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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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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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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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An Attendee's Perspective on the Virtual HL7 FHIR Connectathon & the Future of Tech Conferences

[fa icon="calendar'] May 22, 2020 2:12:42 PM / by Tarun Kumar Chawdhury posted in FHIR, HL7 community, interoperability, Payers, Connectathon, Da Vinci, value based care, implementation guide, notifications, payer data exchange

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Due to COVID-19, most of the in-person conferences have been changed to virtual events. I recently attended my first-ever fully online technology conference, the Virtual HL7 FHIR Connectathon. This article details my experience and recommendations, in general, for all future conferences post-COVID-19.

Introduction

First, let me give my kudos to HL7 Fast Healthcare Interoperability Resources (FHIR) Product Director Grahame Grieve, the planning team, track leads, FHIR community and HL7 for the  excellent execution of  the Virtual FHIR Connectathon. The conference includes healthcare data interoperability topics with different tracks, expertise and both technical non-technical skills.

I have attended many in-person conferences in the past. Over time, I realized people attend conferences for primarily for two reasons:

  1. Learning new skills
  2. Networking

Let me share my thoughts based on my first Virtual FHIR Connectathon experience.

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