September, 2005What IHE Delivers 1 Presenters: Keith W. Boone, John Donnelly, Larry McKnight, Dan Russler IHE Patient Care Coordination

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

3 Patient Care Coordination – Plan for 2006 Development Schedule: New Profile Proposal Drafts:Oct-Nov 2005New Profile Proposal Drafts:Oct-Nov 2005 Profile Proposal Technical Review:Nov-Dec 2005Profile Proposal Technical Review:Nov-Dec 2005 Planning Committee decision:January 2006Planning Committee decision:January 2006 Issue Public Comment version: June 2006Issue Public Comment version: June 2006 Public Comment Due:July 2006Public Comment Due:July 2006 Issue Trial Implementation version: August 2006Issue Trial Implementation version: August 2006 IHE Connectathon: January 2007IHE Connectathon: January 2007 HIMSS Demo: February 2007HIMSS Demo: February 2007 Profile Change Proposals Mar-Sept 2007Profile 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)Sharing of Medical Summaries - Discharge & Specialist Referral (XDS-MS) New Profiles For 2006 Patient-created SummaryPatient-created Summary Referral to Emergency DepartmentReferral to Emergency Department Patient Consent for Access to Medical RecordPatient Consent for Access to Medical Record Pre-surgical History & PhysicalPre-surgical History & Physical Coordination with IHE Labs on Sharable Lab ReportCoordination with IHE Labs on Sharable Lab Report White Paper: EHR Integration for Clinical TrialsWhite Paper: EHR Integration for Clinical Trials

5 Patient-created Summary Use 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 Summary Scope Document content used in transmission of data from a Personal Health Record. Access to content via RHIO, portable media or

8 Patient-created Summary Key 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 Department Use 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 Department Key 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 Record Use 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 Record Value 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 Record Scope 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 Record Key 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 TS /2 – Health Informatics Privilege Management and Access Control  ISO 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 & Physical Use 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 & Physical Value 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 & Physical Scope 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

20 Pre-surgical History & Physical Key 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)

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