Patient Care Coordination

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Patient Care Coordination
John T. Donnelly IntePro Solutions Co-Chair,
Patient Care Coordination Planning Committee
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Revised Agenda

• 100-115 Patient Care Coordination (PCC)
  Domain Objectives
• 115-145 Review of Use Cases for Medical
  Summaries and Transfer Packages
• 145-215 Medical Summaries, Clinical
  Information Sets, and Transfer Profiles
• 215-230 Break
• 230-245 PCC Educational Initiatives and
  Calendar
• 245-330 Open Discussion, Questions, Feedback

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Use Cases for Medical Summaries

• Lawrence McKnight, MD
• Siemens Medical Solutions
• Co-Chair IHE-PCC Planning Committee

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Patient Care Coordination

• Coordination of Care
• Across Providers
• Across Patient Problems
• Across Time
• Building on Success of XDS
• Mix of Data types
• Currently unstructured text primarily
• /- mix of structured data.

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What's In a Document
HP
Chief Complaint
HPI
Problems
Labs
Meds
Allergies
ROS
Exam
Vital Signs
Etc
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What's In a Document
HP
Discharge Summary
Chief Complaint
Chief Complaint
HPI
Problems
HPI
Problems
Labs
Problems
Meds
Labs
Labs
Meds
Meds
Allergies
ROS
Allergies
ROS
Exam
Vital Signs
Etc
Hospital Course
Etc
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Where to Begin?

• Given Much of the most clinically relevant data
  in EMR's are stored as free text.
• Given Structured/Unstructured must live
  together.
• Where to begin/end structuring of free text?
• View
• Import / Reconcile
• Decision Support
• What are the most relevant sections?
• What are the most relevant documents?

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Domain Experts

• Practicing Physicians
• Specialty Groups
• ACP, AMA, AFP, ACEP
• Standards Groups
• SNOMED, HL7
• Consultants, Industry Analysts
• Hospital Systems / Institutions
• Health Care IT Companies
• Large
• Small
• Ambulatory
• Acute

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Areas to Focus

• Roadmap
• Transfer of Care
• Start with Medical Summary
• More than simple Transfer of Information
• Explicit Transfer of Responsibility

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What's in a Medical Summary?
Broad
Permanent Care
Episode Care
Collaborative Care
Problem Scope
Focused
Focused
Broad
Intended Audience
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Medical Summary

• Episode Care
• Purpose to summarize an episode
• Author participation in care continues
  (generally)
• Scope is problems involved in episode
• Ex Admit HP, Discharge Summary, Procedure Note
• Collaborative Care
• Purpose is request help in Patient Management
• Scope involves focus on a problem
• Broad Audience is a side effect
• Ex Referral, admit to long term care
• Permanent Care
• Purpose is Transfer Care
• Author participation in care does not continue
• Scope involves all aspects of care
• Ex discharge from military, patient relocation

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Storyboarding

• A process to help define the Use Case story.
• Time
• Pre-conditions
• Events
• Post-conditions
• Interactions
• Actors

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UC1 Referral

• Outpatient PCP ? Specialist
• "Collaborative Care" Medical Summary
• Preconditions
• Referring Physician Office with EMR
• Specialist Office with EMR
• Data elements available
• EMR's connected in RHIO environment

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UC1 Events for PCP

• Pick Specialist
• Create Request
• Select Data Elements
• Review / Sign
• Give request to StaffAlternate flows
• Staff obtains Consent
• Obtain Payer Authorization Number
• Create Copies
• Attach additional paperwork

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UC1 Events for Specialist

• Office Staff Review Request
• Physician Views Information
• Optional Import
• Optional Query for more info

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UC2 Discharge

• Inpatient ? PCP
• "Episode" Medical Summary
• Preconditions
• Hospital and PCP with EMRs
• Data elements available defined
• EMR's connected in RHIO

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UC2 Events for the InPatient Author

• Select Data Elements
• Review / Sign

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UC2 Events for PCP Office

• Office Staff Review Request
• Physician Views Information
• Optional Import
• Optional Query for more info

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Activity Diagram
Profile
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Major SectionsReferral Note

• Referral-Reason
• Chief-Complaint
• HPI
• Active-Problems
• Current-Medications
• Allergies
• Past-Medical-History
• ROS
• Vital-Signs

• Physical-Exam
• Relevant-Procedures
• Relevant-Tests
• Administrative-Identifiers
• Insurance

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Major SectionsDischarge Summary

• Admit-Date
• Discharge-Date
• Roles
• Chief-Complaint
• HPI
• Hospital-Course
• Discharge-Diagnosis
• Active-Problems
• Resolved-Problems
• Discharge-Medications
• Meds-Administered

• Allergies
• Discharge Diet
• ROS
• Vital-Signs
• Physical-Exam
• Functional-Status
• Relevant Procedures
• Relevant Tests
• Plan Of Care
• Administrative-Identifiers
• Insurance

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Discussion Outcomes

• 3 Common Sections Always relevant
• Problems
• Meds
• Allergies
• UC1 Referral
• Reason for Referral
• UC2 Discharge Summary
• Hospital Course

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Patient Care Coordination Overview of Profiles
Keith W. Boone Dictaphone Corporation IHE PCC
Technical Committee Co-chair
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Patient Care Coordination DomainScope
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Patient Care Coordination Domain Profiles
MedicalSummaries
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Transfer SetAbstract

• Define a general use mechanism for the exchange
  of clinical documents by providers using XDS and
  related profiles.

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Transfer Set Key Technical Properties

• Document Sharing
• Notifications between Providers
• Organize Communications
• Packaging of Documents
• Identification of Master document or Manifest

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Clinical Information SetAbstract

• Develop basic criteria for the exchange of
  narrative medical documents containing
• Problems
• Medications
• Allergies
• Pointers to related material.

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Medical Summaries Abstract

• Define a medical summary format for narrative
  clinical documents for the purpose of transfer of
  care.

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Medical SummariesValue Proposition

• Supports key use cases for transfer of care
• Inpatient to PCP
• PCP to Specialist
• To be expanded in future years to support
• Home Care
• Long Term Care

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Transfer SetTransaction Diagram
Send Transfer PackagePCC-1
Receive Transfer PackagePCC-2
PackageReceiver
PackageSender
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Standards Used

• Medical Summaries
• CDA Release 2.0
• Care Record Summaries Implementation Guide
• Clinical Information Set
• CDA Release 2.0
• HL7 RIM
• Transfer Set
• XDS, NAV, ATNA, XUA, et cetera.

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More information.

• IHE Web sites www.ihe.net
• Technical Frameworks, Supplements
• Fill in relevant supplements and frameworks
• Non-Technical Brochures
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles Guidelines for Buyers
• IHE Connect-a-thon Results
• Vendor Products Integration Statements

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PCC Educational Initiatives

• EHRVA / IHE WORKSHOP CDA IMPL.
• When August 4, 2005
• Where Chicago
• Audience EHR and e-health application
  builders and implementers
• Length full day 830-430
• Prerequisites XML read-through of CDA
  specification and current DRAFT
  Implementation Guide
• NOTE There is also a full day of CDA
  tutorials in Chicago, Wednesday, July 27,
  sponsored by HL7

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CDA Implementation Workshop

• Preliminary Agenda
• Introduction Implementing CDAfinding the
  right place in the complexity scale
• CDA Schemas Header, body (narrative entries)
  and data types
• CDA Document Types Constraining CDA for a
  document architecture
• CDA Document Type Construction Creating a CDA
  Instance
• CDA Document Type Validation Schema and
  XPath/Schematron validation

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PCC Calendar of Events

• July 13-15 TC Face to Face
• July 22 Public Comment Draft
• August 4 EHR-VA CRS/CDA Workshop
• August 22 Public Comment Closes
• Aug 30 Sep 1 TC Face to Face
• September 5 Implementation for Trial Use
• September 15 Application Deadline

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More Information..

• IHE Web site www.ihe.net
• HIMSS IHE site www.himss.org/IHE
• HL7 CDA site www.hl7.org
• Non-Technical Brochures
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles Guidelines for Buyers
• IHE Connect-a-thon Results
• Vendor Products Integration Statements