Wes, Well said - and an excellent informative recap of what's happening in health care apart from HIPAA-land! My personal opinion is that whatever work product results from this group's efforts must support any type of payload consistent with the ebXML MS.
Rachel Foerster -----Original Message----- From: Rishel,Wes [mailto:[EMAIL PROTECTED]] Sent: Saturday, August 24, 2002 6:11 PM To: WEDi/SNIP ID & Routing Subject: RE: Provider to Provider Messaging Messaging that runs provider-to-provider and provider-to-public health agency is primarily concerned with clinical data. HL7 (www.hl7.org) has various standard transactions for sending lab data, clinical reports, test and therapy orders, and numerous other clinical functions. It is widely used now within large provider organizations (> 90% penetration rate) and between regional labs and providers and, in at least one case, between regional labs and a payer for care management. The NCVHS, operating under its authority under the HIPAA legislation, has recommended HL7 as the national standard in the US for most kinds of clinical data, while also recognizing the role of NCPDP and DICOM for certain kinds of clinical data. The Centers for Disease Control has an architecture for various surveillance application (NEDSS -- National Electronic Disease Surveillance System) that includes the use of HL7. HL7 has affiliate organizations serving about 30 countries and it is named by the governments of some countries in Europe and the Pacific Rim as the standard for clinical data. HL7 will also be featured prominently in the NPRM for claims attachments (provider to payer), although in that NPRM the transaction is a hybrid using an X12 transaction to convey the administrative data to relate the transaction to a claim and an HL7 transaction to convey the clinical data. HL7 is supported by all major vendors of clinical systems for large practices and hospitals in the US and all major integration broker vendors that target provider-side clients. HL7 offers two formats, one that is segment and delimiter based, similar to X12, has been an ANSI standard since the early 1990s. Its newer standards are based on XML and a clinical Reference Information Model. Some of the XML standards have already been certified by ANSI and others are in ballot now. A major theme of the annual HL7 plenary meeting in Baltimore on Sept 30 will be the use of HL7 to meet national mandates for the exchange of clinical data. It will include speakers from CMS, CDC, Great Britain, Australia and Japan. We in HL7 are following the work being done in WEDI SNIP for routing transactions over the Internet. We strongly believe that whatever is done for EDI (X12) transactions should easily work for HL7 transactions or, at worse, should work with minor modifications. We certainly hope that this group will create the necessary abstractions to support non-X12 payloads, as the ebXML Message Handling Service has done. Wes Rishel Board Chair, Health Level 7 Vice President, Research Area Director Gartner Research, Healthcare Alameda, CA 510 522 8135 [EMAIL PROTECTED] For client Inquiries: 203 316 1288, or [EMAIL PROTECTED] -----Original Message----- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Saturday, August 24, 2002 3:31 PM To: WEDi/SNIP ID & Routing Subject: Provider to Provider Messaging What EDI transactions are exchanged between providers? I didn't notice any. Most are exchanged between providers and payers, with the possibility of the 837 and 269 exchanged between payers for COB stuff. Same thing for the NCPDP claims. You might have employer-sponsor to payer exchanges with the 834. And maybe some involving banks as intermediaries for the 835. But other than that? When you talk about provider to provider, are you all thinking of HL7? Even if there were to be any provider to provider EDI, the Healthcare CPP can handle this since it is completely symmetric. But unless there's something I'm missing, it doesn't seem there's going to be any EDI (unless it's HL7 clinical data) exchanged between providers - and thus no point in belaboring the point in the overview. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "Christopher J. Feahr, OD" <[EMAIL PROTECTED]> To: "Bruce T LeGrand" <[EMAIL PROTECTED]>; "WEDI/SNIP Listserve" <[EMAIL PROTECTED]> Sent: Wednesday, 14 August, 2002 07:53 PM Subject: Re: Project Overview draft Bruce, Thanks for your comments. We definitely want to support provider-anyone messaging. If we have not made the provider-provider route clear enough in the "overview", however, maybe we can make a bit more of a point of that. Of course, Provider-Provider assumes that there are adequate, standard vocabularies and message structures in place to support it. I suspect that 90% of providers will be looking at CH connectivity for sending to payors and payor-mailbox model for the return path... a year from Oct... and that we are 2-3 years away from 2-way EDI at the provider-desktop level. -Chris At 10:04 AM 8/14/2002 -0400, Bruce T LeGrand wrote: I've been silent for a while, but this has caught my attention, again. Let's step back from the payer issue just a little. As a provider, I can probably address three or four direct connects in any state and deal with 80% plus of my claims volume. For the lower volume, infrequent connect payers, I can find a clearinghouse, probably no more than one or two, to address the remainder. I don't have an overwhelming burden in ensuring the efficient flow of claims, encounters, eligibility, status and other tasks. I have some issues dealing with reporting, but that's not a part of routing. Many vendors are actively developing solutions to remove these addressing burdens from the provider in the payment arena. Where my problem comes in is in the grand scheme of public health, where information I have related to a patient is effectively shared electronically with the potential thousands of specialists and others that will allow health care to be improved. I believe I understood that the objective was to reduce costs and improve health care. If I am looking for a good way to do automation, I don't think that provider to payer is the primary model. Look at provider to provider. A workable means of exchanging this type of data in a wholly automated fashion would indeed be a long term boon to the overall care of health. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268 discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited. discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. 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