2021-08-04 cdex meeting
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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
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