The Standard

Last December, the Centers for Medicaid & Medicare Services (CMS) issued two notices of proposed rulemaking (NPRM) that will greatly influence how FHIR advances.

Da Vinci officially commented March 13 on one the rules, the Advancing Interoperability and Improving Prior Authorization Processes, or “Interop 3,” and submitted comments last week to the other rule, the Attachments NPRM, due on March 20. This rule is a set of HIPAA attachment standards and related definitions for electronic exchange of clinical administrative data to support both prior authorizations and claims adjudication, according to Alix Goss, moderator for the HL7 Da Vinci Project Community Roundtable and HL7 Da Vinci Project PMO, as well as vice president and senior consultant with Imprado.

Da Vinci is not in favor of finalizing the proposed regulations, Goss said. A final rule would require investments across the country that essentially will hardwire the approach making further evolution that much harder and burdensome, and redirecting the industry’s focus, taxing resources.

“Industry payers, providers, clearing houses, vendors, patients and more have to make choices at each step of the interoperability journey, and finalizing these regulations brings complications to the choices already made, and those to come,” Goss said. “We all know that the reality that technology moves faster than policy advancements and we're still working out how to work with this reality.”

Goss advises those who want a deeper dive into these rules to review the January 25 Community Roundtable, where the CMS Office of Burden Reduction and the National Standards group delivered an extensive overview.

Hear about real-world lessons learned on applying the member attribution use case to improve patient matching

In this month’s Community Roundtable, the HL7 Da Vinci Project will offer important use case updates plus a real-world case study on improving patient matching. The virtual roundtable, titled “Use Case Progress and Patient Matching Success: How to Improve Interoperability and Patient Safety,” will be held 4:00 to 5:30 p.m. EDT on Wednesday, March 22.

This informative session will highlight use case milestones for Clinical Data Exchange (CDex), Price Cost Transparency (PCT) and Member Attribution (ATR). Plus, it will offer a case study from Opala and MultiCare Connected Care, implementers of Da Vinci’s member attribution use case. This groundbreaking project resulted in a 10% improvement in patient matching. This benefit helped MultiCare further improve patient safety by ensuring clinicians have the full picture about their patients in real time.

Guest speakers will include:

• Crystal Kallem, project manager, HL7 Da Vinci Project, and senior consultant, Point-of-Care Partners
• Jocelyn Keegan, program manager, HL7 Da Vinci Project, and payer practice lead, Point-of-Care Partners
• Meghan Quint, vice president of solutions and customer success, Opala
• Anna Taylor, AVP, population health and value-based care, MultiCare Connected Care

The moderator will be Alix Goss, HL7 Da Vinci Project PMO, who is vice president and senior consultant at Imprado.

Learn about the rules, how innovators are reaping the benefits of HL7 FHIR APIs and the value of automation at this month’s  Da Vinci Project Community Roundtable

In this month’s Community Roundtable, the HL7 Da Vinci Project is exploring healthcare interoperability with a full line-up of speakers. The virtual roundtable, titled, “Advancing Interoperability via FHIR APIs: An Industry Discussion on Progress, Proposed Rules and the Value of Automation,”will be held Wednesday, Feb. 22, from 4:00 - 5:30 PM EST.

The session will break down the latest federal proposed rules impacting interoperability, the Prior Authorization and Attachments Rules, published last December. Continuing where the January Roundtable left off, Da Vinci guest speakers will address the complex rules and explain their significance in moving forward with FHIR APIs to seamlessly exchange information between payers and providers. CMS is awaiting March comments on the rule, and this roundtable will be a good prep for those who are preparing to comment on this landmark regulation impacting interoperability and seeking to invest in FHIR.

The Da Vinci Project’s January Community Roundtable to be held January 25 from 4:00 – 5:30 p.m. ET

With the issuance of the new federal prior authorization and attachments rule proposals last month, the innovative interoperability work advanced by the HL7 Da Vinci Project is once again being recognized as a path forward for game-changing industry transformation that will reduce burden, increase automation and improve care.

The Intersection of Federal Regulation and The HL7 Da Vinci Project, January’s Community Roundtable, features an overview and frequently asked questions about the rules and their accompanying RFIs from CMS officials. Da Vinci leaders then will share an overview of the implementation guides that are suggested in the proposed rules and how they meet the rules’ objectives.

At the January 25 session, which is scheduled from 4:00 – 5:30 p.m. ET, attendees will learn how to access the resources, participate in community feedback and start getting involved.

Opportunity in partnership with Kaiser Permanente, HL7 and others!

As grounding, the Gravity Project is a national consensus project that develops and tests data standards to represent and exchange social risk data in electronic systems. Together, with a broad collective of stakeholders, Gravity Project defines the language needed to comprehensively address social risks in clinical and community-based settings. To date, the terminology team has completed 17 social risk domains. This has included building critical screening, diagnosis, goal, and intervention concepts for food insecurity, housing instability and homelessness, transportation insecurity, and beyond. In addition, Gravity data standards are included in the United States Core for Data for Interoperability (USCDI), and their value sets serve as a reference for emerging social risk quality measures. (relevant press releases and publications)

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.

The Da Vinci Project’s November Community Roundtable to be held November 30 from 4:00 – 5:30 p.m. ET

During November's Community Roundtable, HL7 Da Vinci Project leaders representing providers, payers and EHR vendors will offer an insightful program discussing real-world implementations of Da Vinci’s Implementation Guides.

“Significant Progress: HL7 Da Vinci Project Year-end Review and 2023 Plans,” begins with a review of this year’s program accomplishments and continues with a panel of industry and HL7 Da Vinci Project leaders sharing the impact of corresponding regulations and the proven guides that reduce burden and enable efficient value-based care workflows.

In particular, they will discuss the reality and progress of Da Vinci implementations in a world where HL7 FHIR APIs are becoming the de facto norm for data sharing for clinical data exchange and prior authorization. The session concludes with a preview of the project goals and activities planned for 2023.

The Da Vinci Project’s September Community Roundtable to be held October 26 from 4:00 – 5:30 p.m. ET

The next Da Vinci Community Roundtable, to be held Oct. 26, will offer timely updates on changes recently made in the Da Vinci Implementation Guides and offer an outlook for next year.

The event, “Current State: HL7 Da Vinci Implementation Guide Progress in 2022,” will be held online from 4 p.m. to 5:30 p.m. ET.

The Da Vinci Project is a private-sector initiative that accelerates the adoption of HL7 Fast Healthcare Interoperability Resources (HL7® FHIR®) as the standard to support and integrate value-based care (VBC) data exchange across communities. The goal of the project is to help payers and providers positively impact clinical, quality, cost and care management outcomes, enabling providers to see the right data at the right time for patient-centered care.

Background

The Biden-Harris Administration will host the White House Conference on Hunger, Nutrition, and Health on September 28, 2022. In addition to announcing a national strategy to address the intersections between food, hunger, nutrition and health, the Administration has issued a call for stakeholder commitments along five pillars, including the “integration of nutrition and health.”

We seek to better integrate nutrition information within a patient’s electronic health record (EHR) by accelerating a standards-based approach to implementing universal social needs screening. With the final CMS IPPS rule requiring hospitals to report on  social determinants of health (SDOH) screening quality measures in 2024, along with similar requirements of MA SNPs and ACO REACH model participants in 2023, we believe a multi-stakeholder effort, which should also include Medicaid agencies and managed care plans, to advance an HL7 Fast Health Interoperability Resources (“FHIR”)-based approach to meet these “functional” requirements will significantly enhance the ability of providers to meet these CMS requirements.

The Da Vinci Project’s September Community Roundtable to be held September 28 from 4:00 – 5:30 p.m. ET

As fee for service shifts to value-based care, value-based contracts have emerged as a mechanism that providers and payers may use to better align their contracting structures with broader changes in the healthcare system.

"Dive Into Performance Reporting for Value-Based Contracts,” this month’s Da Vinci Community Roundtable presentation by representatives from Humana, Providence and the Da Vinci PMO, provides you with front-row access to HL7 Da Vinci Project’s newest use case that aims to develop an HL7 FHIR Implementation Guide to support value-based performance reporting for quality and risk contracts.