The Standard

January Roundtable also features Providence’s Clinical Data Exchange Implementation Journey

Are you interested in hearing federal officials provide an overview of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057)?

If so, register now for next week’s HL7 Da Vinci Project Community Roundtable, “CMS Interoperability Final Rule Overview and a Clinical Data Exchange Success Story: How Standardization Improves Value Based Care Performance,” scheduled for Jan. 24 from 4 – 5:30 p.m. ET.

The HL7 Da Vinci Project is thrilled to have CMS join next Wednesday’s Community Roundtable to offer highlights of the final rule in addition to the scheduled program showcasing Providence’s Da Vinci Clinical Data Exchange (CDex) Implementation Guide implementation journey.

Providence became the first major health system to implement CDex standards, and their journey included piloting with Premera Blue Cross and the vetting and approval by internal quality teams and external Healthcare Effectiveness Data and Information Set (HEDIS) auditors. The session concludes with a discussion of benefits experienced using CDex, including improved decision making, reduced burden, improved patient outcomes and enhanced quality of care to patients.

The Da Vinci Project is a private-sector initiative that accelerates the adoption of HL7 FHIR as the standard to support and integrate value-based care (VBC) data exchange across communities. The goal of the project is to help payers and providers positively impact clinical, quality, cost and care management outcomes, enabling providers to see the right data at the right time for patient-centered care.

The presenters will include:

• Lorraine Doo, Senior Policy Advisory,Centers for Medicare & Medicaid Service
• Alex Mugge, Deputy Chief Health Informatics Officer, Centers for Medicare & Medicaid Service
• Semira Singh, Director, Population Health Informatics, Providence  
• Michael Westover, Vice President, Population Health, Providence 

The session will be  moderated by Alix Goss, HL7 Da Vinci Project PMO, and Senior Consultant, Point-of-Care Partners.

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.

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.

Background

The Biden-Harris Administration will host the White House Conference on Hunger, Nutrition, and Health on September 28, 2022. In addition to announcing a national strategy to address the intersections between food, hunger, nutrition and health, the Administration has issued a call for stakeholder commitments along five pillars, including the “integration of nutrition and health.”

We seek to better integrate nutrition information within a patient’s electronic health record (EHR) by accelerating a standards-based approach to implementing universal social needs screening. With the final CMS IPPS rule requiring hospitals to report on  social determinants of health (SDOH) screening quality measures in 2024, along with similar requirements of MA SNPs and ACO REACH model participants in 2023, we believe a multi-stakeholder effort, which should also include Medicaid agencies and managed care plans, to advance an HL7 Fast Health Interoperability Resources (“FHIR”)-based approach to meet these “functional” requirements will significantly enhance the ability of providers to meet these CMS requirements.

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).

The Centers for Medicare & Medicaid Services (CMS) released the much-awaited Interoperability & Patient Access Rule in March 2020. The objective is to reinforce this rule by further improving health information exchange and obtaining member health records at a single location to reduce burden on payers, providers and members.

The enforcement date for this rule is January 1, 2023, and will be applicable to Medicaid programs, the Children’s Health Insurance Programs (CHIP) and Qualified Health Plan (QHP) issuers on the individual market Federally Facilitated Exchanges (FFEs). However, it will not be applicable to Medicare Advantage (MA) plans.

The CMS proposed rule will include policies to enhance the current Application Programming Interfaces (APIs) from its interoperability rule such as patient access API and payer to payer API. There are a few new APIs and requirements proposed to improve the overall prior authorization process.

Monthly Event is Scheduled for 4:00 to 5:30 p.m. ET on Wednesday, January 27, 2021

In the first community roundtable of 2021, project managers of the HL7 Da Vinci Project will provide updates for how the project’s implementation guides can be used to solve interoperability challenges and meet federal rules.

The roundtable is intended to highlight how Da Vinci Project implementation guides can help organizations reduce burden, advance data exchange and enable better patient access to data.

Participants from the HL7 Da Vinci Project include Jocelyn Keegan, program manager; Viet Nguyen, MD, technical director; and Vanessa Candelora, project manager. The Da Vinci team will show the progress of Implementation Guides (IGs), which give guidance for using the HL7’s Fast Healthcare Interoperability Resources (FHIR®) coding. The team will also provide linkages to specific federal rules and policies, giving you the recipe to solve challenges in alignment with federal rules and leverage the power of standards to improve connectivity across all of your patient populations.

Anthem, Cedars-Sinai, and CareEvolution to share on project to implement Data Exchange for Quality Measures and Event Notification on Wednesday, October 28

Like peeling back the layers of an onion, exchanging information to support value-based care involves complex data challenges for providers and payers alike.

That’s particularly true when it comes to navigating essential communications between providers and payers, using that dialogue to better coordinate care and achieve the best possible results for patients.

Two key areas that challenge everyone is ensuring that quality measures are met and that everyone in the chain is on the same page when it comes to events. Typically, these are hard for all parties in sharing relevant information.

HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard offers an approach that everyone can use to facilitate data exchanges. In an upcoming community roundtable scheduled for 4 to 5:30 p.m. ET on Wednesday, October 28, HL7 Da Vinci Project members Anthem, Cedars-Sinai and CareEvolution will discuss their efforts to put implementation guides for Data Exchange for Quality Measures and Event Notification in place.