Blog from August, 2018

Notes from the August 31, 2018 call
Vassil Peytchev posted on Aug 31, 2018
  1. Discussions on participating in the HIMSS Interoperability Showcase and IHE Connectathon
    1. Dr. Miller and Brett to reach out to EHR vendors who currently don't usually participate in the calls (e.g. EClinicalWorks, athenahealth).
    2. The vendors who have been participating in recent calls (Allscripts, Cerner, Epic, Qvera, Medallies, Netsmart,  Nextgen) are interested, but most can't commit at this point, however most can have a more definitive answer by the next call on September 14.
    3. Regarding the protocol to use at Connectathon and at the Interop Showcase
      1. The specification requires the use of SMTP S/MIME + XDM, however it states that whenever a sender is aware of the capabilities of the receiver, they may use XDR instead
      2. For testing purposes, XDR is easier to set up
      3. In existing Direct implementations, most HISPs can transform between SMTP S/MIME + XDM and XDR, and many connections are managed at an organization level, where the sender already knows the capabilities of the receiver.
      4. The above points mean that we can make the appropriate accommodations at the communications level during Connectathon testing, and at the HIMSS Interop Showcase for anyone interested in participating.
  2. Side discussion on payer/insurance information
    1. Currently, the specification state nothing regarding insurance information. Current C-CDA exchanges don't seem to consistently contain usable information.
    2. Because of the use of HL7 V2 message in the request, we have two possible places to represent the insurance information - the C-CDA payers section, and the GT1 and IN1 segments in the HL7 message.
    3. The Payers section is optional in the CCD document type, and is not part of the Referral Note document type. The latter is an open template, meaning that 360X could add a requirement to have a payers section in the Referral Note as well. Also, the Payers section has only optional entries (discrete data) - another thing that 360X may need to further specify.
    4. Current practice for the use of the Payers section is to include all known insurance information, not necessarily specifying which one is to be used for the purposes of the referral.
    5. Based on the above there is an opportunity to add a payer/insurance option, which will describe how to convey relevant insurance information by
      1. using the HL7 V2 message's GT1/IN1 segments to specify the insurance information that the referral initiator believes to be responsible for the referral
      2. using the C-CDA Payer's section to continue with the current practice to list all known insurance/payer information for the patient.
  3. Dates for September testing: Monday, September 24th, and Thursday, September 27th. Details will be posted soon.
  4. IG updates - some will be made during the month of September.



Notes from the August 17, 2018 call
Vassil Peytchev posted on Aug 17, 2018
  1. Report from the ONC Interoperability Forum demo
    1. Very successful, well received
    2. Worth the effort, based on the feedback of those participating
  2. Lessons learned
    1. referenceIdList as a slot on the Submission Set needs to be emphasized as a requirement to avoid incomplete implementations
    2. There seems to be little utility in adding the stand-alone C-CDA MIME attachment to the Referral Request. For the purposes of the demo, this was disabled. There are various levels of requirements that make handling the XDM structure much more widespread than it was at the beginning of the project.
      Proposal: remove this requirements from the referral request. To be discussed again at next call
    3. When handling the XDM ZIP file contents, there were some issues with the presence of a Byte-Order-Mark (BOM) for files encoded in utf-8. The specification should mention this and either prohibit the use of utf-8 BOM, or alert implementers to properly handle it if present.
    4. Alert implementers that both Direct and XDM are content agnostic - there is no assumption that the content payload is a C-CDA file. Encourage testing of the transactions where the HL7 V2 message is the only payload.
  3. Call for participation in the 2019 HIMSS Interoperability Showcase
    1. there is already a scenario (use case) for 360X; they require around 7 or more participants
    2. Participation at the 2019 IHE North American Connectathon is also necessary to prepare for the Interoperability Showcase
    3. We will need to agree on appropriate infrastructure, as using SMTP and DNS on the internet may not be reliable from the HIMSS floor.
  4. Continued testing
    1. Next testing sessions will be scheduled for the week of September 24
    2. Goals: start preparing for Interoperability Showcase, test the scheduling transactions