.ppt

1enabling healthcare interoperability

2009 Webinar Series

Sponsored by the HITSP Education, Communications and Outreach Committee

Consultations and Transfers of CareHITSP 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 AffairsSuzi Hines, Principal, Sage Consulting, LLC

HITSP – enabling healthcare interoperability 2009 Webinar Series

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 situationhealthcare 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 . . . futurehealthcare interoperability . . . problems and solutions


2009 Webinar Series


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) perspectivee.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.


Section 7.1Requesting Clinician

Section 7.2 Consulting Clinician

7.1.3 Initiate consult request with consulting

clinician

7.1.1 Evaluate patient and

determine need for consult

7.1.2 Discuss with patient and select

consulting clinician

Section 9.0Information Exchange

Section 7.3Patient

7.2.1 Receive and review request & determine ability to accept patient

7.2.3 Evaluate/ manage patient

7.2.2 Request and view additional

clinical information

7.2.4 Complete consultation

7.2.5 Complete and communicate

consult report

7.3.4 Receive consult report information


7.3.1. Select and coordinate with


7.3.2 Provide permissions for

core set of data to be shared

Laboratories

Healthcare Entities

Healthcare Payors

Other EHRs

Medication Network

Intermediaries

Diagnostic Imaging

1

4

Other PHRs/ Health Record

Banks

4

7.1.4 Provide access to

additional clinical information

7.1.5 Receive and review consult

report4

Contextual

Focus

Legend

Focus

Legend

1

4

3

3

3

Perspectives/RolesInformation Sources

& Recipients

May be one or more of those listed

below:

2

Health Information Exchange

OR

Point-to-Point Exchange

OR

Specialty Network Exchange

Capabilities as needed in context

9.3 Subject-data matching

9.2 Data retrieval

9.1 Data delivery

9.4 Summary patient record

exchange

9.6 Support for personally

controlled health records

9.7 Emergency access

9.5 Notification of availability of new or updated data

Scenario 1: Consultations


Section 7.1Requesting Clinician

Section 7.2 Consulting Clinician

7.1.3 Initiate consult request with consulting

clinician

7.1.1 Evaluate patient and

determine need for consult

7.1.2 Discuss with patient and select


Section 9.0Information Exchange

Section 7.3Patient

7.2.1 Receive and review request & determine ability to accept patient

7.2.3 Evaluate/ manage patient

7.2.2 Request and view additional

clinical information


7.2.5 Complete and communicate

consult report

7.3.4 Receive consult report information


7.3.1. Select and coordinate with


7.3.2 Provide permissions for

core set of data to be shared

Laboratories

Healthcare Entities

Healthcare Payors

Other EHRs

Medication Network

Intermediaries

Diagnostic Imaging

1

4


Banks

4


additional clinical information

7.1.5 Receive and review consult

report4

Contextual

Focus

Legend

Focus

Legend

1

4

3

3

3


& Recipients


below:

2


OR


OR




9.2 Data retrieval

9.1 Data delivery


exchange





Scenario 1: Sample of Consultation Data Flows

1

1

4

4


Scenario 2: Samples of Transfer of Care Data Flows

8.1 Discharging/ Transferring

Setting

8.2 Receiving Setting

8.1.5 Transmit additional relevant patient data upon

completion

8.2.2 Accept patient &

coordinate transfer

8.1.1 Determine need to transfer

patient

8.1.3 Initiate plan & coordinate

discharge/transfer

9.0 Information Exchange

8.2.3 Receive and review patient

data & evaluate/ manage patient

8.2.4 Access additional patient

data

8.2.5 Continue to manage patient

3

8.1.2 Select next setting of care &

discuss with patient/family

8.1.4 Discharge/ Transfer patient & transmit available

transfer data

Laboratories

Healthcare Entities

Healthcare Payors

Other EHRs

Medication Network

Intermediaries

Diagnostic Imaging


Banks

2

8.2.1 Receive and review patient

data & determine ability to accept

patient


additional patient data

4

4

Section 8.3Patient

8.3.1. Receive discharge/transfer

data

Contextual

Focus

Legend

Focus

Legend

1

4

3

2

3

3 4

5

5

5


& Recipients


below:


OR


OR




9.2 Data retrieval

9.1 Data delivery


exchange





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


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

HITSP Security and Privacy Constructs Safeguard Information Exchanged during Transfer and Consultations


Interoperability Requirements (IER)IER1-Provide authorization and consentIER-11-Identify provider by patient preferenceIER 14-Send/receive health plan eligibility(…)

Transactions/packages usedTP22 PIX QueryTP 23-Patient demographics queryT29-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 dataIER 22-Send/receive additional patient information(…)

Transactions/packages usedT 29-Notification of document avail.T 31-Document reliable interchangeT 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


2009 Webinar Series


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 . . . futurehealthcare interoperability . . . problems and solutions


Webinar 1 Advances in Sharing Information in Healthcare IT

Thursday, January 15th, 2009 — 2:00-3:30 pm EDT

Webinar 7 Health Information Exchange (HIEs) in the Real World

Thursday, July 9th, 2009 — 2:00-3:30 pm EDT

Webinar 2 Personalized Healthcare Interoperability Specification (IS 08)

Thursday, February 12th, 2009 — 2:00-3:30 pm EDT

Webinar 8 Patient - Provider Secure Messaging Interoperability Specification (IS 12)

Thursday, August 13th, 2009 — 2:00-3:30 pm EDT

Webinar 3 Consultations and Transfers of Care Interoperability Specification (IS 09)

Thursday, March 12th, 2009 — 2:00-3:30 pm EST

Webinar 9 Remote Monitoring Interoperability Specification (IS 77)

Thursday, September 10th, 2009 — 2:00-3:30 pm EDT

Webinar 4 NHIN Real World Sites

Thursday, April 16th, 2009 — 2:00-3:30 pm EDT

Webinar 10 Medication Management Real World Sites

Thursday, October 8th, 2009 — 2:00-3:30 pm EDT

Webinar 5 Immunization & Response Management Interoperability Specification (IS 10)

Thursday, May 14th, 2009 — 1:30-3:00 pm EDT

Webinar 11 Security, Privacy, and Infrastructure

Thursday, November 12th, 2009 — 2:00-3:30 pm EDT

Webinar 6 Public Health Case Reporting Interoperability Specification (IS 11)

Thursday, June 18th, 2009 — 1:30-3:00 pm EDT

Webinar 12 Real World Sites – TBA

Thursday, December 10th, 2009 — 2:00-3:30 pm EDT

The 2009 Webinar Serieswww.HITSP.org/webinars


View the Complete Set of HITSP Deliverableswww.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


Jessica Kant, HIMSS Theresa Wisdom, [email protected] [email protected]

Re: HITSP Technical Committees

Michelle Deane, ANSI [email protected]

Re: HITSP, its Board and Coordinating Committees

Join HITSP in developing a safe and secure

health information network

for the United States

Visit www.hitsp.org or contact:


Sponsor Strategic Partners

www.HITSP.org


2009 Webinar Series


Consultations and Transfers of Care

Questions and Answers

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