Blog from February, 2019

1. Update from HIMSS - demo went very well, we will try to show it via Webex on a future call
2. Long Term Care use case
   1. We want to make sure we scope this properly. There are significant differences among Skilled Nursing Facilities, Long Term Acute Hospitals, and Assisted Living Facilities
      1. Assisted Living Facilities would need detailed functional status, dietary requirements, social data, rehab services, if any, are outside of the facility
      2. SNFs usually have rehab capabilities on site; need only baseline functional status
      3. Long Term Care Acute Hospitals - previous (acute) level of care is still needed
      4. Conclusion: Long Term Care use case to focus on Skilled Nursing Facilities (NSF); make sure we don't mix with more general discharge planning or transition of care workflows
   2. SNF Referrals workflow points:
      1. requests to multiple facilities, hospital system must group them together
      2. Negotiations with the facilities until one is selected
      3. Include families in selection process
   3. Topics for further discussion

      1. referral identifier - one per request, or same one for multiple requests,

      2. how to manage negotiations

      3. what is closing the loop in this case

      4. What is necessary content in order to improve patient care

         1. Partners Healthcare has a list of red flags, therapy notes, high cost items that are sent with the request. In their experience, first-come, first-served is he most common approach in selecting the facility
      5. When sending requests to multiple facilities, what is the general approach? Two-step requests?

:

1. Recap of Connectathon testing
   1. Suggestion: Add 360X tests to pre-Connectathon testing
   2. Suggestion: Have a discussion with IHE on how to improve testing at the Connectathon (e.g. make it clear that a single test covers multiple facets of the specification)
   3. Change to specification: There is no need to have two MIME attachments for the request, remove any mention of an unwrapped CDA as a separate MIME attachment, and leave the XDM MIME attachment as the only one.
2. New topic: LTC referrals. Review high level process, identify where interoperability points are, and what is specific about them

   1. Requests are sent to multiple facilities

   1. Configuration

   2. UI indications

   2. Facilities request additional information

   1. How to request the type of data

   1. Clinical notes

   2. Medicare/Medicaid assessment

   3. Discharge summary

   2. Dependent on level of care

   3. What is possible with C-CDA

   4. Questionnaire (auto-populated)

   5. Based on the diagnoses, initial request can be specific, so no additional information is needed

   6. Handling of declined reference

   3. First week after admission in LT

   1. Who is the provider at the acute facility to contact (add treatment team to order)

   2. No current workflow for followup.

   4. nurses going to acute facility to evaluate before discharge - that will not be needed with an electronic process

   5. Standard vocabulary for LT transitions - data elements library, ONC efforts/regulations

   6. Next discussion March 1st.