1enabling healthcare interoperability
2009 Webinar Series
Sponsored by the HITSP Education, Communications and Outreach Committee
Consultations and Transfers of CareHITSP 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 AffairsSuzi Hines, Principal, Sage Consulting, LLC
Slide 2HITSP – 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
Slide 3HITSP – 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
Slide 4HITSP – 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 situationhealthcare interoperability . . . problems and solutions
Slide 5HITSP – 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 . . . futurehealthcare interoperability . . . problems and solutions
6enabling healthcare interoperability
2009 Webinar Series
Sponsored by the HITSP Education, Communications and Outreach Committee
What is HITSP?
Slide 7HITSP – 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
Slide 8HITSP – 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
Slide 9HITSP – 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
Slide 10HITSP – 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
Slide 11HITSP – 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.
Slide 12HITSP – 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
Slide 13HITSP – 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
Slide 14HITSP – 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) perspectivee.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
Slide 15HITSP – 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.
Slide 16HITSP – 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.
Slide 17HITSP – enabling healthcare interoperability 2009 Webinar Series
Section 7.1Requesting Clinician
Section 7.2 Consulting Clinician
7.1.3 Initiate consult request with consulting
clinician
7.1.1 Evaluate patient and
determine need for consult
7.1.2 Discuss with patient and select
consulting clinician
Section 9.0Information Exchange
Section 7.3Patient
7.2.1 Receive and review request & determine ability to accept patient
7.2.3 Evaluate/ manage patient
7.2.2 Request and view additional
clinical information
7.2.4 Complete consultation
7.2.5 Complete and communicate
consult report
7.3.4 Receive consult report information
7.3.3 Complete consultation
7.3.1. Select and coordinate with
consulting clinician
7.3.2 Provide permissions for
core set of data to be shared
Laboratories
Healthcare Entities
Healthcare Payors
Other EHRs
Medication Network
Intermediaries
Diagnostic Imaging
1
4
Other PHRs/ Health Record
Banks
4
7.1.4 Provide access to
additional clinical information
7.1.5 Receive and review consult
report4
Contextual
Focus
Legend
Focus
Legend
1
4
3
3
3
Perspectives/RolesInformation Sources
& Recipients
May be one or more of those listed
below:
2
Health Information Exchange
OR
Point-to-Point Exchange
OR
Specialty Network Exchange
Capabilities as needed in context
9.3 Subject-data matching
9.2 Data retrieval
9.1 Data delivery
9.4 Summary patient record
exchange
9.6 Support for personally
controlled health records
9.7 Emergency access
9.5 Notification of availability of new or updated data
Scenario 1: Consultations
Slide 18HITSP – enabling healthcare interoperability 2009 Webinar Series
Section 7.1Requesting Clinician
Section 7.2 Consulting Clinician
7.1.3 Initiate consult request with consulting
clinician
7.1.1 Evaluate patient and
determine need for consult
7.1.2 Discuss with patient and select
consulting clinician
Section 9.0Information Exchange
Section 7.3Patient
7.2.1 Receive and review request & determine ability to accept patient
7.2.3 Evaluate/ manage patient
7.2.2 Request and view additional
clinical information
7.2.4 Complete consultation
7.2.5 Complete and communicate
consult report
7.3.4 Receive consult report information
7.3.3 Complete consultation
7.3.1. Select and coordinate with
consulting clinician
7.3.2 Provide permissions for
core set of data to be shared
Laboratories
Healthcare Entities
Healthcare Payors
Other EHRs
Medication Network
Intermediaries
Diagnostic Imaging
1
4
Other PHRs/ Health Record
Banks
4
7.1.4 Provide access to
additional clinical information
7.1.5 Receive and review consult
report4
Contextual
Focus
Legend
Focus
Legend
1
4
3
3
3
Perspectives/RolesInformation Sources
& Recipients
May be one or more of those listed
below:
2
Health Information Exchange
OR
Point-to-Point Exchange
OR
Specialty Network Exchange
Capabilities as needed in context
9.3 Subject-data matching
9.2 Data retrieval
9.1 Data delivery
9.4 Summary patient record
exchange
9.6 Support for personally
controlled health records
9.7 Emergency access
9.5 Notification of availability of new or updated data
Scenario 1: Sample of Consultation Data Flows
1
1
4
4
Slide 19HITSP – enabling healthcare interoperability 2009 Webinar Series
Scenario 2: Samples of Transfer of Care Data Flows
8.1 Discharging/ Transferring
Setting
8.2 Receiving Setting
8.1.5 Transmit additional relevant patient data upon
completion
8.2.2 Accept patient &
coordinate transfer
8.1.1 Determine need to transfer
patient
8.1.3 Initiate plan & coordinate
discharge/transfer
9.0 Information Exchange
8.2.3 Receive and review patient
data & evaluate/ manage patient
8.2.4 Access additional patient
data
8.2.5 Continue to manage patient
3
8.1.2 Select next setting of care &
discuss with patient/family
8.1.4 Discharge/ Transfer patient & transmit available
transfer data
Laboratories
Healthcare Entities
Healthcare Payors
Other EHRs
Medication Network
Intermediaries
Diagnostic Imaging
Other PHRs/ Health Record
Banks
2
8.2.1 Receive and review patient
data & determine ability to accept
patient
8.1.6 Provide access to
additional patient data
4
4
Section 8.3Patient
8.3.1. Receive discharge/transfer
data
Contextual
Focus
Legend
Focus
Legend
1
4
3
2
3
3 4
5
5
5
Perspectives/RolesInformation Sources
& Recipients
May be one or more of those listed
below:
Health Information Exchange
OR
Point-to-Point Exchange
OR
Specialty Network Exchange
Capabilities as needed in context
9.3 Subject-data matching
9.2 Data retrieval
9.1 Data delivery
9.4 Summary patient record
exchange
9.6 Support for personally
controlled health records
9.7 Emergency access
9.5 Notification of availability of new or updated data
3 3
Slide 20HITSP – enabling healthcare interoperability 2009 Webinar Series
Information Exchange Requirements (IER)
IER Description
IER 01 Provide authorization and consent
IER 11 Identify provider based on patient preference
IER 13 Send/receive notification of document availability
IER 14 Send/receive health plan eligibility
IER 15 Send/receive health plan authorization
IER 16 Send/receive clinical summary
IER 17 Send/receive transfer of care data
IER 22 Send/receive additional patient information
IER 25 Send/receive decision support data
IER 28 Download historical health data
IER 37 Update medication information
Slide 21HITSP – enabling healthcare interoperability 2009 Webinar Series
Information Exchange Requirements (continued)
IER Description
IER 43 Send/receive accept patient
IER 45 Send/receive consult results report
IER 57 Identify provider based on health plan
IER 60 Send/receive discharge summary
IER 62 Send/receive encounter or full episode of care record
IER 63 Request additional patient data
IER 64 Send/receive consult request/data
Slide 22HITSP – enabling healthcare interoperability 2009 Webinar Series
Data Requirements for Consultations and Transfers of Care
Data Requirement Number (DR)
Description
DR 2 Patient clinical information, including advance directives, allergies, provider, immunizations, language spoken, medications, person information, procedures, vital signs….
DR 6 Health plan eligibility, including demographics, member ID, co-pay, deductibles, limits and exclusions, coded procedures, effective date
DR 9 Consultation completion, including treatment summary, medication list and reconciliation, recommended care plan
DR 10 Consulting provider registry, including name, location, specialties/capabilities, facilities associated with, schedule, insurance plan associations, contact info
Slide 23HITSP – enabling healthcare interoperability 2009 Webinar Series
Data Requirements for Consultations and Transfers of Care (continued)
Data Requirement Number (DR)
Description
DR 57 Demographic data, including dates, patient demographics, provider info, reason for consult or transfer/discharge
DR 60 Patient 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
Slide 24HITSP – 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
Slide 25HITSP – 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
Slide 26HITSP – 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
HITSP Security and Privacy Constructs Safeguard Information Exchanged during Transfer and Consultations
Slide 27HITSP – enabling healthcare interoperability 2009 Webinar Series
Interoperability Requirements (IER)IER1-Provide authorization and consentIER-11-Identify provider by patient preferenceIER 14-Send/receive health plan eligibility(…)
Transactions/packages usedTP22 PIX QueryTP 23-Patient demographics queryT29-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
Slide 28HITSP – enabling healthcare interoperability 2009 Webinar Series
Interoperability Requirements (IER)IER 13-Send/receive notice of document avail.IER 17-Send/receive transfer of care dataIER 22-Send/receive additional patient information(…)
Transactions/packages usedT 29-Notification of document avail.T 31-Document reliable interchangeT 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
Slide 29HITSP – 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
Slide 30HITSP – enabling healthcare interoperability 2009 Webinar Series
HITSP IS-09 CTC specification: Location and Status
Located at http://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
Slide 31HITSP – 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
Slide 32HITSP – enabling healthcare interoperability 2009 Webinar Series
Next Steps for 2009
Incorporating following 2009 Extensions/Gaps
— Clinical Note Details
— Order Sets
— Long Term Care – Assessments
33enabling healthcare interoperability
2009 Webinar Series
Sponsored by the HITSP Education, Communications and Outreach Committee
Conclusion
Slide 34HITSP – 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
Slide 35HITSP – 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 . . . futurehealthcare interoperability . . . problems and solutions
Slide 36HITSP – enabling healthcare interoperability 2009 Webinar Series
Webinar 1 Advances in Sharing Information in Healthcare IT
Thursday, January 15th, 2009 — 2:00-3:30 pm EDT
Webinar 7 Health Information Exchange (HIEs) in the Real World
Thursday, July 9th, 2009 — 2:00-3:30 pm EDT
Webinar 2 Personalized Healthcare Interoperability Specification (IS 08)
Thursday, February 12th, 2009 — 2:00-3:30 pm EDT
Webinar 8 Patient - Provider Secure Messaging Interoperability Specification (IS 12)
Thursday, August 13th, 2009 — 2:00-3:30 pm EDT
Webinar 3 Consultations and Transfers of Care Interoperability Specification (IS 09)
Thursday, March 12th, 2009 — 2:00-3:30 pm EST
Webinar 9 Remote Monitoring Interoperability Specification (IS 77)
Thursday, September 10th, 2009 — 2:00-3:30 pm EDT
Webinar 4 NHIN Real World Sites
Thursday, April 16th, 2009 — 2:00-3:30 pm EDT
Webinar 10 Medication Management Real World Sites
Thursday, October 8th, 2009 — 2:00-3:30 pm EDT
Webinar 5 Immunization & Response Management Interoperability Specification (IS 10)
Thursday, May 14th, 2009 — 1:30-3:00 pm EDT
Webinar 11 Security, Privacy, and Infrastructure
Thursday, November 12th, 2009 — 2:00-3:30 pm EDT
Webinar 6 Public Health Case Reporting Interoperability Specification (IS 11)
Thursday, June 18th, 2009 — 1:30-3:00 pm EDT
Webinar 12 Real World Sites – TBA
Thursday, December 10th, 2009 — 2:00-3:30 pm EDT
The 2009 Webinar Serieswww.HITSP.org/webinars
Slide 37HITSP – enabling healthcare interoperability 2009 Webinar Series
View the Complete Set of HITSP Deliverableswww.HITSP.org
Slide 38HITSP – 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
Slide 39HITSP – enabling healthcare interoperability 2009 Webinar Series
Jessica Kant, HIMSS Theresa Wisdom, [email protected] [email protected]
Re: HITSP Technical Committees
Michelle Deane, ANSI [email protected]
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:
Slide 40HITSP – enabling healthcare interoperability 2009 Webinar Series
Sponsor Strategic Partners
www.HITSP.org