1. Reviewed the sequence diagram showing multiple requests, multiples accepts, a declines, confirmation, and cancel.
    1. When the list of possible facilities is made, or when the selection of the particular facility is made, the specification will note that the patient (or a delegate) will be provided with the required quality information per the latest CMS rule.
  2. Discussion on what "closing the loop" means, and whether we need to be explicit about it
    1. The "administrative" process of transferring is complete with the physical discharge. In the 360X SNF use case, this will be represented as the Discharge Transaction, which will contain
      1. a C-CDA document representing the reconciled medication list, relevant clinical information, and assessments.
      2. An HL7 v2 message indicating a Complete status.
    2. The "clinical" process may continue after the the physical discharge - diagnostic results, final discharge summary, and other clinical information, which still needs to be properly communicated to the SNF. Several points came up in the discussion:
      1. Post-transfer communications SHOULD take advantage of the unique patient ID provided by the hospital as part of the request. Using the referral ID is not appropriate. The SNF SHOULD properly update the patient chart with the additional clinical information.
      2. The completed Discharge Summary SHALL be sent to the SNF. (Note: this is not a 360X-specific transaction, it is part of communicating the Discharge Summary to the patient/delegate and the patient's care team) 
    3. A lot of communications between the hospital and the SNF happen in the hours before and after the actual transfer, and this information is essential for the quality of the transfer.
      1. These communications do not represent a particular change of state of the transfer, and are therefore not a part of the 360X SNF Use case.
      2. One possible way to address this communication need could be a companion Implementation Guide that profiles the HL7 FHIR Questionnaire and QuestionnaireResponse resources
    4. A patient-centric discharge process, where the patient (or their delegate) is kept properly informed of their condition and necessary next steps, is a more general problem than the 360X SNF use case.
      1. A well executed discharge process has a great impact on the transfer
      2. The 360X SNF use case can indicate the places in the descriptions of the various transactions where the patient/delegate needs to be made aware of the appropriate information.
  3. Question: is there any guidance on the Direct address to be used in the response?
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