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HL7 Da Vinci Project Roundtable Offers Update on Emerging IGs and a Demo of Prior Authorization

[fa icon="calendar'] Sep 16, 2021 3:09:50 PM / by Fred Bazzoli posted in FHIR, Payers, Da Vinci, value based care, prior authorization, FHIR Accelerator, patient cost transparency, burden reduction, Risk Adjustment

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Da Vinci Project's Monthly Meeting to Describe Progress on Price Cost Transparency and Risk Adjustment Initiatives on Wednesday Event, 9/22 at 4:00 pm ET

Important updates on two implementation guide initiatives and a demo of how standards could support prior authorization burden reduction are on the agenda for the next Community Roundtable of the Da Vinci Project.

The roundtable will begin with an update from the project management office of the Da Vinci Project, which will feature updates on the status of the Price Cost Transparency and Risk Adjustment Implementation Guides (IGs). These efforts to use HL7® Fast Healthcare Interoperability Resource (FHIR®) are more complex than previous initiatives. Both efforts anticipate challenges that the industry will face to make healthcare costs more transparent and to accurately reflect patients’ comprehensive conditions and risks related to reimbursement for coverage.

After the update, the prior authorization demonstration will show how FHIR IGs can be used to reduce administrative challenge of anticipating prior authorization documentation requirements, a nagging concern within the industry.

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HL7® FHIR® Emerges as a Key Tool in Achieving Interoperability in Healthcare

[fa icon="calendar'] Sep 10, 2021 3:44:30 PM / by Fred Bazzoli posted in FHIR, HL7, health IT, HIMSS, Da Vinci, CARIN Alliance, Gravity, FHIR Community

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Sessions at HIMSS21 Offer Glimpses into Progress, Potential New Uses for the Standard

After a hiatus of nearly 18 months, a slimmed-down, COVID-sensitive HIMSS 2021 Conference still managed to provide extensive insights into several major trends within the healthcare IT industry.

Along the dual tracks of federal regulations forbidding information blocking and the need for improved data exchange to facilitate, there were many discussions about the capabilities of HL7® Fast Healthcare Interoperability Resources (FHIR®) to support the industry.

The HL7 FHIR community had opportunities at the conference’s Interoperability Showcase to update the industry on dramatic progress by its accelerator groups to advance the use of FHIR in areas where data exchange is essential.

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CMS HL7® FHIR® July Connectathon Recap

[fa icon="calendar'] Aug 27, 2021 2:06:36 PM / by Health Informatics and Interoperability Group posted in FHIR, HL7, HL7 community, health IT, CMS, FHIR Connectathon

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In July 2021, the Centers for Medicare & Medicaid Services (CMS) hosted its second HL7® FHIR® Connectathon, welcoming over 800 participants from Federal agencies, payer organizations, and the health IT industry to a three-day event with more than 70 presentations focusing on education, implementation guide testing, and community-building around Fast Healthcare Interoperability Resources (FHIR)-based application programming interfaces (APIs).

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HL7 Da Vinci Project Roundtable to Discuss Progress on Efforts to Use FHIR at Scale

[fa icon="calendar'] Aug 24, 2021 2:43:55 PM / by Fred Bazzoli posted in FHIR, Payers, Da Vinci, value based care, ONC, payer data exchange, FHIR Accelerator, PDex, ONC FAST

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Recent Initiatives of the ONC’s FHIR at Scale Taskforce (FAST) and Update on Payer-to-Payer Mandate are Key Topics for Wednesday Event, 8/25 at 4:00 pm ET

The success of the HL7® Fast Healthcare Interoperability Resource (FHIR®) standard is becoming increasingly evident.

Successful case studies are emerging. For example, a recently published HL7 case study documents how MultiCare Connected Care and Regence are recognizing significant cost savings by using a FHIR implementation guide standard to definitively ascertain that medication reconciliation has been completed. This case study can be found at https://www.hl7.org/participate/case-studies/index.cfm .

But these isolated successes beg the question – can FHIR be used more broadly, and implemented more widely across the country, handling a multiplicity of interactions across dozens of healthcare organizations simultaneously?

That is the task given to the ONC’s FHIR at Scale Taskforce (FAST), which is seeking to determine solutions and opportunities to influence emerging solutions.

Progress by the ONC FAST effort is of prime importance to the dissemination of FHIR solutions to solve information exchange challenges in healthcare. The panel’s progress over the past year will be one of the topics of the Da Vinci Project’s monthly Community Roundtable event, to be held from 4 to 5:30 p.m. ET on Wednesday, August 25.

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Payer-to-Payer Data Exchange Highlight of HL7 Da Vinci Community Roundtable

[fa icon="calendar'] Jul 23, 2021 9:22:40 AM / by Fred Bazzoli posted in FHIR, Payers, Da Vinci, value based care, payer data exchange, FHIR Accelerator, PDex

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HL7 Da Vinci Roundtable  on July 28 from 4:00 to 5:30 p.m. ET to Feature Payer-to-Payer Data Exchange

Join the Da Vinci Project next Wednesday at its July Community Roundtable titled "Payer-to-Payer Data Exchange: Rising to the Opportunities and the Challenges." The session will focus on the use of HL7's 's Fast Healthcare Interoperability Resources (FHIR®) for payer-to-payer data exchange, highlighting the Payer Data Exchange (PDex) use case.

Presenters for the session include:

  • Michael Gould, business lead - interoperability at Blue Cross Blue Shield Association
  • Patrick Murta, chief interoperability architect & solutions architecture fellow, Humana
  • Heather Kennedy Tanner, director of enterprise architecture, BlueCross BlueShield of Tennessee
The roundtable will feature a current snapshot of Da Vinci's efforts to create a nationwide interoperable approach among payers using PDex-based data exchange. Discover the dynamics you'll encounter in achieving payer-to-payer exchange compliance such as consent and endpoint discovery. You will gain a foundational understanding of the regulatory requirements, learn about technical and business challenges and benefits from real-world implementers, and gain insight into how the industry is working together. 
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Clinical Data Exchange Gets Increased Attention to Meet Efficiency Goals, Regulatory Challenges

[fa icon="calendar'] Jun 22, 2021 4:28:39 PM / by Fred Bazzoli posted in FHIR, Da Vinci, value based care, FHIR Accelerator, CDX, burden reduction

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Da Vinci Roundtable  on June 23 from 4:00 to 5:30 p.m. ET to Look at the Potential for Getting More Value from the Use of Standards

Exchanging clinical data sets is getting more attention, particularly as healthcare organizations focus efforts on gaining efficiency and improving clinical care, while reducing clinician burden.

The ultimate challenge is freeing the data contained in these communications and making it computable and usable with minimal or no manual intervention. That looks ahead to the incorporation of fielded data, which will enable the use of agreed-upon approaches to make data usable.

Sharing the current state of the art for these advances through the use of Fast Healthcare Interoperability Resources (FHIR®) will be the focus of the June Community Roundtable of the Da Vinci Project, taking a deep dive into the Clinical Data Exchange (CDX) use case.

The session, with the title of “Demystifying Attachments to Enable Clinical Data Exchange,” will take place from 4 to 5:30 p.m. ET on June 23. The roundtable will focus specifically on the importance of implementing clinical data exchange capabilities, to anticipate emerging data exchange requirements and potential regulatory efforts.

Steven Lane, MD, MPH, clinical informatics director for privacy, information security and interoperability at Sutter Health, will share the clinician view regarding the challenges, opportunities and benefits of standardized data exchange.

In addition, Mary Lynn Bushman, agile product managers for National Government Services, will showcase their attachments implementation and production successes that it’s experienced with more than 1,500 provider organizations, improving multiple workflows and reducing burden. Da Vinci’s Technical Director Viet Nguyen, MD, will discuss emerging capabilities for provider-provider and provider-payer clinical data exchange.

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U.S. Federal Health Data Solutions in the Era of Interoperability

[fa icon="calendar'] May 25, 2021 4:30:17 PM / by Will Rosenfeld posted in FHIR, HL7, HL7 community, interoperability, SMART on FHIR, Clinical Quality Language, COVID-19, public health, CQL

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Federal health agencies have entered an era where data interoperability-enabled solutions play a critical role. Government leaders can harness the innovative and proven capabilities referenced in this article to deliver on their essential missions.

Background

In 2020, two major events laid the foundation for this era of interoperability.

 

Pandemic Response: The first was the coronavirus pandemic, which led to unprecedented needs for health data in support of agency missions. Since its start, decision-makers have required more access to and insights from these data (e.g., clinical records, administrative claims, patient experience) than ever before.

 

Interoperability Rules: The second was the finalization of the ONC and CMS-led 21st Century Cures Act interoperability rules. These mandates substantially expanded agencies’ ability to leverage health data solutions (e.g., algorithms, applications, and automation) at scale.

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May Community Roundtable Covers Reducing Burden: Da Vinci Quality Measures Tied to CMS RFI and HIPAA Exception Request for Prior Authorization

[fa icon="calendar'] May 21, 2021 10:31:37 AM / by Fred Bazzoli posted in FHIR, Da Vinci, value based care, DEQM, prior authorization, FHIR Accelerator, quality measures

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Monthly Event is Scheduled for 4:00 to 5:30 p.m. ET on Wednesday, May 26, 2021

The Da Vinci Project is offering real-life examples of how healthcare organizations are using its Use Cases to make a difference in information exchange and interoperability. 

The community roundtable will feature a session entitled, “Reducing Burden: Da Vinci Quality Measures tied to CMS RFI and HIPAA Exception Request for Prior Authorization.” The Da Vinci PMO will provide an update including the latest federal proposed rule Request for Information related to digital quality measurement collection using HL7's  Fast Healthcare Interoperability Resources (FHIR®). Learn about Da Vinci’s DEQM and Gaps in Care Implementation Guides to assist you during your review and with crafting your RFI response. Da Vinci leadership will discuss current prior authorization burden and how the available implementation guides can streamline the processes. In addition, the PMO will discuss opportunities provided by the newly granted exception to the HIPAA requirement for Da Vinci payers and their trading partners when using the FHIR standard for prior authorization.

  • Kirk Anderson, Da Vinci Project Steering Committee Member, Vice President & CTO, Cambia Health Solutions
  • Robert Dieterle, Senior Advisor, Da Vinci PMO
  • Jocelyn Keegan, Program Manager, Da Vinci PMO
  • Linda Michaelsen, Director of Healthcare Interoperability Standards, Optum
  • Steven Waldren, MD, Da Vinci Co-Chair, Clinical Advisory Committee, Vice President and CMIO, American Academy of Family Physicians
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Spring 2021 CTO Tooling Update

[fa icon="calendar'] May 12, 2021 11:07:30 AM / by Wayne Kubick posted in FHIR, CDA, HL7, health IT, C-CDA, news, tooling, JIRA, Confluence, publishing, UTG, FHIR registry

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Déjà Vu All Over Again

My last tooling update was titled Focus on Finishing. Thus, in homage to the inimitable Yogi Berra, it would be hypocrisy to change focus now. Focus on Finishing is still the principal theme for the year, building on essentialism, my other guiding light, as expressed in the axiom “Do less, better.”

Toward that end, we continue to move ahead with our transition to our core collaboration tool stack and processes based on workflow-driven online forms. As of this writing, we’re completing final improvements to make the online PSS available to all later this spring. We’ll be working to finish automating most other key form-driven processes after that.

In addition, we hope to finish our transition to a new JIRA-based balloting system, which is also being piloted as of this writing. This, together with the recent transition from GForge Tracker and the STU Feedback web page to JIRA, puts all of our specification feedback in one repository moving forward.

While finishing our transition for balloting is critically important, we also have to update and replace some peripheral systems supporting the balloting process for members, as well as our core business systems for managing membership, events and operations. While we don’t expect to complete this transition to a new Association Management System before the end of 2021, we’ll be focused on finishing this as rapidly as possible since it’s an essential foundation to further systems improvements for the HL7 organization.

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Prior Authorization – A Burning Problem in Need of a Solution

[fa icon="calendar'] Apr 20, 2021 12:52:49 PM / by Lynda Rowe posted in FHIR, HL7 community, interoperability, Da Vinci, value based care, prior authorization, FHIR Accelerator, FHIR Implementation Guides

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Those of us who have been in healthcare a long time know that prior authorization can been a challenge for both payers, providers, and patients. One might think it’s time to remove prior authorization altogether, but until we have consistent clinical practice across the entire US healthcare system, it’s very hard to justify.

The current processes create a huge burden for providers and payers, and cause delays sometimes critical in patient care.

Why is prior authorization such a thorny problem[i]?

  • Prior authorization issues contribute to 92% of care delays
  • Nearly all of provider care delays are associated with inefficiencies and administrative issues with current prior authorization
  • Providers take 6 hours on average to complete these requests, which is the equivalent of two business days. Thirty-four percent of providers have staff dedicated exclusively to completing prior authorizations.
  • The prior authorization process costs $23 to $31 billion per year in the US, according to a 2009 study published in Health Affairs.
  • The health plan cost per manual prior authorization is $3.68, compared to $0.04 per electronic prior authorization, according to a 2017 Chilmark Research report.
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