FHIR works: Notes from Baltimore Plenary Meeting and Virginia CCDA 2.1 Implementationathon

We say this every time we attend a meetup, but it remains true: interest in HL7 interoperability standards continues to grow remarkably. As FHIR in particular matures, we see proliferation of attendees, ballot comments and general buzz. As Graham Grieve mentioned over on the FHIR Directors Blog, the most recent meetup was most likely HL7's largest meeting to date.

Baltimore at night.

Members of the DHIT team traversed the DMV (that's DC-Maryland-Virginia, in Beltway-speak) last month, heading to Baltimore for the annual plenary meeting and Arlington, VA, for the C-CDA Implementation-A-Thon.

News on FHIR
As the FHIR Chief himself, Grahame Grieve, mentions over at his blog, there were some major headlines at the very well-attended FHIR plenary event:

• FHIR release 3 is slated for release at the end of this year.
• New communities are cropping up, including from medical disciplines that hadn't previously shown up on the FHIR scene
• The FHIR Foundation will continue to be a key player, supporting the "implementation process of standard"
• The site fhir.registry.org will go live soon
• Discussion of whether to support logical reference; in short, a "URL-based view of the world," as Grahame puts it, may be incomplete.

As Grahame also mentioned, the "most significant single decision" made at the plenary was to take the specification known previously as “DAF-core” and rename it the US Realm Implementation guide. That may sound like inside baseball, but it's another symbolic leap in the maturity of the standard.

From the DHIT standpoint, we are well underway developing features in our flagship interoperability application, ConnectEHR, and across our product line to support EMR clients, including the development of testing and production FHIR servers. Our overriding goal is for our clients to move forward in interoperability as they meet the latest edition of ONC Certification Standards (2015 Edition).

We anticipate that FHIR may one day become an explicitly mandated standard and, as it stands, is a boon not only to interoperability but meeting meaningful use in Stage 3 and beyond.

We participated in the "CCDA on FHIR" track as document creator as well as document consumer, testing our implementation against multiple servers (including those of other participants as well as the reference servers from Grahame Grieve and Furore). Our coding was done in C# using the fhir-net-api provided by fellow FHIR Chief Ewout Kramer.

CCDAs in VA
HL7 hosted its third C-CDA Implementation-A-Thon last week in Arlington, VA. The DHIT team kept up its perfect attendance, convening with other CCDA developers and experts just outside DC.

In addition to the usual networking and educational opportunities afforded at HL7 Events, it's always interesting to chart the development progress of the industry as a whole. And the "real-world" scenarios provided at the event - creating and exchanging live data - are worth the trip alone.

As is typical of healthcare standards-based Connectathons, clinical scenarios are laid out for participants to navigate. In this case, the exercises were related to the exchange of v2.1 documents, discharge summaries and electronic referrals. We're proud to report that we all the CCDA Homework Scenarios were accomplished. 'A+' goes to the DHIT developers on hand.

Valueset OIDs
Valueset OIDs continue to be a point of some controversy. There was a presentation at the event providing background and information on the process of creating them. For the initiated, value sets for use in EMRs, CQMs, research and other contexts are created by professionals and organizations and submitted to be approved by the National Library of Medicine (NLM), under its Unified Medical Language System (UMLS) arm. The code sets are validated and checked for duplicates. However, our development has uncovered some of the codes may be subject to duplication and we've requested some further information from NLM.

Lessons learned

We left with some takeaways on the process of generating a v2.1 CCDA and we wanted to share with our audience:

• Often overlooked, developers should pay a little bit more attention to mood codes and their usage even though it may complicate the data that is requested from a client
• C-CDA Scorecard is a very useful checkpoint in development
• Having lower score in the scorecard doesn’t mean that the CCDA will fail the validation. Higher scores will determine that the CCDA is much closer to the expected standard
• Display name should come from the code system otherwise it will lower the score. 
• Narrative Text for all sections and textual clinical notes
• The task of categorizing results may tolerate multiple pathways. Example: CT scans go to Procedures or Results or both
• Allergies and problems should always have time recorded
• For effectiveTime of immunizations, do not use low+high when moodCode=EVN

NTT's Optimum and Dynamic Health IT Partner on Forward-Thinking Solution for CQMs

DHIT President Jeff Robbins addressing the
NTT Data Client Conference

After wrapping up our successful ONC certification testing for CQMsolution in early September, we headed to Newport Beach, CA, for the NTT Data Client Conference. Held annually, the conference offers clients of NTT Data products and services a wide range of educational sessions, networking opportunities and face-time with NTT DATA staff.

The event was a great opportunity to meet with implementers and users of CQMsolution. We were able to provide specific education on our application through the lens of the NTT's Optimum clinical ecosystem. CQMsolution is developed as universal quality measure solution, but context always matters, of course.

In keeping with the mission of the conference, we also spent time discussing some policy specifics to help NTT users prepare for changes in quality measurement. This included a glimpse into the future to MIPS/MACRA and Meaningful Use Stage 3.

We also expressed our confidence that our solution will continue to be among the first - if not the very first - to update with each successive release of CMS measures. Among other benefits, this allows maximal testing and educational opportunities in the lead-up to submission.

As with all DHIT clients, we seek to offer a full range of development, quality assurance, support and project management resources, tailored to the environmental needs of the specific implementation and user base. Our close collaboration with NTT has yielded a solution that allows their EMR team to focus on development and customer support, while we provide an effective and aggressively-supported tool to attack quality measures.

DHIT VP Raychelle Fernandez providing
clinical background for CQM calculation process.

By way of demonstration, DHIT gave a detailed presentation on CQMsolution and showed key elements of the software using a specific clinical use case: Ischemic/Hemorrhagic Stroke (via CMS measure 102v4). With our goal of guiding clients through CQMs from start to finish, we discussed not only the calculation and display of measures in CQMsolution, but the process of submission.

It's our hope that CQMsolution, like that Southern California weather, makes everything a little sunnier.

CQMsolution blazes trail as first 2015 Edition Certified CQM product

Dynamic Health IT is proud to announce that we're the first software developer to be certified for Clinical Quality Measures under the latest ONC Health IT Certification (2015 Edition).

But don't take our word for it: our listing on the ONC CHPL website is viewable here.

The process of certification testing gives our clients confidence that our product can support eligible clinicians and eligible hospitals in meeting CMS EHR Incentive Program objectives. We have developed the product with an eye on not only the current formulation of Meaningful Use, PQRS, IQR and other quality measurement programs, but the changes to come under MIPS/MACRA.

“Dynamic Health IT remains a trailblazer in clinical quality measures software development. We’re very proud to be the first vendor to certify for 2015 Edition Quality Measures Quality Measures for Cypress 3.0,” said Jeff Robbins, President of Dynamic Health IT.

Certification is proud achievement, but also a way station to further development. DHIT continues to enhance our software to include bulk, automated practice and user adds, API access and a number of other new features.  We hope to provide our client not only quality measure compliance, but a transparent user interface that enables easy analysis.

CQMsolution 3.0 certification meets the following certification CQM-related criteria:

• 170.315(c)(1) Clinical Quality Measures- Capture And Export
• 170.315(c)(2) Clinical Quality Measures- Incorporate And Calculate
• 170.315(c)(3) Clinical Quality Measures- Reporting
• 170.315(c)(4) Clinical Quality Measures- Filter

CQMsolution Version 3.0 also includes new interface enhancements driven by 170.315(C) (4) - a brand new module in 2015 Edition - allowing users to filter report data on a number of demographic categories. In addition, we also certified our solution on:

• 170.315(g)(4) Quality Management System
• 170.315(d)(1) Authentication, access control, authorization
• 170.315(d)(2) Auditable events and tamper-resistance
• 170.315(d)(3) Audit report(s)
• 170.315(d)(5) Automatic access time-out

The clinical quality measures to which CQMsolution has been certified include:

• All 29 updated measures for eligible hospitals
• All 64 updated measures for eligible professionals
• All 64 aligned PQRS measures for EPs (additional PQRS measures can be supported)

This marks the fourth ONC-certified version of CQMsolution, the previous certification coming in conjunction with the release of Cypress 3.0 validation software.

Photo credit: MJ Boswell

Version 3.0 was certified by ICSA Labs, an Office of the National Coordinator-Authorized Certification Body (ONC-ACB) and is compliant in accordance with applicable criteria adopted by the Secretary of Health and Human Services (HHS).