

FHIR-30816 -  - Theme : Signatures Please clarify whether any human involvement is required, and an example, as well as define the term  (Next Step: Bob write up and share)fulfillment as it relates to attestation.

Update from discussion with CMS: Need a non repudiated way to identify the author to the thing that is relevant to the author.  Need a non - repudiation signature (not an electronic signature) at the end of the author. 

FFS: Documentation to support medical necessity and appropriateness for providers that are under review/audit requires a wet signature. Needed on things like Encounter, operating report. 

Discussion:

eg. V2 feed comes in from a lab,  stored at the Payer in DB as FHIR. 

Are we only talking about Orders? 

There should already be a pseudo wet signature if it's a document. 

Not sure how to solve in FHIR.  

Would likely get: the lab it came from, person who signed off, likely not a wet signature. 

The Provider would sign the review of the lab result (I've seen this about this patient)

Bob may ask Dan from CMS to join our call in 2 weeks 

CDex Ballot Reconciliation

CDex JIRA Dashboard

https://jira.hl7.org/browse/FHIR-32840  add guidance on patient match and how to identify patient (FHIR_id or business identifier)  need to ask 

https://jira.hl7.org/browse/FHIR-32841 - ready to vote

purpose of use:  proposed disposition pending ....

worker queues:  proposed disposition pending ....

Other Discussion Rob Question: How is Da Vinci suggesting people send codes where one code has qaulifiers and others don't? (ability to sequence codable concepts)

 - we do this in the request for additional documentation in PAS for the 278 response with modifiers to to LOINC code using the sequence capability.  We are making an assumption that you have a LOINC code until you hit one that doesn't have a modifier. So, it has the ability to sequence them.

can't presume there is a sequence unless you are given one. the ICD page in FHIR says you are allowed to provide codes.

Rob would like feedback form this community and what to hear how we are doing it so it can be the in CCDA. 

Next Meeting

CDex Ballot Reconciliation

CDex JIRA Dashboard

https://jira.hl7.org/browse/FHIR-32840  add guidance on patient match and how to identify patient (FHIR_id or business identifier)  need to ask 

https://jira.hl7.org/browse/FHIR-32841 - ready to vote

FHIR-31996 purpose of use:  proposed disposition pending ....

FHIR-31890 worker queues:  proposed disposition pending ....

Adjournment Adjourned at  3:01PM EST

Supporting Documents

Outline Reference Supporting Document

Minute Approval

Action items

 Next step: Eric, Bob, and Lloyd to hash out the operation offline.

Create Decision from template

Attendees - 13

Present Name Affiliation

 Eric Haas

 Robert Dieterle Enable Care

 Vanessa Candelora

 Stanley Nachimson Nachimson Advisors

 Vaibhav Gupta

 Laura Hoffman AMA

 Julia Wormwood

 Smitha Harish Mettles

 Lloyd McKenzie Gevity

 Thomas Grannan Azuba

 Joseph Quinn Health Share Exchange (HSX)

 John Donnelly Health Share Exchange

 Ray Duncan Cedars Sinai

  Duncan Weatherston SmileCDR

 Celine Lefebvre AMA

 Melanie Combs-Dyer Mettles

 Jeffrey Danford Allscripts

 Durwin Day BCBS IL

 David DeGandi Cambia Health

 Michael Gould BCBSA

 Jocelyn Keegan Point of Care Partners

 John Kelly Edifecs

 Kevin Lambert BCBS AL

 Mary Kay McDaniel Cognosante

 Gini McGlothin BCBS AL

 Linda Michaelsen Optum

 Viet Nguyen Stratametrics

 Charlie Provenzano HealthLx

 Nick Radov Optum

 Lynda Rowe InterSystems

 Mark Scrimshire NewWave

 Jason Teeple Cigna

 Will Tesch HealthLX

 Eric Thomas Independence Blue Cross

 Clarissa Winchester BCBS AL

 Heather Kennedy BCBS FL

 Chris Johnson BCBS AL

 Rachel E. Foerster Rachel Foerster & Associates

 Sathya Krishnasamy Anthem

 Gay Dolin Namaste informatics

 Laurie Burckhardt WPS Health Solutions

 Deepthi Reddy Mettle Solutions

 India Duncan Optum

 Jim Taylor Tibco

 Christopher Gracon Independent Health

 Dave Foster Edifecs

 Eric Dimmel

 Jeff Brown Cigna

 Lorraine Doo CMS

 Eddy Nieves Epic

 Troy Bergstrand BC Idaho

 Tara Bramhall CMS

 Heather McComas AMA

 Bryan Jeffers PNC

 Matt Elrod MaxMD

 Isaac Vetter Epic

 Holly Miller, MD MedAllies

 Patricia Miller Episource

 Carie Hammond AEGIS

 Thomas Zhou

 Kathleen Connor VA/Book Zurman

 Julie Burgoon

 Tracy Hautanen-Kriel Cigna

 Rob Reeder

 Ezequiel Morales Cigna

 Bapi Behera ClinDCast

 Arsal Hussaini Accenture

 Sai Tumuluru Centene

 Hans Buitendijk Cerner

 Mariel Brechner Evernorth

 Jason Vander Jagt

 Latitia Shotlow PWN Healt

 Ryan Moehrke Aegis

 Vassil Peytchev EPIC

 Rose Serjak Gevity (Gravity) 

 Aash Bhatt (MD. Nephrology)

 George Varghese

   Bruce Schreiber MedAllies

 Mike Arce Moxe

 Semira Singh Providence

 Sneh Giri Deloitte

 Jingdong Li

 Shanna Hartman CMS

 @Nidhi  Azuba Corporation

 Karen Ashton

 @Sandeej Kottal Evernorth

 Eric Liu

 Madhulipa Dash 

 Danny Iacovou

Present Name Affiliation

 Laurie Woodrome Labcorp

 Rohit Shinde eClinicalWorks

 Patrick Leblanc Fallon Health

 Peter Muir

 Michelle Barry Availity

 Susan Langford BCBST

 Serafina Versaggi

 Sreenivas Mallipeddi MCG

 Nancy Spector AMA

 Rajesh Godavarthi

 Sreekanth Puram Mettle Solutions

 Susan Bellile Availity

 Christol Green Anthem

 Jagakarthikeyan Karuppiah Inovalon

 Melanie Jones CMS

 Robert (Rim) Cothren CA HIE

 Yolanda Villanova CMS

 Susan Billet CMS

 Cristol Green Anthem

 Jeanie Smith BCBSFL

 Thomas J. Kessler CMS

 Tori Willows Wellcare

 Robert Bowman CAQH

 Evan Currie BSBCMI

 Greg Zeller

 Ann Gallagher

 Sonja Ziegler Optum

 Aaron  Kohn Chorus

 Kat Ruiz UNC Health

 Sheryl Turney Anthem

 Seth Paradis Healow

 Brandon Raab Anthem

 Paul Knapp

 Padma Kondaveeti Mettle Solutions

 Shilesh Nair

 Eshaa Dhall eClinicalWorks

 Scott Holt Itliti Health

 Srinivas Posinasetty UHC

 Jamie Stamps Edifecs

 Jimmy Lee MiHIN

 Keeyah Shah Casenet

 Igor Sirkovich

 Mrugen Mehta eClinicalWorks

 Jay Lyle

 Scott M. Robertson

 Mark Fleming Change Healthcare

 Patricia Craig Joint Commission

 Patricia Miller

 Janice Karin

 Krshan Patel

 Frank McKinney Point-of-Care Partners

 Srikanth Basavarju

 Eric Thomas

 Gigi Hanna Accenture

 Karin Frank cormac-corp

 Sadiq Saleh Varian

 Mary Winter Framewest Health (payer)

 Matt Reid AMA

 Michael Fasulo Regence

 Michael Shoemaker Providence

 Pam West

 Lenel James BCBSA

 Travis Hendrix DrFirst

 Tony Benson BCBS AL

 Thomson Kuhn

 Ronald Wampler Aetna

 Sean O'Quinn Cerner

 Pamela Maklari

 Rob Brull Infor

 Rob McClure MDpartners

 Alberto S. Llanes Fed Health

 Tusharkumar Shah