Opportunities for Engaging Long Term & Post Acute Care

Providers in Health Information Exchange

Briefing to the Standards &Interoperability LTPAC Workgroup October 20, 2011Jennie Harvell, ASPEMichelle Dougherty, AHIMASue Mitchell, AHIMA

Exchanging Interoperable Patient Assessment Information

Project Focus: Persons who receive NH and HHA service experience

frequent: transitions in care (e.g., NHs to and from hospitals) shared care (i.e., care delivery by remotely located,

organizationally unaffliated team members (e.g., physicians, pharmacies and pharmacists, family members))

Health information exchange (HIE) is needed to support quality and continuity of care.

The ASPE/AHIMA project leverages federally-required assessment instruments as a cost-effective entrance point to HIE for NHs and HHAs.

Project applies Health IT standards to these assessment instruments and supports the re-use of standardized data.

Project OverviewASPE Project Officer:Jennie Harvell

Project Team:AHIMA Foundation:Michelle Dougherty, MA, RHIA, CHPSue Mitchell, RHIARita Scichilone, MA, RHIAMargaret Williams

In Collaboration With:Lantana Consulting GroupBob Dolin, MDGaye Giannone Dolin, MSN, RNRegenstrief Institute, Inc.Daniel Vreeman, PT, DPT, MScSNOMED Terminology ServicesCyndi Lundberg, RN, BSN

Clinical Experts

Goals: Apply content and exchange standards to the

federally-required assessment instruments used by almost 100% of NH & HHA

Identify clinically-relevant subset of assessment items for interoperable HIE at times of transitions/shared care

Develop technical tools and resources for wide spread use (see ASPE website)

Creates a starting point for interoperable exchange and use of health information by NHs and HHAs

Positions providers for more advance HIE (e.g., meds, allergies, problems, Advanced Directives…. )

Report will be available: http://aspe.hhs.gov/daltcp/reports/2011/StratEng.htm

Federal Assessment Requirements CMS requires certain LTPAC providers complete

and electronically transmit patient assessment instruments.

Content and exchange formats of these assessments are not comparable and do not leverage Health IT standards and thus don’t support efficient re-use of this data within and across providers. LTPAC Type Patient Assessment Instrument

Nursing Homes Minimum Data Set version 3.0 (MDS 3.0)

Home Health Agencies Outcome and Assessment Information Set (OASIS-C)

Inpatient Rehabilitation Facilities Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)

Comprehensive assessment for post acute payment reform demonstration (PAC/PRD)

Continuity Assessment Record and Evaluation (CARE) (demonstration)

Project Applied Standards to MDS v3 and OASIS-C Instruments and Assessment -- Summary Identified and mapped content standards to

the MDS 3.0 and OASIS-C federally-required assessment instruments (Developed with the support of Lantana, STS/CAP, Regenstrief Institute)

Determined how assessment content could be reused Mapped to LOINC, SNOMED, ICD-9-CM and ICD-10-CM,

ect. Represented assessment content using

exchange standards: Mapped full MDSv3 Assessment to CDA:

HL7 Implementation Guide for CDA Release 2: CDA Framework for Questionnaire Assessments, Release 1

Mapped MDSv3 and OASIS –C Assessment Summary items to CCD section

Developed Technical Tools

Developed “Rosetta Stone” resource for both MDSv3 and OASIS-C with content standard mappings by assessment item:

Full Assessment Instruments Assessment Summary f or each instrument

Developed document exchange standards and technical tools to support the interoperable exchange of assessment content (Developed by Lantana Consulting Group)

HL7 CDA Implementation Guide for Assessments & MDS Tools MDS Transform Tools and Validator MDS CCD Design Guide

Collaborating and Leveraging Work of ONC and Other Initiatives ONC Grantees and Other Program Participants

Keystone/Geisinger Beacon Community (assessment summary)

MA IMPACT (universal transfer form integrating assessment content)

VNSNY and NY e-Health Collaborative (Home Health Plan of Care)

ONC Standards & Interoperability (S&I) LTPAC Workgroup LTPAC Initiative Launched on October 6, 2011 Advance HIE with LTPAC providers Identify some EHR Certification Criteria for LTPAC Align with Meaningful Use criteria

Non-HIT Sophisticated LTPAC Provider

Nonstandard (not HIT standards enabled) format required by CMS

MDS/OASIS Assessment Completed

Federal assessments electronically transmitted to CMS

HIE Organization makes available 1) Assessment Instrument; and/or 2) Summary Document on Exchange Network

Transform

HIE Organization

HIE Organization receives nonstandard MDS or OASIS and transforms it into either a: (1) standardized assessment and/or (2) standardized Patient Assessment Summary

Standardized Assessment and /or Patient Assessment Summary

LTPAC Provider

More HIT Sophisticated LTPAC Provider

EHR

Nonstandard (not HIT standards enabled) format required by CMS

MDS/OASIS Assessment Completed

Federal assessments electronically transmitted to CMS

Assessment and Summary AvailableOn Exchange Network

HIE Organization

HIE Organization (HIE-O) receives (i) standardized MDS or OASIS and/or (ii) Assessment /Transfer Summary (and possibly additional data). If necessary, the HIE-O links standardized Patient Assessment Summary with additional data.

Step 2: More robust standardized Assessment/ Transfer Summary that includes MDS/OASIS data and possibly additional data (meds, allergies, advanced directives, etc.) . Assessment/ Summary exchanged by provider to othersStep 1: Standardized

MDS or OASIS and/orPatient Assessment Summary

LTPAC Provider

Project Resources and DeliverablesPolicy Report: Opportunities for Engaging Long Term and Post

Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information

Tools and Resources:A. Stakeholder Interview SummaryB. Background Report on Intellectual Property and the Dissemination of

Standardized Federally Required Patient AssessmentsC. Rosetta Stone Mapping Guidelines and HeuristicsD. MDS Rosetta Stone Spreadsheet

A. MDS Value Set of Diagnosis ConceptsE. OASIS Rosetta Stone SpreadsheetF. Current Standards LandscapeG. LTPAC Interoperability Toolkit and Tools

A. CDA Assessment Implementation Guide for MDS and ToolsB. MDS Transform Tools and Validator C. MDS CCD Design Guide

H. Standards Development and Adoption RecommendationsI. Recommendations for Functional StatusJ. Patient Assessment Summary for Health Information ExchangeK. MDS Assessment Summary Rosetta StoneL. OASIS Assessment Summary Rosetta StoneM. Terms and Acronyms

MDS 3.0 Rosetta Stone – Tab 1

MDS 3.0 Rosetta Stone – Tab 2

MDS 3.0 Rosetta Stone – Tab 3

MDS 3.0 Rosetta Stone – Tab 4

MDS 3.0 Rosetta Stone – SNOMED Value Sets (Section I)

OASIS-C Rosetta Stone Includes:• Tab 1 - Overview of Toolkit• Tab 2 - OASIS-C Items Mapping - Model of

Use (LOINC)• Tab 3 - OASIS-C Items Mapping - Model of

Meaning (SNOMED/CVX)

NOTE: The OASIS-C assessment instrument captures diagnoses by ICD-9 –CM codes. OASIS-C does not have a diagnosis “checklist” to which value sets can be attached for ICD-9, ICD-10, or SNOMED codes.

OASIS Summary Rosetta Stone – Tab 1

OASIS Summary Rosetta Stone – Tab 2

OASIS Summary Rosetta Stone – Tab 3

OASIS Summary Rosetta Stone – Tab 4

OASIS Summary Rosetta Stone – Tab 5

OASIS Summary Rosetta Stone – Tab 6

MDS3.0 Summary Rosetta Stone Includes:• Tab 1 – Overview of Project• Tab 2 – Overview of Toolkit• Tab 3 – HL7 CCD/HITSP C-32 Analysis of

MDS Summary Items (Sequenced by CCD Section)

• Tab 4 – HL7 CCD/HITSP C-32 Analysis of MDS Summary Items (Sequenced by MDS Data Item)

• Tab 5 - MDS Summary Items Mapped to MDS Assessment Type

• Tab 6 – MDS Summary Items Mapping - Model of Meaning (SNOMED/ICD-9/ICD-10/CVX)

• Tab 7 - MDS Summary Items Mapping - Model of Use (LOINC)

Questions & Contacts

Jennie Harvell(202) 690-6443jennie.harvell@hhs.gov

Michelle Dougherty(312) 233-1914michelle.dougherty@ahima.org

Sue Mitchell suemitchell@hotmail.com