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  1. FHIR Specification Feedback
  2. FHIR-36183

It is not clear how the EHR knows the CRD endpoint from the coverage

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci CRD (FHIR)
    • 1.1.0-ballot [deprecated]
    • Financial Mgmt
    • Use Cases and Overview
    • 2.2.2
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      Will change "uses Mrs. Smith’s coverage information to initiate a querying to a CRD Service" to "initiates a query to a CRD Service".

      Will also add a section on CRD service configuration saying "When an EHR configures itself to support a payer's CRD service, it will need to identify which Payer(s) the service supports such that it can ensure that the EHR only sends service calls to CRD services that the patient has current coverage for.   The payer endpoint is responsible for any internal routing based on which processing organization handles the decisions.  For this purpose, payer means 'The organization listed on the member's insurance card'.

      Provider and EHR Vendor organizations MAY leverage the [payer registry] developed by PDex (which will eventually fold into the national directory under FAST) as a means of determining which endpoints exist for which payers as candidates for configuration."

      Will submit a change proposal to add similar language to the DTR, PAS IG.

      Will update the existing language around only invoking CRD for payers the patient has active coverage for to link to this new language.

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      Will change "uses Mrs. Smith’s coverage information to initiate a querying to a CRD Service" to "initiates a query to a CRD Service". Will also add a section on CRD service configuration saying "When an EHR configures itself to support a payer's CRD service, it will need to identify which Payer(s) the service supports such that it can ensure that the EHR only sends service calls to CRD services that the patient has current coverage for.   The payer endpoint is responsible for any internal routing based on which processing organization handles the decisions.  For this purpose, payer means 'The organization listed on the member's insurance card'. Provider and EHR Vendor organizations MAY leverage the [payer registry] developed by PDex (which will eventually fold into the national directory under FAST) as a means of determining which endpoints exist for which payers as candidates for configuration." Will submit a change proposal to add similar language to the DTR, PAS IG. Will update the existing language around only invoking CRD for payers the patient has active coverage for to link to this new language.
    • Bob Dieterle / Rachael Foerster : 8-0-0
    • Clarification
    • Non-substantive
    • Yes

    Description

      In the use-cases section, 2.2.2 Scenario 2, IG says

      As Dr. Good begins crafting the order in his EMR, it uses Mrs. Smith’s coverage information to initiate a querying to a CRD Service used by her payer that includes the code for home oxygen therapy.

      However, it is not clear anywhere in the IG that I can tell, how the EHR knows the CRD service for the payer based on the coverage information. So as an EHR implementer, I'm not sure what service I'm going to call.

      Therefore, I request that the IG detail discovery mechanisms / develop a lookup or directory service, or some other methodology for how the EHR can know the CRD endpoints for the various coverages that the organization's patient population may have.

      Elsewhere in section 2.3.1 we also say

      • The EMR would only communicate to CDR[sic] Services they have specifically authenticated and have a trust relationship with.

      It is not clear how the trust relationship is developed either.

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            Unassigned Unassigned
            m_varghese Varghese Mathew
            Varghese Mathew
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            Dates

              Created:
              Updated:
              Resolved: