esMD eDoC WG and eDoC Structured Documentation SWG Meetings
Date of Meeting: 5.22.13 / 1:00pm EDT
Decisions
eDoC WG
Jenny Brush will be taking over UC responsibilities next week while Sweta is out on leave.
Review of eDoC UC
- 3.1 Background
o “generate structured documentation” was changed to “capture”
- 3.3 Out of Scope
o Removed beneficiaries from bullet D.
- 10.2 Activity Diagram
o The alternate workflow necessary to portray prior-authorization, “submits
documentation for prior authorization”
o Remove reference to “device”
o Add a box, “1A. Provider determines a specific service or device is required.”
Prior authorization would branch off of this. The leads will discuss this offline.
o Possibly encapsulate the workflow to include several different work flows within
one basic workflow. Primary workflow will have to reference sub-workflow
(alternate workflows) which are optional.
- 10.3.1 Functional Requirements
o Make sure all references to clinical, required, and supporting documentation
throughout the UC is prefaced by “signed” and “signed and not “signed and
attested.” All signing events are attestations.
o May need to revisit depending on how the workflow changes with regards to
prior-auth for the Payer
- 10.3.2 System Requirements
o May need to update Provider EHR System based on revised prior-auth workflow
o Tom Kuhn (American College of Physicians): Concerned that notion of prior-auth
may not be part of use case. This is the only part (they) get benefit in
administrative fiction.
 Prior-auth isn’t spelled out in general use case. We will have a new
updated version of UC next week that properly accounts for it.
The UC revisions will be presented during next week’s meeting.
Structured Document SWG
The leads discussed the Complete CDA solution which would include all section/entry templates
available in CCDA. The leads posed the ongoing questions of what the next steps are for HL7
and what do we want to produce that will provide implementers with the guidance they need to
give recommendations for the structured data they could potentially generate.
The eDoC-relevant esMD HL7 Issues Presentation slides (slides 29-40) were reviewed, and
emphasis was placed on the complete encounter document into which all relevant visit elements
can be swept.
Reviewed the CCDA issues:
- What does the provider sign prior to billing?
- Does this vary by payer/service?
- Different venues of care (hospital, ambulatory, etc)
-
Limited number of sections are required for any of the document templates
The CCDA for eDoC options were covered:
1) A single document type that will handle all encounters – this may be difficult, especially in
a hospital setting.
2) Variable document template accounting for inpatient or outpatient encounters.
The S&I Framework Companion Guide to Consolidated CDA for Meaningful Use Stage 2 lists all
of the sections required for 2014 certification and may be relevant reading. A link to this
document will be posted to the wiki. Zach will also post a link to the HL7 C-CDA IG.
The document created may also provide a significant vehicle for communication of services
delivered for the sake of patient care. Although this is not the intent of the eDoC efforts, it does
fall in line with the purpose of CCDA.
The leads will look to any existing documents help create a framework for other use cases or user
stories, and define what we need for user stories so it can be captured. To the extent SDC
becomes a viable, we can look seriously at whether that will be a solution.
All documents reviewed during this call can be accessed from the esMD Initiative WG Meeting
artifacts wiki page.
Action Items
Name
Subject
Task
Zach
eDoC
Post a link to the Companion Guide to Consolidated CDA for
MU2 and the HL7 CCDA IG to the wiki.
Due
Date
5/22/13