HL7 Da Vinci Project July 19, 2021

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HL7 Da Vinci Project July 19, 2021
HL7 Da Vinci Project

           July 19, 2021
HL7 Da Vinci Project July 19, 2021
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                                                                                                   2
HL7 Da Vinci Project July 19, 2021
Project Challenge

            To ensure the success of the industry’s shift to Value Based Care

Transform out of Controlled Chaos:           Collaboration:                Success Measures:
  Develop rapid multi-stakeholder     Minimize the development and     Use of FHIR®, implementation
   process to identify, exercise and deployment of unique solutions.     guides and pilot projects.
     implement initial use cases.    Promote industry wide standards
                                              and adoption.

                                                                                                      3
HL7 Da Vinci Project July 19, 2021
Da Vinci 2021 Multi-Stakeholder Membership
HL7 Da Vinci Project July 19, 2021
Use Case Focus Areas

                        Quality Improvement
                                                          Clinical Data               Payer Data                            Payer Data

                                                                                               *
  Data Exchange for                                        Exchange                   Exchange                              Exchange
Quality Measures STU2

                                                                                                       Member Access
                                                      Payer Data Exchange:      Payer Data Exchange:                       Clinical Data

                                                                                                                                               Clinical Data Exchange
   Gaps in Care &
    Information
                                                           Formulary
                                                                      *               Directory
                                                                                               *                            Exchange

                                                        Payer Coverage
                                                       Decision Exchange
                                                                            *
                                                                                     Patient Cost
                                                                                    Transparency                           Notifications
                                                                                                                                           *
                        Coverage / Burden Reduction

      Coverage
    Requirements
   Discovery STU2
                                                                                                                       Patient Data Exchange

                                                       Member Attribution         Risk Adjustment
   Documentation
 Templates and Rules                                                                                                   Performing Laboratory
                                                                 Process Improvement                                         Reporting

 Prior-Authorization                                                              Publishing
       Support                                            Use Case                Balloting
                                                        HL7 Standards                               Aligned with specific ONC or CMS rule
                                                                                  Build
                                                          Progress
                                                                                  Future            Named or supports final CMS or ONC rule                             5
HL7 Da Vinci Project July 19, 2021
Future           Build              Ballot      Published/ing
                                                                                                                                            Use Case
                                       Standard Phase

                                       Connectathon
HL7 Da Vinci Project July 19, 2021
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
Discovery      Assemble Team                   Requirements

                                                          RI Tech
                               Project start             Approach
                                                                                     Build Initial RI              Test RI          Update Final RI
            RI Development
                                                                            Build Data Set
                                                                                             Build Test Set

                        Week          0              2              4            6                 8          10             12        14             16

                                                                        Work with appropriate HL7 workgroup for IG sponsorship and input

                                                                                                                                                           7
HL7 Da Vinci Project July 19, 2021
How Da Vinci Solves Business Challenges
HL7 Da Vinci Project July 19, 2021
Patient - Payer Data Access APIs

Use Case         Status               Core Capabilities                             Regulatory Impacts                             Implementer Progress
                             Enables a health plan to share key clinical     CMS Interoperability and Patient Access final   6 Connectathons
                             data and patient history with application of    rule (CMS-9115-F) – enforcement begins on
                  STU1       patient’s choice.                               July 1, 2021 – use to make patients' clinical   Active implementations underway,
                 Published                                                   (USCDI) data available via Patient Access       emerging vendor and payer go lives in
  Payer Data                                                                 API.                                            preparation for 7/1 rule.
  Exchange

                             Enable payers to share drug estimated cost      CMS Interoperability and Patient Access final   6 Connectathons
                             and information (drug formulary) for            rule (CMS-9115-F) – enforcement begins on
                  STU1       patients/consumers applications. Improves       July 1, 2021 – use to make formulary            Active implementations underway,
                Published    clarity of patient cost under current or        information available via the Patient Access    emerging vendor and payer go lives in
  Formulary                  potential health plan. Improve consumers        API and via publicly accessible API.            preparation for 7/1 rule.
                             ability to shop plan coverage better.

                             Enable patient to more easily understand        CMS Interoperability and Patient Access final   6 Connectathons
                             what providers, facilities, pharmacies are in   rule (CMS-9115-F)– use to make provider
                  STU1       the network covered by the current or           directory data available via publicly           Active implementations underway,
                 Published   potential future plan. Increases                accessible API.                                 emerging vendor and payer go lives
  Directory                  transparency of available service providers                                                     underway.
                             at patient specific level.

                             Provide data exchange standard in support       Rules Impact Evaluation Underway                N/A
                             of payers and providers to display cost         • Consolidated Appropriations Act HR-133
                             information to patients in advance of             (No Surprise Billing)
                Discovery    services.
                                                                             • CMS Transparency in Coverage Final Rule
 Patient Cost
                                                                               (CMS-9915-F) 1/1/2022
Transparency
                                                                             • Hospital Price Transparency – 1/1/2021                                                9
HL7 Da Vinci Project July 19, 2021
Implementation Guides (IG) Options for
                                                          Patient Directed APIs
                               FHIR IG
                                                                                     FHIR Resource Definition
                                 Da Vinci
                                                                                            Patient Direct API 1/1/21
                                Directory
                                                                                            Directory Access API
                               (PLAN NET)
                                                                                            Other related regulation
                                 Da Vinci
              PAYER             Formulary                               Individual
                                                                                     FHIR Accelerator Commentary
             Product                                                                 1.   CMS has proposed use of specific
                                                                                          guides in December Reducing
           Plan Design           Da Vinci
                                                                                          Burden NPRM
Provider                        Payer Data
                                                                                     2.   FHIR Community is working

                                                 OAUTH Security Layer
                                Exchange                                Consumer          collaboratively to ensure the specific
                                PDEX* for                                 Apps            guides meet needs of the final PAAPI
                               Clinical Data                                              rule and the proposed rule
           Operational                                                               3.   All guides are Draft Standards for
            Support                                                                       Trial Use (DSTU and approved or
                                                                                          moving towards a published version
                                                                                          of STU1.
                              CARIN IG for                                           4.   NOTE: Da Vinci Directory and CARIN
Provider                     Blue Button ® for                                            Real Time Benefit Check for
System                          Payer and                                                 consumer facing applications does
                             Pharmacy Claims                                              not fall under 7/1/21 Patient Directed
                                   Data                                                   API regulations but is called out in
                                                                         Member           NPRM and as a resource on other
               Operational                                                Portal
                   PBM                                                                    proposed rules
                Support                                                              5.   CMS has added provider to payer
                                  CARIN                                                   and payer to payer requirements to
                                                                                          leverage this subset and additional
                  PBM           Real Time                                                 named FHIR IGs.
                              Benefit Check
                              for Pharmacy
                                                                        Patient
                                                                        Portal
                                                                                                                             10
Health Record Exchange (HRex)

                                Benefits
                                •   Creates a consistent
                                    framework to exchange clinical
                                    data between Providers and
                                    Payers

FHIR                            •   Enables consistent,
                                    constrained use of FHIR and
                                    US CORE profiled data
        US                          specific resources across all

              Da Vinci
                                    Da Vinci data exchange
       CORE                         Implementation Guides

              Profiles          •   Focuses on nuance of
                                    resources like Provenance
                                    which differs by collection
                                    source, or resources currently
                                    not yet in USCDI and US Core
                                    e.g., Coverage

                                                                     11
Payer Data Exchange (PDex)
                                    Benefits
                                    •     Creates a full picture of all patient activities
                                    •     Providers may be unaware of all the patient clinical activities
                                          outside their facility
                                    •     Addition of payer-based data expands the scope of                                          Provider data
                                          information available to the patient and provider to support                             from CDAs and
                                          clinical decision-making and care planning                                                other sources
                                    •     Improves quality of information shared by using FHIR
                                          standard
                                                                                                                                  Alerts (e.g, ADT)

                                                       Clinical data based FHIR
Patient Visits Provider                                                                                                            Immunizations
                                                               resources
                          Payer Makes
                                                                                                                                   Laboratory (eg,
                              Data                                                                                                  national labs)
                          Available to
                            Provider                                                                                                 PBM (meds)

                                                                                                                                        EOB

                                                                                                    System of record

                                                                                                                                     Adjudication
                          Payer Gathers               Claims based clinical FHIR
      Provider                                                                                   Data Extract Definition
EHR Initiates Request
                          Data Received                       resources                                                                Claims
                           From Source
                            System(s)
                                                                                                            PDex Information Sources/Flow

                                                                                                                                                      12
Payer Data Exchange (PDex): Provider Directory

                                                                                                                     PAYER

                                           RESTful GET

                                             Synchronous
                                                                                                                          Provider Directory
                                                                                             FHIR
                                                                                              API

    Third Party                             Asynchronous
    Application
                                                                                                                          Pharmacy Directory

Benefits
•    Provides a standard approach for requesting and receiving Provider information based on a patient's Insurance plan
•    Enables directory to be called as a service by applications for integration of provider search into workflows
•    Supports patients’ ability to find providers across multiple plans
•    Increases transparency to patients about provider availability in their plan
                                                                                                                                               13
Payer Data Exchange (PDex): Formulary

                                                                         PROVIDER
                                                                                                   Benefits

                                     What are my medications?                                      •   Enables patient and provider
                                                                                                       applications to understand basic
                                                                                                       information about their plan or
                                Medication1, Medication2, Medication3                                  potential plans formulary
                                              RxNorm                                                   coverage
                                                                             Electronic Health
                                                                            Record from Provider   •   Patients can understand the tier
      Medication Copays
                                                                                                       and alternatives for drugs that
Med         Tier     Copay                                                                             have been prescribed, and to
                                     Tell me about Medication1                                         compare their drug costs across
Med1         1            $5
                                                                         PAYER
Med1         4            $30                                                                          different insurance plans
Med3         2            $10
                                          Medication1 info                                         •   Improve transparency for
                                                                                                       patients shopping new plans, or
                                     Tell me about Medication2                                         seeking to understand
                                                                                                       alternative options vs current
                                          Medication2 info                                             PDF
                                                                                                   •   Free data to be used by
                                     Tell me about Medication3                                         consumer facing applications to
                                                                         Formulary Service             improve shopping options
                                       Medication3 info
  Mobile app determines the cost of each
medication under patient's current health plan
                                                                                                                                      14
Payer to Payer APIs

 Use Case           Status               Core Capabilities                              Regulatory Impacts                           Implementer Progress

                                Enables a health plan to share key clinical      Rules Impact Evaluation Underway                 6 Connectathons
                                data and patient history with application of     CMS Interoperability and Patient Access final
                    STU1        patient’s choice.                                rule (CMS-9115-F) –– use to make patients'
                    Published                                                    clinical (USCDI) data available to new Payer,
   Payer Data
                                                                                 named specifically as a proposed resource in
   Exchange
                                                                                 2020 NPRM CMS-9123-P

                                Ability for payer to share active treatment to   Rules Impact Evaluation Underway                 6 Connectathons
                                increase continuity of care. Includes current    Functionality meets requirement for January
                                utilization management decisions and             1, 2022 initially introduced in CMS
                                supporting data. Focus is to reduce rework       Interoperability and Patient Access final rule
Coverage Decision   STU1        by patient and provider when patient             (CMS-9115-F) –– use to make patients'
   Exchange         Published   changes coverag                                  clinical (USCDI) data available to new Payer,
                                                                                 referenced as a resource in 2020 NPRM
                                                                                 CMS-9123-P

                                                                                                                                                            15
Payer to Payer Exchange:
On the Way to Patient Access & Portability with
                                    FHIR APIs

                                                  16
Opportunity to Further Interoperability

• CMS Regulation for Payer to Payer sets a minimum bar for electronic data exchange
• Advanced interoperability requires codified data that is computable
• Da Vinci community members are promoting early adoption of Payer Data Exchange (PDex) as
  their FHIR API of choice for January 1, 2022 deadline
• Goal is to voluntarily meet and exceed rules set by CMS for patient access via 3rd party
  applications, where minimum is FHIR API

                              While technical term is payer to payer, this work will improve patient’s portability across payers, and
                                     reduce burden on patient and providers to reshare critical clinical patient information.

                                                                                                                                 17
Payer Coverage Decision Exchange

                                                                                Patient enrolls in new plan

                                                              Member Authorization

                                                               Current Treatments

                                           Conditions/Diagnoses Supporting Each Treatment

                                           Clinical Guideline References (where appropriate)
     PAYER 1                                                                                                                           PAYER 2
    (“new payer”)                             Scope of Prior Authorizations (where appropriate)                                       (“old payer”)

                                                             Supporting Documentation
Benefits
•   Supports continuity of treatment when patients enroll with a new payer by enabling a transfer of “current active treatments” between the prior payer and the new payer
•   Reduces the need for providers and/or patients to resubmit supporting documentation to the new payer in order to continue patient treatment
•   Reduces interruption in care plan and medication adherence
•   Reduces waste and rework by all parties                                                                                                                                  18
Provider - Payer Access APIs

Use Case           Status                  Core Capabilities                            Regulatory Impacts                           Implementer Progress
                                  A defined format to send unsolicited           May be leveraged to meet ADT notification for   6 Connectathons
                                  notifications to the appropriate actors when   select health systems                           In wait mode until FHIR subscription model
                    STU1          triggered by an event or request. Provides                                                     is matured in R5.
                   Published      enough information to understand what the                                                      Several community members have
 Notifications                    notification is about.                                                                         leveraged this utility IG across several
                                                                                                                                 early adoption FHIR project.

                                  Ability to enable provider to share clinical   None                                            9 Connectathons
                    STU1          data to payers, other providers in workflow                                                    Multiple early adopter projects in flight
                                                                                                                                 across several workflows.
                    Ballot
 Clinical Data   Reconciliation
  Exchange

                                  Enables a health plan to share key clinical    Rules Impact Evaluation Underway                6 Connectathons
                                  data and patient history with application of   CMS proposed extension of this IG to support    Early adoption underway. Some delay for
                    STU1          patient’s choice.                              Provider to Payer exchange of prior             provider implementations due to COVID
                   Published                                                     authorization data in December 2020 NPRM        response and impact at provider
  Payer Data                                                                     CMS-9123-P Specific guide named in NPRM         organizations.
  Exchange

                                  Provide data exchange standard in support      Rules Impact Evaluation Underway                Public calls TBD
                                  of payers and providers to display cost        • Consolidated Appropriations Act HR-133
                                  information to patients in advance of            (No Surprise Billing)
                 Discovery        services.
                                                                                 • CMS Transparency in Coverage Final Rule
 Patient Cost                                                                      (CMS-9915-F) – 1/1/2022
Transparency                                                                     • Hospital Price Transparency – 1/1/2021                                                     19
Notifications

                                                           PRIMARY CARE

                                                 HIE/HIN

                                                           SPECIALTY CARE       Any care team
                                                                                member can be
                                                                                connected directly
        Site Where                                                              or via an
      Notifiable Event                                                          intermediary
         Occurred                                          INPATIENT SERVICES   (e.g., HIE)

Potential Interactions:
                                                           PAYER
1)   Push to “registered” member
     (perhaps via payer care team information)
2)   Push to intermediary

                                                                                                     20
Reducing Prior Authorization Burden

    Use Case                      Status                       Core Capabilities                                      Regulatory Impacts                                      Implementer Progress
                                                     Enables exchange of coverage plan                       Named in the NPRM CMS Interoperability                       9 Connectathons
                                                     requirements from payers to providers at the            and Prior Authorization (CMS-9123-P) by                      Early adopters and pilots underway
                                                     time of treatment decisions, patient specific           January 1, 2023, FHIR-based DRLS API
                                   STU1              with a goal to increase transparency for all
                                 Published           parties of coverage that may impact
                                                     services rendered i.e., is prior authorization
Coverage Requirements
                                                     required, are there other predecessor steps;
      Discovery
                                                     lab tests required, physical therapy

                                                     Builds on CRD to specify how payer rules                Named in the NPRM CMS Interoperability                       8 Connectathons
                                                     can be executed in a provider context to                and Prior Authorization (CMS-9123-P) by                      Early adopters and pilots underway
                                                     ensure that documentation requirements are              January 1, 2023, FHIR-based DRLS API
                                   STU1              met. Provider burden will be reduced
                                 Published           because of reduced manual data entry, i.e.,
                                                     electronic questionnaires from payers,
  Documentation
                                                     extract data to pre-populate response
Templates and Rules
                                                     Defines FHIR based services to enable                   Named in the NPRM CMS Interoperability                       6 Connectathons
                                                     provider, at point of service, to request               and Prior Authorization (CMS-9123-P) by                      Early adopters and pilots underway
                                                     authorization (including all necessary                  January 1, 2023, FHIR-based electronic Prior
                                   STU1              clinical information to support the                     Authorization Support API
                                 Published           request) and receive immediate
  Prior-Authorization                                authorization from Payer (incorporates
        Support                                      HIPAA Tx standards)

DRLS = Document Requirements Lookup Service (DRLS) is CMS’ name for the combination of CRD + DTR.
Notice of Proposed Rulemaking (NPRM) Press Release found here. Note: Final CMS’ Interoperability and Prior Authorization Rule links are unavailable pending HHS review.                                        21
Coverage Requirements Discovery, Documentation
                                         Templates & Rules, & Prior Authorization Support

                     Coverage Requirements                         CDS Hooks                                           Coverage Requirements
                           Discovery                                                                                         Discovery
EHR/PROVIDER BACK
 OFFICE SYSTEMS

                    Documentation Templates                                                                            Documentation Templates
                                                                   FHIR APIs
                      and Coverage Rules

                                                                                                                                                  PAYER
                                                                                                                         and Coverage Rules

                                                                                                      Transformation
                                                  Transformation
                                                                        X12 278

                                                                                           Optional
                                                                                                                            Prior Authorization

                                                                                                          Layer
                                                      Layer
                    Prior Authorization Support
                                                                                                                                  Support
                                                                        X12 275
                                                                        if required

                                                             • Improve transparency
                                                             • Reduce effort for prior authorization
                                                             • Leverage available clinical content and increase automation
                                                                                                                                                          22
Coverage Requirements Discovery (CRD)/
 Documentation Templates & Rules (DTR)

                Benefits
                • Takes guesswork out of patient specific
                  coverage by sharing authorization or
                  process requirements in workflow
                • Improves transparency of patient and
                  procedure specific rules to provider and
                  patient
                • Exposes information about patient
                  benefits when care team is most likely
                  with or near patient, so options can be
                  discussed and decided upon

                                                            23
Automating Quality Improvement

  Use Case             Status                  Core Capabilities                             Regulatory Impacts           Implementer Progress
                                      Focus is on creating a framework to make        No current regulatory impacts   8 Connectathons
                                      quality measure collection, attestation and                                     In production across multiple payer-
                        STU2          proof identifiable, collected and transported                                   provider sites.
                       Published      between trading partners in a repeatable                                        Often initial use case selected for high
Data Exchange for                     way. Work underway to expand examples.                                          financial and shared value across trading
Quality Measures                                                                                                      partners.

                                      To support value-based data exchange by:        No current regulatory impacts   9 Connectathons
                                      Represent open and closed gaps in care
                     BALLOT           Define how providers and payers can be
                     Reconciliation   informed of gaps and closings
 Gaps in Care &                       Define a close the loop framework between
  Information                         vendor/payer and providers.

                                      Ability to enable provider to share clinical    No current regulatory impacts   7 Connectathons
                                      data to payers, other providers in workflow.
                     BALLOT
                     Reconciliation
  Clinical Data
   Exchange

                                      Provides ability for trading partners to        No current regulatory impacts   3 Connectathons
                                      validate patients/members in common to                                          In production or early adopter projects
                        STU1          ensure for secure transfer of correct                                           across multiple payer-provider sites.
                      Publishing      population. Developed to streamline                                             Seen as a utility across many early
Member Attribution                    matching for DEQM use case. Expanded                                            adopters.
                                      as applicable across many FHIR APIs
                                                                                                                                                                  24
Data Exchange for Quality Measures

                                                                       Benefits
                                 Submit Measure Data
                                                                       •   Quality measures are defined as
1. Submit                                                                  computable artifacts
                                   OperationOutcome                    •   Framework automates data collection
               Aggregator or                                 Payer
                 Provider                                                  and quality measure reporting
                                                                       •   Eases the burden of identifying quality
                                                                           measures applicable to specific patients
                                 Collect Measure Data
                                                                       •   Minimizes the burden of manual data
2. Collect                                                                 abstraction for measure reporting

                                  Return Measure Data
                   Payer                                    Provider

                               Subscribe for Measure Data

3. Subscribe
                                   OperationOutcome
   (future)
                Aggregator                                  Provider
                                                                                                                      25
Gaps in Care

    PAYER                  PROVIDER                                                 Benefits
                                                                                    •   Facilitates the exchange of gaps in
                                                                                        care and quality measures between
                                                       Provider System/EHR
                                                                                        providers and payers
                                                                                    •   Identifies gaps based on patient
                                                            Receives list of            criteria and contractual agreements
Analysis triggered        Request triggered
                                                             patients/gaps
   (e.g., patient         (e.g., patient visit,
                                                                                    •   Supports the exchange of clinical data
    enrollment,            eligibility check,
                                                                                        to close clinical and information gaps
 scheduled, etc.)            manual, etc.)
                                                      Automatically or manually         prospectively vs retrospectively
                                                      queried for missing data or   •   Leverages the FHIR-based, quality
                                                              exceptions                measure framework
                     Based on measure
                     criteria, payer determines                                     •   Reduces manual data retrieval and
                     qualifying patient data is                                         cost associated with current practices
                     missing
                                                                                    •   Gets the right triggers to right end
                                                       Missing          Service         users in patient care workflow
                                                      Data Found       performed        increasing probability of positive
              Patient list with                                                         impact
              gaps identified
                                                                                    •   Improve quality of information shared
                                                                                        by using FHIR standard
                                                    Provider sends
                                                                                    •   Can be used for single patient or with
                                                  new data to payer
                                                                                        population of patients                26
Member Attribution
                                 1
                   Producer/Consumer enter                             Benefits
                   relationship and agree on
PRODUCER             attribution method and
                                                CONSUMER               • Allows the provider and payer to
 (e.g., Payer)                                   (e.g., Provider)         establish and maintain an accurate list
                           need for a list                                of patients that are attributable to the
                                                                          provider
  Producer                                     Consumer receives       • Attribution list supports exchange of
creates initial               2                  list & historical        other information including gaps in
attribution list                                    information           care and quality measures
                                                                       • Creates common format across
                                                                          payers and providers, reducing waste
                          Request                                         and maintenance
                       Changes needed
  Producer                                     Consumer reconciles
   adjusts                    3a                 list via their own
algorithm/ list                                attribution algorithm
                     No changes needed                                      Current IG

Producer starts               3b                                            Future version IG
sending list on
 agreed upon
                              4                Consumer loads data          Out of band process
   cadence                                     to various systems to
                                                support various use
                                                       cases
                                                                                                                     27
Emerging or Future Use Cases

   Use Case              Status                 Core Capabilities                             Regulatory Impacts         Implementer Progress
                                       Creating standard methodology (format) for      None                        Public calls started in March 2021
                                       payers to communicate coding gaps to
                        Discovery      providers for an individual or a group of
                                       patients.
  Risk Adjustment

                                       Timely and accurate information exchange        None                        N/A
                                       within the performance period. Focus on
                        Identifying    information that only a payer would have
                        Participants   financial targets, spend, CCFs and quarterly
     VBC Cost                          quality payments. Information at lowest level
Performance Reports                    of granularity. Access via APIs.

                                       Goal is to share clinical details of specific   None                        N/A
                                       lab results between providers, payers and
                                       lab partners. Only a small fraction of lab
                          TBD          data flows today, Define framework to
Performing Laboratory                  expand breadth and scope of data
      Reporting                        exchange.

                                       Enable exchange of patient reported data to     None                        N/A
                                       payer and provider partners.
                          TBD
    Patient Data
     Exchange
                                                                                                                                                        28
Join the Da Vinci Community

                              29
Da Vinci Community Support

                              Most Recent Slides
                                and Updates

                                    Community
                                  Announcements,
                                    Updates and
Page Tree Navigation Easily          Resources
Find Nested Content like Da
      Vinci Calendar                                               30
Implementation Guide Dashboard

    Quick Links & Look at All
     Implementation Guides

Link to Implementor Support Page
                                                                    31
Implementor Support
                                                          FHIR 101 Resources

                                                                      IG Summary &
                                                                       Relationships

                                                                                                   FHIR & DV
                                                                                                 Community Tools

                                                                                            Learn about
                                                                                       Implementation Guides
https://confluence.hl7.org/display/DVP/Da+Vinci+Implementer+Support                                                32
Join the Community

                                                     Getting Started
                                                     1. Register for Confluence
                                                     2. Sign up for Listserv
                                                     3. Find Implementer Pages
                                                     4. Download IGs and
                                                        Resources
                                                     5. Watch for Meetings,
                              Create an Account to      Connectathons
                               Watch Key Pages       6. View Demo and
                                                        Testimonial Recordings
   Sign Up for Listserv for Project                  7. Access Reference
              Updates                                   Implementation Code,
Orientation Resources for Public New                    Sandboxes
             to Da Vinci
                                                                                  33
Membership Support
Summary Ways to Engage

                                                  Number of
                                    Vote on                         Pledge         Access to      Access to Use Provide
       Type       Cost (000s)                     Sponsored
                                   Operating                       Resource        Playbook       Case Artifacts Feedback
                                                  Providers*

    Member           $10-90             1              1-2              X               X                X               X

    Partner          In Kind            -               -               X          By Partner       By Partner      By Partner

    Clinical
    Advisory          None              -               -               X               X                X               X
    Council

    Use Case
    Clinical          None              -               -               X               X                X               X
    Advisor

    Community         None              -               -               -                -               X               X

•    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.
•    Clinical roles are appointed or contracted.

                                                                                                                                   3535
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
• Commitment to implement in 2021

                                                    Da Vinci expanding 2021 membership. Focus on
                                                    missing stakeholders: small and community-
                                                    based providers, regional, Medicaid, CHIP, QHP
                                                    Plans, missing integration partners; EHRs,
                                                    platforms, population health. Contact
                                                    davincipmo@pocp.com if interested.
                                                                                                36
Governance Structure

                      STEERING COMMITTEE                                                         Clinical Advisory Council
                                                                                                 Dr. Steve Waldren, AAFP
                                                                                 HL7 - 1         Dr. Ed Yu, Sutter Health
  Payers -3       Providers - 2         IT Vendors- 2            CMS - 1

Sagran Moodley*        Deepak

                                                                                                           Program Manager & Technical Director
     United          Sadopagan          Hans Buitendjik**

                                                                                                                              Dr. Viet Nguyen
 Kirk Anderson     Providence St.           Cerner               Alex Mugge    Dr. Chuck Jaffe
 Cambia Health         Joseph            Ryan Bohochik              CMS             HL7
   Mike Funk      Dr. Michael Myint          Epic
    Humana            MultiCare

                                                                                                            Jocelyn Keegan
                            OPERATING COMMITTEE

Use Case 1               Use Case 2                                           Use Case n+
Project Lead             Project Lead                                         Project Lead

                               DEPLOYMENT COMMITTEE

                                           Update as of January 27, 2021                                     *Chair **Co-Chair                    37
Existing Provider/Payer Membership Model

                            Operating
                                        Sponsor       PMO          Pledge    Access to   Access to Use Provide
    Level     Cost (000s)   Committee
                                        Partners*   Opportunity   Resource   Playbook    Case Artifacts Feedback
                              Vote

 Premier        $ 90k          1           2            X            X          X             X            X

 Associate      $ 75k          1           1            X            X          X             X            X

                            Sponsored
 Deployment    $75 or 90                  1-2           X            X          X             X            X
                             Partner

 Sponsor        $ 50k          1            -            -           X          X             X            X

 Sponsored         -           1            -            -           X          X             X            X

 Member         $ 10k           -           -            -           X          X             X            X
* Premier and Associate Members have the opportunity to nominate partner organizations to join the
 Contributor   In kind (proxy -membership)
  Operating Committee                    - and must be
                                                     - approvedXby the operating
                                                                            X             X
                                                                                 and steering          X
                                                                                                committees.

                                                                                                                   3838
Structure and Operational Role Attributes

STEERING COMMITTEE                      OPERATING COMMITTEE
• Senior level executive, can make      • Prioritization of use cases and project focus,
  decisions and commit organization       approval for “in kind” and project fees
  resources
                                        • Leader and/or influencer across home organization
• Driving interoperability strategy
                                        • Work closely/aligned with senior leadership at home
  within home organization and
                                          organization, can queue up commitment and
  responsible for coordination with
                                          decisions and drive to conclusion
  industry
                                        • Understands and will own HL7 standards
• Final vote on budget approval and
                                          relationship, commitments
  high-level direction setting based
  upon Operating Committee direction    • Roll up sleeve and problem solve use case
                                          development and inventory, priorities, details
• Technology and business ownership
  to drive “business case” approval     • Identify and gain access/time for “in kind” resources
                                          for priority use case work

                                                                                                  3939
Clinical Advisory Roles

                                                               Operating Committee
            Steering Committee

                                                                                                        Use Case Team

                                 Clinical Advisory                                      Use Case
                                      Council                                        Clinical Advisor

                                                     Program Management Office

Clinical Advisory Council – strategic clinical advisors for the Steering Committee and PMO
Use Case Clinical Advisor – participates in use case development as clinical SME                                        40
Clinical Advisory Roles

                                                                                                                         Provide
                                                 Access to Use Case                              Participation
    Level      Fees     Advisory Council Seats                        Training and Support                             Feedback on
                                                   Requirements                              In Marketing Activities
                                                                                                                        Use cases

Council        None           Individual                 X                     X                       X                   X

Use Case       Non              None                     X                     X                       X                   X

     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.
New Membership Recommendation Template
Process
1.   Member Completes
2.   Submits to PMO
3.   Review/Update
4.   PMO Submits Final to Da Vinci Steering Committee for Approval
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

                                                                                                   43
Membership Recommendation – Denote

                                                                                                                Requested Approval Level:
 Company Name                                                                                                   q Premier
 Mission :                                                                                                      q Associate
                                                                                                                q Sponsor
 Vision :
                                                                                                                q Sponsor(ed) –Denote Sponsoring Org
 Basic Description of Core Business Related to VBC                                                              q Deployment Member
 Use Cases: List Da Vinci use cases prospective member will participate in and plans to implement in            q Refer to Community Member
 2021.                                                                                                          q Differ to 2022
 Experience: Describe role as adopter of new technology, workflows and standards. Describe current
 state in FHIR community and/or subject matter expertise to bring to Da Vinci work

 Senior Management: Key leadership supporting goals of DV and VBC, potential commitment to                      STATUS: To Be Completed by PMO
 leadership of membership category beyond in kind on projects specific work. Demonstrate support for            q Approve
 organization to participate in connectathons, early adopter with sufficient resourcing and internal support.
 Advocate for getting partners to the table.                                                                    q Pended
                                                                                                                q More Information Requested
 Pilot Potential: Describe potential pilot projects, geographical placement to existing or new to Da Vinci
 organizations with a highlight toward provider.

 Relevant Disclosure: Any potential conflicts or opportunities, unknown aspects of organization relevant
 for Da Vinci Steering and PMO to be aware of i.e., ownership stake in partners, ability to bring               Provider/Payer Links:
 subsidiaries to bear on program                                                                                • URLs to key parts of partner orgs
 Lines of Business or Wholly Owned Subsidiaries:
                                                                                                                Primary Sponsor: Current DV members
 Company Links: Key URLS                                                                                        Secondary Sponsor: Optional current DV member

PMO recommendation summary.
Macro View of Organization - X

Add 1 -2 Slides Max                                 • Screenshots of existing
                                                      content/demographic information is fine
• Include in graphical or text format
    ‒ Geography                                     • Goal is a summary view of assets and
    ‒ Lives Covered                                   breadth new partner offers
    ‒ Key partners in market
    ‒ Key technologies in use (companies and
      named technology i.e. Aegis for Testing
      Suite and early adopter of CCDA across
      15 provider/payer partners)
    ‒ Size of organization
    ‒ Breadth/focus of core services
    ‒ Relevant Organization Breakdown,
      included parts of org likely to participate
      in Da Vinci actively
Da Vinci Program Manager:
 Jocelyn Keegan, Point of Care Partners
       jocelyn.keegan@pocp.com

         Da Vinci Technical Lead:
   Dr. Viet Nguyen, Stratametrics LLC
    vietnguyen@stratametrics.com

       Da Vinci Project Manager:
Vanessa Candelora, Point of Care Partners
     vanessa.candelora@pocp.com
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