Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. Interview Process And Participants

12/01/2011

Expert interviews were conducted via a series of 60 minute conference calls in May and June 2010. The investigation team identified categories of stakeholders knowledgeable about advancing the use and exchange of electronic clinical data in LTPAC settings. Key experts from the various stakeholder groups were then identified and contacted to participate in the interview process. The stakeholder groups and interview participants are listed below in Table A-1.

TABLE A-1: Stakeholders and Interview Participants
Stakeholder Group -- Post-Acute and Long Term Care (LTPAC) Providers
Tom Check
Senior Vice-President & Chief Information Officer
Visiting Nurse Service of New York
John Derr, RPh
Strategic Technology Consultant
Golden Living
Peter Kress
Vice President & Chief Information Officer
ACTS Retirement-Life Communities, Inc.
Bill Russell, MD
Vice-President & Corporate Medical Director
Erickson Living
Renae Spohn, MBA, RHIA, CPHQ, FAHIMA, FNAHQ
Director of Clinical Applications
The Evangelical Lutheran Good Samaritan Society
Rustan (Rusty) Williams
Vice President, Information Services/Technology Systems and Chief Information Officer
The Evangelical Lutheran Good Samaritan Society
Stakeholder Group -- Integrated Delivery System (IDS) Providers
Denni McColm
Chief Information Officer
Citizen's Memorial
Jim Walker, MD, FACP
Chief Health Information Officer
Geisinger Health System
Stakeholder Group -- Clinical Information System Software Vendors
Andy Brigant
Chief Product Officer
Point Click Care
Dan Cobb
Chief Technology Officer
Health MedX
Robert C. Davis
CEO
Optimus EMR
Doc DeVore
Vice President - Product Strategy
MDI Achieve
Dave Wessinger
Chief Technology Officer
Point Click Care
 
Stakeholder Group -- Centers for Medicare and Medicaid Services (CMS)
Judy Tobin, MBA, PT
Project Officer, CARE Instrument Development
Office of Clinical Standards and Quality
Quality Measurement and Health Assessment Group
Stakeholder Group -- Federal Advisory Committees (FACAs) and Their Workgroups Addressing Health IT
Christopher G. Chute, MD, Dr PH
Professor & Chair, Biomedical Informatics
Mayo Clinic College of Medicine
Member, Health IT Standards Committee
John Derr, RPh
Strategic Technology Consultant
Golden Living
Member, Health IT Standards Committee
Scott White
Assistant Director, HIT Policy Labor Representative
1199 SEIU Training and Employment Fund
Member, Health IT Policy Committee
Larry Wolf, MS
Health IT Strategist
Kindred Healthcare
Alternate for Richard Chapman (Kindred Healthcare), Health IT Policy Committee
NOTE: These participants did NOT speak for the FACA Committees, the Committee Workgroups, or the ONC.
Stakeholder Group -- State-Level Health Information Exchange (HIE) Initiatives
Phil Magistro
Deputy Director, Program Implementation
State Government HIT Coordinator
Governor's Office of Health Care Reform Pennsylvania
Chris Manning
Director of External Affairs
Delaware Health Information Network
Andrew VanZee, MHA, FACHE
Statewide Health IT Director
Indiana
 
Stakeholder Group -- National Quality Forum (NQF)
Don Casey, MD, MPH, MBA, FACP
Chief Medical Officer and VP Quality
Chief Research and Academic Officer
Atlantic Health
David Gifford, MD, MPH
Director of Health
Rhode Island Department of Health
Howard Goldberg, MD
Director, Clinical Informatics Development
Partners Healthcare
Gerri Lamb, PhD, RN
Emory University
Nell Hodgson Woodruff School of Nursing
Atlanta, GA
Larry Wolf, MS
Health IT Strategist
Kindred Healthcare
 

The investigation team identified the following topics to be addressed with all stakeholder groups:

  • Meaningful Use
  • Health Information Exchange
  • Clinical Document Architecture (CDA) Standard for Transfer of Care
  • Data Re-Use
  • CDA Tools
  • Standards
  • Quality Measures
  • Functional Status

Investigators anticipated that the nature and focus of the discussions would vary across each stakeholder group. Thus, a slate of open-ended questions related to these topics was then crafted to capture the unique perspectives of each stakeholder group (see Table A-2 for a sample slate of questions). The topics and questions were presented to the participants for their review prior to the interview.

TABLE A-2: Sample Slate of Interview Topics and Questions: Providers
Topic Questions
Meaningful Use
  • Do you anticipate that hospital and physician requirements for MU measures will impact LTPAC?
    • If so, how?
Health Information Exchange
  • How do you see that HIT can best help your institution(s) streamline information exchange and reporting?
  • What information is important for an LTPAC organization to exchange (send and receive)?
  • What are the barriers/challenges that keep LTPAC from exchanging information with unaffiliated providers and/or HIE organizations now?
    • What steps/activities are needed to overcome these barriers/challenges?
CDA for Transfer of Care
  • Do you currently send and receive electronic clinical and summary documents? If yes, are they standardized for exchange?
  • Have you thought about standardizing transfer of care patient summary documents?
    • Do you think it is important to use a CDA template/CCD for the creation and exchange of a transfer of care summary document with other providers?
    • To what extent does your EHR have a CDA application?
    • If no current CDA application, what priority is this being given?
Data Re-Use
  • Should MDS or OASIS data be reused in a transfer of care CDA/CCD?
    • If yes, which content in an MDS/OASIS would be most relevant to reuse in a transfer of care CDA/CCD? If no, why not?
  • Should EHR data be reused in a transfer of care summary CDA/CCD?
    • If yes, which EHR data content would be most relevant to reuse in a transfer of care CDA/CCD? If no, why not?
  • Can you reuse transfer of care/summary information that you've received from another provider in the EHR?
    • In the MDS/OASIS? Which content?
CDA Tools
  • What technical assistance and/or other support do you need for the interoperable exchange of assessments and summary documents?
Standards
  • Are there gaps in the CCD standard that impedes the exchange of important LTPAC content for a transfer of care summary?
  • What are the areas where LTPAC needs assistance/guidance in implementing a CCD?
  • In your view, are there gaps in HIT standards for LTPAC that need to be addressed?
  • In your view, what are the barriers to implementing existing HIT standards for LTPAC?
Quality Measures  
Functional Status
  • What are your current challenges to capturing functional status information?
    • What steps/activities are needed to overcome these barriers/challenges?
  • What are your current challenges to capturing cognitive function information?
    • What steps/activities are needed to overcome these barriers/challenges?
  • What type of functional status/cognitive function information do you want to see in a CCD?
  • In addition to questions from the MDS or OASIS, what additional functional status information do you use or need?
  • In addition to questions from MDS or OASIS, what additional cognitive status information do you use or need?
  • Is there a framework for representing functional status and cognitive functioning concepts?
  • Given that there is no single definition of functional status and that multiple concepts are used, what steps are needed to identify a nationally accepted definition of “functional status” and advance the interoperable exchange of content related to functional and cognitive status?

A separate 60 minute conference call was conducted for each stakeholder group interview (a total of eight calls were conducted). A member of the investigation team facilitated participants’ discussion of the slate of topics and open-ended questions. Follow-up questions from investigation team members and interview participants were encouraged.

 

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