HL7 Da Vinci Project: Industry Analysis of Communications
by Jackie Mulrooney, President, J P Systems, Inc.
Healthcare IT Industry Analysis
Payer and Provider Collaboration: What it Could Mean for Your Hospital Mining Payer Data for Better Patient Care Coordination
Clinical information must move to best serve the needs of patients and providers. In all the Healthcare IT ecosystem, it is often the payers that possess access to complete patient treatment data in their claims. No one provider has all the patient data. To increase the secure sharing of clinical data between payers and providers, an initiative called the Da Vinci Project was formed under the umbrella of HL7.
Initially, an impressive array of 27 commercial firms and organizations came together in a privately funded initiative under the HL7 umbrella with the vision of making needed patient care data available in a timely manner. This project addresses the needs of the Value-Based Care (VBC) Community by leveraging the HL7® FHIR® platform to gain access to payer clinical data. Among other things, this payer and provider collaboration will accomplish is to accelerate processes such as a Medication Reconciliation Post-Discharge (MRP) and help prevent duplicate lab tests.
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HL7 Da Vinci Use Cases
Data Exchange for Quality Measures (DEQM): Medication Reconciliation Post-Discharge (MRP)
Coverage Requirements Discovery (CRD)
Documentation Templates and Coverage Rules (DTR)
eHealth Record Exchange: Clinical Data Exchange (CDex)
eHealth Record Exchange: Payer Data Exchange (PDex)
Alerts/Notifications: Admit/Discharge Notifications, Clinical, and Administrative Events
Risk Based Contract Member Identification, aka Attribution
Prior Authorization Support
Performing-Laboratory Reporting
Gaps in Care and Information
Chronic Illness Documentation for Risk Adjustment
Patient Cost Transparency
Patient Data Exchange
Payer Coverage Decision Exchange
What it could mean for you: relevant alerts when you need them!
The HL7 Da Vinci Project is a private sector initiative that addresses the need for cost savings in the Value-Based Care Community by leveraging the HL7® FHIR® platform. By giving providers access to previously unavailable plan insurance provisions, existing Lab test results, and other data, a patient’s existing clinical data can get to the next provider in the longitudinal care plan. HL7’s FHIR is an international data standard for the formatting of messages for the transmission of clinical data that will lead to better and faster processes in healthcare.
Currently many more firms than the original 27 are active in Da Vinci standards development and Use Case project work. Each payer and provider contractually agree on the data they are willing to share.
The Concept
At the annual HIMSS conference in the Interoperability Showcase, the HL7 Da Vinci Project demonstrated the ability to exchange information between payers and providers using HL7® FHIR® and CDS Hooks®. It was one of the most popular conference booths in this unique HIMSS Healthcare IT venue. An Interoperability Showcase booth demonstrates data exchanges between several organizations by following a patient’s story from symptoms of chest pains to diagnosis, treatment and follow up to demonstrate how technology can securely move needed clinical data between providers and payers according to prescribed and pre-calculated work flows, thereby improving interoperability and patient safety. Clinical Decision Support systems need high quality data fed to them in a timely manner.
The HL7 Da Vinci Use Cases
Out of thousands of possible initial Use Cases, the ones selected were prioritized around those which increased interoperability. The current Use Cases are geared to solve immediate pain points in the industry. Each Use Case will have Implementation guides produced for them. As HL7 standards are international, an Implementation Guide (IG) is needed to document exactly how you will utliize the HL7 standard in your organization. The IG then maps how an EHR would give an end user the ability to invoke various services and APIs for a Use Case. For example, automating workflows and provider notifications surrounding a 30 day post discharge medication reconciliation (MRP) will allow MRPs to be done faster. The payer can inform the Primary Care Physician (PCP) that a hospitalization has been completed. If a PCP had referred a patient to a Cardiologist, they might not even have known that the patient had been hospitalized.
In the standards development process, in addition to an Implementation Guide, a Reference Implementation (RI) or sample software program is developed for each use case. This RI is a sample implementation to be used by the IT staff as an example or pattern for creating their own software like it.
Member Firms
The number and strength of the member firms participating in the HL7 Da Vinci project work is more than impressive. It now includes sponsors and members such as Anthem, United Healthcare, Humana, Epic, Allscripts, Cambia Health Solutions, Cerner, CMS, InterSystems, Cognosante, many Blue Cross Blue Shield networks, Optum, Cigna, Sutter Health and HCSC.
Please note that this HL7 sponsored Da Vinci project is unrelated to the Federal jointly funded DOD and VA JIF Da Vinci project.
Methodology
Digital Health uses technology to help improve individuals’ health and wellness. This requires a great deal of planning and data architecture. To provide context for requirements to guide the development of HL7 international data standards, the Da Vinci Projects defines Use Cases. This allows its standards developers to focus on the core data exchange requirements which surround various types of treatment protocols. The objective is to minimize the development and deployment of unique solutions between trading partners (e.g. a payer and provider). To promote interoperability across value-based care stakeholders and to guide the development and deployment of interoperable solutions on a national scale, the industry needs common standards (HL7 FHIR) and common Implementation Guides. Here we will briefly discuss a few of the Da Vinci Use Cases and what they could mean to your hospital and to Payer / Provider collaborations in general.
Use Case: Coverage Requirements Discovery
A second Da Vinci Use Case of insurance Coverage Requirements Discovery was precipitated by the frustration experienced by administrative staff when trying to obtain authorizations for medical procedures. Each plan from a payer can differ unpredictably. Payers need to discover the documentation requirements, the rules for determining needs for treatment, and requirements of Prior Authorizations (PA) or other approvals for payer covered services and devices. A Da Vinci FHIR software app can find out in real time what the payer requirements are that could affect the ability to have services or devices covered by the payer. Thus informed directly by the payer, the providers do not have to guess at what they need to send for an authorization to be finalized.
HL7 Da Vinci Project Leadership
Dr. Viet Nguyen, the technical director of the Da Vinci Project, is an extremely capable FHIR educator and a facilitator at the HL7 ‘Clinicians on FHIR’ sessions at the HL7 Working Group Meetings. His ‘Clinicians on FHIR’ sessions at the HL7 meetings are one of the highlights of the entire conference. For Da Vinci, Dr. Nguyen works across all the uses cases, each of which has an entire project dedicated to it. The regular virtual meetings used to develop use cases have upwards of 20 to 30 people on them. For efficiency, they are leveraging the existing US FHIR core, SMART on FHIR and CDS hooks. Dr. Nguyen is joined by a who’s who of the HL7 data standards world including:
Eric Haas, Health eData Inc
Bryn Rhodes
Jocelyn Keegan, Point of Care Partners
Robert Dieterle, EnableCare
Lloyd Mckenzie, Gevity
and last but never least, Grahame Grieve
What is a CDS Hook?
“A CDS hook is a technology from SMART on FHIR that allows third-party Clinical Decision Support systems to register with an EHR using a “hook” pattern. The third-party CDS system is then able to provide the EHR with information in the form of “cards” that the EHR may use to show the end-user or otherwise interweave into the workflow. The HSPC Bilirubin system is able to use CDS Hooks to alert the EHR of babies that are at risk of Kernicterus.” In general, a CDS Hooks API supports:
- Synchronous, workflow triggered CDS calls returning information and suggestions
- Launching a user-facing SMART app when CDS requires additional interaction
(Source the Health Services Platform Consortium). The cards act as alerts to a needed step.
According to Josh Mandel, M.D., a research scientist in biomedical informatics at Harvard University and lead architect for SMART Health IT: “If you want to run an app that is going to perform a check on some aspect of the clinical data, you have to know when to run that particular app, so the advice is relevant. CDS Hooks is an attempt to help clinicians know what they should be running by running checks automatically for them ahead of time, and then providing information within context within the EHR.” (Source: interoperability-hie/blog/).
The EHR sends off notifications as relevant events happen and a card like the Bilirubin alert image is displayed to the user as a helpful suggestion. The user can control display and governance of the cards to opt to not see cards like this in the future, so they are not overwhelmed by alerts. For more information on creating or using HL7 FHIR apps, CDS hooks, or Da Vinci payer and provider communications in your organization, please contact us at [email protected] or 1 703 815-0900 or 1 703 926-5539.