Interoperability Standards Priorities Task Force Ken Kawamoto, - - PowerPoint PPT Presentation

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Interoperability Standards Priorities Task Force Ken Kawamoto, - - PowerPoint PPT Presentation

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Health IT Advisory Committee Interoperability Standards Priorities Task Force Ken Kawamoto, Co-Chair Steven Lane, Co-Chair October 23, 2018 Agenda Call to Order/ Roll Call Lauren Richie, Designated Federal Officer HITAC Debrief

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Interoperability Standards Priorities Task Force

Ken Kawamoto, Co-Chair Steven Lane, Co-Chair October 23, 2018

Health IT Advisory Committee

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Agenda

  • Call to Order/ Roll Call

» Lauren Richie, Designated Federal Officer

  • HITAC Debrief & Follow-up

» Steven Lane & Ken Kawamoto, Task Force Co-Chairs

  • Overview of Standards Associated with Closed Loop Referrals & Care Coordination

» Brett Andriesen, ONC Staff

  • Presentation on 360X Project

» Holly Miller & Jim Fisher, MedAllies » Vassil Peytchev, Epic

  • Task Force Discussion of Closed Loop Referrals & Care Coordination

» Steven Lane & Ken Kawamoto, Task Force Co-Chairs

  • Public Comment
  • Next Meeting
  • Adjourn

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HITAC Debrief & Follow-up

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Link to ISPTF October 2018 HITAC Update

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Overview of Standards Associated with Closed Loop Referrals & Care Coordination

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Relevant Links

  • Direct Project Wiki - http://wiki.directproject.org/
  • 360X - http://bit.ly/360Xreferrals
  • Cross Enterprise Basic eReferral Workflow Definition -

https://wiki.ihe.net/index.php/Cross- enterprise_Basic_eReferral_Workflow_Definition

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ISA Links

  • ISA Section II: Admission, Discharge and Transfer
  • ISA Section II: Care Plan
  • ISA Section II: Images
  • ISA Section II: Laboratory
  • ISA Section II: Summary Care Record
  • ISA Section V: Health Care Claims and Coordination of Benefits
  • ISA Section V: Administrative Transactions to Support Clinical Care

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Presentation on 360X Project

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360X for Closed Loop Referrals

Interoperability Standards Priority Task Force Holly Miller, MD, MBA, CMO, MedAllies Vassil Peytchev, Lead Technical Advisor, Epic http://bit.ly/360Xreferrals

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360X Background

  • 360X launched 2012 under ONC
  • Developed an implementation guide to work

with standards and specifications commonly used within health IT systems:

  • C-CDA for clinical content
  • Direct protocols for transport
  • XDM for establishing context
  • HL7 V2 messages for referral workflow

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Technical Approach: Layers

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Clinical Information Context and Workflow Transport

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Specialty Info needs Clinical Information Workflow Information XDM Direct S/MIME SMTP

Technical Approach: Layers

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  • Future work by medical societies

Specialty Info needs

  • C-CDA containing MU Common Data Set

Well understood, available

Clinical Information

  • HL7 Version 2.x messages

Well understood

Workflow Information

  • Well understood, available

XDM

  • Well understood and widely

available

Direct S/MIME SMTP

Technical Approach: Layers

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Technical Approach: Workflow Requirements

  • Patient Identity management capabilities

– The Referral Initiator sends basic demographics information and a patient identifier known to them – The Referral Recipient must send back the same patient identifier – The same patient identifier must be used by both sides in any exchanges related to the referral

  • Referral Identifier

– The Referral Initiator assigns a unique referral identifier with the referral request – The Referral Recipient must send back the same referral identifier – The same referral identifier must be used by both sides in any exchange related to the referral

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360X Project Goals

  • Primary Goal: to improve patient care across

referrals

– Standardized type of data exchanged and method

  • f transport

– Transparency of progress and/or gaps in care until the loop is closed – A process w/ a low bar of entry for implementation – Add value to patients, clinicians, office staff and

  • verall clinical workflows

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Patient Story

  • Arnie Pectoris, 67, obese male with

new complaints of chest pain and high risk for heart disease

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Current State: New Patient Referral

Patient requires urgent cardiology request

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PCP Provider A Patient

Patient given cardiology office phone number

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Current State: New Patient Referral

Patient calls cardiology office

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Cardiology

  • ffice A

Patient

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Patient informed no available appointments

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Elapsed time 2 hours

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Current State: New Patient Referral

Patient calls PCP office

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Patient

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Patient told PCP will call back

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PCP Provider A

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PCP office staff call patient back with another cardiologist phone number

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PCP Provider A

Patient

Elapsed time 4 hours

Current State: New Patient Referral

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Patient calls cardiology 2nd

  • ffice

1

Cardiology

  • ffice B

Patient

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Patient given an appointment for the following day

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Current State: New Patient Referral

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Patient experiences chest pain and calls an ambulance

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Hospital Patient

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Patient admitted to hospital, rules

  • ut for MI

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Elapsed time 12 hours

Current State: New Patient Referral

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1

Cardiology

  • ffice B

Patient “no show” to cardiology appointment

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Elapsed time 25 hours

Current State: New Patient Referral

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PCP office staff call patient to inquire about cardiology appointment as no documentation received from cardiology office

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PCP Provider A

Patient

Elapsed time 1+ week

Current State: New Patient Referral

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360X: 1 Referral Request

1

  • Dr. Alex Allen

Patient

  • Dr. Bob Brown
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360X: 3 Referral Decline

  • Dr. Alex Allen

Patient

  • Review

Availability

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  • Dr. Bob Brown
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360X: 4 Referral Request

  • Dr. Alex Allen
  • Dr. Carl Carlyle

Patient

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360X: 5 Referral Accept

  • Dr. Alex Allen
  • Dr. Carl Carlyle

5

Patient

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360X: 7 Consultation

  • Dr. Alex Allen
  • Dr. Carl Carlyle

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  • Create new

patient

  • Pull discrete data

into new patient record

6 7 - Patient

consultation with cardiologist Patient

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360X: 8 Consultation to PCP

  • Dr. Alex Allen
  • Dr. Carl Carlyle

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  • Create new

patient

  • Pull data into

new patient record

6 7 - Patient

consultation with cardiologist Patient

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360X: 9 Closed Loop

  • Dr. Alex Allen
  • Dr. Carl Carlyle

5 8 9 - Automatic

patient match

  • Data

reconciliation

  • Create new patient
  • Pull data into new

patient record

6 7 - Patient

consultation with cardiologist

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31

1

  • Dr. Alex Allen
  • Dr. Bob Brown
  • Dr. Carl Carlyle

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360X: Summary

8 9 - Automatic

patient match

  • Data

reconciliation

  • Create new patient
  • Pull data into new

patient record

6 7 - Patient

consultation with cardiologist

2 - Review

availability

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360X Summary

  • Enhance patient care across ambulatory transitions of care

through standardization of referral tracking and ability to automatically close the referral loop

  • Discrete referral order ID that persists across systems until

the referral loop is closed

  • Administrative tracking messages that allow staff to follow

up:

– Appointment scheduled (date/time); Appointment rescheduled – Patient: “no show”; cancel – Interim consult notes (if multiple encounters included) prior to closing the loop

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http://bit.ly/360Xreferrals

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360X Next Steps

  • Reporting for eCQM CMS Measure ID CMS50v5 Closing

the Referral Loop: Receipt of Specialist Report

  • Include patient’s payer information
  • Expanded use cases

– E.g. Acute to LTPAC – Care coordination and care team workflows – 360X in combination with additional technologies

  • EMDI Pilot

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http://bit.ly/360Xreferrals

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HITAC Role

  • Support that EHR vendors develop to the 360X

implementation guide standards and require this functionality for future certification

  • Support for the 360X standards for Patient

Identity management capabilities be developed and used for all order tracking to completion

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http://bit.ly/360Xreferrals

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Task Force Discussion of Closed Loop Referrals & Care Coordination

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Public Comment To make a comment please call:

Dial: 1-877-407-7192

(once connected, press “*1” to speak)

All public comments will be limited to three minutes. You may enter a comment in the “Public Comment” field below this presentation.

Or, email your public comment to onc-hitac@accelsolutionsllc.com.

Written comments will not be read at this time, but they will be delivered to members of the Task Force and made part of the Public Record.

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Next Meeting

  • November 13, 2018 10-11:30am ET

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@ONC_HealthIT @HHSONC

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Health IT Advisory Committee

Meeting Adjourned