The Standard

Highlighted here is a preview of what’s on the horizon as the Gravity Project matures and
recent examples of Gravity standards integration.

The Gravity Project®, an HL7® FHIR Accelerator, is evolving the way it advances social care data integration as a strategy to promote health equity while maintaining continuity with the mission and consensus-based processes that are core to the project. The project is a national public-private collaborative developing, testing, and implementing consensus-based social determinants of health (SDOH) data standards for use across the health, social services, public health, and research sectors. The Gravity community embodies a truly inclusive representation of over 2,500 stakeholder members of its public work groups and governance committees across the healthcare, health IT, community-based, federal and state agency, payer, academic, and patient/ consumer advocacy sectors.

In 2021, HL7 was awarded a cooperative agreement with the Office of the National Coordinator for Health Information Technology (ONC) to prioritize and expedite the development of standards specific to five gap areas including SDOH. Under this collaborative agreement, the Gravity Pilots Affinity Group was launched in September 2022 as a peer-to-peer learning forum for real-world testing of Gravity terminology and technical standards. Pilot sites are invited to demonstrate the use of social care coded terminologies (e.g., LOINC®, SNOMED-CT®, ICD-10®) and/or the HL7 SDOH Clinical Care FHIR Implementation Guide (SDOH CC IG), share implementation lessons learned with other pilot participants, seek/find partnerships for testing, and gain real-world experience.

Primary author: John D'Amore, Co-Founder, Diameter Health; Co-authors: Brett Marquard, Principal, Wave One Associates and Wayne Kubick, CTO, HL7 International

While HL7 FHIR® (Fast Healthcare Interoperability Resources) is today’s hottest healthcare standard, clinical documents are already exchanged in the billions today. HL7 published the Consolidated Clinical Document Architecture (C-CDA) in 2011 to support care coordination and patient engagement. The ONC 2014 certification rule named C-CDA R1.1 and adoption exploded. The current version of C-CDA, R2.1, remains backwards compatible to that version today. While C-CDA is a flexible, robust standard to record patient care longitudinally or for an encounter, it is structurally complex. The C-CDA standard itself is over 1,000 pages long. Applying the standard to the latest US requirements for clinical data exchange, known as the US Core Data for Interoperability, also routinely requires information from the C-CDA Companion Guide.

HL7 publishes the C-CDA standard and its Companion Guide as PDF documents. That will remain the official version of the standard, but a small team from the CDA Management and Structured Documents Working Groups saw an opportunity to make the C-CDA content easier to use by developing a new web tool. Since the C-CDA has reusable parts, known as “templates,” it seemed logical to make each template searchable and distinct via unique web pages so the standard would be much easier to absorb.

The new HL7 C-CDA Online Search Tool is a searchable, web-based navigation resource for the Consolidated Clinical Document Architecture (C-CDA 2.1) and its Companion Guide. The solution includes over 240 unique web pages that make each template accessible on the web with linkage back to the original PDF content. This navigation is managed through a single searchable index page, like a smart table of contents.

Using the template webpages, health IT vendors can ensure that their C-CDAs are conformant and high-quality for document exchange.  The search tool enables users to search the C-CDA by description, template object identifier (OID) or conformance number. Conformance number searches are particularly valuable for C-CDA implementers, since validators will return these numbers when there’s a violation or warning associated with C-CDA testing. 

Join the Webinar Highlighting MCG Health’s Prior Authorization Journey and Da Vinci’s Two New Use Cases for 2021 on Wednesday, February 24 from 4:00 - 5:30 pm ET.

Healthcare organizations increasing their exposure to value-based care find many tasks complicating the transition, and reducing the burden of those changes is key to thriving under new reimbursement schemes.

New payment approaches incentivize both payers and providers to become more efficient, and that means reducing the number of manual interventions in exchanging data. In addition, value-based care is uncovering new reasons to make information more easily available, to bring new efficiencies to the system.

Examples of these capabilities will be featured in the HL7 Da Vinci Project’s Community Roundtable on February 24. The title for the event is "What it Takes: Learn about MCG Health’s Journey to Help Reduce Prior Auth Burdens and Discover New Da Vinci Use Cases."

The upcoming roundtable will offer an inside understanding of the 18-month effort at MCG Health to advance the use of the HL7 Fast Healthcare Interoperability Resource (FHIR®) standard in solutions that support burden reduction in facilitating the prior authorization process.

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.

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.

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.

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.