Discussion of possible options in addition to current 360X LTAC transactions:

  • There are similarities between the workflow steps for LTAC transfers, and request for extra-clinical services.
  • The scope and need for clinical data is vastly different, the distinction between HIPAA and non-HIPAA partners needs to be taken into account
  • BSeR has already defined content for extra-clinical referrals as FHIR resources
  • A fully FHIR-based solution requires wide adoption of an underlying infrastructure, which will not be present for a while (e.g. Argonaut FHIR Subscription IG is in development, earliest publication date is beginning of 2021 )
  • A possible mixed approach was discussed, consisting of
    • push HL7v2 messages for the Request and Confirmation steps, and
    • RESTful FHIR reads and updates to get appropriate clinical data (for the SNF case, a C-CDA as the content of a DocumentReference resource; for the BSeR case, the appropriate Observation Resources).
  • The conclusion was that this was an interesting idea, but at this point the effort should be on completing the 360X based approach for NSF transfers.

Question about the Cancel transaction, when it is used to indicate that the facility was not chosen: do we follow the Cancel Request/Cancel Confirmation pattern described in 360X? Conclusion: No, this has a specific meaning, not to be confused with a Cancellation request. Will need to make sure this case is easily distinguishable from a generic 360X Cancel.

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