The Standard

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.

Limitations in existing healthcare interoperability present a significant barrier to next-gen computing solutions such as Machine Learning (ML) and Artificial Intelligence (AI). New workflow standards aimed at addressing the integration of AI/ML actors to clinicians in delivering better patient care.

One of the main limitations of standards is streamlining access to data from electronic medical record (EMR) applications. There is a growing need for a holistic view of patient data, and the inclusion of the allied healthcare services such as radiology will play a crucial role in building a 360° patient view. This will help healthcare professionals take accurate and informed decision on patient care, and bridge the gap between fragmented and siloed information that is currently limiting hospitals and healthcare systems from gaining insights to drive better health outcomes.

To seek better exchange of health data among providers and patients, the Health and Human Services (HHS) published final rules that put patients first and bring one step closer to achieving Interoperability. The ONC’s (Office of the National Coordinator for Health Information Technology) rule aims to standardize API via HL7 Fast Healthcare Interoperability Resources (FHIR®) R4, a latest version of the FHIR standard, and making its use mandatory under this rule.

Community Roundtable scheduled for August 26 will detail progress toward DRLS and FAST

The HL7 Da Vinci Project’s August Community Roundtable features updates on two initiatives that leverage healthcare industry collaborative efforts to advance information exchange using HL7® Fast Healthcare Interoperability Resources (FHIR®).

This is in response to two federal agencies that are seeking to maximize efficiency at scale and overcome barriers and physician burden in the healthcare system.

The agencies – the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC)– will provide updates on the progress on these efforts during the August 26 Community Roundtable.

The federal agency efforts aim to build on collaborative efforts underway in the healthcare industry, which are at the heart of the work by the HL7 Da Vinci Project, an accelerator seeking to advance the use of FHIR standards in support of value-based care initiatives.

The CMS Center for Program Integrity began the Documentation Requirement Lookup Service (DRLS) initiative in 2018, working in collaboration with the healthcare industry, in to response to ongoing provider burden experienced when trying to identify coverage-related documentation requirements, including those for prior authorization.

Multi-stakeholder initiative aims to use widely accepted health care standard to enable data exchange to streamline translational and clinical research

HL7 recently announced the launch of its newest FHIR Accelerator, Project Vulcan, which seeks to use its widely recognized data exchange standards to help health care researchers more effectively acquire, exchange and use data in translational and clinical research.

The effort, called Vulcan, intends to use a model for collaboration among diverse stakeholders in the translational and clinical research community to define a common set of standards that can be implemented internationally, built on current agreements to use the HL7 Fast Healthcare Interoperability (FHIR^®) standard to facilitate data exchange.

“Improving data sharing can bring significant benefits to medical research, which is often a time-intensive and costly process that unnecessarily delays progress in discovering treatments for medical conditions because researchers are unable to share critical information,” said HL7 International CEO Charles Jaffe, MD, PhD, “Project Vulcan aims to develop common solutions to help partners overcome these challenges.”

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.