The HL7 Da Vinci Project’s August Community Roundtable to be held August 24 from 4:00 – 5:30 p.m. ET
Da Vinci’s Community Roundtable returns after a summer hiatus with a powerful program highlighting a real-world implementation of Da Vinci’s Prior Authorization Implementation Guides.
“Celebrating HL7 FHIR's Success: From Champions to Prior Authorization Implementers,” will begin with a program update and brief recognition of the 2021 HL7 Da Vinci Community Champions, showcasing individuals making significant contributions to advancing value-based care by leveraging HL7 Fast Healthcare Interoperability Resources (FHIR®) and making the outputs of Da Vinci real.
After the updates, representatives of the 646-bed health system UC Davis Health, the 25.4-million-member payer Centene, and technology solutions vendor InterSystems will discuss their Da Vinci prior authorization journey and the benefits achieved to date.
Presenters for next week’s session include:
- Howard Cohen, Director, Advanced Technology Team, Centene
- Michael B. Marchant, Director, Health Information Exchange, UC Davis Health
- Lynda Rowe, Senior Advisor, Value-based Markets, InterSystems
- Mahesh Siddanati, Vice President, Digital Solutions and Product (Regulatory and Quality), Centene
Attendees will hear first-hand accounts of the considerations, challenges and benefits of working together to establish infrastructure to streamline prior authorization workflows, remove latency and enable real-time data sharing.
The Da Vinci Project’s April Community Roundtable to be held April 27 from 4:00 – 5:30 p.m. ET
Why does interoperability require governance? Find out at this month’s April HL7 Da Vinci Community Roundtable.
This month’s session, Effective Interoperability Governance: The People, Processes and Data, features multiple vantage points to approaching interoperability governance and its complexities in our HL7 FHIR API landscape around people, processes and data.
Learn about the meaning of governance and the importance, challenges and lessons learned when applying these guardrails from four different perspectives: an Accountable Care Organization, an academic medical center, a payer and an IT vendor. Critical considerations around process controls, systems and frameworks will also be addressed.
Presenters include:
- Michael Gould, Business Lead – Interoperability, Blue Cross Blue Shield Association
- Michael B. Marchant, Director, Health Information Exchange, UC Davis Health
- Charlotte Morris, Data Governance Program Director, MultiCare Connected Care
- Lukasz Nosol, Senior Director, Software Development - Enterprise Clinical Integration and Interoperability, Optum
The healthcare industry is in a state of rapid innovation. From aggregated health data apps to telemedicine and digital front doors, the pandemic has propelled consumer demand for innovative and enhanced healthcare solutions. Additionally, The Centers for Medicare and Medicaid (CMS) and The Office of the National Coordinator for Health Information Technology (ONC) mandates on interoperability and HL7 Fast Healthcare Interoperability Resources (FHIR®) have accelerated this innovation by helping bring multiple healthcare stakeholders together to provide better access to quality health data across the board.
Within this context, digital healthcare interoperability has now become a digital supply chain challenge as healthcare providers must retrieve data or information from systems of record, such as electronic health record (EHR) systems, into destination systems and consumers across multiple organizational boundaries while ensuring security and data privacy.
The pandemic taught us that innovation is key in healthcare - organizations with unique digital experiences thrived while those that struggled to adapt suffered. Consumer expectations have also soared in recent years as patients and members expect a frictionless digital experience from their healthcare organizations and access to their data across the healthcare ecosystem. Interoperability - the ability to share the right data across stakeholders, is a key, if not the most important, building block of this movement.
From digital check-ins to connected devices and telehealth programs, patients expect the benefits of a more digitized healthcare experience.
At the same time, they’re also demanding a more personalized approach from healthcare providers. This duality - the need to provide a more convenient experience with one that’s more tailored to the patient - is fueling a wave of technology modernization efforts and the replacement of monolithic legacy IT systems.
With limited re-use outside of the context they were built for and a reliance on nightly batch processing, legacy IT systems fail to deliver the services healthcare IT teams need or provide the experiences patients demand. Modernization should come with a move to microservices that can be used by multiple applications, agile teams that embrace domain driven design principles, and event busses like Kafka to deliver real-time data and functionality to users.
While this transformation is occurring, there’s an 800 lb. gorilla not being widely addressed: Analytics.
What the healthcare industry doesn’t want to talk about is how costly analytics has become; the people, the software, the infrastructure, and particularly how difficult it is to move data in and out of data lakes and warehouses. It's hindering the industry’s ability to deliver insights to patients and providers in a timely and efficient manner.
And yet, so many organizations are modernizing their analytics data warehouses and data lakes with an approach that simply updates the underlying technology. It’s a lift-and-shift effort of tremendous scale and cost, but one that is not addressing the underlying issues preventing the speedy delivery of meaningful insights.
Federal health agencies have entered an era where data interoperability-enabled solutions play a critical role. Government leaders can harness the innovative and proven capabilities referenced in this article to deliver on their essential missions.
Background
In 2020, two major events laid the foundation for this era of interoperability.
Pandemic Response: The first was the coronavirus pandemic, which led to unprecedented needs for health data in support of agency missions. Since its start, decision-makers have required more access to and insights from these data (e.g., clinical records, administrative claims, patient experience) than ever before.
Interoperability Rules: The second was the finalization of the ONC and CMS-led 21st Century Cures Act interoperability rules. These mandates substantially expanded agencies’ ability to leverage health data solutions (e.g., algorithms, applications, and automation) at scale.
Those of us who have been in healthcare a long time know that prior authorization can been a challenge for both payers, providers, and patients. One might think it’s time to remove prior authorization altogether, but until we have consistent clinical practice across the entire US healthcare system, it’s very hard to justify.
The current processes create a huge burden for providers and payers, and cause delays – sometimes critical – in patient care.
Why is prior authorization such a thorny problem[i]?
- Prior authorization issues contribute to 92% of care delays
- Nearly all of provider care delays are associated with inefficiencies and administrative issues with current prior authorization
- Providers take 6 hours on average to complete these requests, which is the equivalent of two business days. Thirty-four percent of providers have staff dedicated exclusively to completing prior authorizations.
- The prior authorization process costs $23 to $31 billion per year in the US, according to a 2009 study published in Health Affairs.
- The health plan cost per manual prior authorization is $3.68, compared to $0.04 per electronic prior authorization, according to a 2017 Chilmark Research report.
Whether Attendees are Novices or Experts on Implementation Guides, Education Will Increase Knowledge and Build Community
Communicating the value of HL7’s Fast Healthcare Interoperability Resource (FHIR®) in healthcare isn’t always easy. Do you tell the story in purely technical terms? Describe the problems it’s intended to solve? Or offer examples of where it’s providing benefits?
The upcoming Da Vinci Education & HL7 FHIR Implementation Event addresses all of those questions for a variety of audiences.
The presenters at the virtual event, scheduled for the week of April 26 to 30, will explain the sense of urgency that underscores the need to accelerate adoption of FHIR-based use cases. They will also provide real-world context to show that these use cases are not just a theoretical construct, but are providing immediate benefits to those organizations that are using it to power the shift to value-based care.
The adoption of FHIR is picking up speed because of this growing recognition of its benefits in reducing clinician burden, improving the exchange of quality measure data and enabling real-time access to data by patients, providers and payers. The adoption of FHIR-based use cases also provides a way for organizations to meet federal rules governing interoperability and patient access to their medical information.
Program Showcases Individuals Making Significant Contributions to Advancing Implementation Guide Use
Initiatives such as the Da Vinci Project make strides toward interoperability as organizations adopt the vision and push it forward to reality
To achieve the progress the HL7 Da Vinci Project has made to date, it relies on the extraordinary efforts of individuals who consistently work to advance the organization’s goals. This might entail stepping forward to lead a work group of peers, spending extra hours editing and reviewing work in progress workflows, recruiting business partners to test early versions as early adopters, or scouring their organization to find the right subject matter expert for a particular business challenge or question, all to ensure that early HL7 Fast Healthcare Interoperability Resources (FHIR®) implementation guides work.
These team members exemplify the spirit and intent of our collaborative industry-first Da Vinci efforts, said Jocelyn Keegan, program manager for the Da Vinci Project. “The work of Da Vinci is, at its core, a human powered effort,” she noted. “It is imperative that we publicly acknowledge the contributions of the smart, dedicated thought leaders who are redefining how payers and providers collaborate.”
To recognize individuals who are taking a lead role in working to make the outputs of Da Vinci real, the project has named six leaders as the initial class of the Da Vinci Community Champion program for their contributions in 2020.
With the ascent of value-based care, interoperability is expected to evolve at an even faster pace to meet the business demands that new reimbursement incentives are producing.
Monthly Event is Scheduled for 4:00 to 5:30 p.m. ET on Wednesday, March 24, 2021
Advancing the use of HL7’s Fast Healthcare Interoperability Resources (FHIR®) takes both strong proponents advocating for the cause and pioneering organizations that lead the industry by putting concepts into practice.
Both aspects important to FHIR adoption will be on display at the March Community Roundtable of the Da Vinci Project, scheduled for Wednesday, March 24, from 4 to 5:30 p.m. ET. The roundtable has become a staple of the Da Vinci Project’s efforts to highlight successful deployments of its implementation guides, intended to help healthcare organizations manage value-based care initiatives.
MiHIN Shares Lessons Learned with Plan-Net
An example of a real-world implementation will be provided by the Michigan Health Information Network (MiHIN). A team from the organization will share lessons learned from its deployment of Plan-Net, the Payer Data Exchange (PDex)-Plan Network Directory Implementation Guide that focuses on Payer-Provider Directories. FHIR offers the potential to automate this typically manually intensive process for all parties, and MiHIN will describe its journey to putting the implementation guide into place to achieve this.