1. Electronic Submission of Medical Documentation (esMD) Electronic Determination of Coverage (eDoC) Structured Data Sub-Workgroup August 16, 2013

2. Meeting Etiquette Please announce your name each time prior to making comments or suggestions during the call Remember: If you are not speaking keep your phone on mute Do not put your phone on hold – if you need to take a call, hang up and dial in again when finished with your other call –Hold = Elevator Music = very frustrated speakers and participants This meeting, like all of our meetings, is being recorded –Another reason to keep your phone on mute when not speaking! Feel free to use the “Chat” or “Q&A” feature for questions or comments 2 NOTE: This meeting is being recorded and will be posted on the esMD Wiki page after the meeting From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute

3. Agenda TopicPresenter Administrative Items and Announcements Zach May eDoC Structured Data SWG C-CDA Template for Orders Viet Nguyen Bob Dieterle 3

4. Developing an Orders Template Survey of types of orders clinicians write and develop an organizational approach Determine Global data elements applicable to ALL orders Determine what standardization work has been done for various classes of orders Develop and harmonize a CDA template approach to orders

5. Levels of Structure PDF Images Unstructured Text Structured Text Coded Terminology Information Model Good Better Best

6. Components of an Order aa Provider Name, Credentials Provider Address, Phone, Fax Patient Name, Identifier, DOB, Gender, etc. Order Recipient Name/Institution/Specialty, Contact Information Diagnosis or Reason Order Details – Depends on class or type of order Orderer Signature or Authentication Date Information Order Urgency

7. Global Order Components

8. Admission, Discharge, and Transfer Pharmacy Diagnostic –Radiology –Non-radiological – e.g. Stress Test, Pulmonary Function tests –Study requiring specialist – e.g. Colonoscopy, Fine Needle Aspiration May or may not need an antecedent referral or consultation Laboratory Blood Bank Professional Services –Referrals –Consultations –Services Direct Healthcare Services – e.g. Nursing, Respiratory/Occupational/Physical Tx, etc. Indirect Services – e.g. Social Work, Care Coordination Classes of Orders

9. Professional Services, cont’d –Direct Healthcare Services – e.g. Nursing, Respiratory/Occupational/Physical Tx, etc. –Indirect Services – e.g. Social Work, Care Coordination Equipment (Durable, semi-durable, and one time) – E.g. Wheelchair, catheters, ostomy supplies, devices (implantable/non-implantable) Dietary/Nutrition – Examples – NPO, ADA Diet, Clear Liquids Administrative – e.g. DNR, POLST Patient Activity – e.g. Bed-rest, ambulation Classes of Orders

10. Grouped Orders –Home Health Care –Hospice Care Remote Patient Monitoring Devices Meta-orders – e.g. hold or cancel existing order Classes of Orders

11. Orders Section Template – Collects all orders for a given episode of care Orders Sub-Section Template – Collection of all orders for a specific signing event (one orderer, one time stamp). E.g. Order sets, Admission Orders. Order Entry Template – may be multiple. Information regarding a specific order for pharmacy, lab, etc. –May be text only –May contain sub-entries that are templated and contain structure and coded terminology –Need to address multiple orderers during a care episode. Approach to Orders Structure

12. The “A”rchitecture of the CDA CDA Document Header Body Orders Section Entry Text Order Subsection 1 Entry Text Order Subsection 2…n One Orders Section Multiple Orders Sub- Sections One or more Orders Entries

13. Issues to Consider Further analysis of components of order messaging that can be used in CDA Order template What orders have structure - HL7 messaging (v2.x or V3), CDA RMIM? Multiple orders during an episode of care (e.g. Hospitalization) Each order must be attributable The Author of the CDA isn’t necessarily the orderer for all orders

14. Questions?