1. Da Vinci
Program Overview
September 2018 AWG

2. Interim Antitrust Policy
ANSI Antitrust Policy
ANSI neither develops standards nor conducts certification programs but instead accredits standards developers and certification bodies under programs requiring adherence to principles of openness, voluntariness, due process and non-discrimination. ANSI, therefore, brings significant, procompetitive benefits to the standards and conformity assessment community.
ANSI nevertheless recognizes that it must not be a vehicle for individuals or organizations to reach unlawful agreements regarding prices, terms of sale, customers, or markets or engage in other aspects of anti- competitive behavior. ANSI’s policy, therefore, is to take all appropriate measures to comply with U.S. antitrust laws and foreign competition laws and ANSI expects the same from its members and volunteers when acting on behalf of ANSI.
Approved by the ANSI Board of Directors May 22, 2014
Note: always clear/include antitrust statement in a public meeting.

3. 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.
Da Vinci simply is an group of industry payers, providers and HIT partners that understand how critical it is to develop common, ideally eventual standard ways for providers and payers to exchange the critical data required for value base case to work. 3

4. VBC Programs Drive Focus to Patient Outcomes
Cost Constraints
Regulatory Impact
Enable provider to see right data at right time for specific patient coverage, benefits and care coordination
Historically, payment and coverage data completely separate from care
VALUE
We’ve all seen version of triple aim, I pause here to simply say focusing on value, really puts improving outcomes on more equal footing as following rules and cost savings.
It is critical a provider understand at point of services the specific information about individual patient, given increase complexity of coverage, networks and increasing cost to consumer in high deductible, risk sharing plans. We can no longer ask patient/providers to look at billing as a retrospective exercise, providers and patients increasingly must understand cost and quality impacts as part of clinical path. Historically, payment and coverage a separate workstream, disconnected from patient clinical care.

5. Empower End Users to Shift to Value
As a private industry project under HL7 International, Da Vinci will unleash critical data between payers and providers required for VBC workflows leveraging HL7® FHIR®
So this is a journey, not immediate change, increasingly providers and the extended care team must have access while caring for a patient, as triggers or integrated in their workflows. While the shift from Fee for Service to paying based on outcomes is a giant shift in US healthcare, this is not a US centric problem. We believe FHIR is best option at this time to get providers across this chasm.
Source: © 2018 Health Catalyst

6. Work Underway to Identify Initial Sites by Use Case
Founding Members
12 Payers
3 EHRs
9 Use Cases
10 HIT Vendors
Our initial founding group of payers, providers and HIT vendors has grown to a membership group of 27 organizations, including 12 payers, 10 HIT vendors, 6 providers and 3 EHR vendors.  Cross-functional teams are currently involved in the project to develop and deploy FHIR-based solutions that positively impact clinical quality, cost and care management outcomes.
We’ve paused on adding addition members , but all artifacts including IGs, reference implementations and pilot partners will be open source and available to public.
½ Dozen Providers
Work Underway to Identify Initial Sites by Use Case

7. 2018 Use Case Inventory and Project Deliverables
Medication Reconciliation Post-Discharge Measure*
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, with working software code)
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
Thousand of potential use cases available.
HL7 and thought leaders representing payers and CMS in coordination and working with groups like HL7 Partners in Interoperability meetings identified initial need for common workflows for Value Based Care led to identification of initial priorities. Further fleshed out with input from early founders.
Focus – Use cases looking for high volume, manual activities that would benefit from automation of portions of workflow that collect critical data to improve outcomes.
Authorization Support
Quality Measure Reporting
Laboratory Results
* In active development and testing
** Discovery and requirements underway 7

8. x Da Vinci 2018 Use Cases – Phase 1 Use Case 4* Use Case 3 Use Case 2
Program Start Up
Dec
Jan
Feb
March
April
May
June
July
Aug
Sep
Oct
Nov
Dec
Simple timeline and
Establish Project
Test Use Case 1 Concepts
Test Use Case 3 Reference Implementation
Test Use Case 1 & 2 Reference Implementation
Test Use Case 2 &3 Concepts
Prelaunch
Use Case 1
Use Case 2
Use Case 3
Use Case 4 8
* Pending final approval.

9. Goal is to develop repeatable production focused projects
Project Deliverables
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
(2) validate the correct functioning of the test suite.
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

10. Program Construct

11. Governance Structure STEERING COMMITTEE OPERATING COMMITTEE
Payers -3
Providers - 2
IT Vendors- 2
CMS* - 1
HL7 - 1
Program Manager & Technical Director
OPERATING COMMITTEE
STEERING COMMITTEE
Senior level executive, can make decisions and commit organization resources
Driving interoperability strategy within home organization and responsible for coordination with industry
Technology and business ownership to drive “business case” approval
OPERATING COMMITTEE
Budget planning and approval for “in kind” and project fees
Leader and/or influencer across home organization
Work closely/aligned with senior leadership at home organization, can queue up commitment and decisions and drive to conclusion
Understands and will own HL7 standards relationship, commitments
Roll up sleeve and problem solve use case development and inventory, priorities, details
Identify and gain access/time for “in kind” resources for priority use case work
Use Case 1 Project Lead
Use Case 2 Project Lead
Use Case n+ Project Lead 11
*CMS (Medicare Fee Service)

12. TRUE INTEROPERABILITY Build Your Organization
Pilot Use Cases - Recommend
Payer
Provider
Tools + + =
Payer
Provider
Reference Software
TRUE INTEROPERABILITY
Multiple payers working with each provider organization, using the same common software code, via FHIR is the objective of the Da Vinci pilot projects
Payer
Provider
Implementation Guide
Build Your Organization 12

13. Project Structure & Timeline
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
Work with appropriate HL7 workgroup for IG sponsorship and input

14. Use Case 1: Medication Reconciliation Post-Discharge

15. Data Exchange for Quality Measures (DEQM):
Medication Reconciliation Post-Discharge (MRP)
Acute Care
Need for provider to attest that Med Rec has been completed post-discharge
Increasingly required for HEDIS and commercial at risk contracts
Focus is to document the comparison of pre/post medication lists to avoid errors
Today done through claims processing or manual review of lists
1. Discharge Notification
Payer
2. Med Rec Need
Provider
Today’s manual and ad hoc processes are costly and will not scale. Using FHIR to unlock silos of this critical

16. Data Exchange Quality Measure: Implementation Guide
1. Submit
Use case creates a common framework for quality data exchange
Enables the exchange of raw quality measure data between quality measurement Teams and Care teams that provide patient care
Timely exchange of key data is critical to evaluate and capture quality
Future work will incorporate additional use cases
2. Collect
3. Subscribe

17. Use Case 2: Coverage Requirements Discovery

18. Coverage Requirements Discovery
Provider
Providers need to easily discover which payer covered services or devices have
Specific documentation requirements,
Rules for determining need for specific treatments/services
Requirement for Prior Authorization (PA) or other approvals
Specific guidance.  
With a FHIR based API, providers can discover in real-time specific payer requirements that may affect the ability to have certain services or devices covered by the responsible payer. 
Response may be
The answer to the discovery request
A list of services, templates, documents, rules
URL to retrieve specific items (e.g. template)
Order Procedure, Lab or Referral
Discover Any
Requirements
Payer

19. Coverage Requirements Discovery Implementation Guide
1) Based on a specific clinical workflow event:
scheduling,
start of encounter,
planning treatment,
ordering,
discharge
Provider’s send FHIR based request, with appropriate clinical context to the responsible payer
2) Payer may request additional information from the provider EHR using existing FHIR APIs
3) Payer responds to the EHR with any specific requirements that may impact the clinical decisions or coverage
Provider utilizes this information to make treatment decisions
while considering specific payer coverage requirements.
Provider requests coverage requirements from payer
Optional: request additional information
Payer responds to the request
Provider
Payer

20. Project Milestones

21. x Da Vinci 2018 Program View Actual Milestone - Public Access
Coverage Rules and Document Templates x
Coverage Requirements Discovery
Core Da Vinci Team
30 Day Medication Reconciliation
Program Start Up
Dec
Jan
Feb
March
April
May
June
July
Aug
Sep
Oct
Nov
Dec
Test Use Case 1 Concepts
Test Use Case 1 & 2
Test Use Case 2 & 3
Establish Project
Test Use Case 3
Project Scope Statement
Notice of Intent to Ballot
All final artifacts submitted to HL7
HL7 Activities to Support Use Case 1 and 2
This is the work of the Da Vinci paid staff members with support from members.
ONC Listening Sessions
DQS Track Leadership & Podium
HIMSS Podium
Dev4Health Podium
DevDays Podium
Events & Communication
Press Release & Collateral 2.0
HL7 Annual TBD
Collateral 1.0
WEDI Podium 21
Prelaunch
Use Case 1
Use Case 2
Use Case 3
Use Case 4

22. Resources Da Vinci Public Site Background collateral
Implementation Guide
Published 8/24 through HL7 balloting process
Reference Implementation –
Available at Sept 29 & 30th to HL7 Connectathon participants
Revised version publicly available post HL7
Follow Progress, Test, Implement
30 Day Med Rec:
Coverage Discovery Requirements :

23. Upcoming Use Cases

24. Documentation Templates and Payer Rules
Providers need to easily incorporate payer requirements into their clinical workflow
Specific documentation requirements,
Rules for determining need for specific treatments/services
Requirement for Prior Authorization (PA) or other approvals
Specific guidance.  
Use a FHIR based standard for representing payer “rules” to communicate, in real-time, payer medical necessity and best clinical practice requirements that may affect the ability to have certain services or devices covered by the responsible payer. 
The template/rules may (examples, not complete list)
Specify provider documentation requirements for coverage, medical necessity
Provide guidance / documentation requirements regarding social determinates that are antecedents for specific care
Collect information for some purpose (e.g. authorizations)
Indicate clinical requirements including appropriate use
Collect specific documentation for Quality Measures
Respond with specific information as requested/documented in the template/rules

25. eHealth Record Exchange
Potential Scenarios
HEDIS/STARS – exchange for quality measures
Gaps in Care – exchange to facilitate determination of gaps in care
Care Planning – exchanges to facilitate the management of care plans across multiple contributors
Support for chronic and acute conditions
Support for home health services (e.g. Home Health Plan of Care)
Orders and Medical Record Exchange (or specific subsets)
Laboratory orders and results

26. Program Contacts Da Vinci Program Manager:
Jocelyn Keegan, Point of Care Partners
Da Vinci Technical Lead:
Dr. Viet Nguyen, Stratametrics LLC
Coverage Related Use Case Leadership:
Robert Dieterle, EnableCare