The Standard

2023 Accomplishments Position Industry for Year Ahead

Substantial progress has been made this year on HL7 Da Vinci Project Implementation Guides (IGs), which describe how to use HL7’s Fast Healthcare Interoperability Resources (HL7 FHIR®) standard for exchanging data to support value-based healthcare and implementations of the guides.

Sizing Up Accomplishments

At the December Da Vinci Community Roundtable, Hans Buitendijk, Da Vinci Project Steering Committee Vice Chair, reviewed progress this year and offered an outlook for 2024.

“We have a number of organizations across the spectrum that have adopted one or more of our [FHIR implementation] capabilities. … That's fantastic in the short number of years that this initiative started to look at what is necessary to make it happen,” Buitendijk said.

“We currently have about eight publishing updates that have been accomplished and quite a few ballot processes that are in flight and being planned for, and there is a good amount of commitment to making this happen. So, we really need to be proud of what we have achieved to date, and particularly in the last year.”

In the year ahead, alignment with emerging regulations, including the final CMS Interoperability Rule, will be a top priority, he pointed out.

Interoperability efforts must go beyond a general set of data to ensure adequate support for public health, research, quality measures and more, he added. “We are all going to impact the ability and the opportunity to share more data over time,” he said.

The key to advancing interoperability by leveraging FHIR, he stressed, is to involve many different parties and develop “the same language where we have a minimum set of capabilities that everybody can support, and leaving room … to grow, to explore, to define new things.”

He also pointed out: “We must continuously raise the bar for what we can exchange and determine what is relevant across many different stakeholders that we should all do in the same way … because the data that we have covered so far is still only a part of the variety of data exchanges that are relevant and can benefit from improvements."

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

Projects required crucial coordination between three HL7 Da Vinci Project members – Cedars-Sinai, Anthem and CareEvolution

Two challenging problems in improving care coordination and quality are the focus of efforts between a prominent Los Angeles-area care delivery system, a large healthcare payer and a technology vendor.

The HL7 Fast Healthcare Interoperability Resource (FHIR®) is playing a role in aiding the effort, but those involved say the FHIR standard, while important, is only a part of the components of their successful project.

Cedars-Sinai, Anthem and CareEvolution detailed the lessons they have learned in the data exchange project during the HL7 Da Vinci Project’s Community Roundtable in October. While FHIR has played an important role in exchanging information, it is only one piece of the puzzle – all participants had several technical and planning tasks to accomplish to ensure the projects succeed and reduce users’ workloads.

Da Vinci’s use cases and implementation guides are “a great starting point, but they only define one stage in that pipeline,” said Brandon Raab, engineer lead for enterprise data and analytics solutions for Anthem. “The end-to-end actualization of the use case will likely involve the integration of upstream and downstream systems.” Achieving the desired results “was a substantially heavier lift than we anticipated.”

Cedars-Sinai, Anthem and CareEvolution – all members of the Da Vinci Project – began discussions about how they could work together to put FHIR into practical use, said Ray Duncan, MD, executive director for technology research and development in enterprise information services for Cedars-Sinai. The partners chose notifications and data exchange for quality measures (DEQM) use cases because those use cases were “pretty far along in the balloting process” and because the organizations “wanted to focus on use cases where we could try them without a lot of changes to clinician workflow.”

Recap of the September HL7 Da Vinci Project Community Roundtable 

Exchanging information is much like a dancing competition – it takes partners who are willing to work hard to coordinate their actions.

Multicare Connected Care and Regence Blue Pilot Medication Reconciliation Project

That was a bedrock of the initiative that paired MultiCare Connected Care and Regence Blue Shield, now bearing results in enabling better medication reconciliation between the healthcare organizations.

The partners described their journey to implement a use case from the HL7 Da Vinci Project in September’s Community Roundtable, noting that they are achieving substantial results in improving data exchange efforts, reducing manual work for the two organizations and enabling them to redirect resources to other projects that benefit both patients and the organizations.

The effort has paid off – MultiCare has achieved dramatic improvements in its compliance with medication reconciliation requirements, while reducing the amount of manual intervention by both organizations, said Anna Taylor, director of operations for population health at MultiCare for its an accountable care organization.

Using standardized interoperability, in the form of a use case for coding from HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard, helps to reduce the burden “on us as providers and as an ACO,” Taylor said. “Success in value-based care models requires data and information from partnering entities; we’re able to use this data and information to make sure that those that are the most sick and need the most care navigation get what they need to stay healthy.”

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

Joint project involves Rush Health, Cigna and InterSystems to use HL7 FHIR Resources to coordinate on three quality measures.

The healthcare industry increasingly has long recognized the importance of data measurement in improving healthcare quality. But it’s not enough for organizations to gather and hoard data – it needs to be shared between providers and payers.

Data sharing, as instantaneously as possible, has become more important as payers and providers collaborate in accountable care organizations and other arrangements that incentivize improving patient outcomes. To date, the exchange of information has been labor intensive, but the use of emerging data exchange standards is enabling more precise data exchange when and where provider teams need it.

Efforts to improve data exchange on quality measures are underway in a collaboration between Cigna, healthcare technology vendor InterSystems and Rush Health, a clinically integrated network of healthcare providers and hospitals in the Chicago area. The partners are using the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard to support the initiative.

Representatives from the partnering organizations described their efforts to date at a Community Roundtable hosted by the HL7 Da Vinci Project on Wednesday, July 22. While FHIR connectivity had not been implemented in live production systems as of that date, the organizations had tested functionality in a non-production environment and continue to work, committing to regular meetings and consistent communication on the project until the scheduled go-live.

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: