Location: Los Angeles, CA / Date: May 18, 2017
Time: 9:00 – 5:00
Facilitator / Durwin Day / Note taker(s) / Penny Probst
Quorum Requirements Met: Yes
First Name / Last Name / Affiliation
Liora / Alschuler / Lantana
Arpi / Amiryan / Kaiser Permanente
Tony / Benson / BCBSAL
Laurie / Burckhardt / WPS
Mary Lynn / Bushman / National Government Services
Patrick / Cannady / American Dental Association
Terry / Cunningham / AMA
Durwin / Day / HCSC ***co-chair***
Robert / Dieterle / CMS/ONC Contractor
Rachel / Foerster / CAQH CORE
Rick / Geimer / Lantana Group
Liz / Hartley-Sommers / BCBSLA
Robin / Isgett / BCBS of SC
Kathy / Jonzzon / Delta Dental
Debbi / Meisner / Change Healthcare
Cathy / Plattner / Kaiser Permanente
Penny / Probst / Highmark, Inc
Deb / Strickland / Conduent
Susan / Titterington / Practice Insight
Sherry / Wilson / Jopari
Laurie / Woodrome / Labcorp
Agenda Topics
1. Joint meeting with WEDI Attachments WG
2. Discussion on LOINC codes use in the response from a request for an Unstructured document
3. Podiatry PSS
4. Review Guide
5. Create ‘HL7 Store’ to put Attachment documents on the website
6. Third Co-chair
7. Plan for webinars on the release of the regulation (education)
Supporting Documents:
Minutes/Conclusions Reached:
1. Joint meeting with WEDI Attachments WG
· Speaker Panel:
Heather Mc Comas , AMA , Mary Lynn Bushman, Medicare (NGS, Anthem) , Sherry Wilson, Jopari Solutions and Crystal Ewing, Zirmed
· Session Description:
Overview Introduction - Provider perspective on attachment workflow automation.
In this session the speakers will present an end to end automated attachment solution from a Provider, Clearinghouse and Payer prospective. Workflow Benchmarks, ROI Metrics and other educational tools will be shared to help Stakeholders assess their Attachment EDI readiness. This session is designed to be an interactive information exchange between stakeholders to share how they are also implementing attachment solutions within their workflow process today.
· See WEDI WG minute for details
2. Discussion on LOINC codes use in the response from a request for an Unstructured document
· Durwin presented a recap/level set of the header constraint for LOINC usage (get slides)
· There are 3 views:
a. Select from document type = DOC (~8000)
b. Select from database (~65000)
c. Select from HIPAA panel (~80)
· The HIPAA tab may be incomplete. The work group has to review, confirm and update as needed.
· The C-CDA R2.1 templates are included in the static list in this document. If a template is added, it would be for an unstructured document. Verbiage that addresses this is in section 4.2.3. A reference to this will be added to appendices C and D.
· There was a lengthy discussion on the use of LOINC codes for attachments. Major points were:
o The intent, from a payer perspective, is that the request will use a finite list of codes. However, the provider response will be up to the provider to send back whatever code they have. It should be left open for cases where providers may send something other than a document.
o For structured documents, compliance with the structured templates is required.
o The clearinghouse view is that the standardization is needed for implementation. It is currently chaotic. It is very important that the responses are limited based on the request.
o The guide allows nullflavor rather than a document code for structured documents: The statement is either SHALL contain LOINC or nullflavor; or If present, SHALL contain LOINC or nullflavor and scale=doc
o The HIPAA tab was originally created so that providers aren't burdened with figuring out which codes to use
o There was a question about the possibility of different payers setting which codes are required and potentially causing non-standardized.
o Authentication is for the document as a whole, not in part. Also, even if x is asked for and y is sent, the receiver still wants to know that y is being sent. CDA can authenticate in the US realm header. Clinicians have said they don't authenticate out of context
o Scale = doc was previously agreed to. Some templates are restrictive, some are not. For unstructured documents, it is acceptable to restrict to codes where scale=doc. (option a) US Realm header does require a code.
· Rachel made a motion that AIGEX-UD2 read SHALL be selected from the LOINC document type code (changed SHOULD to SHALL)
o Liora second
o Discussion
§ It was explained that LOINC document type code is the same as those codes in the database where scale=doc.
§ It was asked why we aren't using option c. It was explained that the 80 are the request codes, not response codes and may be too restrictive.
§ It was noted that this creates restrictions that go above and beyond the underlying standard. However, there are other conformance statements that are more restrictive than the standard so this should be no different. This is the least restrictive option that doesn't violate the underlying model.
§ There was some discussion trying to equate this restriction with limiting code sets in X12
§ It was noted that there is a high risk, of violating information governance, data retention rules, etc if the codes are not restricted.
§ A friendly amendment was made to state that no receiver can reject solely on this code. Rachel declined including any wording instructing an entity on how they do business
§ It was noted that in terms of the document code set being ready, it's not perfect but it's been in use for quite a while. It should be used and improved with use.
§ One payer using attachments today is not validating this type of code and will most likely continue this practice in the future.
§ There was discussion about removing the statement 'accurately represent the content of the unstructured document' as it is in one version of the document but not another. Debbi will check on this.
o Vote: Approve - 13, Disapprove - 3, Abstain - 3
3. Podiatry PSS (see supporting documents above)
· The AWG received a cosponsorship request for the Podiatry Profile of the EHR Functional Model
· This is strictly and EHR functional model
· As a cosponsor, the AWG would help develop criteria/conformance statements.
· There was a question about how this will be coordinated with the other UDI effort. The groups working on that effort are cosponsors on this as well.
· There was a question about this group having the expertise for this subject matter
· This will be discussed and voted on during the next AWG call
4. Review Guide
· Bob made a motion to remove the last paragraph of 4.3
o Rick second
o Discussion: none
o Vote: Approve - 11, Disapprove - 0, Abstain - 4
· Bob made a motion to change 'classified' to 'describe' in section 4,2, first paragraph
o Rick second
o Discussion: none
o Vote: Approve - 12, Disapprove - 0, Abstain - 3
· Bob made a motion to accept the rewrite of section 4
o Liora second
o Discussion: none
o Vote: Approve - 13, Disapprove - 0, Abstain - 2
· Bob made a motion to remove SD6
o Debbi second
o Discussion: Debbi will update the numbering of the subsequent SDs
o Vote: Approve - 15, Disapprove - 0, Abstain - 3
· Bob made a motion to authorize Debbi to finish applying changes, post for internal review, have completed, and ready for posting for removal of negatives a week from Wednesday.
o Debbi second
o Discussion: There was discussion about the process for withdrawing negatives. Liora shared how this is done on the ballot website.
o Vote: Approve - 15, Disapprove - 0, Abstain - 2
5. Create ‘HL7 Store’ to put Attachment documents on the website
· The mandated standards can currently be found at Hl7.org Standards>HL7 Standards Referenced in US Regulation
· We need something for just Attachments to include all documents needed to implement attachments. It has to be accessible to the industry, regardless of SDO membership. There is the challenge that each SDO is responsible for their own content and other SDOs cannot post their content. All SDOs should point to the same source.
· It was suggested to create a page with links rather than trying to reorganize the current document storage. It was cautioned that links can break
· It was suggested to reach out to Dave Hamill and Andy (web master) for options. Perhaps they could join an AWG call
· There was discussion about access to various sites as some do require membership to access certain information. Anyone can get an HL7 website login, membership is not required. Access to certain free content may be limited based on membership.
· It was suggested that a wiki be created because the AWG can maintain it and it doesn't require login
· There was discussion about the posting of the ACP white paper. Durwin will follow up with Chuck.
6. Third Co-chair
· Laurie made a motion to open the third co-chair position
o Debbi second
o Discussion: The position was never closed. An election can be held at the next HL7 WGM
o Laurie withdrew the motion
· Laurie made a motion to open nominations for the third co-chair position
o Debbi second
o Discussion: interested individuals can contact Durwin or Craig
o Vote: Approve - 14, Disapprove - 0, Abstain - 3
7. Plan for webinars on the release of the regulation (education)
· Education is key
· There was discussion about the different levels of education needed and how they might be accomplished. Some suggestions were:
o Conduct a full day of attachments deep dive training in conjunction with the WEDI forum in August.
o A webinar series, perhaps in collaboration with the WEDI forum
o Perhaps extend the X12 meeting for a technical training
· We need to be clear on the audience for the training sessions and be cautious about cramming too much into one day.
· The education content should include information sharing from pilot entities
· It was suggested to get vendor sponsors who are currently exchanging electronic attachments
· It was noted that there are two challenges to be addressed in the training: 1) The X12 transactions and 2) handling the clinical data/document after it is received. The X12 piece is not a huge challenge for payers. The issue is processing the information when it's received. From a provider perspective, there is the issue of pulling the information together for the payload. Workflow issues are the problem. Resources that are good at convergence of clinical and medical data are needed.
· The transcription/dictation vendors should be brought back into the process.
· There was discussion about what is currently occurring in the industry. Everyone is doing something different and at different comfort levels with attachments.
Actions· AWG: review HIPAA tab for completeness
· Debbi: Check on the verbiage for AIGEX-UD2
· Durwin: Reach out to Dave and Andy for web options and to invite to an AWG call
· Durwin: Follow up with Chuck on the posting of the ACP white paper
HL7 Attachments Working Group Meeting Minutes
Location: Los Angeles, CA / Date: May 19, 2017
Time: 9:00– 5:00
Facilitator / Durwin Day / Note taker(s) / Durwin Day
Quorum Requirements Met: Yes
First Name / Last Name / Affiliation
Arpi / Amiryan / Kaiser Permanente
Tony / Benson / BCBSAL
Laurie / Burckhardt / WPS
Mary Lynn / Bushman / National Government Services
Patrick / Cannady / American Dental Association
Terry / Cunningham / AMA
Durwin / Day / HCSC ***co-chair***
Robert / Dieterle / CMS/ONC Contractor
Rick / Geimer / Lantana Group
Liz / Hartley-Sommers / BCBSLA
Robin / Isgett / BCBS of SC
Kathy / Jonzzon / Delta Dental
Debbi / Meisner / Change Healthcare
Cathy / Plattner / Kaiser Permanente
Penny / Probst / Highmark, Inc
Sherry / Wilson / Jopari
Laurie / Woodrome / Labcorp
Agenda Topics
1. Attachment Guide Follow up
2. Health Care Directory PSS
3. UDI Update
4. FHIR Connectathon Update
5. ACP Document
6. Preparation for Industry Implementation
7. CMS Project for Data Exchange Between Providers
8. Other Education Items
Supporting Documents: posted on the AWG website as indicated
Minutes/Conclusions Reached:
1. Attachments Guide Follow up (Mary Lynn)
· There was discussion about the section that includes how to request LOINC codes. It was suggested to add verbiage indicating that the intent is not to deny a code request.
· The document has been approved as written. A comment can be made during work group review and the groups will discuss it.
2. Health Care Directory PSS (Bob)
· ONC/FHA Healthcare Directory
· Bob shared the presentation (above)
· The goal is to submit a FHIR-based IG for the September ballot
· The initial focus is for providers with NPIs, then move onto others
· There is currently a PSS with the Patient Administration WG as sponsor. Current co-sponsors are Financial Management and Attachments(if approve today)
o The AWG would review and provide input
o AWG will receive periodic updates
o Bob made a motion that the AWG approve being a cosponsor for this PSS
§ Rick second
§ Discussion: Rick asked if additional AWG representation is needed. Bob didn't think so - he and Lenel are involved. Laurie is not sure how this fits in our work.