National policy promotes the use of health information technology (IT) to advance health care delivery, payment and outcomes. Post-acute and long-term care (LTPAC) providers are a vital part of the healthcare system, but have not been included in federal incentives to promote adoption of health information technology and electronic exchange of health information.
Nationally, there are approximately:
- 16,000 nursing homes providing services to over 2 million individuals on an annual basis; and
- 9,000 home health agencies providing services to over 3 million individuals on an annual basis.
Persons receiving services from LTPAC providers have numerous encounters and contacts with acute care and ambulatory providers.
- In 2006, more than one-third of Medicare beneficiaries discharged from acute care hospitals were transferred to PAC settings.1
- In 2006, over half of the Medicare beneficiaries discharged from hospitals to PAC settings had episodes of care that involved multiple PAC placements and/or multiple hospital admissions.2
- In 2005, persons living in nursing homes made approximately 2.2 million visits to Emergency Departments.3
- In 2008, almost 23.8 million Part B Medicare claims were allowed for nursing home physician visits.4
The Centers for Medicare and Medicaid Services (CMS) requires Medicare and/or Medicaid participating providers to complete and electronically submit on a routine schedule the:
- Minimum Data Set 3.0 (MDS3.0) assessment instrument for each resident of a nursing home participating in Medicare and/or Medicaid; and
- Outcome and Assessment Information Set (OASIS-C) for each Medicare or Medicaid client of a home health agency over the age of 18 receiving skilled services.
The MDS and OASIS offer feasible entrance points for nursing home and home health agency providers to participate in health information exchange activities and develop awareness of the need for full interoperability. For example, in the third quarter 2010, the CMS MDS Reason for Assessment Count Report showed a total of 4.5 million MDS2.0 assessment documents being received by the National MDS Repository.5 Two benefits of this approach are that it uses existing information technology capabilities and would engage the majority of LTPAC providers. Once engaged, LTPAC stakeholders can then focus on building and using the technical infrastructure to support more sophisticated types of information exchange and sharing.
The Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services has contracted with the American Health Information Management Association (AHIMA) Foundation seeking to advance the interoperable use of health IT and EHRs by LTPAC providers by leveraging federal requirements for the electronic submission of patient assessment instruments. The project was tasked with:
- identifying and applying health IT standards such as LOINC, HL7 Clinical Document Architecture (CDA) Release 2, and SNOMED CT to the MDS and OASIS assessment instruments;
- identifying issues to consider to support the wide spread use of interoperable patient assessment instruments; and
- supporting the reuse and exchange of standardized assessment content in patient assessment summary documents.
This document describes project efforts in support of the task on reuse and exchange of standardized assessment content in patient assessment summary documents.
Creating The Patient Assessment Summary Document
The MDS3.0 and OASIS-C assessment instruments offer a rich repository of patient information designed to present the nursing home and home health professional with a holistic picture of patient strengths and needs, gathering information germane to both quality of care and quality of life. While this wealth of information is invaluable to the LTPAC provider, it can be cumbersome to the acute care clinician. This wealth of information far exceeds the needs -- and capacity for rapid consumption -- of the hospital/ER/physician office clinician. With the increased focus on the exchange of information crucial to transitions of care, the value of creating an electronic summary of MDS and OASIS assessment data for use in health information exchange activities is evident. To this end, this project has worked with expert panels to identify the subset MDS3.0 and OASIS-C data elements that could be clinically usefully to include in a Patient Assessment Summary Document at times of transitions in care (e.g., when a home health patient is being treated in an emergency room or admitted to acute care hospital).