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In a spooky Halloween fashion, this call was cancelled...

• Report out from discussion with ONC SDOH lead and Gravity project: overall well-received, groups to stay connected. Potential for HIMSS21 interoperability showcase alongside a FHIR-based Gravity/SDOH referral demonstration.
  • Use case / user story in development. Dan P/OHIP to distribute user story from their work for reference. Dr. Miller to share user story for input.
• Walkthrough of 360X SDOH Needs Referral Management document in development
  • Discussion on patient consent – largely handled by providers at time referral is made, but to non-clinical providers may be slight differences. OHIP getting legal opinion for sending of PHI from CE to non-CE w/ no BA. Some precedent for social services referrals. Dan P. to bring back legal opinion once they have it.
  • Discussion of statuses – potential need for “pending” status given potential lag
    • Should be addressed by vendor behavior (e.g., eCW referrals go into pending queue in system until next status is received)
    • Still a need for systems to configure or somehow flag if a referral has not been accepted to ensure patients do not fall through cracks.
  • C-CDA template for use: Unstructured Document template – no clinical info, just patient header/demographics. Could include unstructured attachment (e.g. benefits application pdf or image)
    • Could be heavy lift for vendors – conformance validation, etc. XDM metadata could allow PDF sent alongside C-CDA instead of within C-CDA. Unstructured C-CDA as optional.
    • Possibility for two options – one very light information, one with more information as needed for referral. Need to ensure not too onerous for vendor implementation
    • Alan to help make updates to C-CDA section of document based on discussion
  • Direct address provision for non-CEs may be a bit more complicated, but should be possible.
    • If non-provider, non-CE gets a direct address, there’s nothing in the directory to indicate someone is or is not a covered entity.
    • Dan P to look into how DT may be including/flagging non-clinical providers in directory.

Review SNF Discharge Summary contents, provided by Amy

• Good starting point
• Data is present in SNF systems
• Most of the information will be of use for the case where a patient is admitted to the hospital after they were in the ED

Reminder about the IHE public comment on 360XL

• The actual document is at https://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_Suppl_360XL_Rev1-0_PC_2020-08-26.pdf
• Submit comments at https://www.ihe.net/PCC_Public_Comments/

Vassil to send out call for volunteers

Review of discussion with Ohio HIE (OHIP Online)

• Initial focusing on 360X clinical referrals, eCW and Netsmart are on board
• Continue investigating food-related SDoH

Discussions on how we can move forward in this area

• A lot of interest, and very timely considering COVID-19 impact
• At the same time, there are a lot of disparate threads involved
  • Social services Initiation can occur in acute and ambulatory settings
    • Acute settings probably don't need any type of follow-up, unless part of larger organizations that provide primary care. 
    • Ambulatory settings, especially in the cases of PCPs who are members of ACOs or patient centered medical home (PCMH) organizations, will likely have care coordinators who need to know if the patient has followed up on the social services referrals
  • Social services, especially those related to food deficiency, often work together with government programs, and some of the followup includes enrollment in such programs. Current paper forms include enrollment information, some even include voter registration. While we cannot affect electronic communications with government programs, we need to describe the interaction points when possible
• Continue working to analysis, and publish findings on 360X wiki, although it is unlikely that a 360X-based solution can emerge in the short term. A thorough analysis will help guide future efforts.
• Contact major SDoH vendors and invite them to meetings, including the Gravity project

We reviewed a couple of paper forms for SNF to ED transfers. They are a good match to the list from Partners Healthcare, and we will use that as the baseline for content description.

We discussed the OHIP needs for possibly using 360X for SDOH purposes, and specifically food needs for patients, which is an increased concern during the COVID-19 pandemic. We will invite more participants in these calls to continue gathering information on how to best approach this. Basic 360X is not necessarily a good fit for this area.

We reviewed the data elements collected by Partners Healthcare for transfers from SNF to ED. While not all elements are applicable all the time, together they provide a comprehensive snapshot that helps the ED to quickly assess the needs of the patient.

Based on these data elements, we can try to map them to existing C-CDA sections and work on building the content for the initial transaction.

Volunteers to take up this task, as well as visualizing the workflow transitions, are welcome!

Reviewed the ONC Tech Forum - it was a worthwhile experience. We got several questions on SDoH and 360X.

New 360X logo has been put on the Wiki.

Reviewed updated steps for SNF to Acute care transfers from the August 24 call. Open questions about transfer/referral identifiers:

• Transfer to ED is an identifiable event in the SNF system, so the system will assign the required referral ID.
• When the patient is discharged from ED back to SNF, the identifier is used to close the loop.
• If the patient is admitted to the hospital (post-ED), then the discharge is to follow the 360XL steps of request/accept/confirm/transfer
  • if the patient is not going to the originating SNF, then a new referral id will be created. At some point a notification to the originating SNF may have been sent with the originating referral id
  • if the patient is going back to the originating SNF, ideally, we want to use the originating referral ID.
    • Is this possible? It is not clear the ED/Hospital systems would have the original transfer information at this point. Something to check.

Reviewed the data elements for initial transfer to ED from Partners Healthcare.

• Data is thorough, and extremely useful
• Many SNF system have the data is some form
• We will call for volunteers to find matches to C-CDA sections and entries.

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.