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  • IER 1 Provide authorization and consent: PHR or EHR provides electronic access list (created by patient) to external PHR or EHR system IER 11 Identify provider based on patient preference: Identify/select a consulting clinician or next care setting based upon the patient ’ s preference IER 13 Send/receive notification of document availability: Support for notification of availability of new/updated data IER 14 Send/Receive health plan eligibility: Identify and verify eligibility from health plan IER 15 Send/Receive health plan authorization: Obtain Authorization for service from health plan IER 16 Send/Receive clinical summary: Send/Receive Clinical Summary IER 17 Send/Receive transfer of care data: Send/Receive transfer of care information IER 22 Send/Receive additional patient information: Send/Receive additional patient information IER 25 Send/Receive decision support data: Decision support software at each step of the consultation, which may include algorithms, dashboards, status reports and views IER 28 Download historical health data: Download historical health information from EHR ’ s, PHR, health record banks, etc IER 37 Update medication information: Perform medication reconciliation for any modified medications as stated in the 2007 Medication Management Use Case
  • IER 43 Send/Receive accept patient: Send/Receive query/response if the patient can be accepted IER 45 Send/Receive consult results report: Send/Receive consult results report IER 57 Identify provider based on health plan: Identify/Select a consulting clinician or next setting of care, based on capability and health plan association IER 60 Send/Receive discharge summary: Send/Receive discharge/transfer information to personally controlled heath record IER 62 Send/Receive encounter or full episode of care record: Send/Receive data from the current encounter or the full Episode of Care record IER 63 Request additional patient data: Send/Receive a request for additional patient information IER 64 Send/Receive consult request/data: Send/Receive consult request and core data for consult

.ppt .ppt Presentation Transcript

  • Consultations and Transfers of Care HITSP Interoperability Specification (IS) 09 Webinar 3 March 12, 2009 | 2:00 – 3:30 pm (Eastern) Presenters: Michael Lincoln, M.D., F.A.C.M.I, U.S. Department of Veterans Affairs Suzi Hines, Principal, Sage Consulting, LLC
  • Learning Objectives
    • Explore the scope of the Consultations and Transfers of Care Interoperability Specification, including:
      • the information exchange needed when a provider requests and a patient receives a consultation from another provider; and
      • the information exchange needed when a provider requests a transfer of care for a patient and the receiving facility admits the patient
    • Examine the data exchange requirements for requesting a consultation and patient receiving a consultation from another provider, and for requesting a transfer and a patient being transferred to another facility
    • Discover how the requirements of the Consultations and Transfers of Care Use Case map to HITSP constructs
    • Learn about HITSP’s next steps in 2009, which include Incorporating Long Term Care–Assessments and Nursing Documentation
  • Agenda
    • Steve’s Story – current and future
    • What is HITSP?
    • Overview of Interoperability Specification (IS) 09: Consultations and Transfers of Care
    • Consultation scenario
    • Transfer of Care scenario
    • Next Steps/Future Directions
    • Conclusion
    • Questions and Answers
    • Patient is a 27-year-old man who had a brain tumor removed as a child
    • When Steve develops a new onset of seizures, he visits his general practitioner.
      • The general practitioner refers Steve to a neurology consultant.
      • The neurology consultant chooses to admit Steve to the local hospital’s neurology service for further evaluation.
    • The problem: in today’s system, neither the neurologist nor the hospital has easy access to Steve’s recent health records, or his full medical history, including his pediatric neurology records.
    Steve’s Story . . . current situation healthcare interoperability . . . problems and solutions
    • The solution: In the HITSP future, all of Steve’s health records will be interoperable. His health information will be seamlessly and securely exchanged among providers and care settings. With Steve’s consent, providers will gain instant access to past data, such as
      • active and past medication lists
      • allergies
      • current and previous problems and diagnoses
      • visit summaries
      • labs, images, and other test results
      • registration and insurance information
    Steve’s Story . . . future healthcare interoperability . . . problems and solutions
  • What is HITSP?
    • HITSP is a volunteer-driven, consensus-based organization that is funded through a contract from the Department of Health and Human Services
    • The Panel brings together experts from across the healthcare community
      • from consumers to doctors, nurses, and hospitals ;
      • from those who develop healthcare IT products to those who use them ; and
      • from the government agencies who monitor the U.S. healthcare system to those organizations that are actually writing healthcare IT standards .
    Overview
  • Roles and Responsibilities
    • Harmonizes and recommends the technical standards that are necessary to assure the interoperability of electronic health records
      • Creates HITSP-recommended Interoperability Specifications (IS) that specify how and what standards should be used for a particular Use Case/Value Case
      • Supports deployment and implementation of these IS
      • Works with Standards Development Organizations (SDOs) to identify gaps and maintain, revise or develop new standards as required to support the IS
    • Each HITSP Interoperability Specification defines a set of reusable building blocks or “constructs” that:
      • specify how to use selected standards to meet the business needs of a Use Case / Value Case; and
      • define a Roadmap to use emerging standards and to harmonize overlapping standards when resolved.
    • In essence, a HITSP IS represents a suite of documents that integrate and constrain existing standards to satisfy a Use Case / Value Case
    Deliverables and Mode of Operation
  • What Are Consultations and Transfers of Care?
    • Consultations A provider requests and a patient receives a consultation from another provider
    • Transfers of care A provider requests a transfer of care for a patient and the receiving facility admits the patient
  • IS 09: Consultations and Transfers of Care
    • The Consultation and Transfers of Care Interoperability Specification (CTC IS) focuses on the electronic exchange of information to support consultations between clinicians, including specialty services and second opinions. The CTC IS specification also focuses on the exchange of clinical information needed during transfers of care.
    When you go from one doctor or specialist to the next - your information goes with you.
  • IS 09: Clinician Perspectives Steve’s family MD* Consulting neurologist* * Or MD internist, nurse practitioner, psychologist physician assistant, pharmacist, cardiologist…. HITSP IS 09 future: send interoperable consult results Today’s consult results: Communicated via meeting, telephone, postal mail
  • IS 09: Care-setting Perspectives Consulting neurologist* Local hospital * Or nursing home, long term care facility, home healthcare setting, hospice, rehabilitation facility…. Today: send paper patient records overland HITSP IS 09 future: send patient records electronically
  • Other CTC Perspectives
    • Patient perspective e.g., guardians, family caregivers, surrogates
      • Patients or their representatives and surrogates may transfer information among PHRs, health record banks, and provider EHRs as part of a consultation or transfer or care
    • Health Information Exchange (HIE) perspective e.g., Regional Health Information Organizations (RHIOs), care delivery networks, public health networks
      • These entities may support specific functional capabilities which assist in transferring health information, e.g., for reportable diseases sent to public health entities
  • Data Requirements in Consultations
    • Focuses on sharing information to support consultations
      • Includes the consultation request, the consultation itself, and resulting of consult back to origin point
      • Includes administrative and clinical information
      • Sends a core set of clinical information, and then allows consultant to request additional information as needed
    • Information includes reason for consult, images, labs, procedure reports, patient summary information, etc.
  • Data Requirements in Transfers of Care Use Case
    • Focuses on sharing information to support transfers
      • Includes the transfer request, the transfer approval message
      • Includes administrative and clinical information
      • Sends a core set of clinical information, and then allows transfer target facility to request additional information as needed
    • Information includes core information, such as discharge summary, plan of care, procedure documentation, and clinical results.
  • Scenario 1: Consultations
  • Scenario 1: Sample of Consultation Data Flows 1 1 4 4
  • Scenario 2: Samples of Transfer of Care Data Flows 3 3
  • Information Exchange Requirements (IER) IER Description IER 01 Provide authorization and consent IER 11 Identify provider based on patient preference IER 13 Send/receive notification of document availability IER 14 Send/receive health plan eligibility IER 15 Send/receive health plan authorization IER 16 Send/receive clinical summary IER 17 Send/receive transfer of care data IER 22 Send/receive additional patient information IER 25 Send/receive decision support data IER 28 Download historical health data IER 37 Update medication information
  • Information Exchange Requirements (continued) IER Description IER 43 Send/receive accept patient IER 45 Send/receive consult results report IER 57 Identify provider based on health plan IER 60 Send/receive discharge summary IER 62 Send/receive encounter or full episode of care record IER 63 Request additional patient data IER 64 Send/receive consult request/data
  • Data Requirements for Consultations and Transfers of Care Data Requirement Number (DR) Description DR 2 Patient clinical information, including advance directives, allergies, provider, immunizations, language spoken, medications, person information, procedures, vital signs…. DR 6 Health plan eligibility, including demographics, member ID, co-pay, deductibles, limits and exclusions, coded procedures, effective date DR 9 Consultation completion, including treatment summary, medication list and reconciliation, recommended care plan DR 10 Consulting provider registry, including name, location, specialties/capabilities, facilities associated with, schedule, insurance plan associations, contact info
  • Data Requirements for Consultations and Transfers of Care (continued) Data Requirement Number (DR) Description DR 57 Demographic data, including dates, patient demographics, provider info, reason for consult or transfer/discharge DR 60 Patient clinical information, including just about everything you might think of, including PMHx and diagnostic list, physical exam details, problems/conditions, reason for admission or visit, images, care plan, results, med reconciliation, allergies and adverse reactions, DME and equipment, treatment summary, procedures, notes, advance directives, functional status, and other assessments
  • HITSP Constructs for IS 09
    • C32 – Summary Documents using CCD *
    • C37 – Lab Report Document *
    • C48 – Encounter Document *
    • C62 – Unstructured Document *
    • C74 – Remote Monitoring Observation
    • C78 - Immunization Content
    • C84 – Consult and History & Physical Note *
    • T29 - Notification of Document Availability
    • T31 - Document Reliable Interchange
    • T33 - Transfer of Documents on Media
    • T40 - Patient Health Plan Eligibility Verification
    • T68 - Patient Health Plan Authorization Request and Response
    • T79 - Pharmacy to Health Plan Authorization Request and Response
    • TP89 – Sharing Imaging Results *
    • * Key constructs for IS 09
  • CTC IS 09 Base Standards
    • IS 09 relies upon base standards, for example:
      • Documents are formed according to HITSP C32, a summary document that uses the HL7 Continuity of Care Document (CCD) standard
      • Document transfer uses:
        • Document Reliable Interchange (HITSP T31) using the IHE Cross-Enterprise Document Sharing (XDS) standard
        • Transfer of Documents on Media – the patient carries a pen drive –(HITSP T33) using IHE Cross-Enterprise Document Media Interchange standard
      • and others
  • HITSP Security and Privacy Constructs Safeguard Information Exchanged during Transfer and Consultations
    • T17 – Secured Communication Channel
    • TP13 – Manage Sharing of Documents
    • TP20 – Access Control
    • TP30 – Manage Consent Directive
    • C19 – Entity Identity Assertion
    • C26 – Non-repudiation of Origin
    • T15 – Security Audit Trail
    • T16 – Consistent Time
    For more information about how HITSP addresses security and privacy, refer to the August 2008 Security and Privacy Webinar at http://www.hitsp.org/archived_webinars.aspx
  • Interoperability Requirements (IER) IER1-Provide authorization and consent IER-11-Identify provider by patient preference IER 14-Send/receive health plan eligibility (…) Transactions/packages used TP22 PIX Query TP 23-Patient demographics query T29-Send/receive notification (…) To fulfill Data Requirement 57 (Demographic data, consultation and transfer) IS 09: Constructs, IERs, and CRs in Consultations Steve’s family MD* Consulting neurologist* * Or MD internist, nurse practitioner, psychologist physician assistant, pharmacist, cardiologist…. HITSP IS 09 future: send interoperable consult results
  • Interoperability Requirements (IER) IER 13-Send/receive notice of document avail. IER 17-Send/receive transfer of care data IER 22-Send/receive additional patient information (…) Transactions/packages used T 29-Notification of document avail. T 31-Document reliable interchange T 64-Identify communication recipients (…) To fulfill Data Requirement 2 (Patient clinical information) IS 09: Constructs in Transfers of Care Consulting neurologist* Local hospital * Or nursing home, long term care facility, home healthcare setting, hospice, rehabilitation facility…. HITSP IS 09 future: send patient records electronically
  • Scope limits and assumptions
    • Decision support systems (DSS) are not specifically addressed in this IS because they are ubiquitous
    • Patients may bring portable media from one health system to another
    • Consultations continue until they are formally terminated (“Thank you for referring this very interesting patient, we are signing off….”)
    • Transport team notifications are always personal and are not within scope of this IS (see also IS 04, Emergency Responder/EHR)
    • Medication reconciliation is done via HITSP IS 07, Medication Management
  • HITSP IS-09 CTC specification: Location and Status
    • Located at http://www.hitsp.org
    • Currently at version 1.0
    • Accepted by the Secretary of HHS in January 2009
      • Released for one-year period of implementation
      • The reason we’re here today
  • Gaps remaining
    • Clinical data such as ECG, EEG do not have a identified standard and are a gap
    • Medication information cannot be completely communicated (stopped, modified, or “on hold” medications)
    • Send/receive decision support data not defined
    • Functional assessments need a CDA implementation guide
    • No good standard for nurses’ notes
  • Next Steps for 2009
    • Incorporating following 2009 Extensions/Gaps
      • Clinical Note Details
      • Order Sets
      • Long Term Care – Assessments
  • Conclusion
  • Benefits of IS 09 – Consultations and Transfers of Care
    • Better communication among providers means better patient care
    • When data is carried forward, tests do not need to be re-done
    • Patients do not need to continue to fill out paper work with the same information
    • Patients will know right away if their consultation and/or procedure is approved/covered by their insurance
    • Critical information is not lost in the transfer
    • Ensures that the right information and right treatment is linked to the right patient
    • The solution: In the HITSP future, all of Steve’s health records will be interoperable. His health information will be seamlessly and securely exchanged among providers and care settings. With Steve’s consent, providers will gain instant access to past data, such as
      • active and past medication lists
      • allergies
      • current and previous problems and diagnoses
      • visit summaries
      • labs, images, and other test results
      • registration and insurance information
    Steve’s Story . . . future healthcare interoperability . . . problems and solutions
  •  The 2009 Webinar Series www.HITSP.org /webinars   Webinar 1 Advances in Sharing Information in Healthcare IT Thursday, January 15 th , 2009 — 2:00-3:30 pm EDT Webinar 7 Health Information Exchange (HIEs) in the Real World Thursday, July 9 th , 2009 — 2:00-3:30 pm EDT Webinar 2 Personalized Healthcare Interoperability Specification (IS 08) Thursday, February 12 th , 2009 — 2:00-3:30 pm EDT Webinar 8 Patient - Provider Secure Messaging Interoperability Specification (IS 12) Thursday, August 13 th , 2009 — 2:00-3:30 pm EDT Webinar 3 Consultations and Transfers of Care Interoperability Specification (IS 09) Thursday, March 12 th , 2009 — 2:00-3:30 pm EST Webinar 9 Remote Monitoring Interoperability Specification (IS 77) Thursday, September 10 th , 2009 — 2:00-3:30 pm EDT Webinar 4 NHIN Real World Sites Thursday, April 16 th , 2009 — 2:00-3:30 pm EDT Webinar 10 Medication Management Real World Sites Thursday, October 8 th , 2009 — 2:00-3:30 pm EDT Webinar 5 Immunization & Response Management Interoperability Specification (IS 10) Thursday, May 14 th , 2009 — 1:30-3:00 pm EDT Webinar 11 Security, Privacy, and Infrastructure Thursday, November 12 th , 2009 — 2:00-3:30 pm EDT Webinar 6 Public Health Case Reporting Interoperability Specification (IS 11) Thursday, June 18 th , 2009 — 1:30-3:00 pm EDT Webinar 12 Real World Sites – TBA Thursday, December 10 th , 2009 — 2:00-3:30 pm EDT
  • View the Complete Set of HITSP Deliverables www.HITSP.org
    • Use or specify recognized HITSP Interoperability Specifications in your HIT efforts and in your Requests for Proposals (RFPs)
    • Ask for CCHIT certification
    • Leverage Health Information Exchanges to promote HITSP specifications to make connections easier in the future
    • Ask . . . Is there a HITSP standard we could be using?
    • Get involved in HITSP . . . Help shape the standards
    How YOU can become involved
  • Join HITSP in developing a safe and secure health information network for the United States Jessica Kant, HIMSS Theresa Wisdom, HIMSS [email_address] [email_address] Re: HITSP Technical Committees Michelle Deane, ANSI [email_address] Re: HITSP, its Board and Coordinating Committees Visit www.hitsp.org or contact:
  • www.HITSP.org Sponsor Strategic Partners
  • Consultations and Transfers of Care Questions and Answers