1. DA VINCI PROJECT UPDATE
April 4, 2019

2. 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. Pre-Collaboration / Controlled Chaos:
Project Challenge
To ensure the success of the industry’s shift to Value Based Care
Pre-Collaboration / Controlled Chaos:
Develop rapid multi-stakeholder process to identify, exercise and implement initial use cases.
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.
Collaboration:
Minimize the development and deployment of unique solutions.
Promote industry wide standards and adoption.
Success Measures:
Use of FHIR®, implementation guides and pilot projects.

4. 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

5. Focus
In Less Than Two Years, Da Vinci Efforts Will Drive Standards for the Exchange of Information Critical to Patient Care
Prior Auth and Documentation Requirements
Payer Clinical Data Exchange
Gaps in Care
Attribution (Patient Panel)
Medical Records for Value-Based Care
Payers
Providers
Quality Measure Reporting Encounter Notifications

6. 2019 MEMBERSHIP

7. 4 EHRs 14 Use Cases 9 HIT Vendors 16 Payers Dozen Providers
Founding Members
16 Payers
4 EHRs
14 Use Cases
9 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 additional members , but all artifacts including IGs, reference implementations and pilot partners will be open source and available to public.
Members are building initial implementations.
Dozen Providers

8. For current membership: http://www.hl7.org/about/davinci/members.cfm
Da Vinci Members
For current membership:

9. Da Vinci Members

10. New Membership Categories

11. Program Status

12. 2019 Expanded Use Case Status - Post NPRM Update
Data Exchange for Quality Measures
Coverage Requirements Discovery
Documentation Templates and Coverage Rules
In HL7 ballot reconciliation as draft standard
Under active development
2019 use cases
Use cases in discovery
Health Record Exchange:
Clinical Data Exchange
Health Record Exchange:
Payer Data
Exchange
Prior-Authorization Support
Gaps in Care & Information
Risk Based Contract Member Identification
Alerts:
Notification (ADT),
Transitions in Care, ER admit/discharge
Project Outputs
Define requirements (technical, business and testing)
Create Implementation Guide
Create and test Reference Implementation (prove the guide works)
Pilot the solution
Deploy the solution
Performing Laboratory Reporting
Chronic Illness Documentation for
Risk Adjustment
Patient Cost Transparency
Health Record Exchange: Patient Data Exchange
Payer – Payer Coverage Determination

13. Meeting & Connectathon
2019 Use Cases Deliverables & Events
MAY BALLOT:
STU Data Exchange for Quality Measures (DEQM)
STU Coverage Requirements Discovery (CRD)
Comment Documentation Templates & Rules (DTR)
EARLY BALLOT – July 1-30
STU Health Record Exchange (HRex)
STU Payer Data Exchange (PDex)
STU Clinical Data Exchange (CDex)
STU Prior Authorization Support (Prior Auth)
Da Vinci US
Meeting & Connectathon
HL7 Connectathon
2019
2020
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
JAN
FEB
MAR
Simple timeline and
Da Vinci
Connectathon &
Working Session
Sept Ballot - TBD
Dec Ballot - TBD
HL7 Connectathon
Deliverable - HL7 Ballot options are comment/Standard for Trial Use (STU)/Normative
Event – See confluence.hl7.org

14. Activities by the Numbers Activities by the Numbers
UNLOCKING PAYER INFORMATION TO IMPROVE CARE
HIMSS19 Demonstration
Activities by the Numbers
Stats
Total practice runs 3
Total public runs 23
Filming runs 1
Total variations 14
Total roles 96
Total role system issues 7
Role availability
92.7%
Activities by the Numbers
Stats
AEGIS Touchstone available
100%
Total MCs 6
Total EHRs 2
Total Payer/Partner 4
Total Payer only 5
Total Sponsors 16
Number of visitors (approx.)
500
Percent that left during vignette
< 10 %
Patient 1 2 3 4
PCP
Schedule Appt with Payer
Admitted for Angioplasty
Discharged with O2 Therapy
Cardiologist
Hospital
Payer
Med Rec
Patient Data
CLINICAL SUMMARY
Da Vinci is demonstrating the ability to exchange information between payers and providers using HL7® FHIR® and CDS Hooks® as part of the Interoperability Showcase.
The vignette describes a clinical encounter for 78-year-old Asian women named Dara that starts with her primary care physician, proceeds to a cardiologist who admits Dara to the hospital for an angiogram and observation where it is determined that her chronic obstructive pulmonary disease has progressed to the point that she needs supplemental oxygen.
As Dara returns to her primary care physician, her previous medications are reconciled with those prescribed at discharge, the PCP reports the medication reconciliation, in support of a quality measure the Medicare Advantage program is following for its members.
The visual describes the interactions demonstrated at HIMSS Interoperability Showcase, direction of each exchange, the FHIR standards used, the setting where the interaction is occurring and the participants.
Each step represents a provider – payer exchange using FHIR IG

15. Active Use Case Details

16. Sample Project 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
RI Development
Build Initial RI
Test RI
Update Final RI
Build Data Set
Build Test Set
Week
Work with appropriate HL7 workgroup for IG sponsorship and input

17. Subscribe for Measure Data
Quality Data Quality Measures
Submit Measure Data
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
Additional Scenarios underway to expand measure patterns in framework
1. Submit
OperationOutcome
Payer
Aggregator
Collect Measure Data
2. Collect
Return Measure Data
Provider
Payer
Subscribe for Measure Data
3. Subscribe
OperationOutcome
Aggregator
Provider

18. Emerging DEQM Patterns
Measure
Pattern
Status
30 Day Medication Reconciliation
Attestation
STU
Colorectal Cancer Screening
Screening
May Ballot
Venous Thromboembolism Prophylaxis
Process
Initial example of how Da Vinci funding expandable framework
Multiple groups providing resources to build out measures beyond Da Vinci
Evaluating missing components to expand types of measures that could leverage framework i.e., public health

19. Health Record Exchange Simplified
Health Record Exchange Framework
Interactions & Profiles
Payer to Provider Data Exchange (PDex)
Provider can receive relevant Payer Sourced Data about a patient
PROVIDER
PAYER
Provider to Payer Exchange (CDex)
Provider can share relevant Provider Sourced Data to Payer and/or other Providers

20. Pilot Implementation REST Architecture Model
Provider EHR Implementation Scope
Da Vinci’s Deliverable Scope
Payer Implementation Scope
EHR Backend Services
Payer Backend Services
EHR
Payer
Request Resource
Translation Services
Endpoint & APIs
Endpoint & APIs
Translation Services
Response Resource
EHR Database
Payer Database
Implementations conforming to the DaVinci FHIR Profiles following the Implementation Guides
Industry standard DaVinci Use Case FHIR Profiles with respective Implementation Guides
Implementations conforming to the DaVinci FHIR Profiles following the Implementation Guides

21. Order Procedure, Lab or Referral
Coverage Requirements Discovery
Provider
Order Procedure, Lab or Referral
Discover Any
Requirements
Payer
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)

22. Coverage Requirements Discovery
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
Payer may request additional information from the provider EHR using existing FHIR APIs
Payer responds to the EHR with any specific requirements that may impact the clinical decisions or coverage
Payer
Provider
Provider requests coverage requirements from payer
Optional: request additional information
Payer responds to the request
Provider utilizes this information to make treatment decisions while considering specific payer coverage requirements.

23. CRD and Document Templates & Rules
CDS Service searches repository leveraging FHIR data
DME Ordered “order-review” hook triggers query
Invokes service & sends pre-fetch FHIR data including order information
Library of coverage rules/templates
PAYER
SMART on FHIR App
EHR/PROVIDER BACK OFFICE SYSTEMS
Displays Gaps/Template/Rule
Collects Missing Data and Store as Part of Medical Record
Retrieve rules, if necessary. Parse rule from CQL, identify gaps in data available in EHR and populate template
Send CDS Hooks Response with link to SMART on FHIR App

24. Prior Authorization Support Abstraction/Transform for HIPAA Compliance
EHR OR PROVIDER SYSTEM
CLEARINGHOUSE OR INTEGRATION LAYER
PAYER SYSTEM
Prior Authorization Support
X12 278
Support Authorization Support
Transformation Layer
Transformation Layer
X12 275
Clearinghouse or Integration Required to Meet HIPAA Regulations

25. Power to Reduce, Inform and Delegate Prior Authorization Support
Coverage Requirements Discovery
CDS Hooks
Coverage Requirements Discovery
Documentation Templates and Coverage Rules
FHIR APIs
Documentation Templates and Coverage Rules
EHR/PROVIDER BACK OFFICE SYSTEMS
PAYER
Prior Authorization Support
X12 278
Prior Authorization Support
Transformation Layer
Transformation Layer
Optional
X12 275
if required
Improve transparency
Reduce effort for prior authorization
Leverage available clinical content and increase automation

26. Summary of Active Use Cases & Resources

27. Follow Progress, Test, Implement
FIND
Background collateral
Implementation Guide(s)
2 Balloted Sept ’18
3 May Ballot Underway
4 Early Ballot July In Development
Reference Implementation
HL7 Connectathon participants
Publicly available
RESOURCES
HL7 Da Vinci Wiki & Listserv signup -
HL7 Confluence Site -
Where to find Da Vinci in Industry - nci+2019+Calendar
Use Case Summary and Links to Call In & Artifacts - nci+Use+Cases
Reference Implementation Code Repository -

28. Da Vinci Connectathon PUBLIC Jacksonville, FL
Preparations
Register links out to Da Vinci members this week and public next week..
Sign up for desired Da Vinci Track
Attend pre-connectathon planning calls
Establish scenarios
Set up end-points
Determine FHIR resources/Operations
Create data
Create test scripts
Guidewell Hosting
Open to Public, will close at 80 attendees
Da Vinci Led, May 29-30th
Da Vinci Tracks
Data Exchange for Quality Measures
Prior Auth Support (including CRD/DTR)
Clinical Data Exchange (CDex) Combined with Attachments
Payer Data Exchange (PDex)
Tell us YOU ARE COMING
ay+Onsite+Connecthon+-+Guidewell#
SAVE THE DATE: May 29-30th
Disclaimer

29. Highlight:
Spaces (top left)
Watch (top right)
Page Tree (left side)
Program status (center)
- Key items (center)

30. Available Use Cases Stage Q1 2019 Activities 2019 Min Investment
Ballot Reconciliation & Connectathons
Publish
Identify Implementers
Test
Two new measures in inflight: colon cancer screen (COL) and deep vein thrombosis (DVT)
v2: sync with FHIR STU4
Incorporate feedback
Further define patterns and add measures
CMS drive Pilot Test
Add pricing by location functionality
Data Exchange for Quality Measures
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.
Coverage Requirements Discovery

31. 2019 In Flight Use Cases Stage Q12019 Activities 2019 Min Investment
Ballot
Finalize scope
Build Implementation Guide & Reference Implementation
Identify Implementers
Ballot initial IG
Connectathons
Implementations
CMS Testing
Build IG and Reference Implementation
Finalize architectural
Get IG work underway
Ballot initial IG for payer to provider, provider to payer, prior authorization support & eHRx framework
Documentation Templates and Coverage Rules
eHealth Record Exchange

32. Da Vinci Program Manager: Jocelyn Keegan, Point of Care Partners
Da Vinci Technical Lead:
Dr. Viet Nguyen, Stratametrics LLC
Da Vinci Program Office:
Bob Dieterle, Enable Care