Blog from July, 2019

Discussions on how to indicate the different steps of the workflow (as illustrated here). The following conclusions were made:

• The acute facility will identify the requested date and time for the patient transfer in the TQ1 segment (starting time). The SNF can also idicate the exact time they can accept the patient using ORC-27 in their accept message.
• The confirmation will be indicated by the ORC-1 and ORC-5 fields: ORC-1 set to SC and ORC-5 set to SC. A reminder that all other accepted facilitites need to receive a cancelation.
• The discharge transaction will have the HL7 OSU message as follows: ORC-1 set to SC and ORC-5 set to CM. The current agreement is that once the patient is discharged, the loop is closed.

There is a need to clarify that the transaction diagram reflects the multiple recipients of the request. Need to change the diagram. 

Continued discussion on using Cross-organizational FHIR scheduling (Argonaut Scheduling) with 360X. The following topics were discussed:

• Sequence of steps
  • Order for referral placed
  • Cross-organizational scheduling of appointment
  • Send Request package
  • Automatic acceptance
• Alternatively, it could be
  • Order for referral placed
  • Send Request Package
  • Accept received
  • Cross-organizational scheduling of appointment
• The first case seems to be better suited for when the patient gets an appontment before they leave the initating provider.
• Open questions
  • How do we link the appointment to the referral?
  • What types of appointments are best suited to be open for cross-organizational scheduling?
  • If the recipient modifies/cancells the apponitment, how will the initiator know? The Argonaut project is working on support for subscriptions, that would be one possible way.

• Spreadsheet with new column for PDPM relevance
• How to convey "confirmation" to the selected facitlity? Possible solutions
  • Status update message with Order Released code (OE) in ORC-1. Note that HL7 specifies that this code is to be used by the order filler (i.e. referral recipient), so it may not be appropirate
  • Add a special code to ORC-1 (hopefully not necessary)
  • Status update message with Status Change code (SC) in ORC-1, and In-process, Scheduled code in ORC-5 (the code is also SC).

We did not consider the impact of the Independece Day holiday, so the call was adjourned due to low attendance.