Timely and complete health information exchange is widely recognized as necessary to support quality and continuity of care. The meaningful use electronic health record (EHR) incentive program requires the exchange of a variety of types of health information including patient summary documents. As the meaningful use program evolves, the requirements are expected to become more rigorous. To advance health information exchange, critical gaps will need to be addressed including:
- Functional status observations;
- Patient assessment instruments;
- Patient summary documents including assessment summary and transfer summary documents;
- Care Plans.
Identifying the Gaps
This study has applied standards for the exchange of patient assessment instruments and summary documents. In undertaking this work, key gaps have been identified. The HL7 Clinical Document Architecture (CDA) release 2 standard has been adopted as one of the underlying health information exchange standards for the EHR meaningful use incentive program. The meaningful use program leverages CDA release 2 in its use of the Continuity of Care Document (CCD) standard for the exchange of patient summary documents. This study has: (1) applied the CDA as the standard for the exchange of patient assessment documents; and (2) applied the CCD for the exchange of patient assessment summary documents (in collaboration with Keystone Health Information Exchange, Danville, Pennsylvania). In so doing, the study has identified the following gaps:
- CDA, CCD and Health Information Technology Standards Panel (HITSP) C32 Summary Document Using HL7 CCD Components that will not support the interoperable exchange of these document types;
- Functional Status.
Addressing the Gaps
The Federal Health IT Strategic Plan indicates that the Office of the National Coordinator is putting in place policies to support the nationwide health information technology infrastructure (NwHIN). It is recommended that the process established by the Office of the National Coordinator to identify standards, implementation specifications, and certification criteria be leveraged to address the gaps.
The health IT policy and standards committees address the gaps in standards, implementation specifications and certification criteria needed for the representation and exchange of functional status information.
The S&I Framework commission the Transition of Care Initiative to focus on patient assessment and summary documents that includes functional status content identifying:
- Specific CDA sections to support the interoperable exchange of these document types.
- Content and vocabulary standards needed to support the exchange of functional status information.
Health information exchange is a key component for the meaningful use of the EHRs, and essential in providing services and supporting the continuity of care for persons with chronic illnesses and disabilities. There are several critical gaps that need to be addressed for health information exchange on behalf of LTPAC individuals. These gaps include the need for standards, implementation specifications, and certification criteria related to the exchange of functional status content, various patient summary documents (such as the patient assessment documents and patient assessment summary documents), and care plans.
This project has focused on the standards needed for some of the gap areas -- mainly standards needed for assessment instruments that include functional status content as well as patient assessment summary documents that include functional status. The Office of the National Coordinator has implemented a process for the endorsement of interoperable health IT content and messaging standards. As described below, this process should be used for the endorsement of health IT standards needed for the interoperable exchange of functional status content and assessment information:
The health IT policy and standards committees should consider gaps in standards, implementation specifications and certification criteria needed for the representation and exchange of functional status information.
The S&I Framework should undertake work to a standardized approach that can represent functional status assessments, assessment results, and assessment summary documents.
"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)