1. DA VINCI PROJECT UPDATE
May 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. Membership Overview

12. Governance Structure STEERING COMMITTEE OPERATING COMMITTEE
Payers -3
Providers - 2
IT Vendors- 2
CMS - 1
HL7 - 1
Sagran Moodley*
United
Kirk Anderson
Cambia Health
Mike Funk
Humana
Dr. Shafiq Rab, Rush Medical
Dr. Steven Lane
Sutter Health
Hans Buitendjik**
Cerner
Peter DeVault
Epic
Melanie Combs-Dyer
CMS Fee for Service
Dr. Ed Hammond/ Dr. Chuck Jaffe
Program Manager & Technical Director
Jocelyn Keegan Dr. Viet Nguyen
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
OPERATING COMMITTEE
Use Case 1 Project Lead
Use Case 2 Project Lead
Use Case n+ Project Lead
DEPLOYMENT COMMITTEE
Disclaimer
*Chair **Co-Chair

13. Project Structure
All members sign identical Statement of Understanding between member & HL7
Initial agreement 2 year commitment
All outputs to HL7 open source licensing for public use
Coordinate closely with HL7 standards development process to obtain workgroup ownership of Implementation Guides
Acknowledge it is a learning process, identify just enough structure, focus on clear communication.

14. Summary Membership Types
Cost (000s)
Vote on Operating
Number of Sponsored
Providers*
Pledge
Resource
Access to Playbook
Access to Use Case Artifacts
Provide
Feedback
Member
$10-90 1
1-2 X
Partner
In Kind -
By Partner
Deployment Partner
$75 or 90
Through Sponsored Partner
Clinical Advisory Council
None
Use Case Clinical Advisor
* Premier and Associate Members have the opportunity to nominate partner organizations to join the Operating Committee (proxy membership) and must be approved by the operating and steering committees. 14

15. Structure and Operational Role Attributes
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 15

16. Access to Use Case Artifacts
Existing Provider/Payer Membership Model
Level
Cost (000s)
Operating Committee
Vote
Sponsor
Partners*
PMO Opportunity
Pledge
Resource
Access to Playbook
Access to Use Case Artifacts
Provide
Feedback
Premier
$ 90k 1 2 X
Associate
$ 75k
$ 50k -
Member
$ 10k
Contributor
In kind
* Premier and Associate Members have the opportunity to nominate partner organizations to join the Operating Committee (proxy membership) and must be approved by the operating and steering committees. 16

17. Deployment Categories
Level
Deployment Partner Annual
Fees
Deployment
Committee
Vote
Sponsor
Partner Operating Committee Membership
Access to Use Case Requirements
Training and Support
Participation
In Marketing Activities
Provide
Feedback on Use cases
Gold
$ 90,000 1 2 X
Level 2
Silver
$ 75,000
Level 1
Gold and Silver Partners have the opportunity
To invite provider partner organizations to join Operating Committee as full members.
Nominate partners to Operating Committee (not additional organizational votes, partners are subject to review and approval by Steering Committee)
Partners appointments are based on calendar year, but could be changed subject to approval by Steering Committee
Deployment Partners will have access to SME and Technical Support for the
Reformat to delinate separate clinical advisory council and a separate deployment committee 17

18. Clinical Advisory Roles
Program Management Office
Operating Committee
Steering Committee
Use Case Team
Clinical Advisory Council
Use Case Clinical Advisor
Clinical Advisory Council – strategic clinical advisors for the Steering Committee and PMO
Use Case Clinical Advisor – participates in use case development as clinical SME 18

19. Clinical Advisory Roles
Level
Fees
Advisory Council Seats
Access to Use Case Requirements
Training and Support
Participation
In Marketing Activities
Provide
Feedback on Use cases
Council
None
Individual X
Use Case
Non
The Clinical Advisor provides strategic advice to the Steering Committee and Program Management Office on relevant industry direction, clinical workflow, prioritization of specific use cases and other topics relevant to Da Vinci decision making.

20. Program Status

21. 2019 Implementation Guide Status Including CMS NPRM “Adjustments” - April
Data Exchange for Quality Measures
Coverage Requirements Discovery
Documentation Templates and Coverage Rules
Use Case Status
In HL7 May ballot as STU or ballot for comment
Planned for HL7 July ballot as STU
Planned for HL7 September ballot as STU
Use cases in discovery (some may be balloted in January 2020)
Health Record Exchange Framework / Library
Clinical Data
Exchange
Prior-Authorization Support
Payer Data
Exchange
Payer Data Exchange: Directory
Payer Data Exchange: Formulary
Project Process
Define requirements (clinical, business, technical and testing
Create Implementation Guide (IG)
Create and test Reference Implementation (RI) (prove the IG works)
Pilot the solution
Deploy the Solution
Alerts/Notifications:
Transitions in Care, ER admit/discharge
Payer – Payer Coverage Determination
Gaps in Care & Information
Health Record Exchange: Patient Data Exchange
Patient Cost Transparency
Risk Based Contract Member Identification
Performing Laboratory Reporting
Chronic Illness Documentation for
Risk Adjustment 21

22. 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

23. 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

24. HL7 Da Vinci Project: An Overview
Components for success include:
Committed stakeholders; funding and driving VBC solutions.
HL7 FHIR® Standards used to create use-case specific Implementation Guides and Reference Implementations.
Member use-case Implementation Projects.
The above components guide the use case development and are the foundation for deployment of interoperable solutions on a national scale.
To ensure the success of the industry’s shift to Value Based Care, Da Vinci established 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.
Project Process
Define requirements (clinical, business, technical and testing
Create Implementation Guide (IG)
Create and test Reference Implementation (RI) (prove the IG works)
Pilot the solution
Deploy the Solution
Provider Members:
Dallas Children's Health, MultiCare, OHSU, Providence St. Joseph Health, Rush University Medical Center, Sutter Health, Texas Health Resources, Weil Cornel Medicine,
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.
Payer Members:
Anthem, BCBSA, BCBSAL, BCBSM, BCBST, BC Idaho, Cambia Health, Cigna, GuideWell, HCSC, Humana, Independence, United Healthcare
Vendor Members:
Allscripts, Athenahealth/Virence(aka GE Centricity), Casenet, Cerner, Cognosante, Edifecs, Epic, HealthLX, InterSystems, Juxly, Optum, InterSystems, Surescripts, ZeOmega.

25. Summary of Active Use Cases & Resources

26. 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

27. 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

28. 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 & Prior Auth Support

29. 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 -

30. 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

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

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