The Standard

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.”

Anthem, Cedars-Sinai, and CareEvolution to share on project to implement Data Exchange for Quality Measures and Event Notification on Wednesday, October 28

Like peeling back the layers of an onion, exchanging information to support value-based care involves complex data challenges for providers and payers alike.

That’s particularly true when it comes to navigating essential communications between providers and payers, using that dialogue to better coordinate care and achieve the best possible results for patients.

Two key areas that challenge everyone is ensuring that quality measures are met and that everyone in the chain is on the same page when it comes to events. Typically, these are hard for all parties in sharing relevant information.

HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard offers an approach that everyone can use to facilitate data exchanges. In an upcoming community roundtable scheduled for 4 to 5:30 p.m. ET on Wednesday, October 28, HL7 Da Vinci Project members Anthem, Cedars-Sinai and CareEvolution will discuss their efforts to put implementation guides for Data Exchange for Quality Measures and Event Notification in place.

Time is ticking away on healthcare organizations, who face fast approaching federal deadlines to improve the sharing of information to give patients access to their payer data. Additionally, the tools to reduce clinician burden and improve clinical data exchange between payers and providers are rapidly maturing.

The good news is that HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard is the tool that organizations can use to meet new requirements for data sharing. Use cases and accompanying implementation guides from the HL7 Da Vinci Project offer specific, standardized ways for organizations to use plug-and-play technologies with multiple other organizations.

But for many organizations, now the works begins in earnest. Implementing Da Vinci use cases will require input from IT departments and testing with a variety of partners. Fortunately, an upcoming Da Vinci Project event aims to equip participants with the necessary knowledge to get off the ground successfully.

HL7 is offering a Da Vinci-focused Education and FHIR Implementation Event on October 27 to 29, open to both members and non-members. The event goals are to educate the health IT community about HL7 FHIR and FHIR implementation guides develop by the Da Vinci Project and the CARIN Alliance.

Just over one month ago, I leaped into  HL7 FHIR through involvement of the Da Vinci Project. Having worked in the healthcare technology industry for more than 10 years aligned with implementers of payer-provider workflows, data reporting and analytics, it was compelling to see how the proverbial “sausage is made” in the standards world. I made my debut by attending the HL7 FHIR Patient Access API Implementation event in August and I have since attended the September HL7 Connectathon.

Here are three key takeaways from my first month in the FHIR community.

The Room Where it Happens: Developing a Standard Doesn’t Transpire Behind Closed Doors By the Elite.

As an implementer reading a standards’ implementation guide (IG), it’s inevitable to reach a point of confusion where you say to yourself, “Clearly the writer of this didn’t consider my business need.” HL7 has a robust process that prioritizes adoption and reaching consensus among the public community before stamping approval on a standard. The continuous improvement method includes one or more balloting cycles (where the public community essentially critiques the IG and provides detailed feedback) as well as multiple connectathons (at which IGs are tested against by the community), providing ample opportunity for feedback from the community to evolve the IG. The HL7 Da Vinci Project, as well as other FHIR accelerators, have reference implementation prototypes, documented examples, sample test scripts and weekly calls open to the public, encouraging participation throughout the development lifecycle.

Recap of the August Da Vinci Project Community Roundtable on DRLS and FAST

As the HL7 Da Vinci Project continues to make rapid progress in developing use cases to enable the exchange of healthcare information, work has been underway to test and widely deploy these cases among industry players.

Efforts led by federal agencies have been in motion to use solutions based on HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard at scale, as well as to incorporate FHIR use cases in a federal initiative that developed and tested a prototype to demonstrate the capability to streamline clinical workflow access to coverage requirements.

Presenters at a Da Vinci Project community roundtable on August 26 said the initiatives are important in bringing the benefits of automated information exchange throughout the healthcare industry, while taking steps to reduce the burden on providers.

The FAST Initiative
In one initiative, the Office of the National Coordinator for Health Information Technology (ONC) is convening a FHIR at Scale Taskforce (FAST) that brings together a representative group of motivated healthcare industry stakeholders. FAST aims to take use cases that are being demonstrated in initial efforts between partners in the industry and ensure that they can operate more broadly.

“In building solutions for FHIR for interoperability, we realize that individual solutions are being developed to work between one endpoint and another,” said Stephen Konya, senior advisor to ONC and the Department of Health and Human Services. “When we start to roll these out at scale – when there’s a large number of payers sharing a large amount of data with a large number of providers – the game changes.”

Providence St. Joseph, Cambia and MultiCare to Present on Collaborative Effort to Implement Use Case from the HL7 Da Vinci Project on Wednesday, September 23

Clinicians see the need for better access to healthcare information as clearly as others serving in the industry. Because of that, it should be no surprise that clinicians and their teams are playing key roles in the HL7 Da Vinci Project implementations.

Clinicians are not insulated from the changes being wrought by value-based care, so they see the need for adaptations to the digital health ecosystem. That is one force driving change at Providence St. Joseph, which is working with Cambia Health Solutions and MultiCare Connected Care to facilitate information exchange.

These organizations are collaborating on an initiative that is helping lead the way with Da Vinci Project production implementations to enable interoperability and advance value-based care. They will share their insights and experiences next week during the Da Vinci Project’s monthly Community Roundtable from 4:00 – 5:30 pm ET on Wednesday, September 23. The roundtable is entitled “Provider Leadership and Partnerships: The Key to Interoperability and Scalability of Value-Based Care.”

The Centers for Medicare & Medicaid Services (CMS) released the much-awaited Interoperability & Patient Access Rule in early March this year. This rule establishes policies that aim to break down barriers in the health system across the US for better patient engagement. Government bodies are taking significant efforts for governments-sponsored health plans to adopt interoperability to make healthcare system efficient. Multiple initiatives by the Department of Health and Human Services (HHS) and its CMS and Office of the National Coordinator for Health Information Technology (ONC) aim to improve care-coordination and member experience. CMS had proposed the Interoperability & Patient Access Rule to support regulations of the MyHealthEData initiative, with implementation timelines to drive programs such as BlueButton, BlueButton 2.0 and Data at the Point of Care.

In the times of pandemic, healthcare organizations have realized the importance of having access to data for better care coordination and efficient care delivery. With seamless data access, organizations can:

• Share health data of beneficiaries with different care teams
• Identify high-risk population and implement preventive actions to control risk
• Leverage tele-health with access to patient historical health data
• Take timely decisions on emergency treatments based on patient medication history

Doing Less, but Better

For many of us, this desperate pandemic year has led to plenty of introspection.  This has also been true for the HL7 Board, which has been contemplating the future of the HL7 organization after emerging from the current crisis. Among a set of core principles adopted by the Board are agility and focus. To be agile, we need to simplify and refine the organization and core processes as well as provide support with continued improvements to our tooling. This also requires getting our global community to better understand and use the processes more consistently and effectively, so we can better focus on our core work of developing and implementing interoperability standards.  This a perfect segue back toward my long-held core belief in essentialism.

Back to Basics

I first espoused the concept of essentialism to an enthusiastic Board and Technical Steering Committee back in 2016. While we’ve only made small incremental progress in the four years since, it has been guiding our process improvement and tooling initiatives. Essentialism was a driving force behind our adoption of Confluence and JIRA as well as efforts to simplify our product portfolio. Of course, we operate in a complex field, and there were many confounding forces acting at the same time. The HL7 community is more adept at introducing new processes, tools and content than at retiring or eliminating the old stuff. Thus, our commitment to essentialism faded over time, tempered by inertia and continuing demands, not the least of which has been the black swan events of 2020.

Perhaps it’s time to once again review the key elements of essentialism and discuss how it fits with our ongoing tooling strategy and plans.