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Welcome to the Da Vinci Implementer Support Page

  • Da Vinci use cases are interrelated, currently with five categories that have emerged: Quality Improvement, Coverage/Burden Reduction, Member Access, Process Improvement, and Clinical Data Exchange. Early use cases create building blocks and a framework upon which incremental improvements and additional content can be added over time.

  • Da Vinci adopts existing and emerging standards with broad support to create viable solutions, such as FHIR as the core, NCQA HEDIS, CDS Hooks, and SMART on FHIR (layering in OAuth security). Existing profiles are adopted where possible (e.g., Argonaut, US-Core, QI-Core)



What you need to know about FHIR
HL7- FHIR 

Fast Healthcare Interoperability Resources (FHIR) - standard for exchanging healthcare information electronically 

Base Resources can be used alone or as building blocks into profiles. See Resource Index and Resource guide

FHIR defines simple framework for extending existing resources and describing their use with profilesImplementation guides provide structure of how to use the profiles. 

Key concepts with FHIR

New to FHIR- Check these educational resources


Additional resources

US Core

HL7 FHIR

US Core Implementation Guide (FHIR R4)- defines minimum conformance requirements for accessing patient data. 

  • Meet 2015 Edition certification criterion for Patient Selection 170.315(g)(7), and Application Access - Data Category Request 170.315(g)(8)
  • Follows USCDI v1- United States Core Data for Interoperability

General guidance page for mapping/profiles

Check out examples of US Core profile

For full list of available profiles, click here.

QI Core

HL7 FHIR

Quality Improvement Core (QI Core) Implementation Guide (FHIR R4)- defines set of profiles to allow interoperable, quality-focused applications.

  • Further extend use of US Core profiles to build standards on quality measure, includes guidance on use of vocabularies and value sets
  • Encourage consistent access and use of data for clinical quality applications
  • Standardize the exchange of quality-related information between data server and data consumers on calculation of quality measures and decision support.

Quality Data Model to QI Core draft mapping

Check out examples of QI Core Profiles

For full list of available profiles, click here

CDS Hooks

HL7 FHIR

CDS Hooks- HL7 published specification for clinical decision support

  • Evaluate remote clinical decision support by triggering it within the clinician workflow in near real-time
  • API supports return of information and suggestions and launch user-facing SMART app when additional interaction is required

Clinical Decision Support Services

Check out examples of CDS Hooks

SMART on FHIR

HL7 FHIR

 SMART App launch framework - may connect from inside or outside the user interface to an EHR system

  • Intended to be used by app developers, may be stand alone or launch from EHR system
  • Use OAuth scopes to communicate access requirements

Check out examples of SMART on FHIR App

Bulk Data

HL7 FHIR

FHIR Bulk Data Access (Flat FHIR)- defines standardize approach for exporting bulk data.

  • Request bulk data export from server, receive status information and retrieve files
Bulk Data Touchstone TestScripts
What you need to know about an Implementation Guide
Overview of Implementation Guide

Implementation Guide (IG) - set of rules about how HL7 FHIR resources are used to solve a problem. Published as a single unit, provides coherent and concise application of profiles. 

Contains two different types of resource references- Contents and examples

  • Contents- include Use Case, specification, profiles/extension, conformance
  • Examples of resources applicable to the IG (see Table of Contents)

Check out this presentation

Demystifying the Implementation Guide: Data Exchange for Quality Measures (DEQM) By Linda Michaelson

Maturity of Implementation Guide

HL7 Implementation Guide Process Flow

IGs mature through stages that lead to Normative standards- refer to FHIR Maturity Model

Each IG will list the maturity level on the title of the Implementation guide.

Check out Da Vinci current maturity on Use Cases

Da Vinci Project Update Sept

Implementer support

Visit each Da Vinci Use Cases for additional supplemental materials

Have a question? Join us for our reoccurring calls 


What you need to know about Da Vinci Use Cases

Status of Use Cases:  Da Vinci Implementation Guide Dashboard

Focus AreaObjectiveRelevant Use Case IG's 

Aligns with US Core/USCDI

Aligns with ONC/CMS Rule

Example: CMS Interoperability and Patient Access final rule

Coverage/Burden Reduction

Example: Prior Authorization for home oxygen therapy, hospital admission

To enable provider, at point of service, to request prior authorization (including all necessary approval requirements, documentation, and rules to support the request)  and receive immediate authorization to reduce provider burden and support treatment planning

Coverage Requirements Discovery (CRD) 

Documentation Templates and Payer Rules (DTR)

Prior Authorization Support (PAS)

  • US Core/USCDI

Quality Improvement

Example: 30 Day medication reconciliation, colorectal cancer screening

To support value based data exchange by: 

  • Represent open and closed gaps in care
  • Define how providers and payers can be informed of gaps and closings
  • Define a close the loop framework between authorities and providers

Data Exchange for Quality Measures (DEQM)

with Gaps in Care & Information

  • US Core/USCDI

Member Access

(Patient have a right to access their medical information)

Example diagram:

Patient Access and Interoperability API CMS/ONC Ruling Support

Refer to CMS Interoperability and Patient Access final rule

To enable sharing of clinical data generated by providers with payers or other providers

Clinical Data Exchange (CDex)

Health Record Framework (HRex)

  • US Core/USCDI
To enable sharing of clinical data generated by payers to be shared with other payers or providers

Payer Data Exchange (PDex)

Health Record Framework (HRex)

  • US Core/USCDI
  • Aligns with ONC or CMS rule

To enable payers to share drug estimated cost and information (drug formulary) for patients/consumers

  • To determine out of pocket cost under current health plan
  • Compare multiple health plans medication cost

Payer Data Exchange (PDex)- Formulary

Health Record Framework (HRex)

  • US Core/USCDI
  • Aligns with ONC or CMS Rule

To enable payers to share the provider directory for members to identify in-network providers and their information

Example: network status, specialty, language,  hours of operations and new patient acceptance

Payer Data Exchange (PDex)- Provider Directory (Plan Net)

Health Record Framework (HRex)

  • US Core/USCDI
  • Aligns with ONC or CMS rule
To support the portability of coverage by exchanging information between payers to define decision making and supporting documentation with regard to treatment for chronic illnesses without the need to burden the provider and/or patient or risk a discontinuity of care.


Payer Coverage Decision Exchange (PCDE) 


Health Record Framework (HRex)


  • US Core/USCDI
  • Aligns with ONC or CMS rule
Process ImprovementTo enable payers and provider to exchange information that identifies members of a patient population associated with a particular risk based contractRisk Based Contracts Member Attribution (ATR) 
  • US Core/USCDI

Standard methodology (format) for payers to communicate coding gaps to providers​. Ability to communicate coding gaps for individual or group of patients. 

Risk Adjustment

Clinical Data Exchange


To support the real-time exchange of alerts that impact patient care and value based or risk based services

Example: Admit/Discharge/Transfers

Notifications 
  • US Core/USCDI
  • Aligns with ONC or CMS rule


Da Vinci Use Case Maturity

Developer ToolBox
Zulip

Zulip Chat platform allows you to ask questions and view comments from fellow developers to the FHIR community. 

Click here to get started.

For a list of available zulip streams, click here

Did you know-

Each Use Case has additional links specific to their use case. This include Logica specific sandbox, GitHub and Touchstone test scripts.

Visit the Da Vinci Use Case page.



Additional questions or comments?

Bring them to the Da Vinci Public calls. 

Logica Health Sandbox

Logica Health Sandbox offers the FHIR sandbox as a free environment to develop FHIR applications.

Click here for more information

New to Logica- check out this video .

GitHub

Detailed examples of our Reference Implementation are located in GitHub.

Browse the repositories and examples here.

FHIR Servers

FHIR public servers are available as testing servers. Click here for a list of available public servers



Build and Validate with Touchstone

AEGIS Touchstone provides test driven development feedback as you build to Base FHIR and the Da Vinci IGs. Use your own private Touchstone sandbox or join the Da Vinci Organization in Touchstone to get started.

If you are specifically joining the Da Vinci Organization in Touchstone, you may find this Onboarding Session helpful.


The following steps will get you registered and testing in Touchstone:


  • Step 1: Create a User and join an Organization in Touchstone. Getting registered in Touchstone is quick, easy, and free of charge. Our online documentation will guide you through this process.

Here is a video tutorial to walk you through the registration process.


For additional support in setting up your Test System, check out this tutorial.


  • Step 3: Executing Test Setups. Find information on Test Setup in our Test Setup documentation. A video detailing this process can be found down below step 4.

Da Vinci TestScripts can be found in the Da Vinci Sandbox.


  • Step 4: Review your results. Touchstone provides detailed feedback on the results of your test execution. Introspection of your results is as easy as drilling down through the test execution.

Check out our video on Test Setup and Results for additional information.


For an informational overview detailing the importance of FHIR Validation and what Touchstone has to offer, please check out this video.


Need more help? Contact Touchstone Support at touchstone_support@aegis.net or attend Touchstone Office Hours. Also check out our Touchstone Docs, found at the top of each Touchstone page.

Analyst ToolBox
Da Vinci Use Cases

Visit each of the Da Vinci Use Cases for additional information and supplemental materials

Did you know- Each Use Case has supplemental materials and example diagrams.

Public Conference Calls 

Have a question or feedback? Join us on our reoccurring calls.

Educational Session

Join us at the Da Vinci Education & FHIR Implementation Event by HL7 - April 26 - 30 that include educational sessions geared toward Business Analysts

April 26 - 30 

FHIR Connectathons

Join HL7 Connectathons to engage in hands-on development and testing.  Participate with members of the FHIR development communities.

Click here for past Da Vinci related Connectathons. 


Welcome to the Da Vinci Implementer Support Page

  • Da Vinci use cases are interrelated, currently with five categories that have emerged: Quality Improvement, Coverage/Burden Reduction, Member Access, Process Improvement, and Clinical Data Exchange. Early use cases create building blocks and a framework upon which incremental improvements and additional content can be added over time.

  • Da Vinci adopts existing and emerging standards with broad support to create viable solutions, such as FHIR as the core, NCQA HEDIS, CDS Hooks, and SMART on FHIR (layering in OAuth security). Existing profiles are adopted where possible (e.g., Argonaut, US-Core, QI-Core)



What you need to know about FHIR
HL7- FHIR 

Fast Healthcare Interoperability Resources (FHIR) - standard for exchanging healthcare information electronically 

Base Resources can be used alone or as building blocks into profiles. See Resource Index and Resource guide

FHIR defines simple framework for extending existing resources and describing their use with profilesImplementation guides provide structure of how to use the profiles. 

Key concepts with FHIR

New to FHIR- Check these educational resources


Additional resources

US Core

HL7 FHIR

US Core Implementation Guide (FHIR R4)- defines minimum conformance requirements for accessing patient data. 

  • Meet 2015 Edition certification criterion for Patient Selection 170.315(g)(7), and Application Access - Data Category Request 170.315(g)(8)
  • Follows USCDI v1- United States Core Data for Interoperability

General guidance page for mapping/profiles

Check out examples of US Core profile

For full list of available profiles, click here.

QI Core

HL7 FHIR

Quality Improvement Core (QI Core) Implementation Guide (FHIR R4)- defines set of profiles to allow interoperable, quality-focused applications.

  • Further extend use of US Core profiles to build standards on quality measure, includes guidance on use of vocabularies and value sets
  • Encourage consistent access and use of data for clinical quality applications
  • Standardize the exchange of quality-related information between data server and data consumers on calculation of quality measures and decision support.

Quality Data Model to QI Core draft mapping

Check out examples of QI Core Profiles

For full list of available profiles, click here

CDS Hooks

HL7 FHIR

CDS Hooks- HL7 published specification for clinical decision support

  • Evaluate remote clinical decision support by triggering it within the clinician workflow in near real-time
  • API supports return of information and suggestions and launch user-facing SMART app when additional interaction is required

Clinical Decision Support Services

Check out examples of CDS Hooks

SMART on FHIR

HL7 FHIR

 SMART App launch framework - may connect from inside or outside the user interface to an EHR system

  • Intended to be used by app developers, may be stand alone or launch from EHR system
  • Use OAuth scopes to communicate access requirements

Check out examples of SMART on FHIR App

Bulk Data

HL7 FHIR

FHIR Bulk Data Access (Flat FHIR)- defines standardize approach for exporting bulk data.

  • Request bulk data export from server, receive status information and retrieve files
Bulk Data Touchstone TestScripts
What you need to know about an Implementation Guide
Overview of Implementation Guide

Implementation Guide (IG) - set of rules about how HL7 FHIR resources are used to solve a problem. Published as a single unit, provides coherent and concise application of profiles. 

Contains two different types of resource references- Contents and examples

  • Contents- include Use Case, specification, profiles/extension, conformance
  • Examples of resources applicable to the IG (see Table of Contents)

Check out this presentation

Demystifying the Implementation Guide: Data Exchange for Quality Measures (DEQM) By Linda Michaelson

Maturity of Implementation Guide

HL7 Implementation Guide Process Flow

IGs mature through stages that lead to Normative standards- refer to FHIR Maturity Model

Each IG will list the maturity level on the title of the Implementation guide.

Check out Da Vinci current maturity on Use Cases

Da Vinci Project Update Sept

Implementer support

Visit each Da Vinci Use Cases for additional supplemental materials

Have a question? Join us for our reoccurring calls 


What you need to know about Da Vinci Use Cases

Status of Use Cases:  Da Vinci Implementation Guide Dashboard

Focus AreaObjectiveRelevant Use Case IG's 

Aligns with US Core/USCDI

Aligns with ONC/CMS Rule

Example: CMS Interoperability and Patient Access final rule

Coverage/Burden Reduction

Example: Prior Authorization for home oxygen therapy, hospital admission

To enable provider, at point of service, to request prior authorization (including all necessary approval requirements, documentation, and rules to support the request)  and receive immediate authorization to reduce provider burden and support treatment planning

Coverage Requirements Discovery (CRD) 

Documentation Templates and Payer Rules (DTR)

Prior Authorization Support (PAS)

  • US Core/USCDI

Quality Improvement

Example: 30 Day medication reconciliation, colorectal cancer screening

To support value based data exchange by: 

  • Represent open and closed gaps in care
  • Define how providers and payers can be informed of gaps and closings
  • Define a close the loop framework between authorities and providers

Data Exchange for Quality Measures (DEQM)

with Gaps in Care & Information

  • US Core/USCDI

Member Access

(Patient have a right to access their medical information)

Example diagram:

Patient Access and Interoperability API CMS/ONC Ruling Support

Refer to CMS Interoperability and Patient Access final rule

To enable sharing of clinical data generated by providers with payers or other providers

Clinical Data Exchange (CDex)

Health Record Framework (HRex)

  • US Core/USCDI
To enable sharing of clinical data generated by payers to be shared with other payers or providers

Payer Data Exchange (PDex)

Health Record Framework (HRex)

  • US Core/USCDI
  • Aligns with ONC or CMS rule

To enable payers to share drug estimated cost and information (drug formulary) for patients/consumers

  • To determine out of pocket cost under current health plan
  • Compare multiple health plans medication cost

Payer Data Exchange (PDex)- Formulary

Health Record Framework (HRex)

  • US Core/USCDI
  • Aligns with ONC or CMS Rule

To enable payers to share the provider directory for members to identify in-network providers and their information

Example: network status, specialty, language,  hours of operations and new patient acceptance

Payer Data Exchange (PDex)- Provider Directory (Plan Net)

Health Record Framework (HRex)

  • US Core/USCDI
  • Aligns with ONC or CMS rule
To support the portability of coverage by exchanging information between payers to define decision making and supporting documentation with regard to treatment for chronic illnesses without the need to burden the provider and/or patient or risk a discontinuity of care.


Payer Coverage Decision Exchange (PCDE) 


Health Record Framework (HRex)


  • US Core/USCDI
  • Aligns with ONC or CMS rule
Process ImprovementTo enable payers and provider to exchange information that identifies members of a patient population associated with a particular risk based contractRisk Based Contracts Member Attribution (ATR) 
  • US Core/USCDI

Standard methodology (format) for payers to communicate coding gaps to providers​. Ability to communicate coding gaps for individual or group of patients. 

Risk Adjustment

Clinical Data Exchange


To support the real-time exchange of alerts that impact patient care and value based or risk based services

Example: Admit/Discharge/Transfers

Notifications 
  • US Core/USCDI
  • Aligns with ONC or CMS rule


Da Vinci Use Case Maturity

Developer ToolBox
Zulip

Zulip Chat platform allows you to ask questions and view comments from fellow developers to the FHIR community. 

Click here to get started.

For a list of available zulip streams, click here

Did you know-

Each Use Case has additional links specific to their use case. This include Logica specific sandbox, GitHub and Touchstone test scripts.

Visit the Da Vinci Use Case page.



Additional questions or comments?

Bring them to the Da Vinci Public calls. 

Logica Health Sandbox

Logica Health Sandbox offers the FHIR sandbox as a free environment to develop FHIR applications.

Click here for more information

New to Logica- check out this video .

GitHub

Detailed examples of our Reference Implementation are located in GitHub.

Browse the repositories and examples here.

FHIR Servers

FHIR public servers are available as testing servers. Click here for a list of available public servers



Build and Validate with Touchstone

AEGIS Touchstone provides test driven development feedback as you build to Base FHIR and the Da Vinci IGs. Use your own private Touchstone sandbox or join the Da Vinci Organization in Touchstone to get started.

If you are specifically joining the Da Vinci Organization in Touchstone, you may find this Onboarding Session helpful.


The following steps will get you registered and testing in Touchstone:


  • Step 1: Create a User and join an Organization in Touchstone. Getting registered in Touchstone is quick, easy, and free of charge. Our online documentation will guide you through this process.

Here is a video tutorial to walk you through the registration process.


For additional support in setting up your Test System, check out this tutorial.


  • Step 3: Executing Test Setups. Find information on Test Setup in our Test Setup documentation. A video detailing this process can be found down below step 4.

Da Vinci TestScripts can be found in the Da Vinci Sandbox.


  • Step 4: Review your results. Touchstone provides detailed feedback on the results of your test execution. Introspection of your results is as easy as drilling down through the test execution.

Check out our video on Test Setup and Results for additional information.


For an informational overview detailing the importance of FHIR Validation and what Touchstone has to offer, please check out this video.


Need more help? Contact Touchstone Support at touchstone_support@aegis.net or attend Touchstone Office Hours. Also check out our Touchstone Docs, found at the top of each Touchstone page.

Analyst ToolBox
Da Vinci Use Cases

Visit each of the Da Vinci Use Cases for additional information and supplemental materials

Did you know- Each Use Case has supplemental materials and example diagrams.

Public Conference Calls 

Have a question or feedback? Join us on our reoccurring calls.

Educational Session

Join us at the Da Vinci Education & FHIR Implementation Event by HL7 - April 26 - 30 that include educational sessions geared toward Business Analysts

April 26 - 30 

FHIR Connectathons

Join HL7 Connectathons to engage in hands-on development and testing.  Participate with members of the FHIR development communities.

Click here for past Da Vinci related Connectathons. 


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2 Comments

  1. Hi Christopher Madia and Phung Matthews This page has lots of great information. I am not able to access the Demystifying the Implementation Guide: Data Exchange for Quality Measures (DEQM)  material - while logged in. Would you please check the link? Thank you. 

    1. Carmela A. Couderc Thanks for reaching out. It has been updated. Please let me know if you need anything else. Have a great day!- Phung