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    • Type: Change Request
    • Resolution: Persuasive with Modification
    • Priority: Highest
    • US Da Vinci PDex Plan Net (FHIR)
    • 0.1 [deprecated]
    • Financial Mgmt
    • Home
    • Background and Use Cases
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      Agreed.  The first paragraph is intended to address comment.

      Proposed text:

      This implementation guide defines a FHIR interface to a health insurers insurance plans, their associated networks, and the organizations and providers that participate in these networks. Publication of this data through a standard FHIR-based API will enable third parties to develop applications through which consumers and providers can query the participants in a payers network that may provide services that address their health care needs. Although there are multiple types and sources of providers directories, including provider organizations (i.e., a hospital listing all its physicians), government (i.e., listing of providers in Medicare), payers (i.e., a health plan's provider network), and third-party entities (such as vendors that maintain provider directories), the focus of this implementation guide is on Payer Provider Directories.

      The PDEX Payer Network (or Plan-Net) Implementation Guide is based on the [ Validated Healthcare Directory Implementation Guide (VHDir IG)|http://hl7.org/fhir/uv/vhdir/2018Sep/index.html], an international standard. The VHDir IG is based on FHIR Version 4.0. It was developed in cooperation with the Office of the National Coordinator for Health Information Technology (ONC) and Federal Health Architecture (FHA) with guidance from HL7 International, the Patient Administration Workgroup, and the HL7 US Realm Steering Committee.

      [Note remove VHDir Diagram]

      Current text:
      The Payer Directory Implementation Guide is based the [ Validated Healthcare Directory Implementation Guide (VHDir)|http://hl7.org/fhir/uv/vhdir/2018Sep/index.html], an international standard. The VHDir authors developed the IG to support a conceptual, centralized, national source of healthcare data that would be used across multiple use cases. The use of VhDir as the conceptual base for the Payer Directory Implementation Guide, including reuse by reference of a number of the extensions defined there, is intended to protect implementors of the Payer Directory IG from rework/remapping when the VHDir concept reaches implementation, and becomes a source of data for the Payer Directory. The API is based on the HL7 Validated Healthcare Directory IG. The primary changes are to: 1) remove the validation and restriction resources, 2) use US Core for R4 as the base profile, 3) eliminate some of the extensions that are not necessary for this use case, and 4) reduce additional constraints (e.g. search criteria, cardinality, and MustSupport) where appropriate.

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      Agreed.  The first paragraph is intended to address comment. Proposed text: This implementation guide defines a FHIR interface to a health insurers insurance plans, their associated networks, and the organizations and providers that participate in these networks. Publication of this data through a standard FHIR-based API will enable third parties to develop applications through which consumers and providers can query the participants in a payers network that may provide services that address their health care needs. Although there are multiple types and sources of providers directories, including provider organizations (i.e., a hospital listing all its physicians), government (i.e., listing of providers in Medicare), payers (i.e., a health plan's provider network), and third-party entities (such as vendors that maintain provider directories), the focus of this implementation guide is on Payer Provider Directories. The PDEX Payer Network (or Plan-Net) Implementation Guide is based on the [ Validated Healthcare Directory Implementation Guide (VHDir IG)|http://hl7.org/fhir/uv/vhdir/2018Sep/index.html], an international standard. The VHDir IG is based on FHIR Version 4.0 . It was developed in cooperation with the Office of the National Coordinator for Health Information Technology (ONC) and Federal Health Architecture (FHA) with guidance from HL7 International, the Patient Administration Workgroup, and the HL7 US Realm Steering Committee. [Note remove VHDir Diagram] Current text: The Payer Directory Implementation Guide is based the [ Validated Healthcare Directory Implementation Guide (VHDir)|http://hl7.org/fhir/uv/vhdir/2018Sep/index.html], an international standard. The VHDir authors developed the IG to support a conceptual, centralized, national source of healthcare data that would be used across multiple use cases. The use of VhDir as the conceptual base for the Payer Directory Implementation Guide, including reuse by reference of a number of the extensions defined there, is intended to protect implementors of the Payer Directory IG from rework/remapping when the VHDir concept reaches implementation, and becomes a source of data for the Payer Directory. The API is based on the HL7 Validated Healthcare Directory IG. The primary changes are to: 1) remove the validation and restriction resources, 2) use US Core for R4 as the base profile, 3) eliminate some of the extensions that are not necessary for this use case, and 4) reduce additional constraints (e.g. search criteria, cardinality, and MustSupport) where appropriate.
    • Robert Dieterle/Mark Scrimshire: 20-0-0
    • Clarification
    • Non-substantive

      Recommend: 1) clarifying that the purposes of the IG is to be inclusive of both individual providers and provider organization; 2) give examples of provider organizations (hospitals, nursing homes, home health, laboratories, radiology centers, etc); 3) include in the use cases examples of need to access listing of provider organizations - for example list of labs I can go to); and 5) include an example of pharmacy providers

      Existing Wording:

      The background and use cases are very 'practitioner' centric, whereas the Payer Provider Directory is intended to be inclusive of all types of providers (individual, organization)

            Assignee:
            Unassigned
            Reporter:
            Walter Suarez
            Watchers:
            1 Start watching this issue

              Created:
              Updated:
              Resolved: