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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.

Survey was sent to the mailing list, received some responses:

• needed to add newer participants to mailing list
• more responses were sent during call

Looking at the responses, and considering the e-mail from Terry O'Malley, the LTC to acute care was the front-runner for our next use case.

We had more discussions on the various options, and next step.

In addition, the ONC Tech Forum will take place virtually on August 10-11. They will have an "exhibit area", and we are expecting that the 360X project will have presence there. Details will be coming over the next few meetings. Based on that, our focus for the general meetings should be on getting our documentation in the best shape possible for August 10.

Discussion focused on what use cases to consider:

• Current workload - based on following, we may take one new use case, and possibly a second.
  • finish publication of 360XL
  • Improve documentation
    • Insurance and prior authorization description - update IG and finish change proposals
    • Use of Argonaut FHIR scheduling - update IG
• Possible new use cases:
  • LTC facility outbound transfer - to acute, to another LTC faciltiy, to home care
  • eConsult - a consult based on documentation only, no patient visit (in person or tele-)
  • Referrals related to Social Determinants of Health (SDH)
• Additional discussion:
  • Patient involvement - this needs to be better documented (add to current workload)
  • Payer interactions - this needs to be better documented
    • prior authorizations (already in workload)
    • in/out of network (add to current workload)
• Followup - create a survey of the following use case options and send to mailing list
  
  • LTC to Acute
  • LTC to LTC
  • eConsults
  • SDH referrals

Discussions on the relevance of 360X and the COVID-19 pandemic, and future development of the specification:

• Nursing homes/LTC faciltities are hot-spots, what can be done to help care givers?
  • LTC to acute referrals/transfers
  • Acute to nursing home re-admits (Note that the re-admit may not be to the same facility that originated the referral)
• Extra-clinical services, can we extend 360X there?
  • different context for content, C-CDA has too much information, most of it not useful for the referral recipient.
  • BSeR has initial work in that area, as well as the Gravity Project

It seems that looking at LTC to acute referrals is a logical next step.

Discussion to continue next week, June 19th. 

No call today, due to a demo for the VA/DoD

The call was repurposed for demo testing for the Direct Trust Summit testing.

Note: Next Saturday, June 5th, we are having a demo for the VA, and the call is cancelled.

Review of IHE profile proposal for long term care (SNF) transfers - 360XL

A discussion to consider transforming 360X as a "base standard" with different higher layers to include PCP to specialist referrals, acute to SNF referrals, etc. This may be done in a different way, for example in the "XDM and XDR for Direct" specification to be balloted and published by Direct Trust Standards, where fundamental requirements for XDM are specified to be used by other implementation guides like 360X.

Note: the IHE Profile proposal was approved for public comment on the subsequent IHE PCC call. When the public comment period is open, the participants will be notified to provide more feedback.

Short call, work continues on preparing the 360XL (long term to SNF referrals) IHE proposal for public comment.

• Fill out the Doodle poll for possible rehearsal dates and times for the DirectTrust Summit demo.
• The VA/DoD demo will be re-scheduled soon. It will likely be May 22 or June 5
• Review the IHE profile for transfers to SNF (currently at https://drive.google.com/file/d/1eJ1YYoPYNUpXDkBZ1etLNa_so1r-oEp3/view?usp=sharing)

Rehearsal for the May 5th demo. 

• Review of upcoming demos, next week's call will be used for a rehearsal.
• IHE Profile work updates, several participants offered help

Discussion on the uses of LOINC codes as the content type code in the Submission Set.

85187-3 Long term care facility Transfer summary note - for the case where it is an actual transfer from the hospital the SNF

85199-8 Long term care facility Referral note - for the case where it is a referral from an ambulatory setting to the SNF

We will try to get some feedback from CMS.

On the other hand, there are two transactions pushing documents from the hospital - one for the request, another when the actual transfer takes place. In that case the codes could be used like this:

• Hospital to SNF request: 85199-8
• Hospital to selected SNF at time of transfer: 85187-3
• Ambulatory setting to SNF request: 85199-8

Is the common code for request helpful or harmful?

Rehearsal for the demo