For those institutions and individuals who have been working in the healthcare interoperability space for years (and for some of us decades) FHIR can be viewed as a natural and welcome evolution of the standards, and an evolution that brings with it many benefits we have sought for years.
ANN ARBOR, Mich., Sept. 5, 2018 /PRNewswire/ -- Over 20 health care companies have formed the Da Vinci Project, a private-sector initiative that is leveraging HL7 Fast Healthcare Interoperability Resources (FHIR®) to improve data sharing in value-based care (VBC) arrangements via two initial test cases.
Stakeholders clearly understand the criticality of working together to define a common set of standards that can be implemented on a national basis. The project will minimize the development and deployment of one-off solutions between partners with a goal to help medical groups and health plans better deliver on clinical quality, cost and care management outcomes. The HL7 FHIR technology enables easier sharing of health information across plans and practices, reducing duplicative tests and supporting better health outcomes.
Da Vinci Project Founders and Governance
The Da Vinci Project was founded by the following health plans, care providers and vendor organizations: Allscripts, Anthem Blue Cross and Blue Shield, Blue Cross Blue Shield Association, Blue Cross and Blue Shield of Alabama, Blue Cross of Idaho, Cambia Health Solutions, Cerner, Cognosante, Edifecs, Epic, Health Care Service Corporation, Health Level Seven (HL7) International, HealthLX, Humana, Independence Blue Cross, Optum, Rush University Medical Center, Surescripts, UnitedHealthcare and Zeomega. For a full list of members visit: http://www.hl7.org/about/davinci/members.cfm.
The Da Vinci Project, hosted by HL7 International, operates independently but collaborates with HL7 work groups to ensure feedback into FHIR standards. As a founding member, HL7's leadership team provides critical support to ensure, where appropriate, that the project's implementation guides will be balloted through the HL7 process to become open industry standards.
Chief Information Officer, Rush System for Health and Rush University Medical Center, Dr. Shafiq Rab said, "Da Vinci is a collective initiative of concerned, diverse market leaders that include payers, providers, HL7 and EHR vendors that understand how critical it is to put forward and employ standards that promote data exchange in real time. These efforts will enable data to be available at the right time to the right person every time securely.
"This level of collaboration across payers and providers is unprecedented and will have a tremendous impact on how we use data to improve health care while keeping the architecture simple. Da Vinci members are selecting the most relevant use cases that will showcase the effectiveness of its solutions. The initial success has been over joyous, and I believe that such act of selflessness is what our nation needs," Rab said.
The founding member organizations have established a formal governance model for Da Vinci, which includes both steering and operating committees. The Da Vinci operating committee is responsible for the project's day-to-day activities. The steering committee approves recommended business case priorities, consultant resources, contracts required and obligations necessary to complete projects based on the recommendations received by the operating committee.
Sagran Moodley, UnitedHealthcare senior vice president of Clinical Data Services and Technology, serves as the chair of the steering committee. Jocelyn Keegan, payer practice lead at Point-of-Care Partners, acts as the Da Vinci program manager. Dr. Viet Nguyen, founder of Stratametrics, serves as the project's technical director.
"We are thrilled with the initial participation and interest in the work of the Da Vinci Project. The support demonstrates the shared understanding from industry stakeholders that health plans and care providers need to have in common and well-defined ways to exchange critical data in order for the focus on value and outcomes to succeed," said Keegan. "We believe the flexibility and specificity of HL7 FHIR and its underlying resources will enable our partners to define targeted use cases to power standard-based approaches to share the minimal data required by these new contracts and partnerships."
Da Vinci Project Use Cases
To promote interoperability across VBC stakeholders and to guide the development and deployment of interoperable solutions on a national scale, the industry needs common standards such as HL7 FHIR, implementation guides and reference implementations. The Da Vinci Project has identified two initial use cases currently underway:
30-Day Medication Reconciliation Medication reconciliation programs can reduce the incidence of adverse drug events after discharge. The objective is to create a simple workflow that enables care providers to indicate a 30-Day Medication Reconciliation was done for a specific patient on a specific date.
Coverage Requirements Discovery Coverage discovery enables care providers to request and receive information on health plan coverage requirements at point of service.
"Value-based care promotes better patient results at lower costs, and it relies on timely data sharing between doctors and health plans," said Moodley. "The associated data-sharing capabilities support physicians in a number of ways, including enabling them to see patients' benefits in real time, improving medical record exchange and reporting, informing clinical decisions at the point of care, and helping them reduce administrative burden."
Significant progress was made on the initial use cases at a project meeting in Cleveland, April 30-May 1, 2018, and subsequent sessions in Cambridge, Massachusetts, June 21-22, 2018. The Da Vinci team received project scope statement approvals at the May HL7 International Conference and Working Group Meeting and has submitted the initial drafts of the implementation guides in the current September 2018 ballot cycle. The team will bring the initial implementation guides and reference implementations for use at the September HL7 FHIR Connectathon in Baltimore.
About the Da Vinci Project
The Da Vinci Project is a private sector initiative comprised of industry leaders and health information technology technical experts who are working together to accelerate the adoption of HL7® FHIR® as the standard to support and integrate value-based care (VBC) data exchange across communities. The core focus of phase one of the project is to deliver implementation guides and reference software implementations to the public for data exchange and workflows necessary to support providers and payers entering and managing VBC contracts and relationships.
To learn more about the Da Vinci Project, visit www.HL7.me/davinci.
About Health Level Seven International (HL7)
Founded in 1987, Health Level Seven International is the global authority for health care information interoperability and standards with affiliates established in more than 30 countries. HL7 is a nonprofit, ANSI accredited standards development organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services. HL7's more than 2,000 members represent approximately 500 corporate members, which include more than 90 percent of the information systems vendors serving health care. HL7 collaborates with other standards developers and provider, payer, philanthropic and government agencies at the highest levels to ensure the development of comprehensive and reliable standards and successful interoperability efforts.
For more information, please visit: www.HL7.org
Before we talk about value-based healthcare, let’s first get a basic understanding of the current provider-payer-patient relationship. Traditionally, providers (physicians, hospitals, and the like) are reimbursed via a fee-for-service model. It looks something like this:
Provider bills for services (an office visit, ordering a lab test, outpatient surgical procedure, admission to a hospital) they perform
Payer pays for these services
Patients pay a portion per their health plan
Simply put, you pay for what you use. The overwhelming sentiment of providers and payers is that fee-for-service no longer works and value-based care is going to fix the healthcare system.
UNDERSTANDING THE FLAWS IN FEE-FOR-SERVICE
The fee-for-service model isn’t without flaws. Because profit comes directly from the services performed, healthcare providers may be swayed to perform more and more services, some of which are unnecessary. Have a headache? Let’s get a CT scan. It’s rare a patient will reject a physician’s orders if they deem a service necessary. But this ends up in expensive procedures, most of which could have been avoided.
More services also means a need for sick patients. Providers are not incentivized to keep patients healthy but instead to have sick patients. The more sick patients, the more office visits, labs, and procedures. This doesn’t mean that physicians are practicing in a harmful way, but it may suggest that financial incentives are improperly aligned.
DEFINING VALUE-BASED HEALTHCARE
So, what is value-based care and how does it differ from fee-for-service? The core of value-based care is a changing reimbursement model that pays providers based on the quality of care that is provided. There are several variances of this model:
Pay for Performance. An extension of fee-for-service, the provider is still primarily paid based on services plus they receive bonuses or penalties based on the quality of care provided. This model was pioneered by Medicare with the Physician Quality Reporting System (PQRS; replaced by the MACRA/MIPS program). Through PQRS, providers received bonuses (or paid penalties) as a percentage of their Medicare billings based on quality measure results. This doesn’t eliminate fee-for-service, but it does hold providers accountable for the quality of care being delivered. Plus it monitors overuse or reduction of unnecessary services by penalizing providers when those actions are not clinically appropriate (such as unnecessary imaging or prescribing antibiotics)
Bundled Payments/Capitation. While there are differences between options, the concept of these models is that a payer will pay a provider/hospital/health system one lump sum for a group or bundle of services. It is then up to the health system to deliver the care for those services. The payment never changes based on the amount or type of services actually provided which incentivizes providers to be efficient in their care delivery as they will not be paid more for extra services. This model is common for episodes of care like a knee replacement surgery.
Shared Savings. In this model providers can receive an additional payment if actual costs incurred are lower than projected or benchmarked costs. The savings are split between the payer and the provider. Medicare and Medicaid have paved the way with their shared savings program at accountable care organizations (ACOs).
Quality of care is a major component for value-based care and payments to work. In a bundled payments or shared savings model it is critical to measure quality of care being delivered to ensure that necessary services are not bypassed simply to meet spending goals.
Measuring quality of care is nothing new, payers have long been measuring quality based on claims data. Through claims analysis, payers can easily assess when certain procedures have been performed. But claims data only goes so far in helping you measure quality.
For example, if payers are reimbursing for a large group of patients that have diabetes, a claim can tell the payer if a blood sugar A1c test was performed, but it won’t tell you if the patient’s blood sugar value is under control. To effectively measure quality you need clinical data from an EHR. With clinical data, you have access to data like lab results, blood pressure values (no claim is submitted when taking a blood pressure) and social history such as if a patient is a smoker and if they are were they given cessation counseling.
This is the differentiator when it comes to value-based care: combining clinical quality data with cost and utilization data.
To successfully combine all the cost and quality data, it’s important to enable multiple systems to talk to each other. Data from claims, practice management systems, EHRs, outside labs, and so on need to be integrated to paint a full picture of value. This remains one of the biggest challenges in healthcare today.
Great strides are being made with initiatives like the new Fast Healthcare Interoperability Resources (FHIR) standard developed by HL7. FHIR is an open and free standards framework designed to ease the burdens of interoperability. Built using standards like XML and JSON with a focus on ease of implementation, FHIR looks to be a key tool in building value-based care and payment systems for healthcare providers and payers.
At HealthLX, we are proud to support FHIR and HL7 initiatives. HealthLX is a Da Vinci stakeholder working with other industry leaders and health IT technical experts to accelerate 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.
Value-based care is a critical component to fixing our healthcare system. Bringing new payment models, combined with quality measurement and population health, using standards to promote interoperability will create great change in providing better patient care.
BEDFORD, MA – June 24, 2015 – Casenet®, LLC, a leading provider of extensible care management solutions, today announced a partnership with HealthLX™ to deliver TruCare Linx™, a new integration engine solution for the healthcare market. TruCare Linx powered by HealthLX provides a proven suite of pre-built components to support the integration of TruCare to existing clinical systems including health information exchanges (HIEs) and electronic medical records systems (EMRs).
The TruCare Linx integration engine is capable of using a wide range of data message schemas to support HL7, X.12, XML and custom data mappings. The TruCare Linx Standard ADT Message Suite provides a flexible means to accept the HL7 hospital admissions, discharges and transfers (ADT) messages commonly used for care management integration. This approach enables TruCare to be deployed without being dependent on customized backend integration and enables real-time or near real-time notifications of clinical events. TruCare Linx, which is designed specifically for TruCare, can be delivered as an on-premise or hosted-software integration engine to meet the unique needs of Casenet clients.
“We are excited to be partnering with Casenet,” states Will Tesch, CEO of HealthLX and TESCHGlobal. “It is critical for us, all of us, to fully use and leverage health data that is vital to improving patient care. The power of TruCare combined with the TruCare Linx integration engine delivers unprecedented integrated care management capabilities to the care management market. This collaboration will help discover and develop better treatments while improving safety and quality in the delivery of that care.”
Effective care management is facilitated by access to timely clinical information. Understanding and managing changes in member status (such as a pending discharge from a hospital to a skilled nursing facility) allows for more effective care coordination as well as cost management. Additionally, increases to the speed and accuracy in which changes in member status (such as a move to inpatient) can be conveyed to a health plan will enable more effective management of that member resulting in better clinical outcomes and ultimately lower costs.
TruCare Linx further expands Casenet’s ability to improve care coordination between providers, care managers, coaches, pharmacists, families and members. With a single platform for utilization, case and disease management, Casenet delivers unmatched flexibility to implement, coordinate and manage clinical, wellness and quality programs. Using TruCare Linx and its current native web services, TruCare can now be more easily integrated with other systems including EMRs, HIEs, predictive modeling and analytic tools, mobile monitoring devices and collaborative care partner systems enabling a holistic view of all members. As a result, TruCare offers an unparalleled intersection of member data, clinical content, business rules and workflow which makes it unique and which raises the bar for care for all members.
“We are pleased to be partnering with HealthLX,” said Peter Masanotti, Casenet CEO. “By enabling real-time or near-real time access to data from other clinical and administrative systems via TruCare Linx, TruCare will provide care teams with a complete view of its members, enabling truly integrated care management. The result is improved care coordination, member engagement and outcomes as well as reduced time to intervention and cost.”
About Casenet, LLC
Casenet provides a comprehensive suite of extensible, enterprise care management software and services solutions for commercial, Medicaid, Medicare, TPA, provider/ACO and carve-out organizations. These solutions enable our customers to improve care coordination and the quality and delivery of care through enhanced case, disease, utilization and home and community-based services management as well as tools for total population management. Casenet supports small to very large enterprise customers that require tremendous scalability, have many lines of business with benefits that are complex and complicated to administer, and require comprehensive configuration for each targeted member population. These solutions enable organizations to meet their unique requirements and adapt quickly to changing market and regulatory dynamics, identify and target populations having distinct risk characteristics and deliver specific care management programs for those members — taking the first step toward better individual health and total population health management. For more information, visit www.casenetllc.com.
Casenet Media Contact:
Kelli L. Bravo, 781-357-2706, email@example.com
HealthLX™ (Healthcare Language Exchange) gives new healthcare software solutions instant access to comprehensive patient information and real-time analytics by linking legacy data, applications and processes with modern approaches to application integration. The HealthLX platform is built around a software integration engine that is specifically designed for the interoperability needs of the healthcare industry bridging older legacy systems to newly acquired solutions. HealthLX simplifies the effort and cost of new solution integration by configuring application (HL7, X.12, HIPAA) connectors to meet unique client needs. Designed with enhanced levels of transaction monitoring and security the integration platform ensures message integrity and delivery. HealthLX implementation services are provided through its parent company, TESCHGlobal - an experienced healthcare-focused professional services firm specializing in enterprise integration and business intelligence. For more information, visit www.healthlx.com.
HealthLX Media Contact:
Learn more about TruCare®
Request a demonstration and find out how TruCare can improve your member health
Patients and care providers are missing opportunities to improve people’s health and welfare when information about care or health status is not easily available. It is critical for us, all of us, to fully use and leverage the health data that is vital to improving patient care. Doing so will help us discover and develop better treatments while improving safety and quality in the delivery of that care.
HealthLX is pleased to announce its selection by HL7 International and the Office of the National Coordinator for Health Information Technology (ONC) as runner-up entrant in their C-CDA Rendering Tool Challenge.
HL7's Consolidated Clinical Document Architecture (C-CDA) standard defines structure and semantics for the exchange of clinical documents by healthcare providers and patients.
This challenge aims to alleviate clinician frustration with the usability of C-CDA documents.
While this information is critically important to the delivery of high-quality care and timely decision making, the wide variety and volume of data contained in these documents creates a challenge for clinicians who need to sort through this data effectively and quickly.
To rapidly address this problem, this challenge was created to develop an effective C-CDA viewer which can rapidly optimize the usability of this critical information.
As runner-up in the C-CDA Rendering Tool Challenge, HealthLX is to be awarded $5,000 by HL7 International for its submission.
"I could not be more pleased with the performance of our team" stated HealthLX CEO Will Tesch. "Our team responded to HL7's challenge in 30 days and competed against 45 other entries.”
Our C-CDA viewer entry, "Patient Insight 1.0", addresses improvements in three critical usability areas:
Viewing and interacting with large amounts of CCD information
Viewing multiple source schemas (EHR specific, standard, and nonstandard schemas) in one programmatic interface
Create the resulting solution with open source technology.
As a result, CCD information can be of much higher value to clinicians and care managers in delivering care to patients and members from both quality and time perspectives.
HealthLX will be including “Patient Insight 1.0” as an important care management addition to its HealthLX Healthcare Service Bus (HSB) integration and data management solution and will issue a separate press release regarding its availability.
ABOUT HEALTH LEVEL SEVEN
Founded in 1987, Health Level Seven International (HL7) is a not-for-profit, ANSI accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services. Learn more at ttp://www.hl7.or.
ABOUT HEALTHLX, INC.
HealthLX, offers a full integration solution set designed for Healthcare software solution firms to bridge the gap of interoperability and innovation, necessary to enable them to quickly implement their solutions in diverse environments. HealthLX’s solution set includes open source integration software that creates and manages connections and dataflows, integration consulting and connectivity services, and solution management. For Healthcare software solution firms that want to make integration a differentiator, visit ttps://www.healthlx.co.
The way healthcare data is organized today is highly complex and not change ready. There is little to no governance which leads to multiple truths, broken systems, and maintenance and upgrades that can be extremely costly.
Specialization and increasing industry change are forces that continue to contribute to the problems of connecting applications and their data. Whether you are a local or state government, public health organization, healthcare provider or payor, the exchange of clinical information will be critical to meet both regulatory and business viability in the future. Unstable data systems create an environment where both personal security and compliance can easily be breached and we need to avoid this at all costs.
Your future, along with the future of today’s healthcare recipients, depends on choosing the right integration governance solution that efficiently creates and manages intelligent integrations, adequately manages those integrations, and effectively manages and monitors ongoing dataflow.
Doing our part to make a difference in our data-complex world, we developed a revolutionary healthcare product, HealthLX (Healthcare Language Exchange), that was designed with three critically important integration governance capabilities:
Integration connectivity that supports a broad level of service orchestration and data integrity between source and target applications.
Effective HIPAA compliant security between systems supporting enterprise-wide auditability and application service level management.
Monitoring and management of dataflow at the transaction level for enhanced visibility for system-wide performance measurement.
Creating Integrations: HealthLX leverages modern integration best practices and Open-Source technologies to create intelligent connectors that interface source data and external APIs. As a result, creating new integrations is easy and repeatable.
Managing Integrations: Existing connections need to adapt over time to changes in data sources, API’s and functional applications. Because connections are mapped inside the HealthLX integration hub, updating and changing integrations is easier to accomplish.
Managing Dataflow: HealthLX’s management dashboard provides an audit trail of every transaction that passes through it and flags failed transactions providing high levels of security and compliance.
CONNECTING THE WORLD, ONE INNOVATION AT A TIME.
It might seem daunting, since transaction and data integration may not be in your wheelhouse, but potential prospects and customers are looking to you for integration leadership.
If you are selling software solutions into the healthcare market, you are selling into a crowded and growing space. Decision cycles get extended, pricing pressures are greater, and the need to interoperate with external systems and data sources is more complex than ever. In addition, integration's rapidly growing importance is moving the market to a much more prominent role in selections and negotiations.
Being in a position to see a number of in-flight software deals, I can assure you that now is the time to turn integration into a competitive advantage for you and your solution.
Here are some recommendations for making this happen:
Start by making integration a part of your early-stage qualification process
Be prepared for one or more of your competitors to make integration an issue
Prepare yourself to be the competitor that uses integration to create competitive advantage
These are fearful propositions because integration may not be a strength for you or your organization, it may slow down the sales process, and your prospective client may not be giving signs that it's a big deal.
Tips on getting started down the path of integration leadership:
Understand that nobody has all the answers or solutions - so nobody expects you to know or have all the answers
Discover who the thought leaders and forces are that are bringing integration to the forefront (see Will Tesch's latest blog entries for ideas)
Determine who in your organization has the most integration knowledge and spend time with them to gain additional insight
Our experience shows that knowledge and understanding are key elements to becoming an integration leader. Remember, your clients are looking to you for solutions and integration leadership plays a big role in gaining that competitive advantage.
Another enormous HIMSS event came and went. To those that frequent these trade shows, there's always a challenge to cover the floor because of size. This year we walked our miles with the Apple Health App capturing our steps. Reviewing my phone now, I posted nearly 15,000 steps a day at the event. Yay for me! Now what do I do with this information? Therein lies the underlying reality of Healthcare in 2016. I wonder if this same question has been asked for many years except now there's just more data available. In a small way there is a good analogy here.. I saw this same thing at HIMSS16. There is an inevitable chasm our healthcare economy sees between new data and what we should do with it. But, I digress...this post isn't about this new data, instead...it's about how it has value and who will care about this new information in the future so I can help others care for me. Enter in one of the buzziest words of the past few years and the loudest buzz of this year 'Interoperability.' Interoperability has been around for years. So, what happened this year that is different than the past years? Is heightened volume this year a barometer of sorts for the industry truly thinking innovation-like across systems? I think the answer to these questions is 'yes,' but requires some tangible, realistic truths about the momentum before we get excited. So, here's some metadata.
The Office of National Coordination (ONC) announced a plan to accelerate the FHIR standards by way of engaging the private sector in a contest of sorts. Details here.
There was a 'industry-wide interoperability' pledge. Not just any loosey-goosey commitment, but a statement that became a chorus around stated direction for interoperability 'standards.' Could it be?
On these three topics, some added insight...
Karen DeSalvo's session on Tuesday, March 1, was a leading indicator that the ONC and the harmonizing effort around the ONC Interoperability Roadmap released last year is proving to be a common theme for the interoperability movement. At a high level, the vision of the Roadmap is a future state that empowers the consumer by putting the patient as the essential target metric to determine what interoperability success will be. The players to meet this consumer-centered future are going to need encouragement politically, financially and ethically. Without these external forces, the industry will continue to languish because of these Triple-Aim purpose or raison d'etre. Notwithstanding, applause should be given to the ONC for providing a means for moving forward. In and of itself, this has not happened with broad adoption across the players within the Healthcare industry. Well done, Ms. DeSalvo.
Another development that was announced at the beginning of the conference by Sylvia Burwell, Secretary of Health and Human Services, was the 'pledge' by the private sector to provide broad adoption of Interoperability across systems. The big three EMR systems that were referenced during her Keynote opening remarks were Cerner, Epic and Meditech, with other leading vendors that have recently followed for the pledge. I couldn't recall where there existed an almost counter-intuitive theme that corralled proprietary vendors to commit to a cooperative effort in how to share data before. Could this be a turning point in the healthcare industry? I was part of the standards movement in the 90s for the retail industry supporting cross-platform standards. I recall the same issue existed then between proprietary POS platforms. Back in the day, IBM, NCR and others eventually joined hands to have backoffice systems talk to each other. Voila, this became the birth of computer-managed inventory and massive foundational improvements in the Supply Chain for retail. There is a natural and inevitable transition happening with EMR application vendors as well. So, everyone...let's define the rules to play nice together. Wait...let's start by making a pledge to define the rules to play nice together. Check that one off the list. Let's see where this goes.
While at the show, my preference is to work the dark alleys or slow-moving corners of the event. Who's in the first row and hardest to get to? Where's the back of the show? That's where I go. So, what did I find this year? Save for the HL7 booth, which was centrally located at the show, the other 'standards' bodies were on the fringe or in hidden poorly lit corridors. I suspect this is due partly because they don't have the gazillions of dollars that other large brands have to market their wares. Instead, they are the collaborative nice people hoping that their ideas are heard and agreed to by those heavy hitters in the main thoroughfares of the show floor. I wonder...who is more interested in a community agreement about how to share information? The big dogs, or the crafty smaller groups. I would submit, the clever, quiet ones who have the smaller lecture settings but pack in the brightest minds to overcome policy, workflow and technology challenges. I witnessed an interoperability prototype conducted at the Sequoia Project booth. The demonstration was a live health data sharing exercise using carequality members. Systems touched included eClinicalWorks, Epic, NextGen and Surescripts. Essentially. the demo collected pertinent information from each of these systems in real-time; or as best a closed-loop demo can illustrate. The fact that each of these system connections was moving data, enriching payloads and collaborating with credentialed and secure connectivity was the value of the demo. Were there oohs and ahhs in the audience? No, not really...but for those contributing minds, there were smirks of achievement that gave all of us another glimmer of hope that solutions are on their way.
There was certainly more at the show than I was able to cover. But, for me, I've learned that its best to unleash the bloodhound in each of us to track down our passions. Mine is trying to glue ugly systems together. Why? As a human race, we can't advance without talking to each other clearly and timely. So, until next year, HIMSS...thanks for keeping the 'interoperability' theme front and center in this industry.