1. 0 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Consultations and Transfers of Care HITSP Interoperability Specification (IS) 09 Webinar 3 March 12, 2009 | 2:00 – 3:30 pm (Eastern) Presenters: Michael Lincoln, M.D., F.A.C.M.I, U.S. Department of Veterans Affairs Suzi Hines, Principal, Sage Consulting, LLC

2. Slide 1 HITSP – enabling healthcare interoperability 2009 Webinar Series Learning Objectives  Explore the scope of the Consultations and Transfers of Care Interoperability Specification, including: — the information exchange needed when a provider requests and a patient receives a consultation from another provider; and — the information exchange needed when a provider requests a transfer of care for a patient and the receiving facility admits the patient  Examine the data exchange requirements for requesting a consultation and patient receiving a consultation from another provider, and for requesting a transfer and a patient being transferred to another facility  Discover how the requirements of the Consultations and Transfers of Care Use Case map to HITSP constructs  Learn about HITSP’s next steps in 2009, which include Incorporating Long Term Care–Assessments and Nursing Documentation

3. Slide 2 HITSP – enabling healthcare interoperability 2009 Webinar Series Agenda  Steve’s Story – current and future  What is HITSP?  Overview of Interoperability Specification (IS) 09: Consultations and Transfers of Care  Consultation scenario  Transfer of Care scenario  Next Steps/Future Directions  Conclusion  Questions and Answers

4. Slide 3 HITSP – enabling healthcare interoperability 2009 Webinar Series  Patient is a 27-year-old man who had a brain tumor removed as a child  When Steve develops a new onset of seizures, he visits his general practitioner. — The general practitioner refers Steve to a neurology consultant. — The neurology consultant chooses to admit Steve to the local hospital’s neurology service for further evaluation.  The problem: in today’s system, neither the neurologist nor the hospital has easy access to Steve’s recent health records, or his full medical history, including his pediatric neurology records. Steve’s Story... current situation healthcare interoperability... problems and solutions

5. Slide 4 HITSP – enabling healthcare interoperability 2009 Webinar Series  The solution: In the HITSP future, all of Steve’s health records will be interoperable. His health information will be seamlessly and securely exchanged among providers and care settings. With Steve’s consent, providers will gain instant access to past data, such as — active and past medication lists — allergies — current and previous problems and diagnoses — visit summaries — labs, images, and other test results — registration and insurance information Steve’s Story... future healthcare interoperability... problems and solutions

6. 5 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee What is HITSP?

7. Slide 6 HITSP – enabling healthcare interoperability 2009 Webinar Series  HITSP is a volunteer-driven, consensus-based organization that is funded through a contract from the Department of Health and Human Services  The Panel brings together experts from across the healthcare community — from consumers to doctors, nurses, and hospitals; — from those who develop healthcare IT products to those who use them; and — from the government agencies who monitor the U.S. healthcare system to those organizations that are actually writing healthcare IT standards. Overview

8. Slide 7 HITSP – enabling healthcare interoperability 2009 Webinar Series Roles and Responsibilities  Harmonizes and recommends the technical standards that are necessary to assure the interoperability of electronic health records — Creates HITSP-recommended Interoperability Specifications (IS) that specify how and what standards should be used for a particular Use Case/Value Case — Supports deployment and implementation of these IS — Works with Standards Development Organizations (SDOs) to identify gaps and maintain, revise or develop new standards as required to support the IS

9. Slide 8 HITSP – enabling healthcare interoperability 2009 Webinar Series  Each HITSP Interoperability Specification defines a set of reusable building blocks or “constructs” that: — specify how to use selected standards to meet the business needs of a Use Case / Value Case; and — define a Roadmap to use emerging standards and to harmonize overlapping standards when resolved.  In essence, a HITSP IS represents a suite of documents that integrate and constrain existing standards to satisfy a Use Case / Value Case Deliverables and Mode of Operation

10. Slide 9 HITSP – enabling healthcare interoperability 2009 Webinar Series What Are Consultations and Transfers of Care?  Consultations A provider requests and a patient receives a consultation from another provider  Transfers of care A provider requests a transfer of care for a patient and the receiving facility admits the patient

11. Slide 10 HITSP – enabling healthcare interoperability 2009 Webinar Series IS 09: Consultations and Transfers of Care  The Consultation and Transfers of Care Interoperability Specification (CTC IS) focuses on the electronic exchange of information to support consultations between clinicians, including specialty services and second opinions. The CTC IS specification also focuses on the exchange of clinical information needed during transfers of care. When you go from one doctor or specialist to the next - your information goes with you.

12. Slide 11 HITSP – enabling healthcare interoperability 2009 Webinar Series IS 09: Clinician Perspectives Steve’s family MD* Consulting neurologist* * Or MD internist, nurse practitioner, psychologist physician assistant, pharmacist, cardiologist…. HITSP IS 09 future: send interoperable consult results Today’s consult results: Communicated via meeting, telephone, postal mail

13. Slide 12 HITSP – enabling healthcare interoperability 2009 Webinar Series IS 09: Care-setting Perspectives Consulting neurologist* Local hospital * Or nursing home, long term care facility, home healthcare setting, hospice, rehabilitation facility…. Today: send paper patient records overland HITSP IS 09 future: send patient records electronically

14. Slide 13 HITSP – enabling healthcare interoperability 2009 Webinar Series Other CTC Perspectives  Patient perspective e.g., guardians, family caregivers, surrogates — Patients or their representatives and surrogates may transfer information among PHRs, health record banks, and provider EHRs as part of a consultation or transfer or care  Health Information Exchange (HIE) perspective e.g., Regional Health Information Organizations (RHIOs), care delivery networks, public health networks — These entities may support specific functional capabilities which assist in transferring health information, e.g., for reportable diseases sent to public health entities

15. Slide 14 HITSP – enabling healthcare interoperability 2009 Webinar Series Data Requirements in Consultations  Focuses on sharing information to support consultations — Includes the consultation request, the consultation itself, and resulting of consult back to origin point — Includes administrative and clinical information — Sends a core set of clinical information, and then allows consultant to request additional information as needed  Information includes reason for consult, images, labs, procedure reports, patient summary information, etc.

16. Slide 15 HITSP – enabling healthcare interoperability 2009 Webinar Series Data Requirements in Transfers of Care Use Case  Focuses on sharing information to support transfers — Includes the transfer request, the transfer approval message — Includes administrative and clinical information — Sends a core set of clinical information, and then allows transfer target facility to request additional information as needed  Information includes core information, such as discharge summary, plan of care, procedure documentation, and clinical results.

17. Slide 16 HITSP – enabling healthcare interoperability 2009 Webinar Series Scenario 1: Consultations

18. Slide 17 HITSP – enabling healthcare interoperability 2009 Webinar Series Scenario 1: Sample of Consultation Data Flows 1144

19. Slide 18 HITSP – enabling healthcare interoperability 2009 Webinar Series Scenario 2: Samples of Transfer of Care Data Flows 3 3

20. Slide 19 HITSP – enabling healthcare interoperability 2009 Webinar Series Information Exchange Requirements (IER) IERDescription IER 01Provide authorization and consent IER 11Identify provider based on patient preference IER 13Send/receive notification of document availability IER 14Send/receive health plan eligibility IER 15Send/receive health plan authorization IER 16Send/receive clinical summary IER 17Send/receive transfer of care data IER 22Send/receive additional patient information IER 25Send/receive decision support data IER 28Download historical health data IER 37Update medication information

21. Slide 20 HITSP – enabling healthcare interoperability 2009 Webinar Series Information Exchange Requirements (continued) IERDescription IER 43Send/receive accept patient IER 45Send/receive consult results report IER 57Identify provider based on health plan IER 60Send/receive discharge summary IER 62Send/receive encounter or full episode of care record IER 63Request additional patient data IER 64Send/receive consult request/data

22. Slide 21 HITSP – enabling healthcare interoperability 2009 Webinar Series Data Requirements for Consultations and Transfers of Care Data Requirement Number (DR) Description DR 2Patient clinical information, including advance directives, allergies, provider, immunizations, language spoken, medications, person information, procedures, vital signs…. DR 6Health plan eligibility, including demographics, member ID, co-pay, deductibles, limits and exclusions, coded procedures, effective date DR 9Consultation completion, including treatment summary, medication list and reconciliation, recommended care plan DR 10Consulting provider registry, including name, location, specialties/capabilities, facilities associated with, schedule, insurance plan associations, contact info

23. Slide 22 HITSP – enabling healthcare interoperability 2009 Webinar Series Data Requirements for Consultations and Transfers of Care (continued) Data Requirement Number (DR) Description DR 57Demographic data, including dates, patient demographics, provider info, reason for consult or transfer/discharge DR 60Patient clinical information, including just about everything you might think of, including PMHx and diagnostic list, physical exam details, problems/conditions, reason for admission or visit, images, care plan, results, med reconciliation, allergies and adverse reactions, DME and equipment, treatment summary, procedures, notes, advance directives, functional status, and other assessments

24. Slide 23 HITSP – enabling healthcare interoperability 2009 Webinar Series HITSP Constructs for IS 09  C32 – Summary Documents using CCD *  C37 – Lab Report Document *  C48 – Encounter Document *  C62 – Unstructured Document *  C74 – Remote Monitoring Observation  C78 - Immunization Content  C84 – Consult and History & Physical Note *  T29 - Notification of Document Availability  T31 - Document Reliable Interchange  T33 - Transfer of Documents on Media  T40 - Patient Health Plan Eligibility Verification  T68 - Patient Health Plan Authorization Request and Response  T79 - Pharmacy to Health Plan Authorization Request and Response  TP89 – Sharing Imaging Results * * Key constructs for IS 09

25. Slide 24 HITSP – enabling healthcare interoperability 2009 Webinar Series CTC IS 09 Base Standards  IS 09 relies upon base standards, for example: — Documents are formed according to HITSP C32, a summary document that uses the HL7 Continuity of Care Document (CCD) standard — Document transfer uses:  Document Reliable Interchange (HITSP T31) using the IHE Cross- Enterprise Document Sharing (XDS) standard  Transfer of Documents on Media – the patient carries a pen drive – (HITSP T33) using IHE Cross-Enterprise Document Media Interchange standard — and others

26. Slide 25 HITSP – enabling healthcare interoperability 2009 Webinar Series  T17 – Secured Communication Channel  TP13 – Manage Sharing of Documents  TP20 – Access Control  TP30 – Manage Consent Directive  C19 – Entity Identity Assertion  C26 – Non-repudiation of Origin  T15 – Security Audit Trail  T16 – Consistent Time For more information about how HITSP addresses security and privacy, refer to the August 2008 Security and Privacy Webinar at http://www.hitsp.org/ archived_webinars.aspx http://www.hitsp.org/ archived_webinars.aspx HITSP Security and Privacy Constructs Safeguard Information Exchanged during Transfer and Consultations

27. Slide 26 HITSP – enabling healthcare interoperability 2009 Webinar Series Interoperability Requirements (IER) IER1-Provide authorization and consent IER-11-Identify provider by patient preference IER 14-Send/receive health plan eligibility (…) Transactions/packages used TP22 PIX Query TP 23-Patient demographics query T29-Send/receive notification (…) To fulfill Data Requirement 57 (Demographic data, consultation and transfer) IS 09: Constructs, IERs, and CRs in Consultations Steve’s family MD* Consulting neurologist* * Or MD internist, nurse practitioner, psychologist physician assistant, pharmacist, cardiologist…. HITSP IS 09 future: send interoperable consult results

28. Slide 27 HITSP – enabling healthcare interoperability 2009 Webinar Series Interoperability Requirements (IER) IER 13-Send/receive notice of document avail. IER 17-Send/receive transfer of care data IER 22-Send/receive additional patient information (…) Transactions/packages used T 29-Notification of document avail. T 31-Document reliable interchange T 64-Identify communication recipients (…) To fulfill Data Requirement 2 (Patient clinical information) IS 09: Constructs in Transfers of Care Consulting neurologist* Local hospital * Or nursing home, long term care facility, home healthcare setting, hospice, rehabilitation facility…. HITSP IS 09 future: send patient records electronically

29. Slide 28 HITSP – enabling healthcare interoperability 2009 Webinar Series Scope limits and assumptions  Decision support systems (DSS) are not specifically addressed in this IS because they are ubiquitous  Patients may bring portable media from one health system to another  Consultations continue until they are formally terminated (“Thank you for referring this very interesting patient, we are signing off….”)  Transport team notifications are always personal and are not within scope of this IS (see also IS 04, Emergency Responder/EHR)  Medication reconciliation is done via HITSP IS 07, Medication Management

30. Slide 29 HITSP – enabling healthcare interoperability 2009 Webinar Series HITSP IS-09 CTC specification: Location and Status  Located at http://www.hitsp.orghttp://www.hitsp.org  Currently at version 1.0  Accepted by the Secretary of HHS in January 2009 — Released for one-year period of implementation — The reason we’re here today

31. Slide 30 HITSP – enabling healthcare interoperability 2009 Webinar Series Gaps remaining  Clinical data such as ECG, EEG do not have a identified standard and are a gap  Medication information cannot be completely communicated (stopped, modified, or “on hold” medications)  Send/receive decision support data not defined  Functional assessments need a CDA implementation guide  No good standard for nurses’ notes

32. Slide 31 HITSP – enabling healthcare interoperability 2009 Webinar Series Next Steps for 2009  Incorporating following 2009 Extensions/Gaps — Clinical Note Details — Order Sets — Long Term Care – Assessments

33. 32 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Conclusion

34. Slide 33 HITSP – enabling healthcare interoperability 2009 Webinar Series Benefits of IS 09 – Consultations and Transfers of Care  Better communication among providers means better patient care  When data is carried forward, tests do not need to be re-done  Patients do not need to continue to fill out paper work with the same information  Patients will know right away if their consultation and/or procedure is approved/covered by their insurance  Critical information is not lost in the transfer  Ensures that the right information and right treatment is linked to the right patient

35. Slide 34 HITSP – enabling healthcare interoperability 2009 Webinar Series  The solution: In the HITSP future, all of Steve’s health records will be interoperable. His health information will be seamlessly and securely exchanged among providers and care settings. With Steve’s consent, providers will gain instant access to past data, such as — active and past medication lists — allergies — current and previous problems and diagnoses — visit summaries — labs, images, and other test results — registration and insurance information Steve’s Story... future healthcare interoperability... problems and solutions

36. Slide 35 HITSP – enabling healthcare interoperability 2009 Webinar Series Webinar 1 Advances in Sharing Information in Healthcare IT Thursday, January 15 th, 2009 — 2:00-3:30 pm EDT Webinar 7Health Information Exchange (HIEs) in the Real World Thursday, July 9 th, 2009 — 2:00-3:30 pm EDT Webinar 2Personalized Healthcare Interoperability Specification (IS 08) Thursday, February 12 th, 2009 — 2:00-3:30 pm EDT Webinar 8Patient - Provider Secure Messaging Interoperability Specification (IS 12) Thursday, August 13 th, 2009 — 2:00-3:30 pm EDT Webinar 3Consultations and Transfers of Care Interoperability Specification (IS 09) Thursday, March 12 th, 2009 — 2:00-3:30 pm EST Webinar 9Remote Monitoring Interoperability Specification (IS 77) Thursday, September 10 th, 2009 — 2:00-3:30 pm EDT Webinar 4 NHIN Real World Sites Thursday, April 16 th, 2009 — 2:00-3:30 pm EDT Webinar 10Medication Management Real World Sites Thursday, October 8 th, 2009 — 2:00-3:30 pm EDT Webinar 5Immunization & Response Management Interoperability Specification (IS 10) Thursday, May 14 th, 2009 — 1:30-3:00 pm EDT Webinar 11Security, Privacy, and Infrastructure Thursday, November 12 th, 2009 — 2:00-3:30 pm EDT Webinar 6Public Health Case Reporting Interoperability Specification (IS 11) Thursday, June 18 th, 2009 — 1:30-3:00 pm EDT Webinar 12Real World Sites – TBA Thursday, December 10 th, 2009 — 2:00-3:30 pm EDT  The 2009 Webinar Series www.HITSP.org/webinars  

37. Slide 36 HITSP – enabling healthcare interoperability 2009 Webinar Series View the Complete Set of HITSP Deliverables www.HITSP.org www.HITSP.org

38. Slide 37 HITSP – enabling healthcare interoperability 2009 Webinar Series  Use or specify recognized HITSP Interoperability Specifications in your HIT efforts and in your Requests for Proposals (RFPs)  Ask for CCHIT certification  Leverage Health Information Exchanges to promote HITSP specifications to make connections easier in the future  Ask... Is there a HITSP standard we could be using?  Get involved in HITSP... Help shape the standards How YOU can become involved

39. Slide 38 HITSP – enabling healthcare interoperability 2009 Webinar Series Jessica Kant, HIMSSTheresa Wisdom, HIMSS jkant@himss.orgjkant@himss.org twisdom@himss.orgtwisdom@himss.org Re: HITSP Technical Committees Michelle Deane, ANSI mmaasdeane@ansi.org Re: HITSP, its Board and Coordinating Committees Join HITSP in developing a safe and secure health information network for the United States Visit www.hitsp.org or contact:www.hitsp.org

40. Slide 39 HITSP – enabling healthcare interoperability 2009 Webinar Series Sponsor Strategic Partners www.HITSP.org

41. 40 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Consultations and Transfers of Care Questions and Answers