1September, 2005 What IHE Delivers

Presenters:Presenters:Keith W. Boone, John Donnelly, Keith W. Boone, John Donnelly, Larry McKnight, Dan RusslerLarry McKnight, Dan Russler

IHE Patient Care IHE Patient Care CoordinationCoordination

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Patient Care Coordination – Plan for 2006

Development Schedule:Development Schedule:• New Profile Proposal Drafts:New Profile Proposal Drafts: Oct-Nov 2005Oct-Nov 2005• Profile Proposal Technical Review:Profile Proposal Technical Review: Nov-Dec 2005Nov-Dec 2005• Planning Committee decision:Planning Committee decision: January 2006January 2006• Issue Public Comment version: Issue Public Comment version: June 2006June 2006• Public Comment Due:Public Comment Due: July 2006July 2006• Issue Trial Implementation version: Issue Trial Implementation version: August 2006August 2006• IHE Connectathon: IHE Connectathon: January 2007January 2007• HIMSS Demo: HIMSS Demo: February 2007February 2007• Profile Change Proposals Profile Change Proposals Mar-Sept 2007Mar-Sept 2007

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Patient Care Coordination – Plan for 2006

Existing 2005 PCC Integration ProfileExisting 2005 PCC Integration Profile• Sharing of Medical Summaries - Discharge & Specialist Sharing of Medical Summaries - Discharge & Specialist

Referral (XDS-MS)Referral (XDS-MS)

New Profiles For 2006New Profiles For 2006 • Patient-created SummaryPatient-created Summary• Referral to Emergency DepartmentReferral to Emergency Department• Patient Consent for Access to Medical RecordPatient Consent for Access to Medical Record• Pre-surgical History & PhysicalPre-surgical History & Physical• White Paper: EHR Integration for Clinical TrialsWhite Paper: EHR Integration for Clinical Trials

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Patient-created SummaryPatient-created SummaryUse CaseUse Case

Patient presents to a primary care physician and is required to complete standard forms for patient demographics, medical history, etc

Patient presents to a specialist and is required to complete similar standard forms for patient demographics, medical history, etc

Provide personal health record information to Provide personal health record information to an EMR system in a standard manner.an EMR system in a standard manner.

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Patient-created Summary Patient-created Summary Value PropositionValue Proposition

Allows quick and easy access to commonly requested medical data from patients.

Automated transfers of PHR information reduce errors in transcription, forgotten information, et cetera.

Faster intake of new patients.

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Patient-created SummaryPatient-created Summary ScopeScope

Document content used in transmission of data from a Personal Health Record.

Access to content via RHIO, portable media or e-mail

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Patient-created SummaryPatient-created Summary Key Technical PropertiesKey Technical Properties

Employ standards based data sets and syntax ASTM CCR HL7 CDA Release 2.0 HL7/ASTM Continuity of Care Document AHIMA PHR Data Set

Support most common needs first Problems Medications Allergies and Adverse Reactions

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Referral to Emergency DepartmentReferral to Emergency Department Use CaseUse Case

Health care provider determines that a patient needs treatment in an ED

Provider creates an ED referral package using an EMR system

Upon arrival, the ED provider identifies the patient as a referral

The posted referral package is imported into the Emergency Department Information System (EDIS)

Communicate critical health information from ambulatory EMR to an Communicate critical health information from ambulatory EMR to an ED Information System in a standard mannerED Information System in a standard manner

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Referral to Emergency Department Referral to Emergency Department Value PropositionValue Proposition

Access: Quick access to critical health data for emergency department patients

Quality: Document and improve communication of intended patient care plans to ED providers and ensure that no pertinent data is lost

Efficiency: Streamline workflow by obviating telephone calls between busy clinicians

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Referral to Emergency Department Referral to Emergency Department ScopeScope

EMR system capable of creating a care record summary creates a multi-document referral package for an EDIS system

The emergency department information systems (EDIS) retrieves, displays, and potentially imports this referral package data.

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Referral to Emergency DepartmentReferral to Emergency DepartmentKey Technical PropertiesKey Technical Properties

Employ standards based data sets and syntax Data Elements for Emergency Department

Systems (DEEDS) 1.0 (CDC) HL7 V3 ASTM CCR Release 1 HL7 CDA Release 2 Hl7 CDA Care Record Summary (CRS) IHE – XDS-MS Referral (Primary Care to

Specialist)

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Patient Consent for Access to Med RecordPatient Consent for Access to Med RecordUse CaseUse Case

Consents are a fundamental requirement in the electronic exchange of patient health data where the information may be processed and communicated when the patient is not present Pre-authorization Consents used in multiple care settings Implied consent for emergency situations A paper consent is on file ???

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Patient Consent for Access to Med RecordPatient Consent for Access to Med Record

Value PropositionValue Proposition

Capturing and storing patient consents electronically allows practitioners quick access to and proper disclosure processing of the patient's health data

Enable ready access to medical summary data to information systems and practitioners in order to properly process disclosure of the health information

Serve to facilitate the patient registration process where the patient is unconscious or not in a condition to respond

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Patient Consent for Access to Med RecordPatient Consent for Access to Med Record

ScopeScopeDocument content necessary in consents to enable authorized access to medical records

RHIO-based access to consents

Define content of consent to enable future IT infrastructure access control profiles to assert constraints to consent

Out of Scope in 2006: Informed patient consent for participation in clinical studies Informed patient consent for clinical procedures Advanced Directives

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Patient Consent for Access to Med RecordPatient Consent for Access to Med Record

Key Technical PropertiesKey Technical PropertiesThe treating practitioner/facility will need to be able to retrieve patient consent information from a RHIO, preferably in a structured format, with an authorization signature and assurance for data integrity.

Potential Standards: ISO TS22600-1/2 – Health Informatics Privilege Management and

Access Control ISO 22857 - Health informatics -- Guidelines on data protection to

facilitate trans-border flows of personal health information ASTM E1762 – Electronic Signature W3C – XaDES IHE – Document Digital Signature

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Pre-surgical History & PhysicalPre-surgical History & PhysicalUse CaseUse Case

Primary Care Physician reviews available history and records medical evaluation in office EMR

Other tests and studies may be ordered

Consultation results, prior labs or imaging studies are packaged with pre-surgical H&P

H&P and other notes are forwarded to the surgeon / surgical center prior to intervention

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Pre-surgical History & PhysicalPre-surgical History & PhysicalValue propositionValue proposition

Coordinates the collection of extensive data required for surgery Surgical Consultation Note, Laboratory and Imaging Studies, Pre-surgical History & Physical

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Pre-surgical History & PhysicalPre-surgical History & PhysicalScopeScope

Deployment of XDS Submission Set with H&P, labs and test results

Patient history and physical exam data elements added to existing XDS-MS

Access to content via RHIO, portable media or e-mail

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Pre-surgical History & PhysicalPre-surgical History & PhysicalKey Technical PropertiesKey Technical Properties

Employs standards-based data sets and syntax HL7 CDA Release 2.0 HL7 Laboratory Results HL7 V3 ASTM CCR Release 1 HL7/ASTM Continuity of Care Document Hl7 CDA Care Record Summary (CRS)

Supports standards-based exchange mechanisms

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EHR Integration for Clinical TrialsEHR Integration for Clinical Trials

White paper:

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Coordination with IHE LabsCoordination with IHE Labs

Laboratory Results are vital in the communication of patient health status

Laboratory results communicated via messaging are not human readable

Laboratory results can only be shared when “approved” for release by an authorized source: a document oriented laboratory report is needed.

Human readable lab reports are necessary in a wide variety of Patient Care Coordination use cases

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