1. DA VINCI PROJECT UPDATE
March 8, 2018

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

6. 2019 MEMBERSHIP

7. 3 EHRs 12 Use Cases 12 HIT Vendors 12 Payers Dozen Providers
Founding Members
12 Payers
3 EHRs
12 Use Cases
12 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 have begin to implementing use cases.
Dozen Providers

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

9. Da Vinci Members
Sponsors
Members

10. ACTIVE USE CASES

11. Use Case Alignment Project Outputs
2018 Use Case Inventory and Project Deliverables
Use Case Alignment
Data Exchange for Quality Measures
Coverage Requirements Discovery
Documentation Templates and Coverage Rules
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
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
Use Case Status
In HL7 ballot reconciliation as draft standard
Under active development
Planned 2019 Use Cases
Future Use Case
Performing Laboratory Reporting
Chronic Illness Documentation for
Risk Adjustment
Patient Cost Transparency 11

12. x Da Vinci 2019 Use Cases –Year 2 Proposed 2019 Use Cases
Prior Authorization Support Comment
Prior Authorization Support
Payer Data Exchange (Payer to Provider) Comment
Payer Data Exchange (Payer to Provider)
Clinical Data Exchange (Provider to Provider/Payer) Comment
Clinical Data Exchange (Provider to Provider/Payer)
Document Templates & Rules R1/STU
Document Templates & Rules R1/STU x
CRD
Covergage Requirements Discovery Update STU
Data Exchange Quality Measures – Add’l Measures STU
Dec
Dec
Jan
Feb
March
April
May
June
July
Aug
Sep
Oct
Simple timeline and
Nov
HIMSS19 Vignette
HL7 Connectathon
HL7 Connectathon
Connectathon
HL7 Connectathon 12

13. 2019 Expanded Use Case Status - Post NPRM Update
Data Exchange for Quality Measures
Coverage Requirements Discovery
Documentation Templates and Coverage Rules
Use Case Status
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 13
Gaps in Care & Information
Risk Based Contract Member Identification
Alerts:
Notification (ADT),
Transitions in Care, ER admit/discharge
Performing Laboratory Reporting
Chronic Illness Documentation for
Risk Adjustment
Patient Cost Transparency
Health Record Exchange: Patient Data Exchange
Payer – Payer Coverage Determination

14. TRUE INTEROPERABILITY
Progress Toward End Goal
Payer
Provider +
Implementation Guide
Reference Implementations
Tools =
TRUE INTEROPERABILITY
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
Build Your Implementation Success Story

15. 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%
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 %
HIMSS19 Demonstration
Each step represents a provider – payer exchange using FHIR IG
Disclaimer

16. Use Case Details
Disclaimer

17. 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
Disclaimer

18. 30 Day Medication Reconciliation
1. Discharge Notification
Payer
Acute Care
Provider
2. Med Rec Need
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 compare pre/post medication lists to avoid errors
Today done through claims processing or manual review of lists
Implementation Guide Shifted to Framework to Support Wider Set of Data for Quality

19. Subscribe for Measure Data
Quality Data Exchange Implementation Guide
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
Future work will incorporate additional use cases
1. Submit
OperationOutcome
Payer
Aggregator
Collect Measure Data
2. Collect
Return Measure Data
Provider
Payer
Subscribe for Measure Data
3. Subscribe
OperationOutcome
Aggregator
Provider

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
Disclaimer

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 Implementation Guide
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. Pilot Implementation CDS Hooks/REST Architecture Model
Provider EHR Implementation Scope
Da Vinci’s Deliverable Scope
Payer Implementation Scope
EHR Backend Services
Payer Backend Services
CDS HOOKS
Payer
Request Resource
Endpoint & APIs
Endpoint & APIs
Translation Services
Translation Services
Response Resource
EHR Database
Payer Database
Industry standard CDS HOOKS implementing Use Case FHIR Profiles with respective Implementation Guides
Implementation interfaced with the DaVinci SMART on FHIR application
Implementations conforming to the DaVinci FHIR Profiles following the Implementation Guides
Disclaimer

24. 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 24

25. 2019 In Flight Use Cases Stage Q12019 Activities 2019 Min Investment
Definition
Finalize scope
Build Implementation Guide & Reference Implementation
Identify Implementers
Ballot initial IG
Connectathons
Implementations
CMS Testing
Discovery & Definition
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 25

26. Follow Progress, Test, Implement
FIND
Background collateral
Implementation Guide
Balloted Sept ‘18, reconciliation underway
Reference Implementation
HL7 Connectathon participants
Publicly available
RESOURCES
HL7 Da Vinci Wiki & Listserv signup -
HL7 Confluence Site -
Data Exchange For Quality Measures (DEQM) Implementation Guide STU1 Ballot 1
deqm/2018Sep/STU3/index.html
Coverage Requirements Discovery (CRD) Implementation Guide STU1 Ballot 1 
crd/2018Sep/index.html
Reference Implementation Code Repository - DaVinci

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