The Standard

February Roundtable also features Payer Data Exchange and Burden Reduction Overviews

This week’s HL7 Da Vinci Project Community Roundtable, “HL7 Da Vinci Implementation Guides Solve Your Real-World Business Problems: Postable Remittance, Payer Data Exchange and Burden Reduction Overviews,” is scheduled for Feruary 28 from 4 – 5:30 p.m. ET. 

Da Vinci leaders will introduce the newest use case focusing on postable remittance advice and will share an overview of the Implementation Guides that are suggested in the proposed rules and how they meet the rules’ objectives.

With the issuance of the new federal interoperability rules, 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. You will learn how to access the resources, participate in community feedback and start getting involved.

The presenters will include:

• Robert Dieterle, HL7 Da Vinci Project Sr. Advisor and Burden Reduction Lead
• Naomi Miao, Business Operations Manager, athenahealth
• Mark Scrimshire, PDex Project Lead & Implementation Guide Lead, HL7 Da Vinci Project, and Chief Interoperability Officer, Onyx Health

The session is moderated by Alix Goss, HL7 Da Vinci Project PMO, and Senior Consultant, Point-of-Care Partners.

Recent Initiatives of the ONC’s FHIR at Scale Taskforce (FAST) and Update on Payer-to-Payer Mandate are Key Topics for Wednesday Event, 8/25 at 4:00 pm ET

The success of the HL7® Fast Healthcare Interoperability Resource (FHIR®) standard is becoming increasingly evident.

Successful case studies are emerging. For example, a recently published HL7 case study documents how MultiCare Connected Care and Regence are recognizing significant cost savings by using a FHIR implementation guide standard to definitively ascertain that medication reconciliation has been completed. This case study can be found at https://www.hl7.org/participate/case-studies/index.cfm .

But these isolated successes beg the question – can FHIR be used more broadly, and implemented more widely across the country, handling a multiplicity of interactions across dozens of healthcare organizations simultaneously?

That is the task given to the ONC’s FHIR at Scale Taskforce (FAST), which is seeking to determine solutions and opportunities to influence emerging solutions.

Progress by the ONC FAST effort is of prime importance to the dissemination of FHIR solutions to solve information exchange challenges in healthcare. The panel’s progress over the past year will be one of the topics of the Da Vinci Project’s monthly Community Roundtable event, to be held from 4 to 5:30 p.m. ET on Wednesday, August 25.

HL7 Da Vinci Roundtable  on July 28 from 4:00 to 5:30 p.m. ET to Feature Payer-to-Payer Data Exchange

Join the Da Vinci Project next Wednesday at its July Community Roundtable titled "Payer-to-Payer Data Exchange: Rising to the Opportunities and the Challenges." The session will focus on the use of HL7's 's Fast Healthcare Interoperability Resources (FHIR®) for payer-to-payer data exchange, highlighting the Payer Data Exchange (PDex) use case.

Presenters for the session include:

• Michael Gould, business lead - interoperability at Blue Cross Blue Shield Association
• Patrick Murta, chief interoperability architect & solutions architecture fellow, Humana
• Heather Kennedy Tanner, director of enterprise architecture, BlueCross BlueShield of Tennessee

The roundtable will feature a current snapshot of Da Vinci's efforts to create a nationwide interoperable approach among payers using PDex-based data exchange. Discover the dynamics you'll encounter in achieving payer-to-payer exchange compliance such as consent and endpoint discovery. You will gain a foundational understanding of the regulatory requirements, learn about technical and business challenges and benefits from real-world implementers, and gain insight into how the industry is working together. 

The Centers for Medicare & Medicaid Services (CMS) released the much-awaited Interoperability & Patient Access Rule in March 2020. The objective is to reinforce this rule by further improving health information exchange and obtaining member health records at a single location to reduce burden on payers, providers and members.

The enforcement date for this rule is January 1, 2023, and will be applicable to Medicaid programs, the Children’s Health Insurance Programs (CHIP) and Qualified Health Plan (QHP) issuers on the individual market Federally Facilitated Exchanges (FFEs). However, it will not be applicable to Medicare Advantage (MA) plans.

The CMS proposed rule will include policies to enhance the current Application Programming Interfaces (APIs) from its interoperability rule such as patient access API and payer to payer API. There are a few new APIs and requirements proposed to improve the overall prior authorization process.

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

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.

Presenters at the May 27 HL7 Da Vinci Project community roundtable provided concrete evidence demonstrating how the use cases represent specific ways to use HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard for specific purposes in value-based care data exchange interactions between providers and payers.

FHIR for Data Exchange for Quality Measurement (DEQM) Use Case

A clear indication of the value of the medication reconciliation process use case was provided by Kirk Anderson, chief technology officer for Cambia Health Solutions, a nonprofit healthcare organization that’s the parent company of Regence, a member of the Blue Cross Blue Shield Association. Initial efforts to use the FHIR use case with MultiCare, a Tacoma, Washington-based healthcare system, resulted in a dramatic boost in the insurer’s ability to get information on members’ prescribed medications from the provider.

Join the HL7 Da Vinci Project Community Roundtable June 24 from 4 – 5:30 pm EDT.

Due to COVID-19, most of the in-person conferences have been changed to virtual events. I recently attended my first-ever fully online technology conference, the Virtual HL7 FHIR Connectathon. This article details my experience and recommendations, in general, for all future conferences post-COVID-19.

Introduction

First, let me give my kudos to HL7 Fast Healthcare Interoperability Resources (FHIR) Product Director Grahame Grieve, the planning team, track leads, FHIR community and HL7 for the  excellent execution of  the Virtual FHIR Connectathon. The conference includes healthcare data interoperability topics with different tracks, expertise and both technical non-technical skills.

I have attended many in-person conferences in the past. Over time, I realized people attend conferences for primarily for two reasons:

1. Learning new skills
2. Networking

Let me share my thoughts based on my first Virtual FHIR Connectathon experience.