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HL7 FHIR-enabled APIs to Help Payers Meet CMS Requirements for Data Sharing

[fa icon="calendar'] Aug 7, 2020 9:01:07 AM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, implementation guide, payer data exchange

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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.

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HL7 Da Vinci Project Shows the Value of Collaboration to Build FHIR Tools

[fa icon="calendar'] Jul 30, 2020 3:28:32 PM / by Sagran Moodley posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, implementation guide, eCR

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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.

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FHIR's Role in Enabling Quality Measurement Gets a Closer Look at Community Roundtable

[fa icon="calendar'] Jul 18, 2020 12:32:40 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, Da Vinci, value based care, Data Exchange for Qualitiy Measures, implementation guide

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HL7 Da Vinci Project Event Wednesday, July 22, from 4:00 – 5:30 p.m. EDT

Quality measurement is a key factor in improving the delivery of care, especially in value-based care arrangements. And it has become clear that as the shift to value-based care continues, the need for payer-provider collaboration has become essential.

The exchange of data among healthcare industry members can help organizations improve quality, and HL7’s Fast Healthcare Interoperability Resources (FHIR®) can play a significant role. The next Community Roundtable hosted by the HL7 Da Vinci Project entitled “What It Takes: How to Leverage the HL7 Da Vinci Project to Drive Quality Measurement and Value-Based Care,” will examine how organizations are making progress in sharing information for quality purposes.

The roundtable discussion will begin with Jocelyn Keegan, the Da Vinci program manager, providing an overview on the status, maturity and resources available for emerging implementations across Da Vinci focus areas.

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HL7 Da Vinci Project Use Cases Aim to Reduce Documentation Burden in VBC

[fa icon="calendar'] Jul 16, 2020 4:09:54 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, SMART on FHIR, health IT, implementation, Da Vinci, value based care, implementation guide, prior authorization, coverage requirements discovery, documentation templates and payer rules

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Report from Virtual FHIR DevDays 2020 on HL7 Da Vinci Project Use Cases

Developers are fine-tuning ways to use the HL7 Fast Healthcare Interoperability Resource (FHIR) standard to reduce communication challenges and decision impediments between providers and payers.

Working on use cases involving coverage and burden reduction, the HL7 Da Vinci Project is refining early versions of standards and developing implementation guides for value based care (VBC). Speaking to more than 150 attendees during the virtual HL7 FHIR DevDays event, Dr. Viet Nguyen, Da Vinci Project Technical Director, noted that the coverage and burden reduction use cases are intended to address workflows around provider-payer interactions. FHIR implementation guides are then created based on a set of use cases. 

Coverage Requirements Discovery

One use case, Coverage Requirements Discovery, gives providers real-time access to payer approval requirements, documentation and rules at point of service to reduce provider burden and support treatment planning. In its essence, this would answer a provider’s question about whether a procedure or treatment needs a prior authorization from a payer. The aim is to use CDS Hooks to supply an answer to a clinician posing the request within his or her workflow. Work is continuing on developing an implementation guide for this use case.

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HL7 FHIR for HIEs: State Health Information Network for New York

[fa icon="calendar'] Jul 2, 2020 2:26:54 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, health IT, implementation guide, COVID-19, public health

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Report from Virtual FHIR DevDays 2020

A New York State initiative is aiming to change its approach for exchanging patients’ health information among the state’s health information exchanges, using HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard as the conduit.

In addition, the new approach being implemented for the State Health Information Network for New York (SHIN-NY) has taken less time to develop and is expected to enable the exchange of more granular patient data than is possible with the current approach.

Speaking at the HL7 FHIR DevDays virtual meeting on June 15, Luke Doles, senior director of services management for the New York eHealth Collaborative (NYeC), said further implementation of the FHIR-based framework has been delayed because of the urgency to shift resources to support the state’s COVID-19 response. However, the initiative has thus far proven that the concept can be expanded to provide more information across SHIN-NY.

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APIs Could Help in Pandemics, but More Capability is Needed

[fa icon="calendar'] Jul 1, 2020 11:39:29 AM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, health IT, implementation guide, COVID-19, public health

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Report from Virtual FHIR DevDays 2020

Work on incorporating application programming interfaces using HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard can help healthcare organizations better manage the COVID-19 crisis, but much more could be done.

A virtual panel at HL7’s FHIR DevDays indicated that API usage can help with the sharing of data, but more widespread use of this supportive programming could provide more benefits.

“If you look inside the typical hospital, there are more than 20 different clinical systems being used, but only one is the electronic health record getting the API love,” said Keith Boone, enterprise architect for Audacious Inquiry. “COVID data is showing up in bed management systems, command and control systems, ICU central monitoring and more.” Those systems are five years behind EHRs in enabling data exchange.

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Healthcare Organizations Are Implementing Da Vinci Project Use Cases to Achieve Real-World Results in Operations

[fa icon="calendar'] Jun 26, 2020 10:41:50 AM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, Data Exchange for Qualitiy Measures, implementation guide, ONC, payer data exchange

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Presenters at the May 27 HL7 Da Vinci Project community roundtable provided concrete evidence demonstrating how the use cases represent specific ways to use HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard for specific purposes in value-based care data exchange interactions between providers and payers.

FHIR for Data Exchange for Quality Measurement (DEQM) Use Case

A clear indication of the value of the medication reconciliation process use case was provided by Kirk Anderson, chief technology officer for Cambia Health Solutions, a nonprofit healthcare organization that’s the parent company of Regence, a member of the Blue Cross Blue Shield Association. Initial efforts to use the FHIR use case with MultiCare, a Tacoma, Washington-based healthcare system, resulted in a dramatic boost in the insurer’s ability to get information on members’ prescribed medications from the provider.

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SANER Project Using HL7 FHIR to Enable Easier Reporting for Public Health

[fa icon="calendar'] Jun 25, 2020 1:28:48 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, health IT, implementation guide, COVID-19, SANER Project

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Report from Virtual FHIR DevDays 2020

A new initiative is making rapid progress in developing a way to improve how providers report COVID 19 data to public health agencies.

Started in late March, the Situational Awareness for Novel Epidemic Response (SANER) Project has made “huge progress in a short period of time,” said Keith Boone, enterprise architect for Audacious Inquiry, a consulting firm that helped to start the initiative.

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Use Cases Offer Support for Payers in Meeting Final Rule Requirements for Consumers

[fa icon="calendar'] Jun 23, 2020 12:39:22 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, implementation guide, ONC, payer data exchange

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Join the HL7 Da Vinci Project Community Roundtable June 24 from 4 – 5:30 pm EDT.

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Gaps in Care Use Case Continues Efforts Ahead of September Ballot

[fa icon="calendar'] Jun 12, 2020 10:52:12 AM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, Connectathon, Da Vinci, value based care, implementation guide, Gaps in Care

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Much Progress Made on This and Other Da Vinci Project Use Cases During Recent FHIR Connectathon

The HL7 Da Vinci Project’s Gaps in Care use case continues to make rapid progress in developing a Fast Healthcare Interoperability Resources (FHIR®)-based solution to help payers, providers and patients improve care quality under value-based care scenarios.

Several issues were addressed during last month’s Virtual FHIR Connectathon, and the hope is that an implementation guide update for the standard will be balloted in September stated Viet Nguyen, MD and Yan Heras, who are leading the work on the use case. The progress and work on the Gaps in Care use case exemplifies work done on several Da Vinci Project use cases during the Connectathon.

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