FHIR Chat · Presentation to CARIN BB bi-weekly meeting (2021-07-08) · patient empowerment

Stream: patient empowerment

Topic: Presentation to CARIN BB bi-weekly meeting (2021-07-08)

view this post on Zulip Ryan Harrison (Jul 08 2021 at 20:01):

Call: CARIN BB Payer Implementer Forum Weekly Meeting
Thursday, July 8⋅2:00 – 3:00pm

Policy principles

  1. Rooted in HIPAA Privacy Rule, specifically the correction principle.

    • HIPAA provides very specific Implementation Specifications for a Patient's Request to Amend their record
      • Information clinic must give a patient
      • Information for request denial

  2. With inspiration from EU GDPR Right to Rectification

In scope

  • Communication of request from patient to Health Care Provider CEs (Covered Entity)
    • Roadmap: Covered Entity (Providers, Clinical) --> Covered Entity (Payers, EOB)
  • Corrections/Rectifications (starting with clinical corrections to providers)

  • Where corrections are applied as attachments, meaning attachments _could_ be

    1. Existing patient-directed clinical exchange IGs, and their underlying attributes
    2. Any patient-directed clinical exchange attribute
    3. Non-clinical patient-directed exchanges, e.g. Payers/EOBs

Feedback from CARIN Payer community

  • Payers make a distinction between communications and grievances/rights/appeals.
    • The IG could be useful for communications, e.g. routine corrections of spelling, DoB, Address updates
    • However it could be a minefield with respect to payments or grievances.
  • Understanding that your current focus is on the transport mechanism (CommunicationRequest, etc interaction), to ease adoption, consider:
    • Aligning your "communication attachments" with the business/logical data elements described by USCDI/CPCDS
    • Publishing "communication attachment" guidance specific to the most popular consumer-directed IGs
      • e.g. ONC --> Provider --> US Core
      • e.g. CMS --> Payer --> C4BB
  • While Payers may expose clinical data, workflows that involve a patient --> payer --> provider flow will be much more complicated that the payer --> provider/payer workflow (because one must involve an intermediate entity without access to the source system). Therefore, consider intermediated flows only _after_ direct patient --> CE (Covered Entity) flows.

cc @Ryan Howells @Mark Roberts @Debi Willis @Virginia Lorenzi

Last updated: Apr 12 2022 at 19:14 UTC


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