HL7



HL7 Attachments Working Group Meeting MinutesLocation: Baltimore, MDDate: October 1, 2018Time: 9:00 – 12:30Facilitator Christol GreenNote taker(s)Robin IsgettQuorum Requirements Met: FORMCHECKBOX N/A First NameLast NameAffiliationN/AN/AN/AAgenda Topics:Plenary Q1 and Q2.Attachments Workgroup did not meet during Q3 or Q4 due to Da Vinci meeting at HL7Supporting Documents: Posted on AWG site as appropriateMinutes/Conclusions Reached: 1. Opening comments by Charles Jaffe:Sycn4ScienceConsortium for Agile Genomics – Global allianceCDC - death on FHIRMicrosoft - Automation for FHIRONC cooperative agreement with HL7 for the next yearDr. Donald Rucker ONC Coordinator for HIT DHHS1st Cures Act and interoperability and what are the goals:Prohibition on data blockingLook at what’s in the cures act regulatory agency will rule making (HHS/ONC)1m dollar fine for information blocking. Working on exceptions common sense items like State Laws, system issues.Trust and exchange framework (direct trust), common agreementOpen application programming interfaces (APIs)Public standards, sandboxes to test new modelsShould be part of medical careOAuth2, privacy and security laws (HIPAA)Open APIs and the future (structured date, free text)Payments changing with new technologyAlgorithms vs. Templates for structured data Sagram Moodly Senior Vice President of Clinical Data Services & Technology for United Healthcare's Clinical Services organization on Da Vinci (Chair of Da Vinci)Improve patient experienceImprove the health populations/ health outcomesReduce per capita costLandscapeLegislation ACA 21st century cures act/ TEFCAValue Creation P4P Global risk - capitationPayvider (Providers becoming health plans and visa/versa)ACOs CMMI DSRIPNet Promoter Score (NPS) Ratings What is Anthems NPS?Blue ButtonOn demand health insuranceCare modernization (CDS Hook to invoke notification and send information neededPersonalization for members/patientsWorkflow integration – pitching, catching, fetching, placingAuto-triggers from providers to payers (like ADT admit = pitch)Place the FHIR App into workflow.How do you create an Individual Health Record with all disparate data (claims, labs, from multiple providers?) Da VinciStan Huff, Intermountain - Why Interoperability?251,454 deaths/year during inpatient admissionsFHIR is the future to improve interoperability SMART on FHIR and open platform architectureFHIR profiles form CIMI detailed clinical modelsClinical Information Models (CIMI)Nicholas Polys, Director of Visual Computing at Virginia Tech - Interactive 3D Visualization in the Wide Web of Health.ActionsNone HL7 Attachments Working Group Meeting MinutesLocation: Baltimore, MDDate: October 2, 2018Time: 9:00– 5:00FacilitatorDurwin Day & Christol GreenNote taker(s)Robin IsgettQuorum Requirements Met: FORMCHECKBOX Yes First NameLast NameAffiliationLioraAlschulerLantanaTonyBensonBCBSALKeithBooneGE HealthcareToddCooperAFCVictorVaysmanMedsideBrianaBarnesScope Infotech IncAndyGregorowiczMitreDurwinDayHCSC ***co-chair***MarkKrebsBCBS of SCChrisBrancatoDeloitteRachelFoersterCAQH COREChristinaChewningAvailityRickGeimerLantana GroupChristolGreenAnthem ***co-chair***FahrieBoussettaAlmerysPhilHeinrichDHCSRobinIsgettBCBS of SCLenelJamesBCBSAChrisJohnsonBCBS of ALDanKalwaCMSKatrinaKeyesCMSFarrahKhanBCBSAJeanNarcisiADAMary KayMcDanielCognosanteAlexKonturHHSDanielChaputHHSRussOttDeloitte/DoDNickRadovUHCDanielleFrierdEPICJasonWalonoskiMitreCoreySpearsInforAgenda Topics:Status, Industry updates:US Realm SC updates – ChristolHL7 Co-chair meeting updates – DurwinNCVHS Stds. Subcommittee - Predictability Roadmap –AlexOrthodonic update - Jean NWEDI Summer Forum and Scottsdale meetings - Attachments and Prior Authorization – DurwinONC Interoperability Forum and P2 FHIR Task Force - Bob and attendeesDa Vinci (IG CRD)- LenelConnectathon Readout - Attendee's from AWGBallot comment reviewsDa Vinci CRD FHIR Track- Andy Gregorowicz (Mitre)Supporting Documents: Posted on AWG site as appropriateMinutes/Conclusions Reached:IntroductionsThen we shared that Penny P has taken a new role with another company. So we no longer have a scribe. Robin Isgett from Palmetto GBAAlso we have Craig’s co-chair position opening for the January 2018 HL7 Conf in San Antonio. Industry UpdatesUS Realm SC update Co-chair meeting updateNCVHS Update/ Predictability Roadmap Predictability Roadmap: transaction standards and operating rules provide the health care industry with a degree of certainty in the timing and sequence of the development and adoption of new or revised standards and operating rules as required under HIPAA and other legislationAll SDOs need to come to the table to agree on a common vocabulary before moving forward with the roadmap.Orthodontic updateWEDI Summer forum and Scottsdale meetingONC InteroperabilityDa Vinci (IG CRD) – See slide presentation Connectathon Readout – See Danielle’s demonstration on new Coverage Requirements Discovery (Da Vinci) and another new Da Vinici track Data Exchange of Quality measure reporting- DEQM (30 day medication reconciliation)27 Tracks Attachments Track had good participationHL7 FHIR Attachments Track Connectathon 19 Attachments Summary: Electronic attachments/medical records are a high priority for payer/provider interactions (as most attachments at least for claims and prior authorization are manual processes today). Current thinking has attachment submissions occurring via X12 messaging. However, there is substantial interest with FHIR-based messaging for exchanging attachments and prior authorizations. Attachments future electronic request could include clinic data such as Risk Adjustment, Recovery, Audits, HEDIS, UM Care Coordination, Clinical Claim Review, Grievance and appeals. This track explores the feasibility of this approach.Participants:Christol Green – Lead (Anthem)Durwin Day – co-lead (HCSC)Christina Chewning (Availity)Henry Meyne (Availity)Victor Vaysman(Medside)Fahmi Boussetta (Almerys)Durwin Day(HCSC)Amol Vyas (Cambia)Kishore Metla (Mettles)Randall Noval (BCBSA)Bhanu Vemuri (BCNC)Chris Johnson (BCBSAL)Thanks to Paul Knapp who assisted with PreAuth and questions from attachments participants.Thanks to Rick Geimer for his assistance with re-establishing links for the Attachments track.Notable achievements:Built new patients and payer and provider information to build attachment requestsSend Solicited Communication Request from Payer to Provider for supportive document required Xray, and accident report for pended claims. These were the examples we used.Then acted as Provider and to build Communication to send the requested attachment.Sent attachment once as jpeg link to Xray and then again as encoded with base 64.Also acted as provider sending and unsolicited attachment to payor- Built a claim from Provider for Pre-Auth- Then sent a Pre-Authorization Communication to Provider with AuthorizationDiscovered issues / questions (if there are any)Discussion on how the request/response model differs between communication and claims resourcesDiscussion on sync vs. async for different scenariosDiscussion about how you reference resources external resources vs. include some portion of the resource data / de-normalizing within FHIR- Discussed CCDA and the formatting and what embodies a CCDA and how it relates to attachments.Other Comments:Andy Gregorowicz (Mitrev) how our Attachments table the new CRD Track work with FHIR. That may preface an attachment request from provider for additional information/documentation Discussion with EDIFECS Arthem Sopin on Attachments challenges.Ballot Comments- Orthodontic Ballot reconciliation - Russ - 52 votes, 48 affirmative. 5 negatives. EHR vendors Cerner, Epic and Allscripts posted negative comments. Refer to reconciliation spreadsheet. Placeholders for LOINC codes.LOINC value sets.Conformance number ,statuscode is missing a constraint43676-DA lead for EPIC suggested that the detailed observation entries are not required, but why would you not require something? Russ - the narrative can be all or none, structured header with ALL narrative is acceptable. Payers in group agreed. * Should all NULL flavors have comments? take to structured documents.If a count, state as integer. Change all type code "PQ" to integer.1079 ranges, such as 0 to 15 mm. Should there be a boundary/limit? Response is to remove boundaries.Allscripts asking about LOINC codes. copy disposition from previous.NULL flavors, ask structured docs.OID in value set, conformance statement in table 34. OID list vs SNOMED list, ask Emma what she meant.PQ and integer comment, use previous comment per resolution for comment 25.“datetime” - is it valuable for each measurement to have observation time? no, per discussion with plans. IPO comments, could not find the SNODENT codes. Response is because they are new, not yet searchable.Change to reference structured docs, data in a structured format.Epic, some observations are recorded as narrative, not coded values. Too many variances of facial anomalies.Typos on the last two. Recap vote on 10, 11,19,21, 25, 26, 33, 36, 37, 38, 39 42, 43 and 44. Jean makes motion Chris seconds, but decide to table the vote until full attendance. Prepare for a block vote. Get Structured Document recommendations. Submit a "block vote" on a phone call. Next set of NEGATIVELisa Nelson encompassing encounter in the header. Modeling question for Structured Docs. Several dates of service for one encounter.Figure 11, service event, primary care provider should not be in figure 11 as example.US real header, refer to structured docs. Prefer this to be stand alone?Signature code US realm header constraint. Digital signature example ALSP.Figure 24, straight out of the CDA. Da Vinci CRD FHIR Track- Andy Gregorowicz (Mitre) - FHIR based exchange. See slide presentation. Provider to EHR. CDS hooks response from service to say if it was discovered. Rachel - prefetch is optional and part of CDS hooks, multiple services looking out for the hooks and can be plugged into workflow any place, fire off at any point. Notifications, CDS hooks end point (payer) has discovery document. EHR as client, payer as server. Request to server, what do you want? The client can fill the prefetch (in IG), respond with CD hooks cards which could be most anything; PDF link, FHIR resource. The exchange is syncronous, stateless HTTP request. DEMO - in support of CMS, helping out the Da Vinci project, the coverage requirements discovery. Java code to represent the payer. Set of rules that apply to age, gender, procedures, link is in the CDS hook card. The response gives link to where the document is found (simple example). Can be automated. CQL or smart on FHIR for computable.Actions Russ Ott: Prepare comment reconciliation block vote for next WGM call. HL7 Attachments Working Group Meeting MinutesLocation: Baltimore, MDDate: October 3, 2018Time: 9:00– 5:00FacilitatorDurwin Day & Christol GreenNote taker(s)Robin IsgettQuorum Requirements Met: FORMCHECKBOX Yes First NameLast NameAffiliationMarkKrebsBCBS of SCChristinaChewningAvailityTonyBensonBCBS of ALEvelynGallegoEMI AdvisorsRayWickersonScope Infotech IncNandiaYungScope Infotech IncKatrina KeyesCMSPat Van DykeHL7 BoardMattElrodTerryCunninghamAMADurwinDayHCSC ***co-chair***RachelFoersterCAQH COREKeithBooneGE HealthcareChristolGreenAnthem ***co-chair***VictorVaysmanMedSidePhilHeinrichDHCSRobinIsgettBCBS of SCLenelJamesBCBSAChrisJohnsonBCBS of ALDanKalwaCMSLisaNelsonDanielVreemanRegenstrietJeanNarcisiADAAgenda TopicsDiscuss process for the Attachment NPRM release - DurwinAWG review and comment. CMS questions to HL7 for comments. 60 vs 90 day comment period?Review and suggested updates to AWG Mission, Charter and Work Products and Contributions to HL7 Processes Supporting Documents: Posted on AWG site as appropriateMinutes/Conclusions Reached:1.Discuss process for the Attachment NPRM releaseExpecting end of December or into first QTR of 2019. On the Unified agenda (),,view EO 12866 Meetings. TA1 . ACA sevtio1104 c3 attachments. CORE names X12, not FHIR from previous regs. implementation guides.45cfr162.940. can use for pilots or demos projects. statutory process, release schedules. operating rules and implementation guides. Daniel. terry asked about the 278.NCVHS designated to do the standards review process. HIPAA states X12 standard. Health Claim Attachments. AWG review and comment. CMS questions to HL7 for comments. 60 vs 90 day comment period?ACP comment reconciliation.Review and suggested updates to AWG Mission, Charter and Work Products and Contributions to HL7 Processes - Discussion regarding changing the name of the workgroup. Rachel made suggestions. Pat stated that the workgroup is not perceived to be global, more US centric because initially formed because of HIPAA. Be careful about renaming. Terry states we need more provider representation. Need EHR clinician input. 21st century cures act is US realm. Pat does not see a down side to going global. Value based care or fee for service would not change the scope since the regulation does not name either. Use Health plan over payer is from HPID discussions. Reworded Mission statement, Charter - there is a template in the HL7 governance with similar format to other workgroup charters. Pat suggested reviewing 2014, the development of mission and charter statements for User groups. Also, change the URL for attachments, it says "claims" in the URL.Actions AWG: Think about renaming workgroupHL7 Attachments Working Group Meeting MinutesLocation: Baltimore, MDDate: October 4, 2018Time: 9:00– 12:30FacilitatorDurwin Day & Christol GreenNote taker(s)Robin IsgettQuorum Requirements Met: FORMCHECKBOX Yes First NameLast NameAffiliationKeithBooneVVC HoldingsDanAndersonLantanaTimMcNeilSurescriptsMarkKrebsBCBS of SCDanielFreirdEpicDurwinDayHCSC ***co-chair***JocelynKeeganPOCPRachelFoersterCAQH COREChristolGreenAnthem ***co-chair***RobinIsgettBCBS of SCLenelJamesBCBSADanKalwaCMSKatrinaKeyesCMSPatVan DykeHL7 BoardAgenda TopicsDa Vinci Use Cases deeper diveNCVHS meetings regarding the predictability roadmap slide deckPlanning calls and next meetingSupporting Documents: posted on AWG site as appropriateMinutes/Conclusions Reached: Da Vinci Use Cases deeper dive – See Lenel and Jocelyn’s slide presentation. Recap of Da Vinci and deeper dive into the use cases. See HL7 site, about/Da Vinci is available. Open source/antitrust. Objective, Implementation guides. Because of Value Based Care. Set payers and providers up for VBC. Lenel use cases, tooling from Lantana. IMP guides, testing, then connectathons, pilots. 9 use cases. 1) DEQM Data Exchange of Quality measure reporting (30 day medication reconciliation). Examples, discharge notification and med rec need for HEDIS/STARS measurement. The EHR has a place to check when the reconciliation is complete. This must be done within 30 days. Payers and providers need common transport 2) Coverage Requirements Discovery. Do I need to do a prior auth? In realtime, the response could be the answer, a list or a URL. Data capture questionaire resource. Daniele - CDS-hooks from connectathon, a smart app could also be embedded. Testing with reference representation to get CARDS back, used EPIC FHIR server and Postman. How can we determine least amount that will not disrupt their workflow? If you have SMART on FHIR, you do not have to be one of the BIG EHR vendors such as Epic and Allscripts. Rachel asked questions about systems the payers would use for real time. Danielle demonstrated what was done at the connectathon. Supporting HTTPS and rest. Used mitres end points. Provider sends to the service, workflow triggered by the physician if automated. FHIR server test Epic platform orders are sent, execute, then the response such as "No documentation required for a device or service with code 307675”. CMS is using this for DME. 3) Documentation template and coverage rules. 4) eHealth record exchange, HEDIS/STARS & Clinician Exchange. Like CMS blue button 2.0. Derived payer would have EOB data. Multiple EOBs from multiple payers per patient. Apple, dragon authorization support use case - a payload. Rachel CORE OP rules requiring a health plan to return a LOINC or PWK segment. What does it mean as opposed to the HIPAA 278? Could be docs needed to supplement the 278. Daniel - reminded the HIPAA and CORE OP rules as they write their data flow between HER, provider pay. fisma and nista. tls 2.0 example. CMS will fund Mitre. There is technology to cover transport layer. The use cases must be compliant, leveraging. Hopefully the regs will guide Da Vinci. NCVHS testimony for predictability roadmap. HL7 work group chairs would need to talk to HL7 Policy workgroup. Durwin says they have provided testimony. Raising awareness and preview goals from first slide. Allscripts asked, use case covers ADT alerts and notifications on FHIR. NCVHS meetings regarding the predictability roadmap slide deck, get from meeting presentations. Revamp/disband the DSMOS discussion. Planning calls and next meeting – Next meeting will be on Tuesday, October 9th. Go over the Mission and Charter statement. See below for comments, ideas and suggestions for renaming the workgroup.Define healthplanHeathcare exchangeCare coordination HIEAdministration sector support Clinical document exchange Look AWG products What are other workgroups named so as not to compete with others Go to steering regarding the financial pieceLabel that does not constrictIncludes value based and global.Other:Results of the co-chair elections are provided below:Clinical Decision Support – Howard StrasbergClinical Genomics – Bob MiliusClinical Interoperability Council – Russ LeftwichCommunity-Based Care and Privacy – Johnathan Coleman, David PykeConformance – Frank Oemig, Nathan Bunker (please see Karen Van)Emergency Care – Dominik BrammenFHIR Infrastructure – Rick Geimer, Josh MandelFinancial Management – Paul Knapp, Benoit SchoefflerHealth Care Devices – John Garguilo (please see Karen Van)Implementable Technology Specifications – Brian PechInfrastructure and Messaging – Sandy StuartLearning Health Systems – Russ LeftwichMobile Health – Nathan Botts, Gora DattaModeling and Methodology – AbdulMalik Shakir, Ron ShapiroOrders and Observations – Ken McCaslinPublic Health – Joginder MadraSecurity- Trish WilliamsTemplates – Kai HeitmannVocabulary – Reuben DanielsActions AWG: Think about candidates for third Co-chair position.Next Meeting / Preliminary Agenda Items10/09/18 - 2:30 - 3:30 ET Phone Number: +1 770-657-9270, Participant Passcode: 8632591WGM Follow up TBDOpen Discussion ................
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