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CMS, ONC to Offer Updates on Initiatives that Will Rely on FHIR Standards

[fa icon="calendar'] Aug 20, 2020 4:33:22 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, ONC, FAST, DRLS

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Community Roundtable scheduled for August 26 will detail progress toward DRLS and FAST

The HL7 Da Vinci Project’s August Community Roundtable features updates on two initiatives that leverage healthcare industry collaborative efforts to advance information exchange using HL7® Fast Healthcare Interoperability Resources (FHIR®).

This is in response to two federal agencies that are seeking to maximize efficiency at scale and overcome barriers and physician burden in the healthcare system.

The agencies – the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC)– will provide updates on the progress on these efforts during the August 26 Community Roundtable.

The federal agency efforts aim to build on collaborative efforts underway in the healthcare industry, which are at the heart of the work by the HL7 Da Vinci Project, an accelerator seeking to advance the use of FHIR standards in support of value-based care initiatives.

The CMS Center for Program Integrity began the Documentation Requirement Lookup Service (DRLS) initiative in 2018, working in collaboration with the healthcare industry, in to response to ongoing provider burden experienced when trying to identify coverage-related documentation requirements, including those for prior authorization.

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HL7 Event Provides Training to Prepare for Implementing APIs

[fa icon="calendar'] Aug 14, 2020 4:08:44 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, implementation guide, CARIN Alliance

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The Virtual FHIR Patient Access API Implementation Event Scheduled for  August 17-19

The start of the New Year will see healthcare organizations facing new requirements for using application programming interfaces (API) to facilitate the sharing of healthcare information.

That’s made clear by the recent release of final rules by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), which will be the first step in enabling data access.

To help support healthcare organizations in this shift, HL7 is holding the virtual FHIR Patient Access API Implementation event next week. With the impending final rule and the looming implementation deadline, this event will be narrowly focused on the requirements for patient access APIs by payers.

The goals for this Implementation-a-thon and associated educational events are to inform the broader community of the work HL7 FHIR Accelerators have done to lay the groundwork for meeting the final rules; and to help participants prepare for the September HL7 FHIR Connectathon and 34th Annual Plenary & Working Group Meeting.

Education and specific planning in API implementation in a FHIR environment will be important for the industry, as these recently released federal rules require that consumers be able to access their medical information through third-party apps, and that will place pressure on healthcare organizations to develop APIs to enable this access. The HL7 Da Vinci Project continues to develop use cases that will facilitate this patient access to information.

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HL7 FHIR-enabled APIs to Help Payers Meet CMS Requirements for Data Sharing

[fa icon="calendar'] Aug 7, 2020 9:01:07 AM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, implementation guide, payer data exchange

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Recap of the June Session of the HL7 Da Vinci Community Roundtable

The HL7 Da Vinci Community Roundtable held June 24, showcased work that is continuing on applications that can seamlessly deliver healthcare data to consumers using application programming interfaces (APIs) to pull data from payers’ information systems.

The pressure is on to deliver the functionality, and soon. Final rules from the Centers for Medicare & Medicaid Services (CMS) will require payers to make claims payment data and other patient or member clinical information available to consumers with no obstacles, ideally through simple apps that query for, gather and organize the data in meaningful ways that create value for the user.

HHS rules require HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard to be used to support this process, and application vendors have already deployed products that are being used by consumers. Three such app developers demonstrated how their applications work using payer-based data and described the underlying technology at the community roundtable.

CMS Final Rule & Da Vinci Implementation Guides

The final rules call for payers to provide healthcare data to members through the use of FHIR-based APIs, as well as using a similar methodology to make provider directories available to patients. The CMS rules require that CMS-regulated payers allow patients to easily access their claims and encounter information, including cost, as well as a defined subset of their clinical information through third-party app developers of their choice, as long as that data is being maintained by the payer organization.  The CMS implementation resources for pending rules mentions a number of implementation guides developed by the Da Vinci Project to meet the regulations: Payer Data Exchange: Provider Directory (Plan-Net) to share details on available providers and pharmacies for a particular plan design, Payer Data Exchange for payers to share clinical data, and access to clear formulary information to support patient choice capabilities regarding prescription drugs and potential purchasing alternatives through Payer Data Exchange: Formulary.

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HL7 Da Vinci Project Shows the Value of Collaboration to Build FHIR Tools

[fa icon="calendar'] Jul 30, 2020 3:28:32 PM / by Sagran Moodley posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, implementation guide, eCR

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I like to describe the solutions that the HL7 Da Vinci Project and the other HL7 FHIR accelerator programs are creating to build something useful and large out of LEGO blocks.

In the Da Vinci initiative, a cadre of talented technical experts have worked since September 2018 to take the pieces of HL7 FHIR coding and adapt them to real-world solutions that reflect the demands for bi-directional information exchange in support of value-based care arrangements.

Currently, members from 49 organizations are working on a range of use cases that will serve as blueprints for how to address vexing problems in data exchange that must be solved for the nation’s healthcare system to become more efficient.

In one such instance, a payer and three provider organizations in the Pacific Northwest are partnering on a new data-sharing approach. The initiative will use Da Vinci use cases for medication reconciliation and develop an implementation guide that will provide a standard, consistent approach that employs FHIR, to enable easy exchange of data between the providers and the payer.

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Healthcare Organizations Are Implementing Da Vinci Project Use Cases to Achieve Real-World Results in Operations

[fa icon="calendar'] Jun 26, 2020 10:41:50 AM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, Data Exchange for Qualitiy Measures, implementation guide, ONC, payer data exchange

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Presenters at the May 27 HL7 Da Vinci Project community roundtable provided concrete evidence demonstrating how the use cases represent specific ways to use HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard for specific purposes in value-based care data exchange interactions between providers and payers.

FHIR for Data Exchange for Quality Measurement (DEQM) Use Case

A clear indication of the value of the medication reconciliation process use case was provided by Kirk Anderson, chief technology officer for Cambia Health Solutions, a nonprofit healthcare organization that’s the parent company of Regence, a member of the Blue Cross Blue Shield Association. Initial efforts to use the FHIR use case with MultiCare, a Tacoma, Washington-based healthcare system, resulted in a dramatic boost in the insurer’s ability to get information on members’ prescribed medications from the provider.

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Use Cases Offer Support for Payers in Meeting Final Rule Requirements for Consumers

[fa icon="calendar'] Jun 23, 2020 12:39:22 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, implementation guide, ONC, payer data exchange

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Join the HL7 Da Vinci Project Community Roundtable June 24 from 4 – 5:30 pm EDT.

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The Use of HL7 FHIR and CQL By Measure Developers

[fa icon="calendar'] Dec 11, 2019 12:38:04 PM / by Jamie Lehner, MBA, CAPM posted in FHIR, interoperability, CMS, Clinical Quality Language, Quality Data Model, Data Exchange for Qualitiy Measures, QI Core, clinical decision support, Value Set Authority Center, Measure Authoring Tool

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Since the fall of 2017, electronic Clinical Quality Measures (eCQMs) logic has been written using Clinical Quality Language (CQL). With the introduction of CQL, the eCQMs included in the CMS federal programs had to be translated from Quality Data Model (QDM)-based expression logic to CQL.

Though CQL provides more flexibility in expressing measure criteria within the logic that allows measure developers to include greater specificity and precision within the measure requirements, this did not result in a direct translation process, as new attributes and timings were made available. What this means is that clinical workflow and input are perhaps more important because CQL is able to convey these nuances, whereas the QDM-based logic expressions were limited. CQL can also be used to develop Clinical Decision Support (CDS) rules and can reuse logic from measures in those CDS rules.

When composing measures using the CQL syntax, the QDM is still used in conjunction with CQL as the means to characterize required data elements within the measure logic. This conceptual model defines what type of clinical data is needed to satisfy the measure requirements. Therefore, the QDM is still very much a part of electronically specified measures, which is incorporated into the logic definitions written using CQL.

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Intro to HL7® Resources and Work Groups Important to the Quality Measurement Community

[fa icon="calendar'] Dec 9, 2019 12:23:56 PM / by Lisa Anderson, MSN, RN-BC posted in FHIR, interoperability, CIMI, CMS, Da Vinci, Quality Reporting, Clinical Quality Language, DEQM, Quality Data Model, Data Exchange for Qualitiy Measures, QI Core, clinical decision support, clinical quality measures

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Intro to HL7 QMC

Health Level Seven (HL7®) drives the standards upon which electronic Clinical Quality Measures (eCQMs) sit, so participation in these venues is crucial. The HL7 community already has a lot of technical input but lacks input from the clinical side – either from clinicians or clinical informaticists. There is a gap between the clinical intent of quality measures and the technical standard, but clinical informatics experts can help bridge this gap by contributing to the conversation and development of the HL7 standards and resources.

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Overview of Current State of the Use of HL7®FHIR® & Near-Term Future State

[fa icon="calendar'] Dec 4, 2019 4:40:07 PM / by Lisa Anderson, MSN, RN-BC posted in FHIR, interoperability, CMS, Da Vinci, Health Quality Measures Format, Quality Reporting, Clinical Quality Language, DEQM, Quality Data Model, Data Exchange for Qualitiy Measures, QI Core

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Measure development, as we know it, is changing. Quality improvement is important to keeping healthcare costs affordable and patients safe; however, it should not come as a huge burden to clinicians. Goals of electronic Clinical Quality Measures (eCQMs) include reducing the burden of manual abstraction and reporting for provider organizations, as well as fostering the goal of access to real-time data for bedside quality improvement and clinical decision support. We want to hit the “sweet spot” as depicted in this diagram:

 

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What is HL7 + Introduction to Product Lines

[fa icon="calendar'] Dec 3, 2019 12:30:08 PM / by Carol Macumber, MS, PMP, FAMIA posted in FHIR, CDA, Version 2, interoperability, C-CDA, Version 3, CMS, Health Quality Measures Format, Quality Reporting, Clinical Quality Language

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WHY STANDARDS?

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