Blog

Short call, Review testing plans, and white paper.

Open question (Vassil not present to answer):

When the notification is sent from SNF to PCP, what are the expected values for ORC-1 and ORC-5?

IHE Connectathon Report:

• Continued growth
  2018 - 3 participants
  2019 - 5 participants
  2020 - 7 participants
• Organizers eager to optimize tests, and after three years of testing, it makes sense to ask for a supportive testing option

Switching focus to HIMSS demo, and testing schedule:

• Testing slots:

  • 2/21 – 10 - 5 Eastern (will cancel call)
    2/25 – 10 - 5 Eastern
    2/27 – 9 - noon Eastern

• Rehearsal slots:

  • 2/27 – noon - 5 Eastern
    3/2 – use meeting time/Rehearsal afternoon
    3/4 – final  rehearsal - 10 Eastern

Short call, most people are at the Connectathon.

Last preparations for Connectathon

Review of White paper

HIMSS preparation discussion:

• Is there a payer to add to the scenario? Vassil is looking into it
• VIP tour - what time slot, how to organize
• White Paper - under development

There is an AHRQ grant that healthcare organizations may be able to use to implement 360X:
https://grants.nih.gov/grants/guide/pa-files/PA-20-068.html

Short call, welcome back everyone, and Happy New Year!

Connectathon and HIMSS Demo testing preparation review.

Review testing status for Connectathon, and HIMSS Demo. Next call is next year!

Review testing, Connectahon preparation and HIMSS demo. No call on December 27.

Short call, updates on Connectathon and HIMSS demo praparation

Short call, reviewed testing sessions.

No call on 11/29.

The IHE PCC Committee accepted the proposal for a new profile to handle the LTAC use case at the face-to-face meeting this week. The goal is to have the draft document for the February meeting, after which it can be published for a public comment period. In addition, several Change Proposals to the existing 360X profile are in the works, in order to bring the profile up-to-date with our decisions from the past year.

We reviewed the CMS Discharge Planning Rule brief and how it affects the LTAC implementation guide.

We finalized the wording of the Short Description for the HIMSS Interoperability Showcase demo.

Reviewed the testing sessions from the past week, and agreed to another set of sessions on November 19 and November 20.

Logistics for the HIMSS Interop showcase calls

• Mondays noon to 1 pm Eastern time

For next time, we will review the CMS rule for discharge planning

• The Final Rule
• A summary brief of the rule will be sent via e-mail.

Discussion on the last point from October 18th:

1. Current requirement for the use of Direct addresses:
   • The From address in the initial request SHALL be used by the recipient to send back an accept or decline
2. Add the following
   • When the recipient sends an Accept response back to the initiator, the From address MAY be different from the To address on the initial request.
   • If the initiator receives an Accept response with a From address which is different from the To address used on the initial request, it SHALL process the response properly based on the patient and referral identifiers in the metadata. Any further transactions from the initiator to the recipient can use either the new From address or the original To address as the destination.
   • If an Accept response is sent back to the initiator with a From address that is different from the To address on the initial request, the recipient SHALL be able to process any further transactions from the initiator on either of these two addresses.

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?