Opportunities for Engaging Long Term & Post Acute Care Providers in Health Information Exchange

1. Briefing to the Standards &Interoperability LTPAC Workgroup October 20, 2011 Jennie Harvell, ASPE Michelle Dougherty, AHIMA Sue Mitchell, AHIMA Opportunities for Engaging Long Term & Post Acute Care Providers in Health Information Exchange Exchanging Interoperable Patient Assessment Information

2. Project Focus: • Persons who receive NH and HHA service experience frequent: • transitions in care (e.g., NHs to and from hospitals) • shared care (i.e., care delivery by remotely located, organizationally unaffliated team members (e.g., physicians, pharmacies and pharmacists, family members)) • Health information exchange (HIE) is needed to support quality and continuity of care. • The ASPE/AHIMA project leverages federally-required assessment instruments as a cost-effective entrance point to HIE for NHs and HHAs. • Project applies Health IT standards to these assessment instruments and supports the re-use of standardized data.

3. Project Overview ASPE Project Officer: Jennie Harvell Project Team: AHIMA Foundation: Michelle Dougherty, MA, RHIA, CHP Sue Mitchell, RHIA Rita Scichilone, MA, RHIA Margaret Williams In Collaboration With: Lantana Consulting Group Bob Dolin, MD Gaye Giannone Dolin, MSN, RN Regenstrief Institute, Inc. Daniel Vreeman, PT, DPT, MSc SNOMED Terminology Services Cyndi Lundberg, RN, BSN Clinical Experts • Goals: • Apply content and exchange standards to the federally-required assessment instruments used by almost 100% of NH & HHA • Identify clinically-relevant subset of assessment items for interoperable HIE at times of transitions/shared care • Develop technical tools and resources for wide spread use (see ASPE website) • Creates a starting point for interoperable exchange and use of health information by NHs and HHAs • Positions providers for more advance HIE (e.g., meds, allergies, problems, Advanced Directives…. ) • Report will be available: http://aspe.hhs.gov/daltcp/reports/2011/StratEng.htm

4. Federal Assessment Requirements • CMS requires certain LTPAC providers complete and electronically transmit patient assessment instruments. • Content and exchange formats of these assessments are not comparable and do not leverage Health IT standards and thus don’t support efficient re-use of this data within and across providers.

5. Project Applied Standards to MDS v3 and OASIS-C Instruments and Assessment -- Summary • Identified and mapped content standards to the MDS 3.0 and OASIS-C federally-required assessment instruments (Developed with the support of Lantana, STS/CAP, Regenstrief Institute) • Determined how assessment content could be reused • Mapped to LOINC, SNOMED, ICD-9-CM and ICD-10-CM, ect. • Represented assessment content using exchange standards: • Mapped full MDSv3 Assessment to CDA: • HL7 Implementation Guide for CDA Release 2: CDA Framework for Questionnaire Assessments, Release 1 • Mapped MDSv3 and OASIS –C Assessment Summary items to CCD section

6. Developed Technical Tools • Developed “Rosetta Stone” resource for both MDSv3 and OASIS-C with content standard mappings by assessment item: • Full Assessment Instruments • Assessment Summary f or each instrument • Developed document exchange standards and technical tools to support the interoperable exchange of assessment content (Developed by Lantana Consulting Group) • HL7 CDA Implementation Guide for Assessments & MDS Tools • MDS Transform Tools and Validator • MDS CCD Design Guide

7. Collaborating and Leveraging Work of ONC and Other Initiatives • ONC Grantees and Other Program Participants • Keystone/Geisinger Beacon Community (assessment summary) • MA IMPACT (universal transfer form integrating assessment content) • VNSNY and NY e-Health Collaborative (Home Health Plan of Care) • ONC Standards & Interoperability (S&I) LTPAC Workgroup • LTPAC Initiative Launched on October 6, 2011 • Advance HIE with LTPAC providers • Identify some EHR Certification Criteria for LTPAC • Align with Meaningful Use criteria

8. Non-HIT Sophisticated LTPAC Provider LTPAC Provider Nonstandard (not HIT standards enabled) format required by CMS Federal assessments electronically transmitted to CMS MDS/OASIS Assessment Completed HIE Organization Transform HIE Organization receives nonstandard MDS or OASIS and transforms it into either a: (1) standardized assessment and/or (2) standardized Patient Assessment Summary Standardized Assessment and /or Patient Assessment Summary HIE Organization makes available 1) Assessment Instrument; and/or 2) Summary Document on Exchange Network

9. More HIT Sophisticated LTPAC Provider Nonstandard (not HIT standards enabled) format required by CMS LTPAC Provider EHR Federal assessments electronically transmitted to CMS MDS/OASIS Assessment Completed Step 2: More robust standardized Assessment/ Transfer Summary that includes MDS/OASIS data and possibly additional data (meds, allergies, advanced directives, etc.) . Assessment/ Summary exchanged by provider to others Step 1: Standardized MDS or OASIS and/or Patient Assessment Summary HIE Organization Assessment and Summary Available On Exchange Network HIE Organization (HIE-O) receives (i) standardized MDS or OASIS and/or (ii) Assessment /Transfer Summary (and possibly additional data). If necessary, the HIE-O links standardized Patient Assessment Summary with additional data.

10. Project Resources and Deliverables Policy Report: Opportunities for Engaging Long Term and Post Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information Tools and Resources: • Stakeholder Interview Summary • Background Report on Intellectual Property and the Dissemination of Standardized Federally Required Patient Assessments • Rosetta Stone Mapping Guidelines and Heuristics • MDS Rosetta Stone Spreadsheet • MDS Value Set of Diagnosis Concepts • OASIS Rosetta Stone Spreadsheet • Current Standards Landscape • LTPAC Interoperability Toolkit and Tools • CDA Assessment Implementation Guide for MDS and Tools • MDS Transform Tools and Validator • MDS CCD Design Guide • Standards Development and Adoption Recommendations • Recommendations for Functional Status • Patient Assessment Summary for Health Information Exchange • MDS Assessment Summary Rosetta Stone • OASIS Assessment Summary Rosetta Stone • Terms and Acronyms

11. MDS 3.0 Rosetta Stone – Tab 1

12. MDS 3.0 Rosetta Stone – Tab 2

13. MDS 3.0 Rosetta Stone – Tab 3

14. MDS 3.0 Rosetta Stone – Tab 4

15. MDS 3.0 Rosetta Stone – SNOMED Value Sets (Section I)

16. OASIS-C Rosetta Stone • Includes: • Tab 1 - Overview of Toolkit • Tab 2 - OASIS-C Items Mapping - Model of Use (LOINC) • Tab 3 - OASIS-C Items Mapping - Model of Meaning (SNOMED/CVX) NOTE: The OASIS-C assessment instrument captures diagnoses by ICD-9 –CM codes. OASIS-C does not have a diagnosis “checklist” to which value sets can be attached for ICD-9, ICD-10, or SNOMED codes.

17. OASIS Summary Rosetta Stone – Tab 1

18. OASIS Summary Rosetta Stone – Tab 2

19. OASIS Summary Rosetta Stone – Tab 3

20. OASIS Summary Rosetta Stone – Tab 4

21. OASIS Summary Rosetta Stone – Tab 5

22. OASIS Summary Rosetta Stone – Tab 6

23. MDS3.0 Summary Rosetta Stone • Includes: • Tab 1 – Overview of Project • Tab 2 – Overview of Toolkit • Tab 3 – HL7 CCD/HITSP C-32 Analysis of MDS Summary Items (Sequenced by CCD Section) • Tab 4 – HL7 CCD/HITSP C-32 Analysis of MDS Summary Items (Sequenced by MDS Data Item) • Tab 5 - MDS Summary Items Mapped to MDS Assessment Type • Tab 6 – MDS Summary Items Mapping - Model of Meaning (SNOMED/ICD-9/ICD-10/CVX) • Tab 7 - MDS Summary Items Mapping - Model of Use (LOINC)

24. Questions & Contacts Jennie Harvell (202) 690-6443 jennie.harvell@hhs.gov Michelle Dougherty (312) 233-1914 michelle.dougherty@ahima.org Sue Mitchell suemitchell@hotmail.com