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ASC X12/HL7 esMD and Data Payload Standards

Gary Beatty Deloitte Consulting. ASC X12/HL7 esMD and Data Payload Standards. Goal of esMD. esMD Evolution. CMS: Paper Requests Providers choose response type: Paper CD (PDF/TIFF) Fax. esMD Evolution. CMS: Paper Requests Providers: Unstructured content XDR. esMD Evolution.

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ASC X12/HL7 esMD and Data Payload Standards

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  1. Gary Beatty Deloitte Consulting ASC X12/HL7esMDand Data Payload Standards

  2. Goal of esMD

  3. esMD Evolution • CMS: Paper Requests • Providers choose response type: • Paper • CD (PDF/TIFF) • Fax

  4. esMD Evolution • CMS: Paper Requests • Providers: • Unstructured content XDR

  5. esMD Evolution • CMS: Paper Requests • Providers: • Unstructured content X12 275/HL7 CDA

  6. esMD Evolution • CMS: X12 277 Health Care Claim Request for Additional Information • Providers: • Unstructured content X12/HL7

  7. esMD Evolution • CMS: X12 277 Health Care Claim Request for Additional Information • Providers: • Structured content X12 275/HL7 CDA

  8. X12 Transactions 837 Health Care Claim 277 Health Care Claim Request for Additional Information HIH Medicare Gateway 275 Additional Information to Support a Health Care Claim or Encounter ASC X12 275 - 005010X210 ASC X12 277 – 005010X213

  9. 277 and 275 working together • A 277 asks for • Entire Attachment • or • Section/Entry of Attachments • A 275 Returns • Section/Entry of Attachments • Consisting of • Answer part(s) Electronic Attachment Section/Entry Section/Entry Section/Entry Section/Entry Section/Entry Answer Part Answer Part Answer Part Section/Entry Section/Entry Section/Entry Section/Entry Section/Entry - Identified using LOINC - By sending LOINC

  10. 277 Health Care Claim Request for Additional Information

  11. 275 Additional Info to Support a Health Care Claim or Encounter

  12. Interchange control structure

  13. X12 Acknowledgments 837 Health Care Claim 277 Health Care Claim Request for Additional Information HIH Medicare Gateway 275 Additional Information to Support a Health Care Claim or Encounter TA1 / 999 Negative Acknowledgment 834 Positive / Negative Acknowledgment

  14. HL7 Clinical Document Architecture (CDA) Unstructured Clinical Information Human Decision Variant Structured Clinical Information Computer Decision Variant

  15. HL7 CDA basic structure Unstructured clinical information - packaged into a Multipart Mime package <ClinicalDocument> <body> </body> </ClinicalDocument>

  16. Esmd Metadata within hl7 cda

  17. Esmd Metadata within hl7 cda

  18. Sample esmd transaction Example

  19. CDA Templates • XML Based • Single Imp. Guide • Template is set of constraints on full CDA standard • Computer Decision Variant (Structured Data) • Human Decision Variant (Unstructured Data)

  20. CDA Templates • Reusable • Abbreviated Development Cycle • Templates can be transformed to source code • Data Entry Form

  21. Thesaurus Discharge Summary 1 EHR Translation Standardization Discharge Summary Discharge Summary 2 Discharge Summary 1 Style Sheet Discharge Summary 2 Style Sheet

  22. Thank you! Gary Beatty gbeatty@deloitte.com

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