The Standard

August Community Roundtable Provides Multi-Faceted View of Prior Authorization Regulatory Requirements and Da Vinci Implementation Resources   

For the August HL7 Da Vinci Project Community Roundtable, industry leaders will offer an insightful, holistic discussion targeting those who want to better understand how best to meet prior authorization regulatory requirements aiming to increase efficiency and improve patient outcomes.   

With a focus on the latest developments surrounding the Da Vinci Prior Authorization Implementation Guides (IGs), the session begins with an examination of clinical and business drivers and a level-setting overview of federal and state level-activities impacting prior authorization requirements. Then we highlight technical standards, focusing on the underlying requirements of CMS-0057,  HTI-4 and the current status of the IGs.  The session concludes with how Da Vinci responds to industry needs, fostering a supportive environment for implementation and providing education, resources, and learnings from real-world implementers and piloting opportunities for those on their implementation journey. 

New Group Advances Workflow and Process Interoperability Using HL7^® FHIR^®

HL7 is pleased to announce the official launch of its HL7 Business Process Modeling (BPM) Community of Practice. Now open for membership, the community is dedicated to advancing interoperability, process consistency, and process automation through the use of formal modeling techniques promoting better modeling, sharing, and execution of clinical and administrative workflows across the healthcare ecosystem.

BPM Community of Practice builds upon three open standards-based languages – referenced together as “BPM+”, and include:  

• BPMN (Business Process Model and Notation): For prescriptive workflows
• CMMN (Case Management Model and Notation): For reactive activities
• DMN (Decision Model and Notation): For complex decision-making rules

The use of these standards, in concert, allows inherent ambiguities in natural-language guidelines to be clarified, providing precise, automatable guidance to improve care quality and consistency. Organizations use BPM+ to model and streamline processes, ensuring accurate and scalable healthcare delivery, process consistency, comparability, and repeatability.

“HL7’s focus is on bringing together communities to advance all aspects of interoperability, and that includes workflow and care processes,” said Ken Rubin, Community Coordinator of the HL7 BPM Community of Practice. “This launch marks an important step in providing the healthcare industry with tools, models, and frameworks to manage care processes more effectively, consistently, and collaboratively.”

Dr. Daniel Vreeman Named Chief AI Officer to Drive Organization's Strategic AI Agenda

HL7 has launched an Artificial Intelligence (AI) Office to establish foundational standards for safe, trustworthy AI in healthcare and convene the global community driving this transformation.

The new office positions HL7 at the forefront of healthcare's AI revolution, creating frameworks that ensure emerging technologies are trusted, explainable, interoperable, and scalable across clinical, operational, and research settings worldwide.

"Artificial intelligence will fundamentally reshape healthcare delivery, evaluation, and payment," said Charles Jaffe, MD, PhD, CEO of HL7 International. "Our new AI Office positions HL7 as the trusted global convener for responsible, standards-driven AI innovation—ensuring these transformative technologies deliver on their promise to improve health for all."

To lead this initiative, HL7 has appointed Daniel Vreeman, DPT, as its first Chief AI Officer (CAIO). Dr. Vreeman will expand his current role as Chief Standards Development Officer to drive HL7's comprehensive AI strategy, including the HL7 AI Challenge, anti-fraud initiatives, and collaborations with regulators and industry partners globally.

The U.S. Department of Health and Human Services (HHS), in collaboration with over 45 of the nation’s largest health insurers, has announced an important step forward in transforming the problematic processes of prior authorization. By pledging to reduce delays, increase transparency, and standardize processes by 2027, these organizations have signaled a long-overdue shift toward easing administrative burdens and improving access to evidence-based care.

The pledge spans insurance markets (commercial coverage, Medicare Advantage and Medicaid managed care) and will benefit an impressive 257 million Americans. But turning that vision into reality will require more than declarations. It will demand the kind of trusted technical infrastructure that HL7’s community has built together for over 35 years.

 As implementation begins, prior authorization reform demands scalable, open and consensus-driven standards.

Community Roundtable Featuring Clinical Advisory Council Insights on FHIR Adoption on June 25 at 4 pm

openEHR International and HL7 International  announced the successful conclusion of a highly productive joint workshop focused on exploring and advancing collaboration between their respective health data standards communities. The event, held in Amsterdam June 2-3, 2025, brought together leaders from both organizations with experts from the wider community in a spirit of shared commitment to improving global health and research through enhanced interoperability.

Both openEHR and HL7 Fast Healthcare Interoperability Resources (FHIR^®) are community-driven standards, developed and enabled by dedicated global communities with diverse stakeholders including clinicians, informaticians, developers and vendors. This shared foundation provides a powerful springboard for joint efforts to enable better health care delivery, foster innovation and accelerate vital research and development worldwide.

Discussions were overwhelmingly constructive, and characterized by a mutual curiosity and openness from members of both communities. The workshop culminated in the identification of five key strategic areas for future collaborative work, and underpinning enabling themes where closer strategic alignment between the openEHR and HL7 FHIR ecosystems can yield significant benefits for the wider health care community.

Innovators worldwide invited to demonstrate how HL7 standards and
AI can revolutionize healthcare

HL7 is proud to announce the launch HL7 AI Challenge 2025, a global innovation competition designed to spotlight the transformative potential of artificial intelligence (AI) when powered by open health data standards. Selected winners will be recognized on stage during HL7’s 39th Annual Plenary, Working Group Meeting, September 13-19, 2025, in Pittsburgh.

The HL7 AI Challenge is open to any individual, team or organization across academia, industry, and government using HL7 standards to power AI applications that solve real-world clinical, operational or equity-focused problems. HL7 membership is not required, and there is no cost to participate.

 The competition builds on HL7’s long-standing commitment to enabling interoperable, standards-based healthcare innovation and reflects growing global interest in aligning AI adoption with ethical, explainable and secure data practices.

“As AI becomes more deeply embedded in healthcare, we must ensure it advances—not undermines—trust, transparency, and patient outcomes,” said Dr. Charles Jaffe, CEO of HL7 International. “The HL7 AI Challenge invites technologists, researchers and clinicians worldwide to showcase how open standards can anchor responsible, scalable AI innovation, bridging the health IT and AI communities for the benefit of all.”

New publication outlines opportunities for accelerating and improving the use of AI to support payment integrity and reduce fraud, waste, and abuse

Last week, HL7 International released a new report outlining the actions needed to fully realize the benefits of artificial intelligence (AI) in improving payment integrity and reducing fraud, waste, and abuse. Reducing Fraud and Improving Payment Integrity in Healthcare Through the Use of AI brings together insights from payers, providers, and technology experts to define AI opportunities and emerging solutions, current challenges, implementation strategies, and standards needed to increase transparency and trust.

“The U.S. spends more than $900 billion annually on administrative complexity, waste, and improper payments,” said Charles Jaffe, MD, PhD, CEO of HL7 International. “This publication identifies practical and standards-based approaches to harnessing AI for one of healthcare’s most persistent and costly challenges.”

Key recommendations from the report include:

• Developing standards for explainable AI in healthcare with specific transparency requirements and bias mitigation protocols.
• Creating standards and infrastructure for trust and verification of AI-generated results.
• Establishing frameworks for human-in-the-loop validation that balance automation with clinical expertise.
• Implementing pilot programs focused on provider-payer collaboration that create mutually beneficial scenarios for all stakeholders.

A report from the HL7 Da Vinci Project describes how two pioneering organizations demonstrated the real-world practicality and value of applying standard application program interfaces (APIs) to streamline the prior authorization process.

Regence, a payer based in the Pacific Northwest, and MultiCare Health System, a provider based in Washington state, spent about a year testing and fine-tuning processes that leverage HL7’s Fast Healthcare Interoperability Resources (FHIR^®) standard for APIs.

In addition, dozens of other organizations have tested FHIR APIs at more than 15 Connectathon testing events.