The Standard

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.

A Closer Look at the 26th Virtual HL7 FHIR Connectathon Held January 13-15, 2021

Despite adjusting almost everything in life to a pandemic-driven “new normal” these past ten months, most of us have discovered a few unexpected benefits from the upheaval. Such is the case for the HL7 FHIR Connectathons, which migrated from in-person to virtual beginning with the May 2020 Connectathon. The January Connectathon #26, occurring last week, carries the distinction of being the largest Connectathon yet – with over 800 participants!

The in-person, face-to-face Connectathons of the past provided a rare (and delightful) opportunity to join developers, implementers, clinicians and interested stakeholders in testing and development of FHIR standards. Moving to the virtual format, however, has allowed more people to participate without having to travel to the event.

What Happens at a FHIR Connectathon?

If you are still fuzzy on the detailed activities of Connectathons—and whether you should attend one, there are many avenues where you can learn more. FHIR Connectathons serve as events that are centered upon developing the FHIR specification; including resources, profiles, and implementation guides (IG). The first Connectathon occurred in September 2012 and readily set the stage for future Connectathons that typically occur in the days ahead of an HL7 Working Group Meeting, thereby encouraging members to participate in both.

Presentation at HL7 Da Vinci Project’s Community Roundtable Outlines Wide-Ranging Corporate Effort to Democratize and Liberate Data

For Humana, achieving interoperability is more than a nice-to-have way to exchange data every once in a while. It’s something that the company – and the entire healthcare industry – needs to operate efficiently and effectively for patients and clinicians.

It expects that the use of the HL7 Fast Healthcare Interoperability Resources (FHIR) standard will be crucial for achieving widespread interoperability. Current information exchange approaches offer a patchwork solution that works in isolated instances. FHIR’s promise is that it can provide standardized solutions that every industry participant can use.

“Exchange works at small scale because (information) roadways are rebuilt every time a connection is made,” said Patrick Murta, Humana’s chief interoperability architect and solutions architecture fellow, speaking at the November Community Roundtable for the Da Vinci Project, an accelerator program of HL7 seeking to expand the use of FHIR to support information exchange needed for successful value-based care.

Clinical care data is a foundation for research. It is used to understand patient populations and as the core for clinical data capture. The introduction of HL7 Fast Healthcare Interoperability Resources (FHIR®) and its adoption rate creates a new opportunity to exchange data for clinical and translational research. Building off the work already accomplished to create interoperability standards for the exchange of healthcare data bridges clinical research into the greater healthcare ecosystem.

HL7 FHIR® accelerators have been a successful catalyst for standards development and adoption. Following the path of other accelerators, the research community collaborated to create Vulcan. In August 2020, Vulcan was launched by convening the following member organizations: TransCelerate Biopharma, Duke University, Johns Hopkins, Oregon Health and Sciences University, UT Health San Antonio, Society for Clinical Data Management, U.S. National Library of Medicine, National Center for Advancing Translational Sciences (NCATS), Danish Medicines Agency and U.S. Food and Drug Administration. Membership is rapidly growing with new organizations being onboarded each month.

Vulcan Use Cases

After consultation with the Steering and Operations Committee of Vulcan, project teams have been formed to move forward three use cases. These were selected from a larger effort to collect as many as eighteen uses cases which were prioritized based on impact and the ability to deliver to the community. The initial selected use cases include:

• Real world data (including secondary use of electronic health record data)
• Phenopackets
• Schedule of activities

Social Determinants of Health Data Matter for National COVID-19 Response Efforts

The Gravity Project is pleased to announce the publication of its consensus recommendations for food insecurity, housing instability and homelessness data elements. The Gravity Project is a national cross sector grassroots informed collective charged with building consensus data elements and data standards for the capture, exchange, and use of social determinants of health (SDOH) information. The Gravity food insecurity and housing data elements are the result of a year of development with input from its over 1,000 participants with intentional representation from key stakeholders such as patients, providers, community based organizations, payors, technology vendors, and federal and academic food insecurity and housing subject matter experts.

Social determinants of health—the circumstances in which we are born, grow, live, work and age—are estimated to account for 80-90% of health. There is growing interest from the healthcare sector to integrate social risk evaluation and intervention to advance the triple aim: improved health outcomes and quality of care while containing costs. In 2018, Gravity founders University of California San Francisco (UCSF) Social Interventions Research and Evaluation Network (SIREN) conducted an assessment of existing SDOH data and found much work was needed to advance the documentation and use of this data. Enter, the Gravity Project. The Office of the National Coordinator for Health Information Technology (ONC), a Gravity Project sponsor, noted the growing recognition across healthcare that by capturing and accessing SDOH data during the course of care, providers can more easily address non-clinical factors, such as food, housing and transportation insecurities, which can have a profound impact on a person’s overall health.

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.”

Doing Less, but Better

Imagine you’re struggling in a long race – maybe an ultra-marathon over a winding, hilly course. You’ve been running for many hours, and you’re tired, sore and hungry. You’re running up a hill, hoping the end will soon be in sight. But when you get to the top, you only see a turn, not a finish. And after that turn – oh, no! – another hill. We’ve had that feeling during the long pandemic, and, for some of us, we’ve had that feeling even longer with respect to tooling at HL7. We’ve covered a lot of ground, and climbed a lot of hills, and we can feel the end should be in sight very soon. But we’re still running.

Fortunately, we have a team of supporters handing out Gatorade, clapping and cheering us on, and we’ve got our fellow runners pulling us along. And so it is with the HL7 community. We ask a lot of you to help us move forward, with support and understanding; sometimes contributing your valuable time to help us with development or testing, or to struggle patiently with change and the unexpected discoveries of new technology rollouts. While we don’t see that finish line yet, we see plenty of blue skies and greener fields beyond. We won’t always make it on the podium, and sometimes we stumble along the way. But the important thing is to keep moving forward and getting better.

The View from Above

We may not always seem to be progressing very fast, but we’ve really come a long way in the last few years thanks to the important contributions of many of you as well as the ongoing generous support of the US Office of the National Coordinator for Health IT (ONC), which has funded many of our retooling efforts. To list a few prominent examples:

Joint Community Roundtable, Member Forum Event for the HL7 Da Vinci Project is November 18

Gaining traction for standardized approaches across a variety of healthcare organizations can be challenging but possible when common goals are identified, and everyone benefits from the collaborative effort.

That was the track taken by Humana, when the healthcare payer sought to win the support of healthcare provider organizations to adopt the HL7 Fast Healthcare Interoperability Resource (FHIR®) to achieve mutually beneficial goals as a result of easier information exchange.

The Da Vinci Project’s November Community Roundtable will look at Humana’s efforts to better integrate care for its members through the use of FHIR. The session is entitled, “Humana: Achieving Integrated Care Delivery Using FHIR: Why it’s a Big Deal.”

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.”