Today’s electronic information exchanges lack the accuracy, fidelity, and quality (i.e., coding, semantics, structure) necessary to automate or enable computer-assisted processing to support the Medical Record Review process thereby facilitating the work required for these reviews by providers, payers, and Medical Record Review contractors, based on experience gathered by quality improvement organizations. These data quality issues (as they pertain to interoperability) create added burden on provider organizations who must respond to additional requests when submissions are an incomplete response to the request; Medical Record Reviewers are equally hampered by content exported from today’s EHRs as they are only suitable for human review once they have been manually organized without any computer-assistance. As the quality and precision of EHR data for export improves, the resulting data will comprise complete, high-quality medical records that are computable. This will enable computer-assisted processing, thereby reducing some of the burden placed on providers and reviewers and could lead to abilities for quality analysts and clinical researchers to perform in-depth analysis on medical records using artificial intelligence (AI). 

 HL7 C-CDA and FHIR US Core implementation guides are intended to include the data classes and elements as required by USCDI. These HL7 specifications could be reused to support Medical Record Reviews (MRR) requirements with limited enhancements.

This project is aligned with Da Vinci Accelerator as this project fits with the mission to reduce burden and to improve provider experience with the EHR documentation process. In addition, since requests for review may be initiated by a beneficiary or their representative, specifications developed under another HL7 Accelerator project, the CARIN Alliance, may also be reused. 

As a US realm project, MRR will comply with all US Core requirements to reuse existing profiles and submit variances where appropriate (link to boilerplate language). 

As part of this project, we will be addressing qualified MRR-centric requirements for the request and exchange of medical records using CDA and FHIR among providers, reviewers, and the legal entities authorized to support quality improvement initiatives. Enhancements to existing Da Vinci and CARIN specifications to create new standards that support specific MRR requirements will include updates and refinements, as well as new, testing, conformance, and certification criteria. To achieve these goals, MRR must be represented and supported using US-Realm Implementation Guide(s) that address US policy needs (e.g., FHIR US Core, Consolidated CDA).  If the CDA implementation guide develops templates that overlap with existing C-CDA templates we will request approval from US Realm SC, and provide the US Realm approved rationale for deviation in the implementation guide. An accelerator project like the  Da Vinci Project,  allows stakeholders to drive the development of interoperability solutions that reduce provider burden using health IT standards. MRR may be added to the scope of this project resulting in the development of new health IT standards guidance and testing criteria for EHR system in the US, testing and validation infrastructure for certification.