August 16, 2013

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 From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute  NOTE: This meeting is being recorded and will be posted on the esMD Wiki page after the meeting

3. Agenda

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 Information Model Coded Terminology Best Structured Text Better Unstructured Text PDF Images Good

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

7. Global Order Components

8. Classes of Orders • 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

9. Classes of Orders • 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

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

11. Approach to Orders Structure • 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.

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

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?