2020-06-24 DTR Meeting
Transcript of 2020-06-24 DTR Meeting
2020-06-24 DTR Meeting
Chair: Larry Decelles
Scribe: Dana Marcelonis
AttendeesPresent Name Affiliation
Nalini Ambrose Mitre
George Bier Optum
Tony Benson BCBS AL
Michael Brady Rush
Matthew Byrne Optum
Modi Boutrs Rush
Hans Buitendijk Cerner
Chris Cioffi Anthem
Jeffrey Danford Allscripts
Jeremy Davis Davis InterSystems
Stephen Dean Allscripts
Larry Decelles Mitre
David DeGandi Cambia Health
Raymond Delano Cerner
Robert Dieterle Enable Care
Kristen Edsall Optum
Richard Ettema Aegis
Beth Galt-Salsamendi BCBS FL
Daniel Gottlieb InterSystems
Christol Green Anthem
Andy Gregorowicz Mitre
Kenneth Hall Hall Allscripts
Roxanne Hanson Optum
Jackie Hardison Humana
Patrick Haren Cigna
Claudia Hartman Highmark Health
Mark Hingham Anthem
Wendy Hofner Optum
Sheljina Ibrahim Kutty Anthem
Emma Jones Allscripts
Jocelyn Keegan Point of Care Partners
Geeta Krishnan Edifecs
Patrick LaRocque Mitre
Russell Leftwich InterSystems
Alberto S. Llanes Anthem
Tso Luke Optum
Dana Marcelonis Point of Care Partners
Timothy McCrimmon Optum
Mary Kay McDaniel Cognosante
Linda Michaelsen Optum
Patrick Murta Humana
Viet Nguyen Stratametrics
Henry Pham Casenet
Unknown User (rpena2) Allscripts
Nick Radov Optum
John Romza Optum
Lynda Rowe InterSystems
C Simeone Optum
Jeanie Smith BCBS FL
Julie Smith InterSystems
Grace Stambaugh Veradigm
Ashley Stedding CMS
Jay Taylor Casenet
Tiffanny Welch Independence Blue Cross
Karen L. Zapata Anthem
Gary Dickinson CentriHealth
Henry Pham CaseNet
India Duncan Optum
Jason Cassidy
Joseph Quinn Optum
Lloyd McKenzie Gevity
Tracy McCutcheon KPMG
Rashmi Menon KMHP
Mario Jarrin Change healthcare
Luis Maas
Terrence Cunningham AMA
Ann Gallagher Optum
Megan Smith-Hallingshead Regence
Holly Weeks Regence
Anthony Smith UNC Health
Sonja Ziegler Optum
John Moehrke
Unknown User (estonner)
Jennifer Joe
Diann Smith Texas Health
Kathleen Connor
Jeff Brown Cigna
Laurie Woodrome Labcorp
Jay Johnstone Cigna
Matt Dyer Vyne
Paul Knapp
Barbara Kramer-Zarins MITRE
Sai Tumuluru Centene
Barbara Wood PNC
Greta Honeycutt CoverMyMeds
Lenel James BCBSA
Reed Gelzer
Yunwei Wang MITRE
Keya Shah Casenet
Rich Bloch
John Donnelly Interpro
Lauri Shock
Andrew Johnson National Decision Support
Benjamin Langley MITRE
Mark Fleming Change Healthcare
Mrugen Mehta eClinicalWorks
Prathima
Rachel E. Foerster Rachel Foerster & Associates
Heather McComas AMA
Megan Riley MITRE
Summer Duman Regence
Michelle Barry Availity
Chris Cera
Michael Fasulo Regence
Melanie Combs-Dyer Mettle
Present Name Affiliation
Peter Muir ESAC
Rachel E. Foerster
Ryanne Laurence OHSU
Serafina Versaggi
Cole Springate-Combs Mitre
Susan Billet CMS
Barbara Antuna Aim Specialty Health
Christy Dodson MCG
Jim Taylor Tibco
Laurie Burckhardt
Rajesh Godavarthi
Santosh
Tom Hartman
Tori Willows Wellcare
Alise Widmer Lumeris
Bart Carlson Azuba
David Bruinsma Colonial Med
Deepthi Reddy Mettle Solutions
Danny Brennan MA Health Data
Patrick Edwards
Gay Dolin
Jodie Zellerhoff Cambia Health
Lorraine Doo CMS
Pallavi Talekar Scope Info Tech
Rajesh Garlapati Rush
Susan Bellile Availity
Susan Langford BCBST
Ralph Saint-Phard
Kristi Cushman OHSU
Briana Barnes Scope Info Tech
Didi Davis Sequoia Project
Sreekanth Puram Mettle Solutions
Duane Walker BCBSM
EMDI Team
David Hill Mitre
Kevin Lambert BCBS AL
Nandini Ganguly EMDI
Rachel E. Foerster
Rajesh Godavarthi MCG Health
Rim Cothren
Donna Campbell BCBSIL
Joanna Gaskill Lumeris
Lindee Chin Edifecs
Michael Cabral CMS
Sudhir Nair Anthem
Saul Karavitz Mitre
Dawn Perreault BCBSM
Brent Woodman BCBSM
Yolanda Villanova CMS
Deryl Lam
John Kelly Edifecs
Karen Tott CMS
Keeyan Ghoreshi MITRE
Luis Sayago Dacarba
Michael Flanigan Carradora
Rachel Goldstein
Ric Light Humana
Rohit Shinde eClinicalWorks
Seth Paradis Healow
Wanda Govan-Jenkins HHS
Cindy Monarch BCBSM
Edward Yurcisin
Frank Hone Veradigm
Hibah Qudsi Mitre
Nancy Spector AMA
Patrick Leblanc
Anupam Thakur BCBSFL
Sreenivas Mallipeddi MCG
Chris Klesges Mitre
Michael Gould BCBSA
Gregory Magazu CaseNet
Isaac Vetter Epic
Kat Ruiz UNC Health
Laura Bright
Nancy Beavin Humana
Roland Gamache
Katherine Lusk Childrens
Brandon Raab Anthem
Reed D. Gelzer
Chris Johnson BCBS AL
Jim Adamson Arkansas Blue Cross
Carry Denny
Corey Spears Infor
Karen Iapoce
Anna Meisheid CMS
Celine Lefebvre AMA
Eshaa Dhall eClinicalWorks
Evan Currie BCBSM
Unknown User (harvey_kuang) Express Scripts
Sandhya
Christopher Gracon Independent Health
Candice Titus Crisp Health
Mariana Singh CAQH
Troy Bergstrand BC Idaho
Shilesh Nair Gdit
Kensaku Kawamoto
Jason Teeple
Vipul Kashyap
Srinivas Posinasetty UHC
Tammy Banks Providence St. Joseph
Bob Harrington Allscripts
Vishnu
Danielle Sutter Health
Gary P. Gryan MITRE
Sonya May Optum
Molly Malavey AMA
Amit Shah Guidewell
Angela Bublik Regence
Mona Chandrapal
Create Decision from template
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
Links DTR IG: http://hl7.org/fhir/us/davinci-dtr/2019May/
Reference Implementation: https://github.com/HL7-DaVinci/dtr
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."
Healow/eClinicalWorks Team Implementation Questions
( )Mrugen Mehta
Take a clinical example such as ordering a Diagnostic Image of EchocardiogramEMR User selects EchocardiogramBundle everything that is needed, create CDS Hook (Order Select) and send information to the payerLooking to explore options to either using a SMART on FHIR app for DTR questionnaire and responses, or not using thatOnce we get the CDS CARD back for Echocardiogram requirements - questionnaire needed, does patient need testing
Are we expecting that to be part of CDS CARD because not part of SMART appIntent was, if provider is ordering, you'd send via CRD/CDS Hooks an indication of being ordered - it's up to payer (CDS endpoint) to decide how to respond
Respond by saying no requirement, or a documentation requirement, or a prior authorization requirementIf latter 2, would send link to the rules that are important to that documentation or prior authorizationPrior auth rules - rules required to collect data to support the prior authAt that point the SMART app or native app would connect to that URL/endpoint, pull down the rules (CQL and questionnaire), gather the information via FHIR APIs to 'populate' the questionnaire - if there's something missing, query the provider or someone else in the practiceAt that point if there's documentation that has been collected it should be written back to the record (observation or document, etc.)If this is going on for prior authorization or post-acute orders... the data that was collected to support necessity determination would flow into the requirements in the PAS IG - at that point assemble info necessary to provider prior authorization FHIR bundle which includes info needed to translate from FHIR to 278
You could do that translation, or piece of software outside of EMR, or clearinghouse or business associate could do that translationDocumentation could be exchanged via 275 or something else - expectation is that entire FHIR bundle is exchanged
Question: does this allow for provider to send info and payer to respond with a question (e.g., does the patient have chest pain? yes/no) - NoQuestion: can payer respond with a 2 part CARD - if chest pain click that URL if not chest pain, click that URL
No interactive process inherent in CRD IGYou could have 2 CARDS come back each with different actions - consistent with CDS HooksYou can get back multiple hooks
Other option is that payer provides the rules for EMR to evaluate the data collected from the record or provider entryConcrete examples based into the Reference Implementation
Discussed putting together supplemental examples together on Confluence - interaction diagrams and JSON to go along with itMITRE is currently finishing up IG, but could look at this as next taskeClinicalWorks/Healow would be willing to assist from EMR point of view to help putting together examples -
and to schedule time together offlineMrugen Mehta Larry DecellesSreekanth Puram will share something to test with via email to Mrugen MehtaOffline work will be brought back to the group for review as examples/share learnings
Viet Nguyen and - possibly use next week's call to define this framework - where are we going to Robert Dieterleput this information, how do we organize it, and how do we get feedback from HL7 workgroups
Payer Uniformity in Documentation Efforts
(Melanie Combs-)Dyer
Call with CMS to find out if someone from Medicare FFS program wanted to join the team to encourage payer uniformity in documentation elements
CMS wanted to clarify that role of team was to put together a superset of data elements from which payers could choose - goal is not to agree on unique set of data elementsPAS team realized assumptions were made re: superset vs. distinct set of documentation elements that all payers agreed to for each item and servicePAS call consensus/direction toward superset approach
CMS press release - new org change - office of burden reduction and health informatics that combines Dr. Mary Green's area and Alex Mugge's area under Dr. Mary GreenCMS believes effort will move faster if we head in superset directionJay Johnstone volunteered to be co-chair with on this teamMelanie Combs-Dyer
Jeff Brown as support from HL7/FHIR perspectiveAre we saying every possible data element that a payer could ask for depending upon what the prior authorization is on the clinical side?
We know what this is from an administrative perspectiveDocumentation elements = medical recordFor example if Medicare FFS program is looking for PO2 test - 5 data elements would be on the list. If Cigna says we need all of those things plus 1 more, then all 6 of those data elements would be on the list.Are we using words for this or clinical coding?
Start out looking at words, but after agree on superset, will do gap analysis to make sure every one of those items has a corresponding LOINC code or USCDI code or US Core code
Are you thinking of creating a PSS and doing a project around this?PSS - yesHaven't landed on whether this is under Da Vinci or HL7 - likely broader HL7 effort with support from Da Vinci communityNeed to get a PSS built and decide which HL7 workgroups are going to be addressed as sponsors/co-sponsors
Meetings will be openNeed payer and provider participantsAlso a terminology problem - ultimately will have to go back to LOINC or SNOMED if there's something that hasn't been codedNeed to design output of this group - if we understand what you're going to produce, we can understand how we're going to get thereMelanie and Jay are going to work on example of what end-output/structure would look like to bring back to this group for feedbackShould reach out to Medicaid Medical Directors to request participation - will try to find out Mary Kay McDanielwho's running their association Payers should reach out to if interested in [email protected]
No way to extract data from DTR Questionnaire Response to generate PAS bundle?Can have a questionnaire where expectation is to extract info from questionnaire and fill in elements in the prior authorization itself - wouldn't be common, but possibleFor most questionnaires coming back from DTR, expectation is that Questionnaire Response would be included as attachment with prior authorization requestExample: need primary and secondary diagnosis - expectation is that it will always be available, but what if provider enters this data - primary diagnosis needs to be put in the claim/278 at a later stage right?
If information needs to be in the prior authorization/X12 instance you would have to do extractionIntent has been that when done with DTR we have a questionnaire response that is populated and the resources that were used to populate it
Those are the elements that go into the PAS bundle as documentationIf somebody needs to fill in the form manually, and not pulled in directly from EHR - where can we insert that data?
Application itself can manage that That data needs to be in the record
If provider gets a questionnaire and it's prefilled, but needs to complete the 10th data element because not in the medical record - where does that 10th question go? Does it get inserted in the medical record?
Yes, but how depends on EHR capabilityIf there's data you collect, intended to be written back to EHR
If you have to type in data, how does that get communicated to payer as a FHIR resourceOnly reliable way is in questionnaire response itself
Required fields to create prior auth - there should be a way for someone to input that information - not only clinical data, where do you put in data mandatory for prior auth request itself?
Basic demographics will be required every time do a prior auth, so needs to be part of the record3 sets of data:
Data collected from EMR via DTRData required for 278Data specific to the request itself that is not reasonably expected to be available in the medical record?
Assuming most of it would beAssumption is that all PAS request data elements are in the medical record/EMR or associated coverage informationPick this up again next week or on PAS call this Friday
Next Agenda
Adjournment
Adjourned at 12:03pm ET
Supporting Documents
Outline Reference Supporting Document
Minute Approval
Action items