Identifying Data Sets for Potential Full Automation - Payer Survey |
To increase CDex adoption, we seek feedback to understand your priority data sets and scenarios.
Thank you for participating in our survey. Your feedback is important.
The Da Vinci Clinical Data Exchange (CDex) and Payer Data Exchange (PDex) use cases enable either providers to request/receive a data set from a payer (PDex) or payers to request/receive a data set from a provider (CDex). We believe there is an opportunity to establish an initial set of well-defined data sets for specific purposes that can be agreed upon to enable trusted parties to fully automate requests, enabling the necessary data to be automatically collected and automatically sent without further human intervention. The content and purpose can be predefined, thus reducing the effort to provide the data with an agreed to level of trust.
The Da Vinci Clinical Data Exchange (CDex) and Payer Data Exchange (PDex) use cases enable either providers to request/receive a data set from a payer (PDex) or payers to request/receive a data set from a provider (CDex). We believe there is an opportunity to establish an initial set of well-defined data sets for specific purposes that can be agreed upon to enable trusted parties to fully automate requests, enabling the necessary data to be automatically collected and automatically sent without further human intervention. The content and purpose can be predefined, thus reducing the effort to provide the data with an agreed to level of trust.
We would like your input on the initial data sets of interest to define the scenarios to interact with a payer, including further defining the two methods within CDex that enable a payer to make an unsolicited request directly using FHIR APIs. All appropriate auditing, security and purpose of use would be captured, and/or the provider system may present the request that requires human intervention to fulfill and review.
Here are a few scenarios of data exchange that could use further refinement to leverage CDex or PDex:
- Record Completeness - For a patient (or list) of Current Procedural Terminology (CPT) codes that the payer received from other sources than the requester since “N.”. For an individual patient or a population, e.g., patients being scheduled in next “X” days, or monthly “catch-up”.
- Record Completeness - For a patient (or list), Social Determinants of Health (SDOH) data and other demographics that the provider (or payer) may not have.
Note a few potential data set examples that are out of scope:
- Data sets needed to support claims/attachment data, prior-authorization-supporting information, and specific quality measures’ source data.
- Data sets requiring patient consent for some or all of the data.
To determine whether there is an opportunity to pursue this refinement work further within Da Vinci, we are reaching out to providers and payers to identify and prioritize current business challenges to create data sets of interest. We will then work with the community to further define and validate each specific example for adoption.
We appreciate your thoughtful feedback and thank you for your time.
We appreciate your thoughtful feedback and thank you for your time.