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Patient is a 49-year-old woman with obesity, hypertension and hyperlipidemia at high hUigh risk for developing type II diabetes.  During a telehealth encounter (planned remote encounter due to the pandemic) with her primary care physician (PCP)  where they discuss her risks for developing Type II Diabetes and her difficulties in maintaining a healthy lifestyle on her own.  She recognizes her risk and agrees to a referral to the YMCA Diabetic Prevention Program offered at the local YMCA.  These meetings are currently being held remotely via “Zoom” also due to the pandemic.

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Direct accounts can be created for coved and non-covered entities, but type of entity is not yet indicated in the Direct Directory.

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What are the necessary components for a 360X-SD implementation

Infrastructure

Direct Protocol

The initiator and recipient need to be able to use Secure Direct Messaging. Usually this means using the service of a HISP. (Expand with references).

Support for XDM payload in Direct Secure Messaging

Make sure that both the recipient and the HISP support full XDM metadata receipt and transmission.

Select appropriate architecture

In many cases the ultimate recipients of the referral may need help in using and maintaining an IT infrastructure. In such cases an intermediary or a consolidation provider may be the destination for the secure messaging, while the service providers used tools provided by the intermediary.

Format

The information about the referral is present in the transaction metadata (In XML format) and in an HL7 v2 message. Both sides will need to be able to create and process these two formats.

Context and Content

Sharing of Assessment Data

The SDOH needs of a patient are usually determined by assessments. Based on the needs that were determined, the referral request should contain the relevant questions and answers from the assessment.

(Add guidance for how the combination of question/response order specific questions and the diagnoses Z-codes correspond to the the FHIR Observation.interpretation). In the cases where additional assessments are done at the intermediary/consolidator or at the service provider, that information will available via the Referral Status Query.

Use standard coding systems (SNOMED-CT and ICD-10CM)

The request contains the determination of the clinician that the patient has specific needs, ranging from "Needs social services assessment" to specific services that need to be provided. In general, the needs are conveyed as "Reason for Referral" using ICD-10CM codes, while the goals/interventions are conveyed using SNOMED-CT codes.