1. Da Vinci Update
Defining Value Based Care Standards Between Payers and Providers
First like to thank HL7 for giving us a home to execute on this project. I’m standing here today through the hard work, openness and willingness of others to work for greater good across many barriers.
Thank you to Chuck Jafffe and Karen Van Henteryck through their leadership in creation of Partners in Interopability and long term efforst to bring payers into HL7 development the idea of was able to thrive. We’ll discuss why now, but I’d also like to acknoweldget the relationships and participation from many active payers at HL7 like LJ from BCBSA, Mike Gould from IBC, folks like Bob D to enter into discussions about how and what Da Vinci should and could be as a project.
March 6, 2018

2. The Da Vinci Project The Opportunity
to Enable
Providers
Payers
HIT vendors
Industry Cooperation
Lead the first significant initiative with payers and providers working together with their HIT vendors to solve interoperability problems
Empower providers teams to make the best clinical, quality or administrative decision at point of service, in context of their day to day workflows
Increase opportunity got provider and payers to do it right the first time -- eliminate rework where possible
Leverage HIT vendors to implement one solution for each use case --- reduces cost, complexity, deployment and support
Truly a unique opportunity at a point in time to accomplish something of meaningful change for the industry.
As more organizations shift their contract models away from FFS and begin to take on risk to show value and improve outcomes with the care they provide, Da Vinci enables all stakeholders to work collaboratively to get the right information and details into care teams hands to be able to make the best decisions for a particular patients. The goal is to move from retrospective to prospective access to critical information about patient to empower teams to make best decisions. It is time to merge what have been two distinct world and bring all the right patient specific data in a way that can scale once we get it nailed down.
Payers, providers and HIT vendors solving interoperability problems to improve patient care

3. Drive to Improve Outcomes
Background for folks not following along from home. VBC is not a new concept, but a number of activites on the regularity front is pushing it to the front for all participants in federal programs, and commercial plans are following suite. Market acknowledges we need to fundamentally change the way we pay for care, and the folks at CMS are doing a great job of starting to put the levers in place to bring organizatins across the chasm.
Source:

4. VBC Provides Necessary Alignment of Priorities
Cost Control
Patient Outcomes
Regulatory Impact
Regulatory is just one factor. We all well know priorities for the industry, but candid;y they haven’t always been aligned. With regulatory impact and cost containment, we put care providers in a difficult situation frequently to keep focus on patient outcomes.
But really, that’s why we are all here, right?
Use my primary care practice as an example and my own PHI, I live in Boston, think I’m living future state. well my kid’s, so I have two asthmatics in my house, my multispecialth. Part of early ACO, but after 2-3 ER visits with my youngest, called and scheduled us to come in, discussed what was going wrong, evaluated meds, made a change, ER free for about 5 years.
Since then, they left ACO, but practice shifted work model, this past Christmas, did all right things, following regiment and still end up 11pm ER Christmas night. Visit next day, discussed how to avoid in future, and changed emergency inhaler.
Key to me isn’t whether did “right” thing, could handled differently, but this practice has incentive alignment to fund to NP that do case/coordination, spot and look for patient’s like my then 6-7 year old and retrained me as a patient so when year later we ended up there again, I was calling, consults and advice, and looking for what tweaks and changes we needed to make and could get an appt nearly immediately in the middle of a budy flu season to see one of the NPs
SO why is this important, I live in portion country advancing, high commitment to interop, through relationship changes, left ACO, sold to local regional hospital, custom integrations are now broken and need to be rebuilt. As increasing number of the patients in a practice panel are in value based contracts it will be critically important for practices like mine to have visibility when they see me whether I’m in one of the VBC and each of these events

5. Vision & Goal Multi-stakeholder
The Da Vinci Initiative Realization of a Vision
Vision & Goal
Multi-stakeholder
Utilize best talent
High impact
Focus on implementable solutions
Agile model: learn and deliver fast
Open participation: Payers, Providers, HIT vendors and industry
Led by experts: Staffed by members and stakeholders
Promotes FHIR for VBC: Use cases selected by impact and effort
Simplify broad adoption: Concurrent development of reference implementation and implementation guide
Creatively flexible & innovative: Identify barriers early, reprioritize as necessary, minimize cycle from requirements to reference implementation
Payers, providers and HIT vendors solving interoperability problems to improve patient care

6. Objective
To ensure the success of the industry’s shift to Value Based Care there is a need to establish a rapid multi-stakeholder process to identify, exercise and implement initial use cases between payers and provider organizations.
The objective is to minimize the development and deployment of unique solutions with focus on reference architectures that will promote industry wide standards and adoption.
Components for success include (and where needed, create extensions to or craft revisions for) common:
Standards (HL7 FHIR®),
Implementation guides, and
Reference implementations and pilot projects to guide the development and deployment of interoperable solutions on a national scale. 6

7. Working with Founders to Identify Initial Sites by Use Case
Founding Members
10 Payers
3 EHRs
9 Use Cases
4 HIT Vendors
½ Dozen Providers
Working with Founders to Identify Initial Sites by Use Case

8. Define solutions for Value Based Care (VBC) use cases
Relationship Between Da Vinci & P2 FHIR Task Force
Using FHIR to Solve Payer-Provider and Provider-Provider Interoperability Problems
Solve VBC Exchange
Scope
Scale the Solution
HL7
ONC
Convener
Da Vinci
Stakeholder
Participants
P2 FHIR Task Force
Define solutions for Value Based Care (VBC) use cases
Establish FHIR ecosystems standards and best practice to allow solutions to scale nationally
Focus
Start with a VBC use case (e.g. 30-day medication reconciliation)
Define the requirements (business, technical)
Create implementation guide and reference implementation
Pilot the solution
Identity management
Security and Authentication
API discovery
Scaling solutions
Content identification and Routing
Testing and certification

9. Da Vinci and P2 FHIR Task Force Payer, Provider and HIT vendors
Using FHIR to Solve Payer-Provider and Provider-Provider Interoperability Problems
P2 FHIR Task Force
Scale Solutions Nationally
HIT Solutions
How can a payer scale this to 30,000 providers serving 3 million members
Payers/Providers
Providers
Da Vinci
Solutions to VBC Use Cases
How can a payer request and receive a response from a provider regarding 30-day medication reconciliation
(content and semantics of the messages)
HIT Solutions

10. 2018 Use Case Inventory and Project Deliverables
30 Day Medication Reconciliation*
Coverage Requirements Discovery*
Documentation Templates and Coverage Rules*
Project Deliverables
Define requirements (technical, business and testing)
Create Implementation Guide
Create and test Reference Implementation ( prove the guide works
Pilot the solution
Deploy the solution
eHealth Record Exchange: HEDIS/Stars & Clinician Exchange
Notification (ADT): Transitions in Care, ER admit/discharge
Risk Based Contract Member Identification
Authorization Support
Quality Measure Reporting
Laboratory Results
* Initial use cases 10

11. Scope of Work
Targets “Payer – Provider” and “Provider – Provider” exchanges
Leverage existing FHIR resources and identify gaps for concurrent standards development
Enable improved patient care outcomes
Empower better clinical decision making by integrating historical “administrative” decisions into the provider workflow
Open Source- Da Vinci specifications and artifacts will be made available to the community and where relevant brought into standards process at HL7 for balloting.
INITIAL FOCUS AREAS:
Agree upon short and long term use cases to support VBC workflows
Business case priorities established by Steering Committee
Ideal phase one includes one simple and one complex use case to demonstrate value of using FHIR to establish ecosystem standards vs. one-off solutions
NOTE: High membership interest and related resources could mean TWO simple use cases and initiation of a complex use case.
Goal is to promote and accelerate FHIR for data exchange required for Value Based Care Delivery (VBC) 11

12. Goal is to develop repeatable production focused projects
Project Artifact Definitions
Implementation Guide (IG)
A specification that defines how the capabilities defined by the FHIR specification are used in particular data exchanges, or to solve particular problems (adapted from the HL7 FHIR Foundation Implementation Guide Registry (
Reference Implementation (RI)
A reference implementation is, in general, an implementation of a specification to be used as a definitive interpretation for that specification . During the development of the ... conformance test suite, at least one relatively trusted implementation of each interface is necessary to (1) discover errors or ambiguities in the specification, and (2) validate the correct functioning of the test suite.[1]
Characteristics of a Reference Implementation:
Developed concurrently with the specification and test suite;
Verifies that specification is implementable;
Enables the test suite to be tested;
Serves as a Gold Standard against which other implementations can be measured;
Helps to clarify the intent of the specification in situations where conformance tests are inadequate
Goal is to develop repeatable production focused projects

13. x Draft Timeline Phase 1* Use Case 3 Use Case 2 Use Case 1
Program Start Up
Dec
Jan
Feb
March
April
May
June
July
Aug
Sep
Oct
Nov
Dec
Establish Project
Test Use Case 1 Concepts
Test Use Case 3 Reference Implementation
Test Use Case 1 Reference Implementation
Test Use Case 2 &3 Concepts
Prelaunch
Use Case 1
Use Case 2 13
* Pending use case approval and SOU agreement/funding
Use Case 3

14. Project Timeline (small fast project)
Plan on 2 week sprint cycles
Represents 4 weeks
2-4 sprints
IG Development
Specify profiles, …
IG Framework
Create Draft IG
Revise and Finalize IG
FHIR Gap Analysis
Assemble Team
Requirements
RI Tech Approach
Project start
Build Initial RI
Test RI
Update Final RI
RI Development
Build Data Set
Build Test Set
Week

15. HIMSS18 Events Topic Location Time Speaker Audience
Da Vinci: The Art of Value-Based Care
HL7 Booth #5623
Tuesday, March 6
9:40 -10:10 am
Viet Nguyen, MD
Public
Payer Provider Panel Discussion
HIMS18 Interoperability Showcase
Wednesday, March 8
11:30-12:30pm
Lenel James, BCBSA moderator
Dr. Rab, CMIO, Rush Medical
Kirk Anderson, CTO, Cambia Health
Mark Gingrich, CTO, Surescripts
Thursday, March 8
3:00 – 3:30 pm
Jocelyn Keegan 15

16. Da Vinci Project Manager Payer Practice Lead Point of Care Partners
Jocelyn Keegan
Da Vinci Project Manager
Payer Practice Lead
Point of Care Partners
(781)
Viet Nguyen, MD
Da Vinci Technical Director
Founder
Stratametrics
(801)