The Standard

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.

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.

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.

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

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.

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.

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:

WHY STANDARDS?

On July 30, as part of the second Blue Button Developers Conference at the White House, a broad coalition of health systems, health plans, and other health IT stakeholders committed to real-world testing of the soon to be published  HL7® FHIR® Bulk Data implementation guide (IG). 

The announcement was made on stage by HL7 International CEO Dr. Charles Jaffe, later joined by Steven Posnack from ONC and Dr. Shafiq Rab of Rush University System for Health. More than 20 early adopters who have committed to advance this important use of HL7 FHIR were identified.

Much of the focus around HL7 FHIR APIs to date has involved  transactions representing  a single patient. While those use cases are important, especially for patients desiring more seamless access to their data via their smartphones, the FHIR Bulk Data Implementation Guide (IG) unleashes FHIR’s potential to revolutionize population health by enabling new services powered by big data. The standardized approach offered by the Bulk Data IG is being used by CMS in its new Data at the Point of Care (DPC) pilot and could help transform the ways healthcare providers and health plans share data for quality improvement and cost accountability.

The Bulk Data IG is the result of a two-year effort funded by ONC’s cooperative agreement with HL7 in partnership with the SMART team at Boston Children’s Hospital/Harvard Medical School.

The following organizations will participate in real-world testing of the HL7 FHIR Bulk Data IG, and Steven noted ONC’s willingness to support these organizations. Participants will collaborate on providing a common set of artifacts, tools and services with an aim to lower standards implementation costs by making them as reusable and transferable as practicable.

Committed organizations include:

Signed,

Charles Jaffe, MD, PhD
HL7 International CEO 

Steven Posnack, MS, MHS
Executive Director, Office of Technology, ONC

We are delighted to announce that HL7 has received a letter of support applauding our work in standards development from the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma.

Based on the impact that HL7 has made on improving interoperability and current adoption of the HL7® FHIR® standard, CMS has shared their priorities for collaboration in the coming year. 

HL7 will be developing a strategy over the next several weeks, with input from CMS, to meet each of these priorities. I will share more information about this in the near future. In the meantime, I'd like to thank you for your contributions to the work of this organization and ask you to join me as we focus our efforts on meeting these needs.
 

To view the letter in its entirety, please click here.

Sincerely,


HL7 International CEO 
Charles Jaffe, MD, PhD