IHE Patient Care Coordination Presenters Keith W Boone

IHE Patient Care Coordination Presenters: Keith W. Boone, John Donnelly, Larry Mc. Knight, Dan Russler 3/15/2018 1

Patient Care Coordination – 2005 Development Schedule: • • • Patient Care Domain Sponsored: Profile Proposal Technical Review: Public Comment Version Issued: Trial Implementation Issued: IHE Connectathon: HIMSS Demo: April 2005 May 2005 July 2005 September 2006 January 2006 February 2006 2

Patient Care Coordination – Plan for 2006 Development Schedule: • • • New Profile Proposal Drafts: Profile Proposal Technical Review: Planning Committee decision: Issue Public Comment version: Public Comment Due: Issue Trial Implementation version: IHE Connectathon: HIMSS Demo: Profile Change Proposals Oct-Nov 2005 Nov-Dec 2005 January 2006 June 2006 July 2006 August 2006 January 2007 February 2007 Mar-Sept 2007 3

Patient Care Coordination – Plan for 2006 Existing 2005 PCC Integration Profile • Sharing of Medical Summaries - Discharge & Specialist Referral (XDS-MS) New Profiles For 2006 • • • Patient-created Summary Referral to Emergency Department Patient Consent for Access to Medical Record Pre-surgical History & Physical Coordination with IHE Labs on Sharable Lab Report White Paper: EHR Integration for Clinical Trials 4

Patient-created Summary Use 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 an EMR system in a standard manner. 5

Patient-created Summary Value 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. 6

Patient-created Summary Scope Document content used in transmission of data from a Personal Health Record. Access to content via RHIO, portable media or e-mail 7

Patient-created Summary Key Technical Properties Employ standards based data sets and syntax Ø ASTM CCR Ø HL 7 CDA Release 2. 0 Ø HL 7/ASTM Continuity of Care Document Ø AHIMA PHR Data Set Support most common needs first Ø Problems Ø Medications Ø Allergies and Adverse Reactions 8

Referral to Emergency Department Use 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 ED Information System in a standard manner 9

Referral to Emergency Department Value 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 10

Referral to Emergency Department Scope 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. 11

Referral to Emergency Department Key Technical Properties Employ standards based data sets and syntax Ø Data Elements for Emergency Department Systems (DEEDS) 1. 0 (CDC) Ø HL 7 V 3 Ø ASTM CCR Release 1 Ø HL 7 CDA Release 2 Ø Hl 7 CDA Care Record Summary (CRS) Ø IHE – XDS-MS Referral (Primary Care to Specialist) 12

Patient Consent for Access to Med Record Use 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 Ø Pre-authorization Ø Consents used in multiple care settings Ø Implied consent for emergency situations Ø A paper consent on file 13

Patient Consent for Access to Med Record Value 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 14

Patient Consent for Access to Med Record Scope Document 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: Ø Informed patient consent for participation in clinical studies Ø Informed patient consent for clinical procedures Ø Advanced Directives 15

Patient Consent for Access to Med Record Key Technical Properties The 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: Ø ISO TS 22600 -1/2 – Health Informatics Privilege Ø Ø Management and Access Control ISO 22857 - Health informatics -- Guidelines on data protection to facilitate trans-border flows of personal health information ASTM E 1762 – Electronic Signature W 3 C – Xa. DES IHE – Document Digital Signature 16

Pre-surgical History & Physical Use 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 and other notes are forwarded to the surgeon / surgical center prior to intervention 17

Pre-surgical History & Physical Value proposition Coordinates the collection of extensive data required for surgery Ø Surgical Consultation Note, Ø Laboratory and Imaging Studies, Ø Pre-surgical History & Physical 18

Pre-surgical History & Physical Scope 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 19

Pre-surgical History & Physical Key Technical Properties Employs standards-based data sets and syntax Ø HL 7 CDA Release 2. 0 Ø HL 7 Laboratory Results Ø HL 7 V 3 Ø ASTM CCR Release 1 Ø HL 7/ASTM Continuity of Care Document Ø Hl 7 CDA Care Record Summary (CRS) Supports standards-based exchange mechanisms 20

Coordination 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 21

EHR Integration for Clinical Trials White paper: Electronic tool for Study Coordinator to use in lieu of paper-based Case Report Forms Definition of form content tailored to a specific clinical trial which can be extracted from EHR or entered additionally Completed form content transferred electronically to trial sponsors Content specification coordinated with IHE IT Infrastructure profile for Request Forms for Display (RFD) 22

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