The Standard

Multistakeholder Discussion Features Panelists from Centers for Medicare & Medicaid Services, Epic, Florida Blue and Providence

Is your organization planning to use FHIR APIs to support data exchange for patient cost transparency (PCT)?

Join us on Wednesday, Sept. 27, from 4:00 – 5:30 p.m. for the September Community Roundtable presentation titled, “No Surprises Now: How the HL7 Da Vinci Project Accelerates Patient Cost Transparency.” Featuring a provider, payer, vendor and regulator, the multistakeholder discussion begins with an initial level setting session outlining the regulatory landscape, including the No Surprises Act, regulations and resources.

Next is a review of the HL7 Da Vinci Project’s PCT use case, which aims to develop a standard data exchange in support of patient cost transparency for devices, services and collection of services using FHIR APIs for exchange of data. The session will close with insights on the benefits of testing and implementation of PCT from the following presenters:

• Vanessa Candelora, HL7 Da Vinci Project Patient Cost Transparency Co-Lead and Senior Consultant, Point-of-Care-Partners
• Tina Mintyala, Program Manager, Revenue Cycle, Providence
• Alice O’Carroll, HL7 Da Vinci Project Patient Cost Transparency Co-Lead and Interoperability Product Manager, Florida Blue
• Carmen Smiley, Health Insurance Specialist, Division of Consumer Protection Policy, Consumer Support Group, Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services
• Zackery Welch, Executive Director, Pre-Services: Providence Health and Services
• Jacob Woodford, HL7 Da Vinci Project Patient Cost Transparency Co-Lead and Technical Services, Epic

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

Hear Two Experts Discuss Real-World Genomics Data Exchange & Use Case
 Progress at Friday's Event

August brings a CodeX Community of Practice meeting that highlights advances in the Accelerator’s genomics domain, lessons learned and how the work improves research and patient care. The virtual session, which will be held on Friday, August 25, 2023, 12 – 1 p.m. ET., features two presentations:  

Advancing Genomics Data Exchange Using HL7 FHIR at the Molit Institut 

In the realm of genomic testing, most data presently is sent from the laboratory to health care organizations in the form of a PDF, which isolates this non-computable information within the EHR and limits access to the data for clinical care and research. 

Join us to hear how an early adopter of HL7 FHIR in this realm, Patrick Werner of the Molit Institut, is working to use FHIR to free the data. As a small independent non-profit research organization in Germany, Molit has received FHIR genomic reports for more than two years. Werner will share the opportunities, challenges and lessons learned with Molit’s successful genomics data exchange, including strategies implemented to ease data standards adoption across participating labs.  A review of Molit’s virtual tumor board for molecular oncology will showcase how Molit structures data and identifies possible gaps to assist identification of variants, prognosis on variants and recommendations.   

Presenter: 

Patrick Werner, Process Manager, Interoperability, Molit Institut 

Explore the Cross Accelerator Collaboration During the Discussion Aug. 23, 4 :00 – 5:30 p.m. ET

“Reducing Prior Authorization Burden and Improving Oncologic Care with HL7 FHIR,” August’s Community Roundtable, will highlight why and how Da Vinci is tackling prior authorization and hear how CodeX is leveraging the work of the Da Vinci Implementation Guides (IGs), which have been referenced in federal proposed interoperability rules, to tackle prior authorization challenges in oncology.  

 Join the session and discover the endeavors of the CodeX Prior Authorization in Oncology Use Case team to improve the care journey for cancer patients by expediting prior authorization via automation. 

The discussion will share real-world success stories from Da Vinci and how these efforts can serve as building blocks for CodeX solutions, as well as reveal how you can become involved and the benefits of participation in this work.

Presenters for this session include:

• Ellen Anderson, Enterprise Architect, Evernorth
• Kirk Anderson, Vice President and Chief Technology Officer, Chair, Da Vinci Steering Committee, Cambia Health Solutions
• Su Chen, MD, CodeX Program Manager, Clinical Science Principal, MITRE

Alix Goss, HL7 Da Vinci Project PMO, and Senior Consultant, Point-of-Care Partners, serves as the session moderator.

Hear about the ONC’s USCDI+ Quality Initiative and learn the latest about the Quality Measures for Cancer Use Case on July 28

Latest advances in the use case and the success of Mayo Clinic’s adoption of minimal Common Oncology Data Elements (mCODE) to improve routine oncology clinical care focus of June Community of Practice

Prior authorization continues to be a pain point across the health care spectrum, and this month’s CodeX Community of Practice meeting will be highlighting prior authorization and how a standards-based approach is improving care at the Mayo Clinic.

According to a 2022 American Medical Association survey, 94% of physicians reported care delays associated with prior authorization, and 80% said these requirements can at least sometimes lead to patients abandoning treatment.

When treating cancer, the delays could be deadly.

Within CodeX, the Prior Authorization in Oncologyuse case focused on prostate cancer treatment is making strides in its iteratively phased proof-of-concept (POC). A goal of the use case is to automate prior authorization for cancer treatment so that 80% of approvals do not require manual inspection, expediting care for patients and reducing physician burden. CodeX participants are proving the utility of the Implementation Guides Coverage Requirements Discovery (CRD), Documents Template Requirements (DTR) and Prior Authorization Support (PAS) as developed by the HL7 Da Vinci Project Burden Reduction use case as well as in the Centers for Medicare and Medicaid Services December 2022 proposed rule Advancing Interoperability and Improving Prior Authorization Processes.

The Da Vinci Project’s June Community Roundtable to be held June 28 from 4:00 – 5:30 pm ET

Representatives from athenahealth and Optum discuss the HL7 Da Vinci Project’s newest use case during the June Community Roundtable, scheduled on Wednesday, June 28, from 4 – 5:30 p.m. ET.

In addition to learning the latest project updates, attendees will learn how the Da Vinci Risk Adjustment Implementation Guide (IG) supports exchange of risk adjustment gap reports at the point of care. Attendees will discover how standard protocols, which are payer agnostic, enable communication of chronic conditions and simplified workflows. Presenters will also illustrate how providers gain the ability to share real-time feedback and clinical evidence to address gaps. An overview of the IG and a question-and-answer period will conclude the webinar.

 Presenters for this session, “Risk Adjustment Reporting at the Point-of-Care​,” include:

• Josh Lamb, Integration Architect, Optum
• Linda Michaelsen, Director, Healthcare Interoperability Standards, Optum
• Nidhi Pengoria, Senior Product Manager, athenahealth

Alix Goss, HL7 Da Vinci Project PMO, and Senior Consultant, Point-of-Care Partners, serves as the session moderator.

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.

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.