ONC’s State HIE Technical Assistance Webinar:
Patient Care Summary Exchange and Meaningful Use
August 6, 2010
Excerpted from the State HIE Leadership Forum/Presentations and Webinars Page on August 11, 2010
Slide Set PDF
Audio
The audio (and appears to have been presented in teleconference audio format only) starts out talking about “meaningful use” since  the focus is on the exchange of  Patient Care Summaries and Stage 1 of Meaningful Use. It  includes a discussion about the Continuity of Care Record (CCR) and the newer Continuity of Care Document (CCD); NHIN direct and NHIN Exchange; and several case studies presented by the people involved (NEHEN in Massachussetts; MedVirginia in Virginia, NHIN, and Social Security Administration; KHIE in Kentucky; and Rhode Island HIE and NHIN Direct).

Excerpts selected from slides:
Care Summaries & Stage 1 Meaningful Use
Based on the Meaningful Use Final Rule, “eligible professional, eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals.”

–Core requirement is to perform at least one test of EHR’s capacity ot electronically exchange information.
–To fulfill menu set requirement, EHR must enable a user to electronically transmit a patient summary record to other providers and organizations including
        –at a minmum, diagnostic test results, problem list, medication list, and a medication allergy list
       –uses HL7 CCD or ASTM CCR

Stage 1 Meaningful Use Objectives that might require sharing of a CCD/CCR:
–Provide patients with an electronic copy of their health information upon request
–Provide a clinical summary for each visit
–Exchange clinical information electronically with other providers and patient authorized entities
–Provide summary care record for each transition of care and referral
–Provide patients with an electronic copy of their discharge instructions and procedures
–Other MU requirements could use clinical documents (e.g. lab results, public health reporting)

Initial Set of Standards
–Requires clinical summaries for patients for each office visit in “human readable” format  and on electronic media
–Clinical summary can (be) either HITSP C32-compliant CCD or ASTM CCR
–Why 2 standards?
            — CCD growing in popularity
            — CCR still in use, especially among early adopters
            — In some circumstances the CCR is easier, faster, and requires fewer resources to implement than the CCD
             — Electronic exchange not required in Stage 1, so why make anyone migrate now from one format to the other?

NHIN Specifications
–Both NHIN Exchaneg and NHIN Direct offers means to transport clinical summaries
–Both mechanisms support Stage 1 Meaningful Use
–Both rely on standards for effective communication
–NHIN Exchange offers the means for transporting care summaries; relies on more spohisticated technology, most suitable when participants do not necesssarily know each other personally
–NHIN Direct offers specifications that enable transport of care summaries; relies on simpler technology, most suitable when participants know each other personally and have a data exchange relationship
–Many states are interested in supporting both models for different workflows.

State HIE Strategies
–Can take several forms, just like statewide HIE can take several forms
–Requires some elements of policy, some elements of infrastructure
–Use data from environmental scan to understand current situation, capabilities, pilots, including other relevant states
–Work with RECs to develop consistent message and appropriate capabilities; rely on their services
–Insist on common terminology and coding
–Keep EHR system vendors’ feet to the fire in implementing capabilities “in the field”
–Recognize that manysites are still using HL7 v2 messages
–Provide HIE services to support care summaries
         –Full services like RLS, MPI, directory, IHE XCA
         –Enabling service for NHIN Direct like provider directory
–Consider the impact of the availability of many clinical documents when exchange is successful

Data Aggregation and Data Content issues to be considered are highlighted.