Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. II. Study Methods

12/01/2011

In 2007, ASPE/HHS contracted with the AHIMA Foundation to advance the interoperable use of HIT and EHRs by LTPAC providers by leveraging federal requirements for the electronic submission of PAIs. The study, building on work that had been undertaken by the Consolidated Health Informatics Initiative and endorsed by the National Committee on Vital and Health Statistics (NCVHS),4 involved the identification and application of HIT standards to the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS) instruments, development of technical tools to support interoperable exchange of assessment instruments and the re-use of assessment content for patient assessment summary documents, identification of opportunities to support the widespread adoption and use of interoperable patient assessment information, and steps needed to advance HIE with and by LTPAC providers.

The AHIMA Foundation subcontracted with several technical experts to assist in linking recognized vocabulary standards to PAIs, develop implementation guides for the interoperable exchange of PAIs, and identify issues that need to be addressed to enable the interoperable exchange of patient assessment summary documents. These technical experts included:

  • Lantana Consulting Group, Bob Dolin, MD, and Gaye Giannone Dolin, MSN, RN
  • Sue Mitchell, RHIA, HIM and Standards Consultant
  • Cyndi Lundberg, RN, BSN, SNOMED Terminology Solutions, College of American Pathologists
  • Daniel Vreeman, PT, DPT, MSc, Regenstrief Institute, Inc.
  • Keystone Beacon Community, Jim Walker, MD, CMIO and Jim Younkin, Director, Keystone Health Information Exchange
  • LTPAC and industry stakeholders as noted in: Appendix A: Stakeholder Interview Summary, and Appendix J: Patient Assessment Summary for Health Information Exchange

To support the opportunities outlined in this report, AHIMA developed 13 Appendices that offer essential background information and technical tools developed as part of the four-year study. Study methods included:

  • Conducting stakeholder interviews to discuss incentives for and barriers to HIT adoption and HIE by LTPAC providers. 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 (see Appendix A: Stakeholder Interview Summary). The stakeholder interviews were instrumental in identifying and developing the opportunities identified in this report.

  • Engaging experts to determine a technical approach and interoperability tools for content and exchange standards to be applied to the MDS Version 3 (MDS 3.0) and OASIS.

  • Mapping HIT content standards to assessment items and developing a "Rosetta Stone" as a resource for assessment items and their standard representations.

  • Engaging experts to identify a subset of assessment content for a summary to provide a clinically relevant snapshot of an individual's status.

  • Testing the premise of the study to re-use assessment content to support HIE with a provider and HIE organization.

In addition to the technical tools in Appendices A-L, a list of Terms and Acronyms was compiled that readers may find useful when reading the report (Appendix M: Terms and Acronyms).

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