The Standard

Time is ticking away on healthcare organizations, who face fast approaching federal deadlines to improve the sharing of information to give patients access to their payer data. Additionally, the tools to reduce clinician burden and improve clinical data exchange between payers and providers are rapidly maturing.

The good news is that HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard is the tool that organizations can use to meet new requirements for data sharing. Use cases and accompanying implementation guides from the HL7 Da Vinci Project offer specific, standardized ways for organizations to use plug-and-play technologies with multiple other organizations.

But for many organizations, now the works begins in earnest. Implementing Da Vinci use cases will require input from IT departments and testing with a variety of partners. Fortunately, an upcoming Da Vinci Project event aims to equip participants with the necessary knowledge to get off the ground successfully.

HL7 is offering a Da Vinci-focused Education and FHIR Implementation Event on October 27 to 29, open to both members and non-members. The event goals are to educate the health IT community about HL7 FHIR and FHIR implementation guides develop by the Da Vinci Project and the CARIN Alliance.

Just over one month ago, I leaped into  HL7 FHIR through involvement of the Da Vinci Project. Having worked in the healthcare technology industry for more than 10 years aligned with implementers of payer-provider workflows, data reporting and analytics, it was compelling to see how the proverbial “sausage is made” in the standards world. I made my debut by attending the HL7 FHIR Patient Access API Implementation event in August and I have since attended the September HL7 Connectathon.

Here are three key takeaways from my first month in the FHIR community.

The Room Where it Happens: Developing a Standard Doesn’t Transpire Behind Closed Doors By the Elite.

As an implementer reading a standards’ implementation guide (IG), it’s inevitable to reach a point of confusion where you say to yourself, “Clearly the writer of this didn’t consider my business need.” HL7 has a robust process that prioritizes adoption and reaching consensus among the public community before stamping approval on a standard. The continuous improvement method includes one or more balloting cycles (where the public community essentially critiques the IG and provides detailed feedback) as well as multiple connectathons (at which IGs are tested against by the community), providing ample opportunity for feedback from the community to evolve the IG. The HL7 Da Vinci Project, as well as other FHIR accelerators, have reference implementation prototypes, documented examples, sample test scripts and weekly calls open to the public, encouraging participation throughout the development lifecycle.

Recap of the August Da Vinci Project Community Roundtable on DRLS and FAST

As the HL7 Da Vinci Project continues to make rapid progress in developing use cases to enable the exchange of healthcare information, work has been underway to test and widely deploy these cases among industry players.

Efforts led by federal agencies have been in motion to use solutions based on HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard at scale, as well as to incorporate FHIR use cases in a federal initiative that developed and tested a prototype to demonstrate the capability to streamline clinical workflow access to coverage requirements.

Presenters at a Da Vinci Project community roundtable on August 26 said the initiatives are important in bringing the benefits of automated information exchange throughout the healthcare industry, while taking steps to reduce the burden on providers.

The FAST Initiative
In one initiative, the Office of the National Coordinator for Health Information Technology (ONC) is convening a FHIR at Scale Taskforce (FAST) that brings together a representative group of motivated healthcare industry stakeholders. FAST aims to take use cases that are being demonstrated in initial efforts between partners in the industry and ensure that they can operate more broadly.

“In building solutions for FHIR for interoperability, we realize that individual solutions are being developed to work between one endpoint and another,” said Stephen Konya, senior advisor to ONC and the Department of Health and Human Services. “When we start to roll these out at scale – when there’s a large number of payers sharing a large amount of data with a large number of providers – the game changes.”

Providence St. Joseph, Cambia and MultiCare to Present on Collaborative Effort to Implement Use Case from the HL7 Da Vinci Project on Wednesday, September 23

Clinicians see the need for better access to healthcare information as clearly as others serving in the industry. Because of that, it should be no surprise that clinicians and their teams are playing key roles in the HL7 Da Vinci Project implementations.

Clinicians are not insulated from the changes being wrought by value-based care, so they see the need for adaptations to the digital health ecosystem. That is one force driving change at Providence St. Joseph, which is working with Cambia Health Solutions and MultiCare Connected Care to facilitate information exchange.

These organizations are collaborating on an initiative that is helping lead the way with Da Vinci Project production implementations to enable interoperability and advance value-based care. They will share their insights and experiences next week during the Da Vinci Project’s monthly Community Roundtable from 4:00 – 5:30 pm ET on Wednesday, September 23. The roundtable is entitled “Provider Leadership and Partnerships: The Key to Interoperability and Scalability of Value-Based Care.”

The Centers for Medicare & Medicaid Services (CMS) released the much-awaited Interoperability & Patient Access Rule in early March this year. This rule establishes policies that aim to break down barriers in the health system across the US for better patient engagement. Government bodies are taking significant efforts for governments-sponsored health plans to adopt interoperability to make healthcare system efficient. Multiple initiatives by the Department of Health and Human Services (HHS) and its CMS and Office of the National Coordinator for Health Information Technology (ONC) aim to improve care-coordination and member experience. CMS had proposed the Interoperability & Patient Access Rule to support regulations of the MyHealthEData initiative, with implementation timelines to drive programs such as BlueButton, BlueButton 2.0 and Data at the Point of Care.

In the times of pandemic, healthcare organizations have realized the importance of having access to data for better care coordination and efficient care delivery. With seamless data access, organizations can:

• Share health data of beneficiaries with different care teams
• Identify high-risk population and implement preventive actions to control risk
• Leverage tele-health with access to patient historical health data
• Take timely decisions on emergency treatments based on patient medication history

Limitations in existing healthcare interoperability present a significant barrier to next-gen computing solutions such as Machine Learning (ML) and Artificial Intelligence (AI). New workflow standards aimed at addressing the integration of AI/ML actors to clinicians in delivering better patient care.

One of the main limitations of standards is streamlining access to data from electronic medical record (EMR) applications. There is a growing need for a holistic view of patient data, and the inclusion of the allied healthcare services such as radiology will play a crucial role in building a 360° patient view. This will help healthcare professionals take accurate and informed decision on patient care, and bridge the gap between fragmented and siloed information that is currently limiting hospitals and healthcare systems from gaining insights to drive better health outcomes.

To seek better exchange of health data among providers and patients, the Health and Human Services (HHS) published final rules that put patients first and bring one step closer to achieving Interoperability. The ONC’s (Office of the National Coordinator for Health Information Technology) rule aims to standardize API via HL7 Fast Healthcare Interoperability Resources (FHIR®) R4, a latest version of the FHIR standard, and making its use mandatory under this rule.

Community Roundtable scheduled for August 26 will detail progress toward DRLS and FAST

The HL7 Da Vinci Project’s August Community Roundtable features updates on two initiatives that leverage healthcare industry collaborative efforts to advance information exchange using HL7® Fast Healthcare Interoperability Resources (FHIR®).

This is in response to two federal agencies that are seeking to maximize efficiency at scale and overcome barriers and physician burden in the healthcare system.

The agencies – the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC)– will provide updates on the progress on these efforts during the August 26 Community Roundtable.

The federal agency efforts aim to build on collaborative efforts underway in the healthcare industry, which are at the heart of the work by the HL7 Da Vinci Project, an accelerator seeking to advance the use of FHIR standards in support of value-based care initiatives.

The CMS Center for Program Integrity began the Documentation Requirement Lookup Service (DRLS) initiative in 2018, working in collaboration with the healthcare industry, in to response to ongoing provider burden experienced when trying to identify coverage-related documentation requirements, including those for prior authorization.

The Virtual FHIR Patient Access API Implementation Event Scheduled for  August 17-19

The start of the New Year will see healthcare organizations facing new requirements for using application programming interfaces (API) to facilitate the sharing of healthcare information.

That’s made clear by the recent release of final rules by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), which will be the first step in enabling data access.

To help support healthcare organizations in this shift, HL7 is holding the virtual FHIR Patient Access API Implementation event next week. With the impending final rule and the looming implementation deadline, this event will be narrowly focused on the requirements for patient access APIs by payers.

The goals for this Implementation-a-thon and associated educational events are to inform the broader community of the work HL7 FHIR Accelerators have done to lay the groundwork for meeting the final rules; and to help participants prepare for the September HL7 FHIR Connectathon and 34^th Annual Plenary & Working Group Meeting.

Education and specific planning in API implementation in a FHIR environment will be important for the industry, as these recently released federal rules require that consumers be able to access their medical information through third-party apps, and that will place pressure on healthcare organizations to develop APIs to enable this access. The HL7 Da Vinci Project continues to develop use cases that will facilitate this patient access to information.

Recap of the June Session of the HL7 Da Vinci Community Roundtable

The HL7 Da Vinci Community Roundtable held June 24, showcased work that is continuing on applications that can seamlessly deliver healthcare data to consumers using application programming interfaces (APIs) to pull data from payers’ information systems.

The pressure is on to deliver the functionality, and soon. Final rules from the Centers for Medicare & Medicaid Services (CMS) will require payers to make claims payment data and other patient or member clinical information available to consumers with no obstacles, ideally through simple apps that query for, gather and organize the data in meaningful ways that create value for the user.

HHS rules require HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard to be used to support this process, and application vendors have already deployed products that are being used by consumers. Three such app developers demonstrated how their applications work using payer-based data and described the underlying technology at the community roundtable.

CMS Final Rule & Da Vinci Implementation Guides

The final rules call for payers to provide healthcare data to members through the use of FHIR-based APIs, as well as using a similar methodology to make provider directories available to patients. The CMS rules require that CMS-regulated payers allow patients to easily access their claims and encounter information, including cost, as well as a defined subset of their clinical information through third-party app developers of their choice, as long as that data is being maintained by the payer organization.  The CMS implementation resources for pending rules mentions a number of implementation guides developed by the Da Vinci Project to meet the regulations: Payer Data Exchange: Provider Directory (Plan-Net) to share details on available providers and pharmacies for a particular plan design, Payer Data Exchange for payers to share clinical data, and access to clear formulary information to support patient choice capabilities regarding prescription drugs and potential purchasing alternatives through Payer Data Exchange: Formulary.

I like to describe the solutions that the HL7 Da Vinci Project and the other HL7 FHIR accelerator programs are creating to build something useful and large out of LEGO blocks.

In the Da Vinci initiative, a cadre of talented technical experts have worked since September 2018 to take the pieces of HL7 FHIR coding and adapt them to real-world solutions that reflect the demands for bi-directional information exchange in support of value-based care arrangements.

Currently, members from 49 organizations are working on a range of use cases that will serve as blueprints for how to address vexing problems in data exchange that must be solved for the nation’s healthcare system to become more efficient.

In one such instance, a payer and three provider organizations in the Pacific Northwest are partnering on a new data-sharing approach. The initiative will use Da Vinci use cases for medication reconciliation and develop an implementation guide that will provide a standard, consistent approach that employs FHIR, to enable easy exchange of data between the providers and the payer.