Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. Identifying Content for the Patient Assessment Summary

12/01/2011

A two-phased approach was used in identifying the subset of MDS3.0 and OASIS-C data elements for a Patient Assessment Summary Document.

  • Phase 1 -- Identification of an initial subset of MDS3.0 and OASIS-C data elements for the Patient Assessment Summary by clinical expert from the Keystone Beacon Community.

  • Phase 2 -- Validation of the initial MDS3.0 and OASIS-C subset of data elements and determination of a final Patient Assessment Summary data set by a panel of national experts.

Phase 1 -- Identification of an Initial Subset of MDS3.0 and OASIS-C Data Elements

The Keystone Health Information Exchange (KeyHIE), and its’ affiliated Keystone Beacon Community, was identified as a volunteer partner for the Phase 1 activities to tap the synergy of this ASPE project and the grants awarded by the Office of the National Coordinator (ONC) and the Agency for Healthcare Research and Quality (AHRQ) to KeyHIE that includes expansion of HIE activities to additional healthcare providers such as nursing homes and home health agencies.

A series of Webex-supported conference calls were conducted during fourth quarter 2010 with clinical experts convened by the Keystone Beacon Community. These calls were used to identify an initial subset of data items from the MDS3.0 and OASIS-C that would be clinically relevant to include in Patient Assessment Summary documents. Each MDS3.0 and OASIS-C data item was reviewed and discussed to determine clinical relevance to the patient assessment summary. Decisions on the applicability of the MDS3.0 and OASIS-C data elements for a Patient Assessment Summary document were documented in spreadsheets for use in the Phase 2 review process.

Keystone Beacon Community

Geisinger Health System, an integrated delivery network recognized for its innovative use of healthcare IT-supported care coordination and a founding participant in KeyHIE, recently received a $16 million Beacon Community award from ONC. As part of that award, the Keystone Beacon Community will use KeyHIE to extend patient-focused care coordination across a community of more than 250,000 residents.

The AHRQ also awarded Geisinger a $2.3M grant to extend the KeyHIE connected community to additional regional hospitals, long-term care facilities, home health organizations, and physician practices. In addition to expanding participation across the community, KeyHIE will use the five-year AHRQ grant to make new clinical applications and document types available within the HIE.6

Phase 2 -- Validation of the Initial MDS3.0 and OASIS-C Subset of Data Elements

Step #1 -- Identify participants for MDS3.0 and OASIS-C Expert Panels

With the assistance of the ONC LTPAC/HIE Affinity Group and the LTPAC HIT Collaborative, and approval by the ASPE Project Officer, expert panels were identified to validate the appropriateness of data elements identified in Phase 1 for inclusion in MDS3.0 and OASIS-C Patient Assessment Summary documents.

LTPAC/HIE Affinity Group -- ONC has established Affinity Groups (i.e., groups of HIE stakeholders among the ONC grantees that share similar interests). One such Affinity Group is the LTPAC/HIE Affinity Group.

LTPAC HIT Collaborative -- The Long-Term and Post-Acute Care (L TPAC) HIT Collaborative, formed in 2005, is a group of LTPAC provider and vendor associations, researchers, and other public and private sector stakeholders who recognized their common interests and vision for health information technology. The collaborative was formed to advance HIT issues for providers of long-term and post-acute care through coordinated efforts.

Participants in the MDS3.0 and OASIS-C expert panels are identified in Table J-1 and Table J-2.

Step #2 -- Capture Panelists Agreement/Disagreement with Phase 1 Recommendations

Members of the MDS3.0 and OASIS-C expert panels were provided with an orientation to the project and to the spreadsheet that had been designed for their use in validating the Phase 1 recommendations for MDS3.0 and OASIS-C Patient Assessment Summary data elements. The spreadsheet contained:

  • MDS3.0 IDs and descriptions for all sections, questions and answers as identified in the CMS data specifications v1.01.0, December 2010.

  • OASIS-C IDs and descriptions for all questions and answers as identified in the CMS data specifications v2.00, Revision 3, October 2009.

  • Recommendations of the Phase 1 expert panel regarding the inclusion or exclusion of each data element in the MDS3.0 Patient Assessment Summary and the OASIS-C Patient Assessment Summary.

  • Cells to capture the panelist’s agreement or disagreement with the recommendations of the Phase 1 panel for the inclusion or exclusion of each data element.

Panelists were given several weeks to review the data elements and return their completed spreadsheets to the project team.

Step #3 -- Identify Final Slate of MDS3.0 and OASIS-C Data Elements for Patient Assessment Summary Documents

To identify the final slate of MDS3.0 and OASIS-C data elements recommended as clinically useful for Patient Assessment Summary documents, panelist’s spreadsheets were amalgamated to determine points of consensus and points of disagreement. Data elements were flagged for group discussion if two or more panelists disagreed with the Phase 1 recommendation. A series of Webex-supported conference calls were held for the MDS3.0 and the OASIS-C expert panels to discuss their respective data elements flagged for reconciliation. Consensus recommendations were reached through group discussion and documented in the amalgamated MDS3.0 and OASIS-C spreadsheets.

In finalizing the slate of MDS3.0 and OASIS-C questions/check-list data elements for inclusion in the Patient Assessment Summary, the expert panels identified two important considerations for conveyance of the selected data elements in a manner readily consumable to the receiving clinician:

  1. Clinicians consuming MDS/OASIS Patient Assessment Summary documents in acute care settings (hospitals/ERs/physician offices) would be more interested in “problem” conditions than “normal” conditions. To that end, MDS3.0 and OASIS-C questions/responses selected for the Assessment Summary would NOT include items that indicated a "normal" status except for basic cognitive and functional status items (e.g. hearing, vision, memory, ADLs).

    Example of excluded question/response:

    MDS question B0100 (Comatose) was selected for inclusion in the MDS3.0 Patient Assessment Summary. Available responses to this question are:

    • 0 = No
    • 1 = Yes

    A "0" for MDS question B0100 would indicate the resident is not comatose and therefore the question/response would not be displayed in the Patient Assessment Summary. However, a response of “1” for MDS question B0100 would indicate the resident was comatose and the question/ response would be displayed on the Summary.

  2. There are several clinical assessment scales used in the MDS3.0 and OASIS-C such as the Brief Interview for Mental Status (BIMS) and the PHQ-9 (nine item depression scale). The expert panels identified the summary scores for these scales as the salient information to include in the Patient Assessment Summary, however there was concern that the receiving clinician may not be aware of the scale associated with the score. To address this issue, the expert panels recommended that the implementation guide for the Patient Assessment Summary stipulate that, whenever summary scores are conveyed, corresponding scales be displayed in the Assessment Summary to allow interpretation of the score.

Final Slate of Patient Assessment Summary Data Elements

From the 502 questions and checklist items found in Sections A-Q of the MDS3.0, 263 questions/checklist data elements were selected by the Phase 2 expert panel for inclusion in the MDS3.0 Patient Assessment Summary. The final slate of MDS3.0 data elements selected for the Summary document is listed in Table J-3.

From the 180 questions and checklist items found in the Oasis-C, 141 questions/checklist data elements were selected by the Phase 2 expert panel for inclusion in the OASIS-C Patient Assessment Summary. The final slate of OASIS-C data elements selected for the Summary document is listed in Table J-4.

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