Patient Care Coordination

1. Patient Care Coordination IHE Workshop 2006 IHE Patient Care Coordination Education John Donnelly

2. Primary Membership • Physician Associations & Colleges • ACP, AAP, AAFP, FACEP • EMR & Other Department System Vendors • Ambulatory, Inpatient, Emergency Dept • PHR Vendors • PC-based systems, Portal solutions • Other Stakeholders in HIT • Clinical research initiatives, Public health agencies

3. Profile Roadmap • Year 2005-2006 (Trial Implementation) • Medical Summary [MS] – Acute Care Discharge to PCP, PCP Referral to Specialist • Unstructured Document – CDA-wrapped PDF • Year 2006-2007 (Development & Testing) • Medical Summary [MS] – ED Referral [EDR] • Pre-procedure H&P [PPHP] • Basic Patient Privacy Consents [BPPC] • Exchange Personal Health Record [XPHR] • Coordination with Laboratory Domain [XDS-LAB] • Future (Profile Document / White Paper) • Medical Summary [MS] – Discharge to LTC • Forms Display for Data Capture (e.g. clinical research)

4. Domain Visibility & Support • HIMSS Annual Conference • 2006 HIMSS ‘RHIO’ Showcase – 30+ vendors exchanged XDS-MS, XDS-pdf documents • Informational Presentations from Providers & HIT Vendors • ACC Annual Conference • 2006 ACC Interoperability Showcase – ?? vendors exchanged XDS-pdf documents • Informational Presentations from HIT Vendors • Physician Association Annual Meetings • Informational Presentations Planned • Real-world RHIO Participation • NHIIN “Pilot” RHIO’s • Independent Community-sponsored RHIO’s

5. Patient Care CoordinationTechnical Framework • Reuse of ITI Profiles • ITI Cross Enterprise Document Sharing (XDS) • ITI Cross Enterprise Point-to-Point Sharing (XDP) • New Actors / Transactions • None Yet, but… • Content Integration Profiles • XDS Medical Summaries • Bindings • Binds Content to IHE Transactions • Medical Document to XDS • Medical Document to XDP • Declared in Integration Statements • Options • Some options defined for XDS, XDP

6. Patient Care CoordinationContent Integration Profiles • Content using a Specific Standard • CDA Release 2.0 • HL7 Care Record Summary • ASTM/HL7 Continuity of Care Document • Others as Needed (e.g., ASTM CCR, DICOM …) • Library of Reusable Parts • Document Types • Sections • Entries

7. Patient Care CoordinationContent Integration Profiles 2005-2006 XDS-MS 2006-2007 MedicalDocuments PPHP BCCP MedicalSummaries History andPhysical Consent EDR XPHR Referral DischargeSummary EmergencyDepartmentReferral PHR Extract PreprocedureHistory andPhysical XDSLAB PHR Update CDA Lab

8. Emergency Department Referral Todd Rothenhaus, MD FACEP American College of Emergency Physicians

9. XDS-MS MedicalDocuments EDR EmergencyDepartmentReferral PPHP BCCP MedicalSummaries History andPhysical Consent EDR XPHR Referral DischargeSummary EmergencyDepartmentReferral PHR Extract PreprocedureHistory andPhysical XDSLAB PHR Update CDA Lab Emergency DepartmentReferral

10. Emergency DepartmentReferralUse Case • Health care provider determines that a patient needs to go to the ED • Provider creates an ED referral package using his or her EHR • Upon arrival, the ED provider identifies the patient as a referral • The posted referral package is imported into the Emergency Department Information System (EDIS) Provide access to critical health information to ED information systems in a standard manner.

11. Emergency DepartmentReferralValue Proposition • Nearly 5000 EDs in US • Significant percentage of ED visits are referrals • Shortage of critical health data for emergency department patients • Need to improve communication of intended patient care plans to ED providers and ensure that no pertinent data is lost • Streamline workflow by obviating telephone calls between busy clinicians

12. Emergency DepartmentReferralScope • EHR system capable of creating a care record summary would be capable of creating a referral package for a receiving system • The emergency department information systems (EDIS) will need to retrieve and read and display this data.

13. Basic Patient Privacy Consents (BPPC) IHE Vendors Workshop 2006 IHE Patient Care Coordination Education John Moehrke, Robert Horn, Lori Fourquet, Keith W. Boone

14. XDS-MS MedicalDocuments PPHP BCCP MedicalSummaries History andPhysical Consent EDR XPHR Referral DischargeSummary EmergencyDepartmentReferral PHR Extract PreprocedureHistory andPhysical XDSLAB PHR Update CDA Lab BCCP Consent Basic Patient Privacy Consents

15. Basic Patient Privacy ConsentsAbstract • The Basic Patient Privacy Consents (BPPC) profile provide mechanisms to: • Record the patient privacy consent(s), • Mark documents published to XDS with the patient privacy consent that was used to authorize the publication, • Enforce the privacy consent appropriate to the use.

16. Basic Patient Privacy ConsentsScope • Document Sources and Document Consumers in an XDS Affinity Domain • Document Sources and Document Receivers using Cross Enterprise Point-to-Point Document Sharing

17. Basic Patient Privacy ConsentsValue Proposition • an Affinity Domain can • develop privacy policies, • and implement them with role-based or other access control mechanisms supported by EHR systems. • A patient can • Be made aware of an institutions privacy policies. • Have an opportunity to selectively control access to their healthcare information.

18. Basic Patient Privacy ConsentsKey Technical Properties • Human Readable Consents • Machine Processable • Support for standards-based Role-Based Access Control

19. Basic Patient Privacy ConsentsStandards and Profiles Used • CDA Release 2.0 • XDS Scanned Documents • Document Digital Signature • Cross Enterprise Document Sharing • Cross Enterprise Point-to-Point Document Sharing

20. Pre-procedure History and Physical (PPHP) IHE Development Team Workshop 2006 IHE Patient Care Coordination Education Dan Russler, MD, co-chair PCC Technical Committee

21. XDS-MS MedicalDocuments PPHP PPHP BCCP MedicalSummaries History andPhysical History andPhysical Consent EDR XPHR EmergencyDepartmentReferral Referral DischargeSummary PHR Extract PreprocedureHistory andPhysical PreprocedureHistory andPhysical XDSLAB PHR Update CDA Lab Pre-procedure History and Physical

22. Use Case • H&P documentation required prior to procedure that is designed to assess: • Procedure Risk • Anesthesia Risk • Factors influencing procedure after-care decisions • Desired outcomes • Minimize injury during procedure • Optimize procedure after-care Pre-procedure H&P

23. Scope • To identify the required and optional PPHP document content templates including: • CDA Document Header • CDA Document Type(s) • CDA Section Types • CDA Entry Types Pre-procedure H&P

24. Value Proposition • A procedure risk assessment must be present and evaluated by the operative and after-care teams before the patient is allowed to have the procedure. Missing information is frequently a reason for canceling the procedure for the day, which leads to expensive underutilization of resources and dissatisfied patients. Further, incomplete information about the patient’s clinical or home status may create a situation where a procedure is performed that ultimately results in an injury, inadequate aftercare or other undesirable outcome. Pre-procedure H&P

25. Key Technical Properties • PPHP Profile inherits specifications required for other IHE PCC Medical Documents • PPHP Profile follows documentation practices for all IHE PCC Medical Documents • PPHP Profile emphasizes re-usability of CDA template identifiers in order to reduce un-necessary variability in IHE Content Profiles Pre-procedure H&P

26. Standards Used • IHE Medical Document Content Profiles • HL7 Reference Information Model ANSI Standard • HL7 CDA R2 ANSI Standard • HL7 Care Provision Domain DSTU (in process) • Implementation Guides • HL7 Care Record Summary CDA R2 Implementation Guide (in process) • HL7/ASTM Continuity of Care Document Implementation Guide (in process)

27. Exchange of PHR Content(XPHR) IHE Vendors Workshop 2006 IHE Patient Care Coordination Education Keith W. Boone, GE Healthcare IHE PCC Co-chair

28. XDS-MS MedicalDocuments PPHP BCCP MedicalSummaries History andPhysical Consent XPHR Referral DischargeSummary PHR Extract PreprocedureHistory andPhysical EDR EmergencyDepartmentReferral XDSLAB PHR Update CDA Lab XPHR PHR Extract PHR Update Exchange of PHR Content

29. Exchange of PHR ContentAbstract • The Exchange of Personal Health Record Content (XPHR) provides a standards-based specification for managing the interchange of documents between a Personal Health Record and an EHR System to enable better interoperability between these systems.

30. Exchange of PHR InformationScope • Personal Health Record (PHR) Systems • Electronic Health Record (EHR) Systems

31. Exchange of PHR InformationValue Proposition • Supports interchange of PHR Information • Demographics • Insurance Information • Medications, Problems, Allergies • Health History • Other Information

32. Exchange of PHR InformationStandards Used • CDA Release 2.0 • ASTM Continuity of Care Data Set • ASTM/HL7 Continuity of Care Document • HL7 Care Record Summary • AHIMA PHR Common Data Elements • XDS, XDP • Document Digital Signature

33. Exchange of PHR InformationKey Technical Properties • Information is Human Readable • and Machine Processable • Support Static and Dynamic Information Sharing Domains (XDS and XDP) • Protects Information using Digital Signature • Update Model for EHR to PHR Changes

34. CDA Lab Report IHE Vendors Workshop 2006 IHE Patient Care Coordination Education Francois Macary, AgfaIHE Lab Co-chair

35. XDS-MS MedicalDocuments PPHP BCCP MedicalSummaries History andPhysical Consent XPHR Referral DischargeSummary PHR Extract PreprocedureHistory andPhysical EDR EmergencyDepartmentReferral XDSLAB PHR Update CDA Lab XDSLAB CDA Lab XDS Laboratory Report

36. How to Get Involved

37. Next Steps

38. Questions ?

39. References