The Standard

May Community Roundtable Will Feature Case Study on How Standardized Information Sharing Between Providers, Payers Improves Patient Care

In this month’s Community Roundtable, the HL7 Da Vinci Project will offer timely insights on achieving bidirectional clinical data exchange between payers and providers using Da Vinci’s PDex (Patient Data Exchange) and CDex (Clinical Data Exchange) implementation guides.

The virtual roundtable, titled “Improving Patient Outcomes Using FHIR: How providers are exchanging clinical data with payers to deliver better quality of care,” will be held 4-5:30 p.m. EDT on Wednesday, May 24.

This free online event will feature an implementation story from Florida Blue, healow Insights and Humana that describes how standardized information sharing improves patient care. The session will include a demonstration of clinical data exchange capabilities, such as point of care alerts and up-to-date patient histories, underscoring the value of using HL7 FHIR® (Fast Healthcare Interoperability Resources) standards to optimize electronic medical record integration to assist in achieving value-based care outcomes.

This blog post was created through discussion over the past year among various payers, federal entities, providers, quality organizations, and HL7 staff with a focus on the importance of standardized data collection and management of race and ethnicity data. The discussion below represents a synthesis of these themes and identifies ways HL7 can help support the field.

High-quality, reliable, data are key to facilitating achievement of health equity, “the state in which everyone has a fair and just opportunity to attain their highest level of health”. This includes the collection, analysis and sharing of race and ethnicity data. However, misaligned approaches to standardized data collection present challenges to action. In addition, many organizations lack awareness of or experience challenges in applying standards when collecting and exchanging such data. In this blog, we explore existing resources that can help facilitate standardized data collection and management – HL7 is here to help.

The collection of high-quality race and ethnicity data is essential to address preventable differences - disparities - in health and healthcare. Such data are used to drive assessments, identify gaps, and the support decision-making that leads to actions to close gaps while improving outcomes. There are documented use cases by payers, providers, policymakers, and industry, for research, quality improvement and care delivery purposes. These use cases demonstrate how creating more inclusive datasets can support efforts to reduce health disparities and increase access to higher-quality care for historically marginalized communities. For example, race and ethnicity data can help provide transparency on disparate access to and uptake of services that can lead to targeted quality improvement and enhanced services for under-resourced populations. For this to occur, reliable, accurate, and consistent data are needed.

The Da Vinci Project’s April Community Roundtable to be held April 26 from 4:00 – 5:30 pm ET

Join us for our April Community Roundtable this Wednesday, April 26, from 4 – 5:30 pm, to hear the latest from the HL7 Da Vinci Project and recent industry activity as well as our featured implementation story from athenahealth, Availity and Humana.

Straight from the Spotlight Theater at HIMSS23, this national payer, EHR vendor and health information network will share lessons learned from their collaborative development of an end-to-end prior authorization process leveraging the Da Vinci Burden Reduction Implementation Guides.

Presenters for this session, “A Transformative Trifecta: An End-to-End Prior Authorization Journey,” include:

• Susan Bellile, Principal, Clinical Solutions, Availity
• Jocelyn Keegan, Program Manager, HL7 Da Vinci Project; Payer/Practice Lead, Point-of-Care Partners
• Amy Mattingly, Director, UM Interoperability Product Management, Humana
• Gillian McCabe, Director, Product Management, Authorization Management, athenahealth

The moderator for the Community Roundtable is Alix Goss, HL7 Da Vinci Project PMO, Vice President and Senior Consultant, Imprado.

Last December, the Centers for Medicaid & Medicare Services (CMS) issued two notices of proposed rulemaking (NPRM) that will greatly influence how FHIR advances.

Da Vinci officially commented March 13 on one the rules, the Advancing Interoperability and Improving Prior Authorization Processes, or “Interop 3,” and submitted comments last week to the other rule, the Attachments NPRM, due on March 20. This rule is a set of HIPAA attachment standards and related definitions for electronic exchange of clinical administrative data to support both prior authorizations and claims adjudication, according to Alix Goss, moderator for the HL7 Da Vinci Project Community Roundtable and HL7 Da Vinci Project PMO, as well as vice president and senior consultant with Imprado.

Da Vinci is not in favor of finalizing the proposed regulations, Goss said. A final rule would require investments across the country that essentially will hardwire the approach making further evolution that much harder and burdensome, and redirecting the industry’s focus, taxing resources.

“Industry payers, providers, clearing houses, vendors, patients and more have to make choices at each step of the interoperability journey, and finalizing these regulations brings complications to the choices already made, and those to come,” Goss said. “We all know that the reality that technology moves faster than policy advancements and we're still working out how to work with this reality.”

Goss advises those who want a deeper dive into these rules to review the January 25 Community Roundtable, where the CMS Office of Burden Reduction and the National Standards group delivered an extensive overview.

Five new Steering Committee members will bring unique insights to an upcoming slate of HL7 FHIR use cases in oncology, cardiovascular health, and genomics.

CodeX, the HL7® Fast Healthcare Interoperability Resources (FHIR®) Accelerator™ working to advance the adoption of FHIR as the standard to obtain high-quality, computable data for patient care and research, including the domains of oncology, cardiovascular health, and genomics, announced an expanded steering committee and new members of its leadership team.

“These experts in their fields are committed to helping CodeX develop and implement a strategic vision for the future with integrity, fairness, and equity. We embrace the HL7 ethos of collaboration and community to collectively solve interoperability challenges,” said Su Chen, M.D., program manager and clinical director of CodeX & digital health clinical principal at MITRE. In her role, Chen serves as chair of the CodeX Steering Committee.

Hear about real-world lessons learned on applying the member attribution use case to improve patient matching

In this month’s Community Roundtable, the HL7 Da Vinci Project will offer important use case updates plus a real-world case study on improving patient matching. The virtual roundtable, titled “Use Case Progress and Patient Matching Success: How to Improve Interoperability and Patient Safety,” will be held 4:00 to 5:30 p.m. EDT on Wednesday, March 22.

This informative session will highlight use case milestones for Clinical Data Exchange (CDex), Price Cost Transparency (PCT) and Member Attribution (ATR). Plus, it will offer a case study from Opala and MultiCare Connected Care, implementers of Da Vinci’s member attribution use case. This groundbreaking project resulted in a 10% improvement in patient matching. This benefit helped MultiCare further improve patient safety by ensuring clinicians have the full picture about their patients in real time.

Guest speakers will include:

• Crystal Kallem, project manager, HL7 Da Vinci Project, and senior consultant, Point-of-Care Partners
• Jocelyn Keegan, program manager, HL7 Da Vinci Project, and payer practice lead, Point-of-Care Partners
• Meghan Quint, vice president of solutions and customer success, Opala
• Anna Taylor, AVP, population health and value-based care, MultiCare Connected Care

The moderator will be Alix Goss, HL7 Da Vinci Project PMO, who is vice president and senior consultant at Imprado.

Learn about the rules, how innovators are reaping the benefits of HL7 FHIR APIs and the value of automation at this month’s  Da Vinci Project Community Roundtable

In this month’s Community Roundtable, the HL7 Da Vinci Project is exploring healthcare interoperability with a full line-up of speakers. The virtual roundtable, titled, “Advancing Interoperability via FHIR APIs: An Industry Discussion on Progress, Proposed Rules and the Value of Automation,”will be held Wednesday, Feb. 22, from 4:00 - 5:30 PM EST.

The session will break down the latest federal proposed rules impacting interoperability, the Prior Authorization and Attachments Rules, published last December. Continuing where the January Roundtable left off, Da Vinci guest speakers will address the complex rules and explain their significance in moving forward with FHIR APIs to seamlessly exchange information between payers and providers. CMS is awaiting March comments on the rule, and this roundtable will be a good prep for those who are preparing to comment on this landmark regulation impacting interoperability and seeking to invest in FHIR.

The Da Vinci Project’s January Community Roundtable to be held January 25 from 4:00 – 5:30 p.m. ET

With the issuance of the new federal prior authorization and attachments rule proposals last month, the innovative interoperability work advanced by the HL7 Da Vinci Project is once again being recognized as a path forward for game-changing industry transformation that will reduce burden, increase automation and improve care.

The Intersection of Federal Regulation and The HL7 Da Vinci Project, January’s Community Roundtable, features an overview and frequently asked questions about the rules and their accompanying RFIs from CMS officials. Da Vinci leaders then will share an overview of the implementation guides that are suggested in the proposed rules and how they meet the rules’ objectives.

At the January 25 session, which is scheduled from 4:00 – 5:30 p.m. ET, attendees will learn how to access the resources, participate in community feedback and start getting involved.

Opportunity in partnership with Kaiser Permanente, HL7 and others!

As grounding, the Gravity Project is a national consensus project that develops and tests data standards to represent and exchange social risk data in electronic systems. Together, with a broad collective of stakeholders, Gravity Project defines the language needed to comprehensively address social risks in clinical and community-based settings. To date, the terminology team has completed 17 social risk domains. This has included building critical screening, diagnosis, goal, and intervention concepts for food insecurity, housing instability and homelessness, transportation insecurity, and beyond. In addition, Gravity data standards are included in the United States Core for Data for Interoperability (USCDI), and their value sets serve as a reference for emerging social risk quality measures. (relevant press releases and publications)

Highlighted here is a preview of what’s on the horizon as the Gravity Project matures and
recent examples of Gravity standards integration.

The Gravity Project®, an HL7® FHIR Accelerator, is evolving the way it advances social care data integration as a strategy to promote health equity while maintaining continuity with the mission and consensus-based processes that are core to the project. The project is a national public-private collaborative developing, testing, and implementing consensus-based social determinants of health (SDOH) data standards for use across the health, social services, public health, and research sectors. The Gravity community embodies a truly inclusive representation of over 2,500 stakeholder members of its public work groups and governance committees across the healthcare, health IT, community-based, federal and state agency, payer, academic, and patient/ consumer advocacy sectors.

In 2021, HL7 was awarded a cooperative agreement with the Office of the National Coordinator for Health Information Technology (ONC) to prioritize and expedite the development of standards specific to five gap areas including SDOH. Under this collaborative agreement, the Gravity Pilots Affinity Group was launched in September 2022 as a peer-to-peer learning forum for real-world testing of Gravity terminology and technical standards. Pilot sites are invited to demonstrate the use of social care coded terminologies (e.g., LOINC®, SNOMED-CT®, ICD-10®) and/or the HL7 SDOH Clinical Care FHIR Implementation Guide (SDOH CC IG), share implementation lessons learned with other pilot participants, seek/find partnerships for testing, and gain real-world experience.