The Standard

The Virtual FHIR Patient Access API Implementation Event Scheduled for  August 17-19

The start of the New Year will see healthcare organizations facing new requirements for using application programming interfaces (API) to facilitate the sharing of healthcare information.

That’s made clear by the recent release of final rules by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), which will be the first step in enabling data access.

To help support healthcare organizations in this shift, HL7 is holding the virtual FHIR Patient Access API Implementation event next week. With the impending final rule and the looming implementation deadline, this event will be narrowly focused on the requirements for patient access APIs by payers.

The goals for this Implementation-a-thon and associated educational events are to inform the broader community of the work HL7 FHIR Accelerators have done to lay the groundwork for meeting the final rules; and to help participants prepare for the September HL7 FHIR Connectathon and 34^th Annual Plenary & Working Group Meeting.

Education and specific planning in API implementation in a FHIR environment will be important for the industry, as these recently released federal rules require that consumers be able to access their medical information through third-party apps, and that will place pressure on healthcare organizations to develop APIs to enable this access. The HL7 Da Vinci Project continues to develop use cases that will facilitate this patient access to information.

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.

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.

HL7 Da Vinci Project Event Wednesday, July 22, from 4:00 – 5:30 p.m. EDT

Quality measurement is a key factor in improving the delivery of care, especially in value-based care arrangements. And it has become clear that as the shift to value-based care continues, the need for payer-provider collaboration has become essential.

The exchange of data among healthcare industry members can help organizations improve quality, and HL7’s Fast Healthcare Interoperability Resources (FHIR®) can play a significant role. The next Community Roundtable hosted by the HL7 Da Vinci Project entitled “What It Takes: How to Leverage the HL7 Da Vinci Project to Drive Quality Measurement and Value-Based Care,” will examine how organizations are making progress in sharing information for quality purposes.

The roundtable discussion will begin with Jocelyn Keegan, the Da Vinci program manager, providing an overview on the status, maturity and resources available for emerging implementations across Da Vinci focus areas.

Report from Virtual FHIR DevDays 2020 on HL7 Da Vinci Project Use Cases

Developers are fine-tuning ways to use the HL7 Fast Healthcare Interoperability Resource (FHIR) standard to reduce communication challenges and decision impediments between providers and payers.

Working on use cases involving coverage and burden reduction, the HL7 Da Vinci Project is refining early versions of standards and developing implementation guides for value based care (VBC). Speaking to more than 150 attendees during the virtual HL7 FHIR DevDays event, Dr. Viet Nguyen, Da Vinci Project Technical Director, noted that the coverage and burden reduction use cases are intended to address workflows around provider-payer interactions. FHIR implementation guides are then created based on a set of use cases. 

Coverage Requirements Discovery

One use case, Coverage Requirements Discovery, gives providers real-time access to payer approval requirements, documentation and rules at point of service to reduce provider burden and support treatment planning. In its essence, this would answer a provider’s question about whether a procedure or treatment needs a prior authorization from a payer. The aim is to use CDS Hooks to supply an answer to a clinician posing the request within his or her workflow. Work is continuing on developing an implementation guide for this use case.

Report from Virtual FHIR DevDays 2020 on the Patient Innovator Track

Initiatives seeking to expand the use of HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard were highlighted at the recent HL7 FHIR Dev Days 2020 virtual event.

The Patient Innovator track included four presentations highlighting its recent move to encourage the use of technology to support patient involvement in care. HL7’s Patient Empowerment Work Group has a mission of promoting and amplifying the viewpoint of patients and caregivers in HL7’s standards work. Its initial priorities include enabling patients to correct errors in records, contribute their data to records, plan care, and efficiently gather and store patient consents.

The four presentations were judged by a panel of HL7 experts for their use or projected vision for the use of FHIR to solve problems in patient empowerment in healthcare. In addition, attendees at the virtual Dev Days event could vote to award one of the participants a People’s Choice award.

Report from Virtual FHIR DevDays 2020

The Cleveland Clinic and Oscar Health announced a partnership in mid-2017 that was going to require a level of provider-payer integration that the organization hadn’t attempted before.

More challenging still was the fact that the timeline was short – some of the capabilities that would enable improved patient interactions had to be in place by January 2018. The use of the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard addressed many of the technical challenges in hitting those deadlines.

Integration between the entities still was difficult to achieve, noted Matthew Coolidge, who was then the IT product director at the Cleveland Clinic and is now CEO of Orbital Health. When he was in his Cleveland Clinic role, he was the organization’s subject matter expert on FHIR. Coolidge shared lessons learned in the initiative in a keynote presentation at the recent HL7 FHIR DevDays virtual meeting.

Report from Virtual FHIR DevDays 2020

A New York State initiative is aiming to change its approach for exchanging patients’ health information among the state’s health information exchanges, using HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard as the conduit.

In addition, the new approach being implemented for the State Health Information Network for New York (SHIN-NY) has taken less time to develop and is expected to enable the exchange of more granular patient data than is possible with the current approach.

Speaking at the HL7 FHIR DevDays virtual meeting on June 15, Luke Doles, senior director of services management for the New York eHealth Collaborative (NYeC), said further implementation of the FHIR-based framework has been delayed because of the urgency to shift resources to support the state’s COVID-19 response. However, the initiative has thus far proven that the concept can be expanded to provide more information across SHIN-NY.

Report from Virtual FHIR DevDays 2020

Work on incorporating application programming interfaces using HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard can help healthcare organizations better manage the COVID-19 crisis, but much more could be done.

A virtual panel at HL7’s FHIR DevDays indicated that API usage can help with the sharing of data, but more widespread use of this supportive programming could provide more benefits.

“If you look inside the typical hospital, there are more than 20 different clinical systems being used, but only one is the electronic health record getting the API love,” said Keith Boone, enterprise architect for Audacious Inquiry. “COVID data is showing up in bed management systems, command and control systems, ICU central monitoring and more.” Those systems are five years behind EHRs in enabling data exchange.