FHIR Implementation Guide for Data Exchange for Quality Measures (Da Vinci Pjt)

- Payers and providers need common exchange process to share the data required to complete quality measures as well as gaps in care.

- The initial focus of this PSS was both the standard for exchange and the specific use case of medication reconciliation attestation and the underlying process from which the attestation is created that support information for transitions of care, and care management plans involving medication changes.

- Proof of 30 day medication reconciliations is increasingly required for value based care incentives. Providers and care coordinators face the challenge of collecting accurate and complete patient medication records across care settings.

- Additional work has been completed to support additional example measures: Colorectal Cancer Screening and Venous Thromboembolism Prophylaxis.

- Today’s manual and ad hoc processes are costly and will not scale.

Description of the proposed initial FHIR IG

- Scope: to address the general case of requesting/exchanging specific (patient level) detailed information for quality measures

General concept:

- Develop general use case for one or more measures where an Aggregator (potentially CQL driven) is the requestor and/or recipient of individual measures on one or more patients

- Note: Aggregator may be part of EHR, Payer system or a standalone service

- Aggregator will exchange information with the Provider’s EHR or other provider service as a pull, push, or subscribe operation (recommendation/options/requirements as part of IG development)

- Exchange with provider system may have more than one FHIR content set depending on the requirements of the specific use case and HIT technology (scope determined as part of IG development)

- The attestation to 30-day Medication Reconciliation Post discharge (MRP) will be used as the example use case to test the general framework

- US-Core profiles will be utilized to provide compatibility with STU3

- Since US-Core updates will not be until after FHIR R4 is balloted and finalized, Da Vinci profiles will be created for any STU3 US-Core profiles that will be in R4. When US-Core profiles updates, the IG will be updated and aligned with R4 US-Core profiles.

Other aspects of medication reconciliation to be addressed in subsequent phases are (may be one or more IGs):

- knowing when a patient is discharged

- ensuring a discharge medication list is created in

- communicating the discharge medication list to the responsible ambulatory provider

- consuming the discharge medication list within the ambulatory provider's EHR

- comparing the discharge medication list with the preadmission medication list and reconciling the differences

- producing a reconciled medication list

- documenting/attesting to the completion of medication reconciliation

- communicating changes in the reconciled medication list to the patient

- communicating completion of medication reconciliation to the payer and other responsible organizations