Health Information Exchange in Post-Acute and Long-Term Care Case Study Findings: Final Report. C. Interoperable HIT

09/18/2007

As mentioned above and described throughout this report and the literature review, the lack of HIT standards particularly for: (i) PAC and LTC providers; and (ii) e-HIE often have been identified as barriers to more timely exchange of needed, interoperable health information. However, over the last few years, there have been several significant advances related to the identification, endorsement, and/or use of HIT standards that will, if implemented, support interoperable HIE, including HIE on behalf of PAC and LTC patients, including the:

  • The endorsement by the Secretary of HHS in August 2007 of the CHI Disability and Patient Assessment standards and commitment that these standards will be used by federal agencies in implementing new and to the extent feasible in modifying existing health information systems. These standards:

    • Have been and will continue to be applied to the NH MDS;
    • Will be applied to the home health OASIS instrument; and
    • Will be applied to the CARE assessment instrument (previously known as the "PAC-PAI") and will be used by CMS in the Medicare Post-Acute Care Payment Reform demonstration required in Section 5008 of the Deficit Reduction Act.
  • Approval by HL7 of the CCD implementation guide for the standardized exchange of clinical documents (e.g., discharge and transfer documents).

  • Approval by the HITSP of the CCD as the standard for certain types of HIE.

  • Projected use of the CCD standard by the CCHIT as the standard to support the exchange of documents by certified physician office and hospital EHRs.

  • Announcement by CCHIT of its intent to specify certification criteria for NH EHRs. Such criteria are expected to include specifications concerning the functionality of certified EHRs and the interoperability standards that certified EHRs must support. For example, certification criteria are expected to include the need for EHRs to support standardized assessments and standardized exchange of patient summaries.

  • Use of the CCD standard and/or CHI Patient Assessment standards in upcoming private sector HIE demonstrations that will include PAC and LTC providers.

  • Findings from the AHRQ/CMS e-prescribing pilots that found that standardized e-prescribing (including in NHs) created efficiencies gains and quality improvements.

  • CMS regulations requiring the use of certain standards to support e-prescribing under Medicare Part D (however, it is important to note that at present NHs are excluded from the requirement to use these standards).

  • Approval in September 2007 by ANSI of the e-prescribing standard needed to support e-prescribing in NHs (i.e., NCPDP SCRIPT v10.1).

  • Approval by the AHIC of the need for a use case that will focus on HIE at the time of referrals and transfers in care. This use case should be developed in 2007 and submitted to the HITSP in early 2008 for the identification of the specific standards needed to support the exchange.

The endorsement of CHI standards for patient assessments, the application of these standards to the NH MDS and expected application to the home health OASIS; approval by HL7 of the CCD implementation guide and the use of this standard by CCHIT; specification by CMS of e-prescribing standards and the approval by ANSI of the e-prescribing standards needed to support e-prescribing in NHs will enable providers to request and HIT vendors to develop products that support: (i) standardized assessments; and (ii) the exchange of certain types of information needed on behalf of patients treated by PAC and LTC providers.

The specification of NH EHR certification criteria by CCHIT is expected to level the playing field between HIT vendors and providers, enabling providers to have greater confidence in the functionality and standards included in the HIT products they purchase, and creating a roadmap that vendors can use for the development of increasingly standardized EHR products.

The application of the CHI Patient Assessment standards to the NH MDS and planned application to the home health OASIS; use of these standards by CMS in the demonstration of the CARE instrument; expected use of the patient assessment and information exchange standards in private sector demonstrations to be conducted by CAST and Integrating the Healthcare Enterprise, and the anticipated specification of HITSP standards for an AHIC use case on referrals and transfers of care will provide guidance to the vendor and provider communities about how these standards can be applied to support standardized HIT products and interoperable HIE to support the care needed by PAC and LTC patients.

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