Blog from July, 2020

Review of ONC Tech Forum information and signup.

Update on outstanding work on existing specifications

• AUT HL7 segment information was recorded (thanks Chuck!)
• 360XL has been submitted to IHE for public comment

Update on the discussions with the Ohio Health Information Partnership (OHIP)

• They are very excited about 360X becoming available form vendors
• They have a very strong statewide foodbank network (Ohio Association of Foodbanks)
• They want to see how using 360X can help with social care referrals
• Challenges:
  • Clinical information is not meant to be sent with the request
  • Support for 360X for initiating clinical referrals does not easily transfer to extra-clinical referrals (different users, different workflows)
  • If we add social care referrals to 360X, it will likely be years before implementations are available to users, and OHIP is looking for quick turnaround.
• We will continue discussions next time

Transfers from LTPAC facilities to Acute care facilities. We answered some of the questions of the steps, and updated as follows:

1. Referral to ED
   1. This is a notification, not a request. We will need to be careful to describe edge cases where ED cannot take the patient (re-routing, etc.)
   2. Starting set of the data needed from SNF to ED from Partners Healthcare
2. Discharge from ED back to SNF
   1. Notification, with a summary of what happened in the ED - close the loop outcome
3. Transfer to Hospital admission
   1. Notification from ED/Hospital to SNF
   2. Response from SNF to Hospital with additional information
   3. Can we keep the referral ID? Should we call it something else?
4. Determination whether the patient will be discharged to the same SNF
   1. Can be due to timing - whether the patient bed can stay on hold for time necessary to be at the hospital - possibly a notification from SNF to hospital
   2. Patient may decide to look for a different facility - notification form hospital to SNF
5. Patient Discharge - close the loop. Whether they go to the same SNF or another, follow the 360XL process of request, select, transfer
   1. Which identifier? Use two?

We need a diagram for this, any volunteers?

There are some existing transactions: https://pathway-interact.com/ - we will review in two weeks.

Discussions about the ONC Tech forum booth, exhibit materials, and time slots.

• Sheila will send out a doodle poll for volunteers to sign up.

Discussions about existing work that needs to be completed:

• Chuck will fill out the missing HL7 segment information
• Vassil will submit 360XL for IHE PCC public forum

ONC Tech forum - 360X will have a booth in the "virtual exhibition hall". We may be able to have a live booth presence, there were several  volunteers to be present during the the event. We will discuss setup and other details on 7/17 call.

Discussion on the top next proposed project for 360X - transfers from LTAC facilities to Acute care facilities

• Main points for SNF to acute transfer:
  • initial transfer is most commonly to the ED - referral for consultation
  • ED transfers have very specific, targeted information requirements from the SNF
  • In many cases patient is then transferred back to SNF - loop is closed 
  • In other cases patient is moved form ED to Hospital admission
  • Hospital admissions have different information requirements to be obtained from the SNF, mainly to inform inpatient nursing staff how the patient needs to be managed
  • Discharge from hospital admission can be to same SNF or to a different one
• Steps to consider
  1. Referral to ED
     1. Is this a request that can be denied, or is it more like a notification to the ED (expect this patient)?
     2. Need to describe the data needed from SNF to ED
  2. Discharge from ED back to SNF
     1. Notification, with a summary of what happened in the ED - close the loop outcome
  3. Transfer to Hospital admission
     1. Notification from ED/Hospital to SNF
     2. Response from SNF to Hospital with additional information
     3. Can we keep the referral ID? Should we call it something else?
  4. Determination whether the patient will be discharged to the same SNF
     1. Can be due to timing - whether the patient bed can stay on hold for time necessary to be at the hospital - possibly a notification from SNF to hospital
     2. Patient may decide to look for a different facility - notification form hospital to SNF
  5. Patient Discharge - close the loop
     1. to same SNF - folow steps from 360XL for an already selected facility
     2. to a different SNF - use the full 360XL process - request, select, transfer 

We will continue discussions during the 7/24 call.

No call today, most everyone had the day off for Independence Day.