IHE Patient Care Coordination

1. IHE Patient Care Coordination Presenters: Keith W. Boone, John Donnelly, Larry McKnight, Dan Russler

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

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

4. 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

5. Patient-created SummaryUse 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.

6. 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.

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

8. Patient-created SummaryKey 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

9. Referral to Emergency DepartmentUse 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

10. 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

11. 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.

12. Referral to Emergency DepartmentKey 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)

13. Patient Consent for Access to Med RecordUse 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 on file

14. Patient Consent for Access to Med RecordValue 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

15. Patient Consent for Access to Med RecordScope • 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: • Informed patient consent for participation in clinical studies • Informed patient consent for clinical procedures • Advanced Directives

16. Patient Consent for Access to Med RecordKey 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: • 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

17. Pre-surgical History & PhysicalUse 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

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

19. Pre-surgical History & PhysicalScope • 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

20. Pre-surgical History & PhysicalKey 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

21. 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

22. 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)