Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. The Process Leading To Meaningful Use Includes The Development, Adoption, And Maintenance Of Appropriate Standards

12/01/2011

The exchange of functional status content is critically important in providing services and supporting the continuity of care for persons with chronic illnesses and disabilities. The standards development community has identified two approaches for exchange of content related to functional status -- one approach applies to the exchange of question and answer pairs that could include functional content and supports the exchange of functional status observations. The second approach is to exchange functional status assertion pattern -- that is exchange only the assertion of a functional status impairment (See below for XML Examples for Question/Answer Pattern and Assertion Pattern). Additional consideration is needed to determine whether additional messaging specifications are needed for the exchange of functional status content.

Recommendations and Process

  • The S&I Framework should undertake work to identify whether approaches to exchange functional status information observations using HL7 -- assertion patterns or question/answer pairs (or whether other approaches could be used). Specifically, the S&I Framework will look at the current CDA Functional Status section and suggest refinements/improvements, and may also suggest potential new CDA sections as needed.

  • Meaningful use across the health care continuum will require more complete specifications health IT content and messaging standards. Developing a standard approach to representing functional status is a key step to enable the inclusion of functional status in meaningful use. The following process is recommended:

    • Develop use cases for the exchange of key documents that include functional status content (e.g., exchange of: assessment instruments, assessment summary documents, discharge/transfer documents, and care plans).
    • Engage stakeholders -- CMS, quality measure developers, instrument developers, providers, vendors, health information exchange organizations.
    • Establish participant roles and responsibilities.
    • Ensure that Regenstrief and IHTSDO are participants, so that we can determine how these terminologies overlap, complement one another or conflict with one another.
    • Ensure involvement of HL7 (i.e., Structured Documents and Patient Care committees).
    • If needed, conduct a precedent analysis.
    • Evaluate terminology work related to SNOMED, LOINC and others as appropriate.
    • Conduct a content analysis on some or all of the 47 instruments listed in Table I-1.
    • Complete CDA (and CCD and C32 mappings) work on functional status observations.
    • Develop and ballot the standard.
    • Request that the NLM explore the need to and options for maintaining linkages between LOINC, SNOMED and other vocabularies used in standardizing functional assessment content represented in standardized assessment instruments.

XML Examples for Question/Answer Pattern and Assertion Pattern

Question/Answer pattern:

<observation classCode="OBS" moodCode="EVN">
     <!-- represent functional status deficit question -->  
     <code code="54598-8"
          codeSystem="2.16.840.1.113883.6.1"
          displayName=”Hearing”/>
     </code>
     ...
     <!-- represent functional status deficit's answer -->
     <value xsi:type="CD" code="LA10941-5"
          codeSystem="2.16.840.1.113883.6.1"
          displayName=”Adequate – no difficulty...”>
     </value>
</observation>

Assertion pattern:

<observation classCode="OBS" moodCode="EVN">
     <!-- assert whether the functional status finding present -->  
     <code code="ASSERTION"
          codeSystem="2.16.840.1.113883.5.4"/>
     ...
     <!-- the functional status finding to assess -->
     <value xsi:type="CD" code="105504002"
          codeSystem="2.16.840.1.113883.6.96"
          displayName="Dependence on cane"/>
</observation>

 

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