Patient Care Coordination

1. Patient Care Coordination IHE Europe Workshop 2007 IHE Patient Care Coordination Charles Parisot, GE Healthcare

2. Content 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 H&P [PPHP] • Basic Patient Privacy Consents [BPPC] • Exchange Personal Health Record [XPHR]

3. PCC Content Integration Profiles XDS-MS XD*-LAB BCCP Lab Report Consent MedicalDocuments MedicalSummaries ACS PPHP CA AntenatalCareSummary History andPhysical CareAssessments Referral DischargeSummary PreprocedureHistory andPhysical XPHR EDN EDR PHR Extract EmergencyDepartmentNote EmergencyDepartmentReferral 2005-20062006-20072007-2008 PHR Update

4. PCC Content Integration Profiles • Content using a Specific Standard • CDA Release 2.0 • HL7 Care Record Summary • HL7/ASTM Continuity of Care Document • Library of Reusable Parts • Document Types • Sections • Entries

5. Basic Patient Privacy Consents (BPPC) IHE Vendors Workshop 2006 IHE Patient Care Coordination Education John Moehrke, Robert Horn, Lori Fourquet, Keith W. Boone

6. Basic Patient Privacy ConsentsAbstract • 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.

7. Basic Patient Privacy ConsentsScope • Document Sources and Document Consumers in an XDS Affinity Domain • Document Sources and Document Receivers using Cross Enterprise Point-to-Point Document Sharing

8. Basic Patient Privacy ConsentsValue 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.

9. Basic Patient Privacy ConsentsKey Technical Properties • Human Readable Consents • Machine Processable • Support for standards-based Role-Based Access Control

10. Basic Patient Privacy ConsentsStandards and Profiles Used • CDA Release 2.0 • XDS Scanned Documents • Document Digital Signature • Cross Enterprise Document Sharing • Cross Enterprise Point-to-Point Document Sharing

11. Basic Patient Privacy ConsentsExample • Encounter 1(Requires A) Consent A Consent B • Encounter 2(OK with B)

12. Pre-procedure History and Physical (PPHP) IHE Development Team Workshop 2006 IHE Patient Care Coordination Education Dan Russler, MD, co-chair PCC Technical Committee

13. Use Case • H&P 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 H&P

14. 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 H&P

15. 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 patient’s 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 H&P

16. 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 H&P

17. 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) Pre-procedure H&P

18. Emergency Department Referral Todd Rothenhaus, MD FACEP American College of Emergency Physicians

19. Emergency DepartmentReferralValue Proposition • Nearly 5000 EDs in US or in Europe • 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

20. Emergency DepartmentReferralScope • 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.

21. Emergency DepartmentReferralUse 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 to ED information systems in a standard manner.

22. Exchange of PHR Content(XPHR) IHE Vendors Workshop 2006 IHE Patient Care Coordination Education Keith W. Boone, GE Healthcare [co-chair PCC Technical Committee]

23. XDS-MS MedicalDocuments PPHP BCCP MedicalSummaries History andPhysical Consent XPHR Referral DischargeSummary PHR Extract PreprocedureHistory andPhysical EDR EmergencyDepartmentReferral XDSLAB PHR Update CDA Lab XPHR PHR Extract PHR Update Exchange of PHR Content

24. 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

25. Scope • Personal Health Record (PHR) Systems • Electronic Health Record (EHR) Systems Exchange of PHR Content

26. Value Proposition • Supports interchange of PHR Information • Demographics • Insurance Information • Medications, Problems, Allergies • Health History • Other Information Exchange of PHR Content

27. Standards Used • CDA Release 2.0 • ASTM Continuity of Care Data Set • ASTM/HL7 Continuity of Care Document • HL7 Care Record Summary • AHIMA PHR Common Data Elements • XDS, XDR • Document Digital Signature Exchange of PHR Content

28. Key Technical Properties • Information is Human Readable • and Machine Processable • Support Static and Dynamic Information Sharing Domains (XDS and XDR) • Protects Information using Digital Signature • Update Model for EHR to PHR Changes Exchange of PHR Content

29. PreSurgery PPHP Consent BPPC Emergency EDR Scanned Doc XDS-SD Laboratory XD*-Lab Discharge &Referrals XDS-MS PHR Exchange XPHR Imaging XDS-I Doc Sharing XDS Pt-Pt DocInterchange XDR MediaInterchange XDM Key Profiles for Document Content and Exchange Doc Content Profiles Doc Exchange Integration Profiles

30. PCC Content Integration Profiles XDS-MS XD*-LAB BCCP Lab Report Consent MedicalDocuments MedicalSummaries ACS PPHP CA AntenatalCareSummary History andPhysical CareAssessments Referral DischargeSummary PreprocedureHistory andPhysical XPHR EDN EDR PHR Extract EmergencyDepartmentNote EmergencyDepartmentReferral 2005-20062006-20072007-2008 PHR Update

31. Structured and Coded Header Patient, Aut hor, Authenticator, Institution, etc. S t r u c t u r e d C o n t e n t w i t h c o d e d S t r u c t u r e d C o n t e n t w i t h c o d e d s e c t i o n s : s e c t i o n s : · · R e a s o n f o r R e f e r r a l R e a s o n f o r R e f e r r a l · · V i t a l S i g n s V i t a l S i g n s · · M e d i c a t i o n M e d i c a t i o n Structured Text Section Coded Section Entries · · S t u d i e s S t u d i e s · · A l l e r g i e s A l l e r g i e s Structured Text Section Coded Section · · S o c i a l H i s t o r y S o c i a l H i s t o r y Entries · · P r o b l e m s P r o b l e m s Structured Text Section Coded Section · C a r e P l a n C a r e P l a n Entries Rossi-Mori EU survey mapping to XDS-MS

32. Actor Options Vol & Section Content Source Discharge Summary Option(1) Referral Option (1) PCC TF-1: 3.4.1 PCC TF-1: 3.4.2 Content Consumer View Option (2) Document Import Option(2) Section Import Option (2) Discrete Data Import Option (2) PCC TF-1: 3.4.3 PCC TF-1: 3.4.4 PCC TF-1: 3.4.5 PCC TF-1: 3.4.6 Document Registry No Options - Document Repository No Options - Patient Identity Feed No Options - Example of XDS-MS Options

33. IHE flexibility in leveraging standards for Document Format • Content Format leverages Specific Standards • HL7 CDA Release 2.0 • HL7/ASTM Continuity of Care Document • LOINC, SNOMED (if applicable) • Others as Needed (e.g. PDF) • IHE is defining a library of Reusable Parts • Document Types • Sections (only title is coded) • Entries (clinical info semantically coded)

34. In Conclusion • IHE is experienced with patient summaries. IHE ready to engage in fostering a consistent family of patient summary documents and a sharing infrastructure between countries and regions in Europe.