One of the most efficient ways to exchange data among providers and payers for prior authorization and other purposes is by taking advantage of standard application program interfaces (APIs) and a central hub to avoid manual processes and support of point-to-point interfaces.
The HL7® Da Vinci Project’s new Trebuchet pilot program, launched earlier this year, is enabling additional pioneers to test that approach.
Trebuchet was created when Da Vinci members Regence, MultiCare Connected Care, and Blue Cross Blue Shield Arkansas sought ways to pilot Da Vinci use cases on the emerging TEFCA framework. They contacted multiple Qualified Health Information Networks™, or QHINs™, to gauge their interest in joining the pilot. eHealth Exchange joined the effort to perform the QHIN functions and provided valuable project management support.
The team named the coalition “Trebuchet” to illustrate how the success of a third-century military catapult could inspire providers, payers, and a QHIN to accelerate trusted and scalable exchange.
As efforts advanced and participants increased, Trebuchet asked Da Vinci to take over project management. Now a priority project adopted by Da Vinci, Trebuchet is proving how eHealth Exchange’s nationwide trust model and “Networked FHIR” architecture rapidly deploy Smart-on-FHIR Prior Authorization and Clinical Data Exchange (CDex) at scale
“Representatives of the Da Vinci members and industry participants are working collaboratively to improve healthcare data exchanges in support of patient care by piloting Da Vinci Project Implementation Guides (IGs), providing a path toward production use,” says Alix Goss, HL7 Da Vinci Project program manager.
Participants are using APIs that leverage HL7’s Fast Healthcare Interoperability Resources® (FHIR®) standard to exchange data via a QHIN, as called for in the Trusted Exchange Framework and Common Agreement, or TEFCA, to maintain trust.
If QHINs prove to be successful, they could connect to each other to enable the sharing of healthcare information from coast to coast. That would be the equivalent of a “new electrical grid” for healthcare that would allow providers and payers to “innovate off of a new maturity level and infrastructure,” says test participant Anna Taylor, associate vice president of Population Health and Value Based Care at MultiCare Health System in Washington state.
So far, the HL7 FHIR implementation guides (IGs) developed by Da Vinci being tested in the Trebuchet program include Clinical Data Exchange (CDex), Member Attribution (ATR) and three prior authorization IGs: Coverage Requirements Discovery (CRD). Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS). Plans call for testing soon the Provider Access API as part of the Payer Data Exchange (PDex) IG, and other use cases may eventually be tested over the coming year.
“The value of the pilots is to work with data exchange partners to implement Da Vinci IGs in real-world scenarios,” says Michele Galioto, project management support to the Trebuchet Project and senior consultant with Point-of-Care Partners.
Michael Westover, vice president of data partnerships and informatics at Providence, describes why his organization is participating in the pilot project: “We joined the Trebuchet meetings because they connected us with health plans, providers and technology vendors who had practical expertise and who were working through the same challenges we faced. They helped us decide which use cases to pursue and which health plans would be engaged partners.”
Westover says that through Trebuchet, “we found a network of friends who know more about modern healthcare interoperability than just about anyone in the world. It’s a forum where we can build common ground with health plans and technology vendors. The work we’ve done through Da Vinci and Trebuchet has had a meaningful impact on our value-based care contract performance and our ability to share clinical information with health plans at scale.”
The Da Vinci Project’s participation in Connectathons is one aspect of Trebuchet testing that enables participants to work on exchanging limited test data using FHIR APIs on a small scale to get their feet wet, Galioto explains.
“In the Trebuchet pilots, you have an opportunity to plan how your organization will implement an IG, and which data you will exchange with business partners/exchange partners, to implement FHIR IGs to support meeting regulatory requirements as well as organizational needs and goals,” she says. “Pilots offer an opportunity to learn from partner organizations, fail fast and adjust to move toward success.”
A list of the Trebuchet participants and the projects they are working on is available here: https://confluence.hl7.org/display/DVP/Da+Vinci+Trebuchet+FHIR+Pilots+Goal+Tracker
Prior Authorization Final Rule
The final version of the federal Interoperability and Prior Authorization Rule requires many payers to use FHIR APIs for prior authorization transactions and other patient data exchange.
The rule, which has a compliance date of January 2027, does not, however, require the use of a TEFCA-defined QHIN. Organizations can opt to use FHIR APIs for point-to-point data exchange instead.
Regence, a payer organization with health plans in Idaho, Oregon, Utah and Washington, is working with eHealth Exchange in the Trebuchet project to test using the FHIR APIs, says Kirk Anderson, says Regence’s CTO. In addition to prior authorization transactions and clinical data exchange, Regence will test the Provider Access API.
Earlier, Regence partnered with MultiCare Health System to test point-to-point prior authorization data exchange using FHIR APIs. Da Vinci released a report on that project, which was conducted under a HIPAA exception.
Anderson says the Trebuchet project is valuable because it gives participants the opportunity to influence processes that will be adopted in using the TEFCA model for FHIR-based exchanges (see: https://rce.sequoiaproject.org/three-year-fhir-roadmap-for-tefca/).
“Early adopters will have a voice in setting what become the standard operating procedures,” he says. “Trebuchet also provides a test bed for multiple providers and payers to validate the FHIR APIs that the federal regulators are mandating are, indeed, going to work as they are supposed to, rather than turning them on in January 2027 [the compliance deadline] and discovering problems.”
Making Progress
Jay Nakashima, president at eHealth Exchange, says the group was “eager to show that FHIR can work at scale. We are pleased that Da Vinci agreed to take on the project. We continue to support an open and shared approach to solving payer and health exchange challenges, and the opportunity to work with even more key stakeholders to advance FHIR is exciting.”
Scott Rossignol, a consultant working with eHealth Exchange says, “We have had a ton of great conversations with new organizations and helped pave the way for others who will be following soon as they work on CMS-0057-F compliance. One major benefit of this work is watching as the industry slowly progresses toward a more interoperable future, which is a core goal of ours.”
Rossignol says that by participating in the Trebuchet pilots, eHealth Exchange has “learned a lot about how FHIR works with EHRs and what assumptions folks make when working with FHIR for the first time. This allows us to provide more proactive guidance to implementers and make their lives simpler as they start implementing the Da Vinci standards.”
Rossignol urges other organizations to test-drive FHIR APIs through the Trebuchet pilots.
“FHIR is here to stay, and you’ll either learn to use it or struggle to adapt,” he points out. “Organizations that fall behind are spending time and money maintaining old technologies that will not be suitable in the future. Organizations should get involved now so they can leverage this community of folks in the same boat as them. This will help save a lot of time and money compared to doing things on your own, and will lead to better outcomes for your business.”
For an update on lessons learned in the project, visit: https://confluence.hl7.org/display/DVP/Da+Vinci+Trebuchet+FHIR+Pilots
Get Involved
Westover of Providence says the Trebuchet project offers a practical way to get the ball rolling on shifting to FHIR APIs.
"As an employee of a provider organization or health plan, trying to jump in and use FHIR can seem overwhelming,” he acknowledges. “It’s a technical topic, and there is a dizzying number of committees and subcommittees working on different aspects of interoperability. The Trebuchet meetings are a great way to get started. They have step-by-step instructions, periodic training meetings, and many of the members are happy to share what they know.”
He suggests that those who are considering joining Trebuchet attend one of the free public calls and speak with one of the participants about how best to make progress.
Join the Next Call on December 19!
Plan to attend the Da Vinci Trebuchet FHIR Pilots meeting on Dec. 19, 2-3 p.m. ET, for a payer-focused overview of CMS 0057 and the HL7 Da Vinci Project implementation guides. All are welcome to attend, so invite your technical and non-technical colleagues who want to begin implementing HL7 FHIR APIs but are unsure where to start.
No pre-registration is required; join the call using the link below:
Zoom Meeting
https://hl7-org.zoom.us/j/94157013265?pwd=ZDNETlJqKzIxeWxpT09YaTNHM1RqUT09
Meeting ID: 941 5701 3265
Passcode: 724409
Join the Da Vinci Community
To learn more and join the community, visit hl7.me/davincinews.