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March 1, 2013

e lectronic s ubmission of Medical Documentation ( esMD ) Determination of Coverage ( eDoC ) Workgroup Kick-Off of Structured Data Sub-Workgroup. March 1, 2013. Welcome and Introductions. Viet Nguyen, MD Sub-Working Group Lead Chief Medical Information Officer Systems Made Simple, Inc.

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March 1, 2013

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  1. electronic submission of Medical Documentation (esMD) Determination of Coverage (eDoC) WorkgroupKick-Off ofStructured Data Sub-Workgroup March 1, 2013

  2. Welcome and Introductions Viet Nguyen, MD Sub-Working Group Lead Chief Medical Information Officer Systems Made Simple, Inc. Dan Kalwa Health Insurance Specialist,CMS / OFM / Provider Compliance Group Michael Handrigan, MD Medical OfficerCMS / OFM / Provider Compliance Group Mark D Pilley, MD AAFP, AADEP, ABQAURP Medical Director StrategicHealthSolutions, LLC Robert Dieterle esMD Initiative Coordinator 2

  3. Agenda 3

  4. SWG Goals • Define a reusable process by which Payors can define and standardize the data they need to perform a DoC • Identify and apply standards to data utilized in the DoC process - PMD Use Case • Create a set of artifacts (e.g. CDA template) that can be utilized by Implementers 4

  5. SWG Process • Define EXISTING business processes/rules and data requirements in the DoC • Identify and enumerate existing data capture artifacts for PMD • Identify and enumerate data elements • Determine if data element is best represented by narrative or codes • Evaluate and apply existing standards • Create artifacts to support implementation 5

  6. Business Processes 6

  7. eDoC General Workflow Patient LCMP Physician Specialist / Service Provider Templates and Rules Payer 7

  8. Request Process for PMD Visits Physician/ Practitioner Beneficiary • Documents the F2F visit in progress note in medical record. • Must include: • Purpose of the visit is to document the need for a PMD • Exam findings Ordering Physician/Practitioner Signs/Dates Detailed Product Description Writes 7-element order • Submits Documentation Package including: • F2F note • 7-Element Order • Detailed Product Description • Other Supporting Documentation Receives/Files F2F visit progress note and order Receives/Files Signed/Dated Detailed Product Description Completes Detailed Product Description Supplier 8

  9. Licensed/Certified Medical Professional (LCMP) (PT/OT) Role in Face-to-Face Process Visits Physician/ Practitioner Visits LCMP for Evaluation Beneficiary Documents the F2F visit in medical record Must include: - Send for LCMP evaluation Reviews, states concurrence, signs and dates LCMP evaluation Ordering Physician/Practitioner Writes 7-element order Writes order for LCMP evaluation Documents the Mobility Evaluation in medical record LCMP 9

  10. Existing Data Capture artifacts and data elements 10

  11. CMS PMD Clinical Template 11

  12. Seven Element Order • 1. Patient’s name, • 2. Description of item ordered (description may be general [e.g., “power operated vehicle”, “power wheelchair”, or “power mobility device”] or more specific), • 3. Date of face-to-face examination, • 4. Pertinent diagnoses/conditions that relate to the need for a PMD, • 5. Length of need, • 6. Physician’s signature, and • 7. Date of physician’s signature. 12

  13. Evaluate Existing Standards • Consolidated Clinical Document Architecture (C-CDA) • Predefined and HL7 approved • Documents, Sections and Elements • Standard Coding Systems • SNOMED • LOINC • ICD • Standard Evaluation Terminology • International Classification of Functionality 13

  14. Consolidated CDA Document Types • Continuity of Care Document 1.1 • History and Physical • Consult Note • Discharge Summary • Diagnostic Imaging Report • Procedure Note • Operative Note • Progress Note • Unstructured Document 14

  15. C-CDA – History and Physical • Allergies Section (entries optional) • Assessment and Plan Section • Assessment Section • Chief Complaint and Reason for Visit Section • Chief Complaint Section • Family History Section • General Status Section • History of Past Illness Section • History of Present Illness Section • Immunizations Section (entries optional) • Instructions Section • Medications Section (entries optional) • Physical Exam Section • Plan of Care Section • Problem Section (entries optional) • Procedures Section (entries optional) • Reason for Visit Section • Results Section (entries optional) • Review of Systems Section • Social History Section • Vital Signs Section (entries optional) 15

  16. Sample C-CDA Section • History of Past Illness • This section describes the history related to the patient’s past complaints, problems, or diagnoses. It records these details up until, and possibly pertinent to, the patient’s current complaint or reason for seeking medical care. • 1. SHALL contain exactly one [1..1] templateId (CONF:7828) such that it • a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.2.20" (CONF:10390). • 2. SHALL contain exactly one [1..1] code (CONF:15474). • a. This code SHALL contain exactly one [1..1] @code="11348-0" History of Past Illness (CodeSystem: LOINC 2.16.840.1.113883.6.1 STATIC) (CONF:15475). • 3. SHALL contain exactly one [1..1] title (CONF:7830). • 4. SHALL contain exactly one [1..1] text (CONF:7831). • 5. MAY contain zero or more [0..*] entry (CONF:8791) such that it • a. SHALL contain exactly one [1..1] Problem Observation (templateId:2.16.840.1.113883.10.20.22.4.4) (CONF:15476). 16

  17. Sample C-CDA Entry • Problem Observation • … • SHALLcontain exactly one [1..1] value with @xsi:type="CD", where the @code SHOULD be selected from ValueSet Problem Value Set 2.16.840.1.113883.3.88.12.3221.7.4 DYNAMIC (CONF:9058). • This value MAY contain zero or more [0..*] translation (CONF:16749). • The translation, if present, MAY contain zero or one [0..1] @code (CodeSystem: ICD10CM 2.16.840.1.113883.6.90 STATIC) (CONF:16750). • … 17

  18. ValueSet Problem Value Set OID 2.16.840.1.113883.3.88.12.3221.7.4 18

  19. Data Mapping 19

  20. Document & Section Mapping 20

  21. Entry Level Mapping 21

  22. SWG Artifacts • Data Set Requirements • Data Model • Harmonization with existing C-CDA Document Template and other standards 22

  23. eDoC Timeline July ‘13 Mar ‘13 May ‘ 13 Aug ‘13 Jun ‘13 Feb ‘13 Apr ‘13 Pre-Discovery Workgroup Charter/Scope Kick-Off PMD Phase 1 Pilots (TBD) PMD Phase 1 Implementation Guide Use Case #1: PMD Phase 1 Standards/Data Model/Harmonization PMD Phase 1 Sub Workgroup PMD Structured Data PMD Phase 2 Implementation Guide Use Case #1: PMD Phase 2 Standards/Data Model/Harmonization PMD Phase 2 (TBD) Sub Workgroup PMD Data Capture Template Sub Workgroup PMD Decision Support 23 23

  24. Challenges • Coordinating work with other S&I Framework Initiatives (HeD and SDC) • Coordinating document types in EMR • Issues of coordination with HL7 regarding gaps in C-CDA or additional templates that must be part of C-CDA 24

  25. Community Involvement • Assist with elaboration of use case and variations • Identification of data elements • Identification and mapping to standards • HL7 CDA expertise 25

  26. Sub-Work Group Meeting Times • Wednesdays – 2-3 PM Eastern following the esMD Author of Record • Fridays – 2-3 PM Eastern • Next Meeting – Wednesday, March 13. 2-3 PM Eastern

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