electronic submission of medical documentation (esmd)
DESCRIPTION
Electronic Submission of Medical Documentation (esMD). Provider Profiles Authentication Workgroup. Agenda. Face-to-Face Meeting - April, 2012. Face to Face April meeting has been scheduled for April 11-13 th Location –Westin Alexandria 400 Courthouse Square Alexandria, Virginia - PowerPoint PPT PresentationTRANSCRIPT
Electronic Submission of Medical Documentation (esMD)
1:30pm – 3:00pmMarch 7, 2012
Provider Profiles Authentication Workgroup
1
Agenda
2
Topic Presenter Time Allotted
Face to Face April 2012 Announcements Presha Patel 1:30 – 1:40
Use Case 1 Consensus Voting Process Overview Presha Patel 1:40 – 1:50
Recap of Where We Are:• CMS esMD Phases• PPA workgroup timeline• Workgroup purpose• Incorporating Structured Content
Presha Patel / Bob Dieterle
1:50 – 2:10
Introduction to Harmonization Activities Will Ryan 2:10 – 2:30Architecture approach for Structured Content of eMDR Bob Dieterle 2:30 – 2:45
Time Permitting - Discussion of UC 2 Items • Overview of Context Diagrams• User Story• Actors / Roles• Assumptions, Pre-Post Conditions
Bob Dieterle /Presha Patel
2:45 – 3:00
Face-to-Face Meeting - April, 2012• Face to Face April meeting has been scheduled for April 11-13th
• Location –Westin Alexandria• 400 Courthouse Square Alexandria, Virginia
• Additional registration and logistics information will be emailed to all S&I participants via email
• FYI - No phone or WebEx will be available during the Face to Face• Wiki Link - http://wiki.siframework.org/S%26I+2012+Face+to+Face+%28F2F%29+Meeting
Date esMD Session Tentative Agenda
Wednesday, April 11 Afternoon PPA Use Case 2 / Structured Content
Thursday, April 12 Morning PPA Use Case 2 / Structured Content
Thursday, April 12 Afternoon Harmonization
Friday, April 13 (TBD) Morning RMES - Author of Record
3
UC 1 Consensus Voting OpenPPA UC 1 is up for consensus as of Monday 3/5/12 and will close EOD next Monday 3/12/12. Full Use Case is posted - http://wiki.siframework.org/PPA+Use+Case+1+-+Provider+Registration+with+Payer
Consensus voting page - http://wiki.siframework.org/esMD+PPA+Use+Case+Consensus+Form
The goal is unanimous consent, which is obtained by carefully considering and addressing significant input from the Community of Interest. Where unanimity is not possible, a group SHOULD strive to make consensus decisions where there is significant support and few abstentions.
Only one vote per organization will count towards total votes. Each Initiative Member will provide one of the following votes during the Consensus process:
• Yes - A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Initiative Member, but that it is better to move forward than to block the deliverable
• Yes with comments - If a Consensus Process attracts significant comments (through Yes with comment votes), it is expected that the comments be addressed in a future revision of the deliverable.
• Formal Objection- with comments indicating a path to address the objection in a way that meets the known concerns of other members of the Community of Interest. "Formal Objection" vote without such comments will be considered Abstain votes.
• Abstain (decline to vote)4
5
Phase 1:
electronic
Paper Medical Documentation
Request (MDR)
electronic
Phase 2: electronicMDR
Went live 9/15/11
Future release
Reminder CMS: Phase 1 and Phase 2 of esMD
This is the portion our workgroup is currently working on
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esMD Provider Profiles Authentication Timeline
11/30-12/7Charter Consensus
Pre-DiscoveryInitiative
Charter/Scope
Today (3/7/12)
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Oct ‘11
Kick-Off/ F2F
Oct ‘12
Structured Content WG
Associated with Use Case #2: Sending eMDR
(Fri)
Jan ‘12 April ‘12 July ‘12
PPA Workgroup
Use Case #2: Sending eMDR (Weds)
Outline Use Cases &Stories
Goal: Use Case #2 Consensus by 4/30
Harmonization/ Standards Analysis of Registration (Use Case #1)
Harmonization/ Standards Analysis of eMDR (Use Case #2)
Use Case #1: Registration
Discovery Implementation Pilot
Target Initiative
Completion: Oct ‘12
Use Case #1 Goal: Consensus by 3/14
Harmonization/ Standards Analysis of UC #1 and #2
Combined Registration/ eMDR Pilots
PPA Purpose (Wednesday Focus)
The purpose of the PPA workgroup is to evaluate solutions to:• UC 1: Register providers with payers to receive electronic medical
document requests (eMDR) –Consensus Voting Ongoing• UC 2: Send eMDRs from a payer or their contractor to a provider or their
agent
These solutions will enable Payers/CMS Review Contractors to send electronic medical document requests (eMDR), as an alternative to current paper processes.
This effort culminates in the selection/creation of standards for message format and content to communicate with CMS and its Review Contractors that may be adopted by other segments of the payer community to simplify and automate communication between providers and payers with respect to requests for medical documentation.
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Structured Content merge with PPA UC 2 (Friday Focus)
• The purpose of Structured Content WG was to define the requirements for the structure of the electronic Medical Documentation Request (eMDR) itself
• Work related to Structured Content will now be incorporated into the development of PPA UC 2. – The focus of PPA UC 2 is around securely sending the eMDR
from the payer/payer contractor to the provider
• Structured Content Wiki page- http://wiki.siframework.org/esMD+-+Structured+Content
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esMD Use Case 1: Introduction to Harmonization
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esMD Initiative: Harmonization ProcessHarmonization for Use Case 1 may include the following steps:1. Expand dataset requirements into a full data model
• Reuse elements from PD Data Model and CEDD
2. Review and select standards identified by SDS• Choose standards based on use case, data model requirements, and community
expertise
3. Map data model to select standards• Identify gaps and work with SDS to communicate needs with SDOs
4. Develop registration processes for CMS and commercial payers• Expand on Section 10 in Use Case 1 document to prepare detailed process
guidance for Implementation Guide(s)
5. Develop Implementation Guide(s) for CMS and commercial payers• Guide should enable implementation of data model and registration request
processes
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esMD Initiative: Harmonization ProcessIn order to align Use Case 1 and Use Case 2 to the same standards, we will focus on steps 1 and 4 while Use Case 2 is under development. We will continue with steps 2, 3, and 5 when Use Case 2 is complete.
1. Expand dataset requirements into a full data model• Reuse elements from PD Data Model and CEDD
2. Review and select standards identified by SDS• Choose standards based on use case and data model requirements and
community expertise
3. Map data model to select standards• Identify gaps and work with SDS to communicate needs with SDOs
4. Develop registration processes for CMS and commercial payers• Expand on Section 10 in Use Case 1 document to prepare detailed process
guidance for Implementation Guide(s)
5. Develop Implementation Guide(s) for CMS and commercial payers• Guide should enable implementation of data model and registration request
processes12
esMD Initiative Notional Timeline
PPA Use Case 2 Development
Initial Harmonization
of PPA Use Case 1
Combined Registration and
eMDR Pilot
PPA Workgroup
Jul 2012
Oct 2011
Nov 2011
Dec 2011
Jan 2012
Feb 2012
Mar 2012
Apr 2012
May 2012
Jun 2012
Aug 2012
Sept 2012
Oct 2012
Combined Harmonization of PPA Use Case 1, Use Case 2, and Structured Content
Outline Use Cases and Stories Harmonization Phase
PPA Use Case 1 Development
Structured Content Development
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Meeting schedules
Use Case 2 Development will take place concurrently with the initial phase of Use Case 1 Harmonization.
• Use Case 2 Development– Wednesdays, 1:30 – 3:00 PM EST– Fridays, 2:00 – 3:00 PM EST
• Use Case 1 Harmonization– Support team will identify new meeting time– Meetings will begin week of March 12th
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General Approach to Structured ContentWe have two broad approaches for Use Case 2 and Structured Content
• Design Structured Content of the eMDR with the goal of including it as part of a transaction where the individual elements are specifically defined.• Examples: Most X12N, IHE and HL7 messages
• Work with the assumption that the eMDR is an object or metadata structure (like the CDA/CCD) and the transaction/messaging standard manages the identification, routing, and security, but is otherwise content neutral. • Examples: IHE XDS, Direct, HL7 MDM, …
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Next Steps / Questions• Next Steps
• Continue Use Case 2 Development during regularly scheduled times• Identify new meeting time for Use Case 1 Harmonization starting week of March 12 th
• Next Work Group Meeting • Use Case 1 Consensus/Use Case 2 Development - Friday, March 9th 2:00pm - 3:00pm
• For questions, please feel free to contact esMD support leads• Sam Elias (IC); [email protected]• Emily Mitchell (Use Case); [email protected]• Presha Patel (Use Case); [email protected]• William Ryan (Harmonization); [email protected]• Shay Paintal (Harmonization); [email protected]• Sweta Ladwa (Overall); [email protected]
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Kick off PPA UC 2Use Case Context Diagrams
PPA Use Case Context Diagram – Information Exchange Paths – Generic
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Payer
Registration Requestor (Provider /
Provider Organization)
Contractors / Intermediaries
Agent / Access
Access
Gate
way
ExternalProvider
Directories
Payer Internal System
PPA Use Case Context Diagram – CMSSecure MDR transmission from Contractors
19
CMS
Registration Requestor (Provider /
Provider Organization
)
Contractors / Intermediaries
HIH
ConnectesM
D Ga
tew
ay
In to ContractorOut from Contractor
5. Electronic medical documentation request (eMDR) sent securely to Provider or HIH as needed *
1. Sends request for provider registration status
4. Receives updated
ESI Information
2. Receives validation of registration status
3. Sends request to retrieve
updated ESI informationOut to Provider
Payer Internal System
External Provider
Directories
Key : ESI – Electronic Services InformationPD – Provider DirectoryHIH – Health Information HandlerCMS - Medicare
PPA Use Case Context Diagram – Secure eMDR transmission from Commercial Payer via Contractor
20
Commercial Payer
Registration Requestor (Provider /
Provider Organization
)
Contractors / Intermediaries
Agent
Connect
Gate
way
In to ContractorOut from Contractor
5. Electronic medical documentation request (eMDR) sent securely to Provider or Agent as needed *
1. Sends request for provider registration status
4. Receives updated
ESI Information
2. Receives validation of registration status
3. Sends request to retrieve
updated ESI informationOut to Provider
Payer Internal System
External Provider
Directories
Key : ESI – Electronic Services Information
PPA Use Case Context Diagram – Secure eMDR transmission from Commercial Payer
21
Commercial Payer
Registration Requestor (Provider /
Provider Organization
)
External Provider
Directories
Agent
Connect
Gate
way
3. Electronic medical documentation request (eMDR) sent securely to Provider or Agent as needed *
2. Receives updated
ESI Information
1. Sends request to retrieve
updated ESI informationOut to Provider
Payer Internal System
Key : ESI – Electronic Services Information
Volunteers to draft the following• Assumptions
– BM– Mahbulbul
• Pre Conditions– BM– Mahbulbul
• Post conditions– BM– Mahbulbul