October 30, 2013

1. electronic Submission of Medical Documentation (esMD)electronic Determination of Coverage (eDoC)PMD Discrete Data Definition October 30, 2013

2. Goals • What we are doing • Facilitate the review process for the F2F evaluation, LCMP evaluation, and DME supplier documentation • Move from unstructured data (PDF) to structured data • Move from text to discrete data elements • Move to standards based clinical vocabularies • Determine where we can use discrete data sets and where they will not work • What we are not doing • Designing forms with check boxes • Designating a single method for evaluation and/or documentation • Requiring that discrete data sets and coded medical data must be used • Code all medical data • Define all possible reasons that a PMD is necessary and appropriate

3. Structured Documentation • Moving from unstructured documents to structured documents • Using the Consolidated CDA as the basis for the record • Able to accommodate both coded and un-coded (textual) information • Provides a “home” for the various components of the documentation • Reference: mapping work for the eDoC general use case • Reference: current work on Additional Administrative Templates • Provides entry templates that allow for highly coded information • Can accommodate specific assessment tools (e.g. OASIS) that use highly coded data

4. Approach • Take the most easily coded information first • Supplier information • Home evaluation • Patient willingness to use • Ability to ambulate • Diagnoses --separate into appropriate groups (discuss) • Simple single cause (e.g. spinal injury) • Complex single cause (e.g. progressive COPD) • Multiple causes (co-morbidities that contribute) • COPD • CHF • Obesity • Validate degree of specificity for the various code sets (e.g. ICD-10)

5. Summary • Create discrete data definitions for key components of the PMD eClinical template • Use the C-CDA as the standard for communication the structured data • Follow the process of coding simple information first and then more complex data sets • Identify exemplary assessment tools, relevant to PMD, that currently or with some effort can produce highly coded discrete data sets. • Avoid trying to “solve” coding all problems

6. Questions?