The appendices provide essential background information, documentation, and tools to support the approach proposed in this report. Several provide the research and in-depth technical analyses that form the backbone of this study. These include a summary of stakeholder interviews (Appendix A) and the environmental assessment of the existing standards landscape (Appendix F). Appendices B through E offer the methods and results of careful technical analyses of existing standards for application with PAIs. Two appendices (Appendix H and Appendix I) provide more details about the recommendations for needed HIT standards. Appendix G is a practical implementation toolkit for LTPAC providers and vendors. Appendices J through L provide guidance on the patient assessment summary. Appendix M provides a glossary of key terms and abbreviations used in this report.
A: Stakeholder Interview Summary
Summary of stakeholder interviews conducted to discuss incentives for and barriers to adoption. The interviews also explored implications of limited HIT interoperability and gathered insights on how to advance the use and exchange of electronic clinical information in LTPAC settings. The stakeholder interviews were instrumental in developing the approach identified in this report.
B: Background Report on Intellectual Property and the Dissemination of Standardized Federally Required Patient Assessments
This report identifies and evaluates potential intellectual property issues that emerge and need to be considered with the application of HIT content standards to federally required assessment instruments. Assessment instrument developers should consider intellectual property implications that will arise with the free dissemination of HIT content standards that will be necessary to facilitate re-use and exchange of assessment information.
C: Rosetta Stone Mapping Guidelines and Heuristics
This resource offers the guidelines and rules that were used to map recognized HIT vocabularies -- specifically, LOINC® and SNOMED CT -- to the MDS and OASIS assessments, and the use of coded vocabularies in an HL7 messaging standard (the CDA Patient Assessment Questionnaire Implementation Guide) to enable the interoperable transmission of these assessments. The exchange standard enables assessments to be represented as intended by assessment developer (using a "model of use" format) and enables the re-use of assessment content (i.e., using the model of meaning format).
D: MDS Rosetta Stone Spreadsheet
This resource maps each MDS 3.0 question and answer to applicable terminologies and code sets including LOINC®, SNOMED, ICD-9-CM and ICD-10. This is expected to be a useful reference for nursing home EHR vendors and HIE organizations.
MDS Value Set of Diagnosis Concepts
The MDS value set of diagnosis concepts file provides a set of SNOMED concepts to illustrate how the MDS problem/diagnosis section could be semi-populated from the EHR.
E: OASIS Rosetta Stone Spreadsheet
This resource maps each OASIS question and answer to applicable terminologies and code sets including LOINC®, SNOMED, ICD-9-CM and ICD-10. This is expected to be a useful reference for home health EHR vendors and HIE organizations.
F: Current Standards Landscape
A discussion about current standards and their application to assessment content and enabling re-use of health information. This resource could be used by LTPAC providers and vendors to facilitate their awareness and understanding.
G: LTPAC Interoperability Toolkit and Tools
This appendix document provides a summary of the technical tools available in the toolkit.
CDA Assessment Implementation Guide for MDS and Tools
This guide describes how to represent questions and answers in PAIs as an HL7 CDA document. The implementation guide represents the MDS 3.0 as an example of a CDA patient assessment document.
MDS Transform Tools and Validator
Various tools for transforming the MDS from a CDA format to the CMS transmission format and tools to validate the conversion.
MDS CCD Design Guide
This document provides general information on how to design a valid CCD document using patient assessment content from the MDS.
H: Standards Development and Adoption Recommendations
Provides recommendations for advancing and accelerating the use of HIT and EHRs in the LTPAC industry based on existing standards and known gaps. Discusses the relationship of existing and potential national policy strategies in relating to the standards recommendations.
I: Recommendations for Functional Status
Defines functional status in the context of HIT standards and the importance of the data to support the continuity of care for persons with chronic illnesses and disabilities. Recommends an approach for addressing gaps in standards to address functional status content and representation.
J: Patient Assessment Summary for Health Information Exchange
Describes the project and methodology for developing a patient assessment summary for the MDS and OASIS in collaboration with Keystone Beacon Community.
K: MDS Assessment Summary Rosetta Stone
A technical resource in Excel which identifies the MDS item selected for the summary, the related SNOMED concept, LOINC code, CCD Section, and analyzed compatibility with HITSP C32 requirements.
L: OASIS Assessment Summary Rosetta Stone
A technical resource in Excel which identifies the OASIS item selected for the summary, the related SNOMED concept, LOINC code, CCD Section, and analyzed compatibility with HITSP C32 requirements.
M. Terms and Acronyms
A resource that lists the terms and acronyms used in this report.
"StratEng.pdf" (pdf, 1.74Mb)
"StratEng-A.pdf" (pdf, 198.14Kb)
"StratEng-B.pdf" (pdf, 534.93Kb)
"StratEng-C.pdf" (pdf, 214.97Kb)
"StratEng-D.pdf" (pdf, 4.65Mb)
"StratEng-D1.pdf" (pdf, 12.32Mb)
"StratEng-D2a.pdf" (pdf, 3.62Mb)
"StratEng-D2b.pdf" (pdf, 3.58Mb)
"StratEng-E.pdf" (pdf, 3.66Mb)
"StratEng-F.pdf" (pdf, 162.5Kb)
"StratEng-G.pdf" (pdf, 340.24Kb)
"StratEng-H.pdf" (pdf, 173.91Kb)
"StratEng-I.pdf" (pdf, 194.52Kb)
"StratEng-J.pdf" (pdf, 311.03Kb)
"StratEng-K.pdf" (pdf, 4Mb)
"StratEng-L.pdf" (pdf, 2.33Mb)