HL7 Clinical Guidelines SIG Conference Call Minutes

HL7 Clinical Guidelines SIG Conference Call Minutes

HL7 GELLO& Prior Authorization of Prescription Drugs6/3/05 Meeting Minutes

1st Task Group Teleconference

Friday, 6/3/05 11-12 noon (US EDT)

Ross D. Martin, MD, MHA (author)

Attendees: Ajit Dhavle, POCP Robert Dunlop, InferMed Robert Greenes, Partners Robert Jenders, UCLA Ross Martin, Pfizer Barbara McKinnon, POCP Tony Schueth, POCP Margarita Sordo, Harvard

Topics of Discussion:

Task Group Charter:
Bob Greenes: Suggested that the charter might need to be more re-worded so that its primary focus was on the HL7 GELLO implementation without highlighting a implementation with PA since the charter wording may be included within documents going out to multiple funding sources.

Ross Martin: Agreed that the wording may need to be altered when going out to funding sources but hesitated to alter the task group charter since it had passed committee resolution.

Resolution: No change to task group charter.

Prior Work - GELLO:

Bob Greenes: Notification just received that HL7 GELLO passes as an ANSI standard.

Work in Progress – PA:

Tony Schueth: NCPDP Task Group is composed of multiple groups: SDO’s; physicians, plans, vendors, pharmaceuticals.

Obtained AHRQ funding to collect PA forms and rules, primarily from commercial health plans, enter them in a database and analyze their contents.

Currently in the processing of requesting additional funding to continue normalizing the data across PA forms. This activity is in progress and completion expected by the end of 6/05.

Use of GELLO with PA has not been addressed with the task group. Expect to add this topic to the agenda as soon as the data normalization process is completed.

Some controversy around allowing prescribers to have health plan PA criteria. Mostly with PBM’s who currently house these rules within their organizations and consider this as a asset.

Balancing those that feel this is a proprietary issue versus those that understand the need to supply branching logic to prescribers is an issue we are very sensitive to. Issue being addressed in private discussions with these groups outside of task group meetings.

Tony Schueth: After introducing GELLO to the Task Group, the next step would be to bring the NCPDP Task Group into discussion with this task group.

Ross Martin: The electronic standards that will be used to transmit PA information to prescribers and then allow prescribers to transmit completed information back to the health plans are: X12N 278 & 275 and HL7 Prior Authorization Attachment

Representatives for each of these standards are currently serving on the NCPDP Task Group.

See GELLO as a means of creating standard sets of PA form criteria that can be imported and exported within HIPAA guidelines. Create a library of standard rule sets. Ultimately GELLO expressions should align to SPL.

Robert Jenders: Need to evaluate PA forms and their branching logic and code it into GELLO expressions; then test it.

Ross Martin: PA demo developed by InferMed which was based on initial 5-6 PA forms sent to Robert Dunlop. This demo illustrated how ProForma could provide a structured way of moving through the PA decision making process.

Robert Dunlop: InferMed committed to incorporating the GELLO into the ProForma model. InferMed also working on Pain Management Guidelines with Brown University for LTC setting. Knows CMS is looking closely at this project.

Ross Martin: Sees alignment between InferMed’s project and the GELLO PA project.

Bob Greenes: A parallel task group has also been formed for a conversion GELLO model within the HL7 DSS/CGL committee . Sees this as another alignment of projects.

Ross Martin: Next steps for completion of GELLO funding request.

-  Break up requests for funding into smaller chunks. Request funding for evaluation of how GELLO & ProForma structure map to PA forms.

-  In parallel, work on completing the funding request for the GELLO parser, compiler, and interfaces.

-  Provide reasons why AHRQ and other funding resources should consider these projects.

Bob Greenes: Who will be primary funding sources?

Ross Martin: AHRQ, and possibly other private companies.

Next Steps

1.  Create a 2 page paper to request AHRQ funding (in the range of $30,000-40,000) to evaluate PA forms against the HL7 RIM and convert the forms into GELLO expressions. Complete paper by end of June 05. On point: R. Martin, B. Greenes, M. Sordo, R. Dunlop, A. Dhavle.

a.  T, Schueth to forward copy of recent AHRQ funding request for PA form normalization.

2.  Continue work of request for funding for GELLO parser, compiler, and interfaces. In order to determine timing, B. Greenes speak to E. Hammond about (1) possibility of including this aspect of project as part of an HL7 grant, (2) timing, and (3) ask for samples of completed HL7 project grant proposals. B. McKinnon to e-mail most recent version of request to team members.

Next Teleconference

Thursday, June 16, 2005
US EDT – 12 – 1 pm
Dial in #: 1-877-922-6597 (pass code 154330#)