The Standard

New publication outlines opportunities for accelerating and improving the use of AI to support payment integrity and reduce fraud, waste, and abuse

Last week, HL7 International released a new report outlining the actions needed to fully realize the benefits of artificial intelligence (AI) in improving payment integrity and reducing fraud, waste, and abuse. Reducing Fraud and Improving Payment Integrity in Healthcare Through the Use of AI brings together insights from payers, providers, and technology experts to define AI opportunities and emerging solutions, current challenges, implementation strategies, and standards needed to increase transparency and trust.

“The U.S. spends more than $900 billion annually on administrative complexity, waste, and improper payments,” said Charles Jaffe, MD, PhD, CEO of HL7 International. “This publication identifies practical and standards-based approaches to harnessing AI for one of healthcare’s most persistent and costly challenges.”

Key recommendations from the report include:

• Developing standards for explainable AI in healthcare with specific transparency requirements and bias mitigation protocols.
• Creating standards and infrastructure for trust and verification of AI-generated results.
• Establishing frameworks for human-in-the-loop validation that balance automation with clinical expertise.
• Implementing pilot programs focused on provider-payer collaboration that create mutually beneficial scenarios for all stakeholders.

HL7 International is pleased to announce the appointment of three distinguished members to its 2025 Board of Directors.

These new appointees bring a wealth of industry leadership and expertise across data standards, artificial intelligence and clinical innovation, and will serve a two-year term:

• Christopher Longhurst, M.D., M.S., FACMI, chief clinical and innovation officer, University of California, San Diego (UCSD)
  Longhurst is a nationally recognized leader in clinical informatics and digital health innovation. As the chief clinical and innovation officer at UCSD, Dr. Longhurst oversees a broad portfolio, including the Offices of the Chief Medical Officer, Quality and Patient Safety, Care Management, Information Services, and the Jacobs Center for Health Innovation, where he leads AI initiatives for personalized medicine and health equity. His leadership in developing cutting-edge health IT aligns with HL7’s mission to empower global health interoperability.
  
  
• Genevieve Melton-Meaux, M.D., Ph.D., FACMI, director, Center for Learning Health System Sciences, University of Minnesota
  Melton-Meaux is an accomplished leader in clinical informatics and AI implementation. With extensive research on learning health systems and digital transformation, she has pioneered strategies that optimize health IT and promote evidence-based care. The current chair of the American Medical Informatics Association (AMIA), her global recognition in AI-driven healthcare innovation underscores HL7’s dedication to advancing intelligent, interoperable solutions.
  

"Our response to interoperability isn’t just about managing data—it’s about building the future of healthcare through open standards." - Dan Vreeman, DPT, Chief Standards Development Officer, HL7 International

Last week at Civitas 2024 in Detroit, HL7 International/s Chief Standards Development Officer,Dan Vreeman, DPT, led an insightful panel session on how HL7® Fast Healthcare Interoperability Resources (FHIR®) is revolutionizing interoperability. As data sharing becomes increasingly critical, HL7 is at the forefront, driving collaboration with over 45 organizations and developing 35-45 new FHIR implementation guides annually! Dan was joined by leaders from the Da Vinci Project, FAST, Gravity Project, and Helios, to discuss their HL7 FHIR Accelerator projects, including objectives and progress made to date in advancing open data standards development and interoperability.

Health Level Seven International (HL7^®), the global authority on interoperability of health information technology with members in 55 countries, announced election results for its board of directors, international council and technical steering committee during its annual business meeting at the 38th Annual Plenary and Working Group Meeting in Atlanta.

Chair-Elect

The membership selected Carol Macumber, executive vice president of Clinical Architecture, as chair-elect in 2025 and board chair for 2026-2027.

HL7 Board Member Elections

The following members were elected to the HL7 board of directors for the 2025-2026 term:

• Secretary — Yan Heras, Ph.D., principal, Optimum eHealth LLC
• Director — Gora Datta, FHL7, chairman and chief executive officer, CAL2CAL Corporation
• Director — Ken Rubin, FHL7, senior advisor, standards and interoperability, CIDMO, U.S. Department of Veterans Affairs
• Affiliate Director — Ron Parker, FHL7, chair, HL7 Canada; principal, Parker Digital Health Consulting Inc
• Affiliate Director — Line Saele​, chair, HL7 Norway; enterprise architect, Norwegian Institute of Public Health

Health Level Seven International (HL7^®), the leading global standards-development organization dedicated to improving how healthcare information is shared, is excited to announce it has assumed stewardship of the open source FHIR^® Shorthand (FSH) tools from MITRE. This strategic transition will ensure the long-term sustainability and growth of these essential tools, which simplify and speed up the creation of HL7 Fast Healthcare Interoperability Resources (FHIR^®) implementation guides that define how healthcare data should be structured and shared between systems to ensure smooth and accurate data exchange.

HL7 FHIR Shorthand (FSH) is a streamlined, text-based tool that enables healthcare IT stakeholders to create implementation guides, or "blueprints," for sharing critical health information such as patient records, lab results, treatments across different systems, and much more. Developed by MITRE in 2020, the FSH standard has quickly become an essential tool in hundreds of healthcare projects worldwide, helping to simplify the process of developing systems that support better coordination and improved patient outcomes.

HL7 applauds the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) for its April 22, 2024 Common Agreement Version 2.0 release, which announced the requirement for health information networks participating in the Trusted Exchange Framework and Common Agreement (TEFCA) to support the HL7 Fast Healthcare Interoperability Resources (FHIR^®) standard.

By the US Realm Co-Chairs: Brett Marquard, Steve Posnack and Dan Vreeman, DPT

Greetings HL7 community, your US Realm Steering Committee co-chairs come bearing news. For the past few years, we have started to do a “state of the realm” recap for everyone at the January WGM. The full details are available here, but we wanted to celebrate and acknowledge some of 2023’s great work and what’s to come in 2024 through this post as well.

2023

• US Core 6.1.0 and C-CDA Companion Guide R4.1 were published to add USCDI version 3 guidance.
• CDA Web and C-CDA Web were balloted in a common HL7 publication framework.
• US Public Health Library 1.0.0 was published, which represents a domain specific profile library in the US Realm and a foundation for future public health projects.

2024

• US Core will finalize USCDI v4 in May 2024, and then begin v5 design (in the fall).
• C-CDA web publishing, using the FHIR StructureDefinition to support USCDI v4 (now) and then v5 (in the fall).
• Now that ONC’s HTI-1 Final Rule is out and concrete dates are set, the industry transition from US Core 3.1.1 as a baseline to 6.1.0 is upon us. US Realm, in collaboration with other work groups, will be prioritizing its time to focus on supporting this migration. Please engage early and often this year as transition issues pop-up for you.

Communities Advancing FHIR and Healthcare Interoperability Formalize Joint Efforts for the Public Good

HL7 and The Sequoia Project, a non-profit and trusted advocate for nationwide health information technology (health IT) interoperability, are pleased to announce a strategic collaboration to advance global health data interoperability by accelerating the adoption of the HL7 Fast Healthcare Interoperability Resources (FHIR®) standards in the U.S.

“We are thrilled to announce this alliance with HL7,” said Mariann Yeager, CEO of The Sequoia Project. “We look forward to working with HL7, alongside private and public sector subject matter experts, to advance nationwide FHIR implementation to improve interoperability nationwide.”

 HL7 and The Sequoia Project will work together to accelerate the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard through coordinating with the work of FHIR at Scale Taskforce HL7 FHIR^® Accelerator (FAST).

Through this strategic relationship, HL7 and The Sequoia Project aim to continue working together in areas of mutual interest, including standards deployment and adoption, alignment between HL7 FHIR Accelerator projects and Sequoia initiatives, and creating a feedback loop to HL7 based on lessons learned from real-world production-level exchange initiatives, education, and testing. 

“At HL7, we are delighted to continue the journey toward meaningful interoperability with The Sequoia Project,” said Charles Jaffe, M.D., Ph.D., HL7 CEO. “Close collaboration is certain speed to market health IT interoperability improvements to reduce the strain on health systems, diminish clinician burden, and improve the lives of our patients.” 

After 32 years of serving HL7 International as the Executive Director, Mark McDougall will retire at the end of this year. HL7 leadership would like to acknowledge Mark's significant contributions to the organization across the decades.

Andy Truscott, FHL7, HL7 Board Chair states, "Mark's unwavering commitment and visionary leadership have been pivotal in advancing healthcare standards and interoperability across our organization. As Executive Director, Mark consistently demonstrated an extraordinary dedication to our mission. His ability to navigate the ever-evolving landscape of healthcare informatics and standards development has been instrumental in shaping HL7 into the dynamic organization it is today. Mark's passion for improving healthcare outcomes through enhanced interoperability has not only guided our work but has served as an inspiration to us all.

As Mark prepares to embark upon retirement, we wish him all the best in his future endeavors. His legacy within HL7 will be enduring, shaping the way we approach healthcare standards and data exchange for years to come.

We acknowledge and honor his exemplary service and commitment to our cause. Thank you, Mark, for your invaluable contributions, and we wish you a retirement filled with happiness, health and new adventures."