The Standard

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 21^st Century Cures Act interoperability rules. These mandates substantially expanded agencies’ ability to leverage health data solutions (e.g., algorithms, applications, and automation) at scale.

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

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.

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.

Whether Attendees are Novices or Experts on Implementation Guides, Education Will Increase Knowledge and Build Community

Communicating the value of HL7’s Fast Healthcare Interoperability Resource (FHIR®) in healthcare isn’t always easy. Do you tell the story in purely technical terms? Describe the problems it’s intended to solve? Or offer examples of where it’s providing benefits?

The upcoming Da Vinci Education & HL7 FHIR Implementation Event addresses all of those questions for a variety of audiences.

The presenters at the virtual event, scheduled for the week of April 26 to 30, will explain the sense of urgency that underscores the need to accelerate adoption of FHIR-based use cases. They will also provide real-world context to show that these use cases are not just a theoretical construct, but are providing immediate benefits to those organizations that are using it to power the shift to value-based care.

The adoption of FHIR is picking up speed because of this growing recognition of its benefits in reducing clinician burden, improving the exchange of quality measure data and enabling real-time access to data by patients, providers and payers. The adoption of FHIR-based use cases also provides a way for organizations to meet federal rules governing interoperability and patient access to their medical information.

Program Showcases Individuals Making Significant Contributions to Advancing Implementation Guide Use

Initiatives such as the Da Vinci Project make strides toward interoperability as organizations adopt the vision and push it forward to reality

To achieve the progress the HL7 Da Vinci Project has made to date, it relies on the extraordinary efforts of individuals who consistently work to advance the organization’s goals. This might entail stepping forward to lead a work group of peers, spending extra hours editing and reviewing work in progress workflows, recruiting business partners to test early versions as early adopters, or scouring their organization to find the right subject matter expert for a particular business challenge or question, all to ensure that early HL7 Fast Healthcare Interoperability Resources (FHIR®) implementation guides work.

These team members exemplify the spirit and intent of our collaborative industry-first Da Vinci efforts, said Jocelyn Keegan, program manager for the Da Vinci Project. “The work of Da Vinci is, at its core, a human powered effort,” she noted. “It is imperative that we publicly acknowledge the contributions of the smart, dedicated thought leaders who are redefining how payers and providers collaborate.”

To recognize individuals who are taking a lead role in working to make the outputs of Da Vinci real, the project has named six leaders as the initial class of the Da Vinci Community Champion program for their contributions in 2020.

With the ascent of value-based care, interoperability is expected to evolve at an even faster pace to meet the business demands that new reimbursement incentives are producing.

Monthly Event is Scheduled for 4:00 to 5:30 p.m. ET on Wednesday, March 24, 2021

Advancing the use of HL7’s Fast Healthcare Interoperability Resources (FHIR®) takes both strong proponents advocating for the cause and pioneering organizations that lead the industry by putting concepts into practice.

Both aspects important to FHIR adoption will be on display at the March Community Roundtable of the Da Vinci Project, scheduled for Wednesday, March 24, from 4 to 5:30 p.m. ET. The roundtable has become a staple of the Da Vinci Project’s efforts to highlight successful deployments of its implementation guides, intended to help healthcare organizations manage value-based care initiatives.

MiHIN Shares Lessons Learned with Plan-Net

An example of a real-world implementation will be provided by the Michigan Health Information Network (MiHIN). A team from the organization will share lessons learned from its deployment of Plan-Net, the Payer Data Exchange (PDex)-Plan Network Directory Implementation Guide that focuses on Payer-Provider Directories. FHIR offers the potential to automate this typically manually intensive process for all parties, and MiHIN will describe its journey to putting the implementation guide into place to achieve this.

Health Level Seven® (HL7®) International recently announced the appointment of three new members to the HL7 board of directors to serve a two-year term: Lori Evans Bernstein, MPH, co-founder and president, HealthReveal; Karen DeSalvo, M.D., MPH, chief health officer, Google Health; and Carolyn Petersen, MS, MBI, FAMIA, senior editor, Mayo Clinic.

“These leaders represent a broad spectrum of global stakeholders who are committed to advancing health through information technology. We are delighted to welcome them to the HL7 board of directors,” said Charles Jaffe, M.D., Ph.D., CEO of HL7. “Their strategic expertise and diverse experience will contribute greatly to HL7’s goal of improving the quality of care and reducing costs by overcoming the barriers to interoperability.”

Project Achieves a Tipping Point as Adoption Begins in Earnest to Meet Upcoming and Proposed Federal Regulation and Solve Interoperability Challenges

The Da Vinci Project made significant progress in 2020 in advancing the maturity of implementation guides, and now looks to increasingly demonstrate the value of its implementation guides (IGs) across production implementations this year.

Members of the HL7 FHIR® Accelerator group helped push forward work on several implementation guides that were published in 2020, but further refinement lies ahead, said project managers who presented a progress report on the Da Vinci Project at its January Community Roundtable.

In addition to the update on progress with publishing new standards, the presentation offered members a tour of the Da Vinci Project’s enhanced Confluence website, as well as an invitation for more organizations to consider membership to help ensure implementation guides meet the needs of the entire healthcare community.

This year, there will be a growing need to use the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard, as application programming interfaces (APIs) emerge to meet federal information exchange requirements and business needs of value-based care.

The CDA Management Group (CMG) aims to use the next C-CDA Implementation-A-Thon (IAT) to expand outreach to engage new communities and increase the impact of this content improvement effort.  “We learned so much last year about how to maximize the value of implementer-led implementation-a-thons,” said CMG Co-Chair Lisa Nelson. “The new approach was a step in the right direction. It helped implementers drive the conversation and focus the community on making changes that would yield valuable improvements,” she explained.