Patient Care Coordination

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Patient Care Coordination

• IHE Workshop 2006
• IHE Patient Care Coordination Education
• Keith W Boone, John Donnelly, Larry McKnight MD,
  Dan Russler MD

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Primary Membership

• Physician Associations Colleges
• ACP, AAP, AAFP, FACEP
• EMR Other Department System Vendors
• Ambulatory, Inpatient, Emergency Dept
• PHR Vendors
• PC-based systems, Portal solutions
• Other Stakeholders in HIT
• Clinical research initiatives, Public health
  agencies

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Profile Roadmap

• Year 2005-2006 (Trial Implementation)
• Medical Summary MS Acute Care Discharge to
  PCP, PCP Referral to Specialist
• Unstructured Document CDA-wrapped PDF
• Year 2006-2007 (Development Testing)
• Medical Summary MS ED Referral EDR
• Pre-procedure HP PPHP
• Basic Patient Privacy Consents BPPC
• Exchange Personal Health Record XPHR
• Coordination with Laboratory Domain XDS-LAB
  
• Future (Profile Document / White Paper)
  
• Medical Summary MS Discharge to LTC
• Forms Display for Data Capture (e.g. clinical
  research)

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Domain Visibility Support

• HIMSS Annual Conference
• 2006 HIMSS RHIO Showcase 30 vendors
  exchanged XDS-MS, XDS-pdf documents
• Informational Presentations from Providers HIT
  Vendors
• ACC Annual Conference
• 2006 ACC Interoperability Showcase ?? vendors
  exchanged XDS-pdf documents
• Informational Presentations from HIT Vendors
• Physician Association Annual Meetings
• Informational Presentations Planned
• Real-world RHIO Participation
• NHIIN Pilot RHIOs
• Independent Community-sponsored RHIOs

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Medical Summary Profiles

• IHE Vendors Workshop 2006
• IHE Patient Care Coordination Education
• Larry McKnight MD co-chair PCC Planning
  Committee

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Abstract

• Define a medical summary format for clinical
  documents containing at a minimum
• Problems
• Allergies
• Medications
• Pointers to other material

Medical Summaries
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Value Proposition

• Leverage Clinical Documents ontology
• A common mechanism for transfer of encoded
  clinical data embedded in documents
• Basis for ongoing harmonization of CCR/CCD
• Enhances Clinical Documents criteria for key use
  cases
• Inpatient to Primary Care Provider
• Primary Care Provider to Specialist
• To be enhanced in future years to support
• Home Care
• Long Term Care

Medical Summaries
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Key Technical Properties

• Document Transfer (Integration Profile)
• XDS/XDP for document sharing.
• NAV for notification.
• XDS Folders to support organization.
• XDS Submission Sets to support packaging.
• Identification of Master document or Manifest
• Document Content (Content Profile)
• CDA Release 2.0
• Care Record Summaries Implementation Guide

Medical Summaries
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Content Integration Profiles

• IHE Vendors Workshop 2006
• IHE Patient Care Coordination Education
• Keith W. Boone, GE Healthcare co-chair PCC
  Technical Committee

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Technical Framework

• Reuse of ITI Profiles
• ITI Cross Enterprise Document Sharing (XDS)
• ITI Cross Enterprise Point-to-Point Sharing (XDP)
• New Actors / Transactions
• None Yet, but
• Content Integration Profiles
• XDS Medical Summaries
• Bindings
• Binds Content to IHE Transactions
• Medical Document to XDS
• Medical Document to XDP
• Declared in Integration Statements
• Options
• Some options defined for XDS, XDP

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Content Integration Profiles

• Content using a Specific Standard
• CDA Release 2.0
• HL7 Care Record Summary
• ASTM/HL7 Continuity of Care Document
• Others as Needed (e.g., ASTM CCR, DICOM )
• Library of Reusable Parts
• Document Types
• Sections
• Entries

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Content Integration Profiles
XDS-MS
2005-2006
2006-2007
MedicalDocuments
BCCP
PPHP
MedicalSummaries
Consent
History andPhysical
EDR
XPHR
Referral
DischargeSummary
EmergencyDepartmentReferral
PreprocedureHistory andPhysical
PHR Extract
XDS-LAB
PHR Update
Lab Report
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Emergency Department Referral

• IHE Vendors Workshop 2006
• Todd Rothenhaus, MD FACEP
• American College of Emergency Physicians

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Emergency Department Referral
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Use Case

• Health care provider determines that a patient
  needs to go to the ED
• Provider creates an ED referral package using his
  or her EHR
• Upon arrival, the ED provider identifies the
  patient as a referral
• The posted referral package is imported into the
  Emergency Department Information System (EDIS)

Provide access to critical health information
in ED information systems in a standard manner\
ED Referral
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Value Proposition

• Nearly 5000 EDs in US
• Significant percentage of ED visits are referrals
• Shortage of critical health data for emergency
  department patients
• Need to improve communication of intended patient
  care plans to ED providers and ensure that no
  pertinent data is lost
• Streamline workflow by obviating telephone calls
  between busy clinicians

ED Referral
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Scope

• EHR system capable of creating a care record
  summary would be capable of creating a referral
  package for a receiving system
• The emergency department information systems
  (EDIS) will need to retrieve and read and display
  this data.

ED Referral
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Basic Patient Privacy Consents (BPPC)

• IHE Vendors Workshop 2006
• IHE Patient Care Coordination Education
• Lori Fourquet, e-Healthsign

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Basic Patient Privacy Consents
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Abstract

• The Basic Patient Privacy Consents (BPPC) profile
  provide mechanisms to
• Record the patient privacy consent(s),
• Mark documents published to XDS with the patient
  privacy consent that was used to authorize the
  publication,
• Enforce the privacy consent appropriate to the
  use.

Basic Patient Privacy Consents
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Scope

• Document Sources and Document Consumers in an XDS
  Affinity Domain
• Document Sources and Document Receivers using
  Cross Enterprise Point-to-Point Document Sharing

Basic Patient Privacy Consents
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Value Proposition

• An Affinity Domain can
• develop privacy policies,
• and implement them with role-based or other
  access control mechanisms supported by EHR
  systems.
• A patient can
• Be made aware of an institutions privacy
  policies.
• Have an opportunity to selectively control access
  to their healthcare information.

Basic Patient Privacy Consents
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Key Technical Properties

• Human Readable Consents
• Machine Processable
• Support for standards-based Role-Based Access
  Control

Basic Patient Privacy Consents
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Standards and Profiles Used

• CDA Release 2.0
• XDS Scanned Documents
• Document Digital Signature
• Cross Enterprise Document Sharing
• Cross Enterprise Point-to-Point Document Sharing

Basic Patient Privacy Consents
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Pre-procedure History and Physical (PPHP)

• IHE Development Team Workshop 2006
• IHE Patient Care Coordination Education
• Dan Russler, MD, Mckesson co-chair PCC Technical
  Committee

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Pre-procedure History and Physical
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Use Case

• HP documentation required prior to procedure
  that is designed to assess
• Procedure Risk
• Anesthesia Risk
• Factors influencing procedure after-care
  decisions
• Desired outcomes
• Minimize injury during procedure
• Optimize procedure after-care

Pre-procedure HP
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Scope

• To identify the required and optional PPHP
  document content templates including
• CDA Document Header
• CDA Document Type(s)
• CDA Section Types
• CDA Entry Types

Pre-procedure HP
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Value Proposition

• A procedure risk assessment must be present and
  evaluated by the operative and after-care teams
  before the patient is allowed to have the
  procedure. Missing information is frequently a
  reason for canceling the procedure for the day,
  which leads to expensive underutilization of
  resources and dissatisfied patients. Further,
  incomplete information about the patients
  clinical or home status may create a situation
  where a procedure is performed that ultimately
  results in an injury, inadequate aftercare or
  other undesirable outcome.

Pre-procedure HP
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Key Technical Properties

• PPHP Profile inherits specifications required for
  other IHE PCC Medical Documents
• PPHP Profile follows documentation practices for
  all IHE PCC Medical Documents
• PPHP Profile emphasizes re-usability of CDA
  template identifiers in order to reduce
  un-necessary variability in IHE Content Profiles

Pre-procedure HP
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Standards Used

• IHE Medical Document Content Profiles
• HL7 Reference Information Model ANSI Standard
• HL7 CDA R2 ANSI Standard
• HL7 Care Provision Domain DSTU (in process)
• Implementation Guides
• HL7 Care Record Summary CDA R2 Implementation
  Guide (in process)
• HL7/ASTM Continuity of Care Document
  Implementation Guide (in process)

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Exchange of PHR Content(XPHR)

• IHE Vendors Workshop 2006
• IHE Patient Care Coordination Education
• Keith W. Boone, GE Healthcare co-chair PCC
  Technical Committee

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Exchange of PHR Content
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Abstract

• The Exchange of Personal Health Record Content
  (XPHR) provides a standards-based specification
  for managing the interchange of documents between
  a Personal Health Record and an EHR System to
  enable better interoperability between these
  systems.

Exchange of PHR Content
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Scope

• Personal Health Record (PHR) Systems
• Electronic Health Record (EHR) Systems

Exchange of PHR Content
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Value Proposition

• Supports interchange of PHR Information
• Demographics
• Insurance Information
• Medications, Problems, Allergies
• Health History
• Other Information

Exchange of PHR Content
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Standards Used

• CDA Release 2.0
• ASTM Continuity of Care (CCR) Data Set
• ASTM/HL7 Continuity of Care Document (CCD)
• HL7 Care Record Summary
• AHIMA PHR Common Data Elements
• XDS, XDP
• Document Digital Signature

Exchange of PHR Content
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Key Technical Properties

• Information is Human Readable
• and Machine Processable
• Support Static and Dynamic Information Sharing
  Domains (XDS and XDP)
• Protects Information using Digital Signature
• Update Model for EHR to PHR Changes

Exchange of PHR Content
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Sharing of Lab Reports

• IHE Vendors Workshop 2006
• IHE Patient Care Coordination Education
• Francois Macary, Agfa co-chair Lab Technical
  Committee

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XDS Laboratory Report
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Scope

• The clinical laboratory report is
• A report of a set of final results (the
  fulfillment process being completed) to be shared
  as historical information.
• Human-readable, shared between care providers of
  various specialties and patients (e.g. through a
  PHR)
• May contain machine readable coded entries
  (decision support, bio-surveillance)
• All clinical laboratory specialties in scope,
  except
• Blood banks (blood products out of scope, but
  blood tests in scope)
• Pathology (has its dedicated domain in IHE)

Sharing of Lab Reports
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Value Proposition

• Use case 1 Hospital lab report ? RHIO ? EHRs At
  discharge time, a hospital physician selects the
  most significant laboratory reports produced
  during patient stay, and issues these reports
  individually to a health information exchange
  (e.g. XDS Affinity Domain) shared by a number of
  healthcare enterprises and primary care
  providers.
• Use case 2 Ambulatory lab report ? RHIO ? PHRA
  private laboratory having signed a final report
  for a patient, sends this report in an electronic
  format to the patient record in the national EHR.
• Use case 3 Lab report ? PHRA physician reviews
  the results received from a reference laboratory
  for his patient. The doctor, as requested by the
  patient, sends this laboratory report in the
  patients personal health record in an electronic
  format.
• Use case 4 Lab report automatically shared ?
  RHIOA community or hospital laboratory,
  systematically (with some degree of automatism)
  shares its final reports with a regional
  healthcare network.
• Use case 5 Hospitals EHR Lab report ? RHIOAt
  discharge time of an inpatient, a hospital
  physician selects the most significant lab
  results, produced by one or more laboratories of
  the healthcare enterprise during patient stay,
  and builds a cumulative report sent to an health
  info exchange shared by a number of healthcare
  enterprises and primary care providers.

Sharing of Lab Reports
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Standards Used

• CDA Release 2.0
• ASTM/HL7 Continuity of Care Document (CCD)
• HL7 V3 Laboratory DMIM
• HL7 Care Record Summary
• LOINC SNOMED
• HIPAA Lab Claim Attachment NPRM
• IHE XDS (registry/repository) XDP (pt-pt)
• Document Digital Signature

Sharing of Lab Reports
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Key Technical Properties

• Information is Human Readable (two levels of
  sections) and machine processable
• Full alignments with HL7 V3 lab messages
• Supports custom report organizations and results
  rendering regulations (e.g. CLIA in the USA).
• Complements the real-time result return to
  ordering provider (e.g. ELINCS).
• Used both in sharing (XDS) pt-pt interchange
  (XDP)
• May protect Information using Digital Signature

Sharing of Lab Reports
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PCC Wrap-up

• IHE Workshop 2006
• IHE Patient Care Coordination Education
• John Donnelly, IntePro Solutions co-chair PCC
  Planning Committee

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PCC RoadMap

• Care Transfers
• Medical Summary 2005
• EDR, PPHP 2006
• Labs 2006-7
• Growth Charts
• Consumer Empowerment
• PHR 2006
• Consents 2006
• Provider Ordering
• Ambulatory Ordering 2006
• Medication Lists 2007
• Clinical Data Reuse
• Clinical Trials (RFD) 2006-7
• Biosurveillance 2007-8

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How to Get Involved?

• As a Provider or Vendor Contributor
• Offer Clinical Use Case Input to Drive IHE
  Profile Development
• Become a member of relevant domains Planning or
  Technical Committees
• Become a member of relevant Regional/National
  Committees
• Help to shape IHEs future direction
• As a Vendor Participant
• Respond to Public Comments of Domain Supplements
• Attend the June Educational Workshop
• Participate in Connect-a-thons and Demonstrations
• As a Provider/Consultant Participant
• Respond to Public Comments of Domain Supplements
• Attend the June Educational Workshop
• Attend Demonstrations and include IHE Integration
  Profiles in your RFPs and Integration Projects.

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Special Call for Participation

• Reach out to Physicians as Liaisons
• Expand presence at annual physician society and
  association meetings (e.g. ACP, ACEP, ASP, etc)
• Help with Use Case component of PCC profiles
• Assistance with ASTM/CCR HL7 CDA/CCD Transforms
• Focal point of harmonization effort between
  medical summary initiatives of two SDOs
• Facilitate widespread interoperability between
  product offerings in EHR and PHR segments

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IHE Patient Care Coordination Plan for 2006

• Development Schedule
• Planning Committee decision mid-March
• 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
• Final text April 2007
• New Profiles For 2006 Public Comment June 19,
  2006
• Medical Summary (MS) ED Referral EDR
• Pre-procedure HP PPHP
• Basic Patient Privacy Consents BPPC
• Exchange Personal Health Record XPHR

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More Information

• IHE Web Site - http//www.ihe.net
• Technical Frameworks
• Technical Framework Supplements Trial
  Implementation
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles Guidelines for Buyers
• IHE Connectathon Results
• Vendors Product Integration Statements
• Sponsors IHE sites
• http//www.himss.org/IHE
• http//www.rsna.org/IHE
• http//www.acc.org/quality/ihe.htm

Questions?