The following figure lays out a roadmap for the LTPAC vendor or implementer to adopt HIT standards. While no Meaningful Use criteria today apply to LTPAC, it is reasonable to assume that future stages of meaningful use will extend health information exchange activities to LTPAC providers. For interoperable exchange to happen, many standards defined for the meaningful use program will ultimately be applied to LTPAC providers and vendors. The recommendations in Figure H-1 parallel the type of strategy one would implement if working to achieve EHR certification. Therefore, we recommend a strategy beginning with the most broadly applicable standard that not only addresses today's requirements, but also positions the LTPAC setting for new criteria in the coming years.
|FIGURE H-1: Transforming and Exchanging Interoperable LTPAC Provider Data|
Recommended standard adoption roadmap includes:
HL7 CDA R2: As the base standard for a growing number of interoperability solutions, including HL7 CCD, the HL7 CDA R2 provides a base foundation. Simple, minimally conformant CDA documents include key demographic data, and rich clinical narrative, which will become progressively more structured as one progresses along the roadmap.
MDS/OASIS CCD Transformation: Harvesting data from MDS and OASIS and including that data in the CCD will enrich the CCD, making it more valuable in several scenarios, such as a transfer of care. The MDS often has clinically relevant data elements not otherwise captured -- such as regarding functional and cognitive status.
HL7 CCD (for select domains): Problems, medications, allergies, labs, immunizations, and procedures are key data elements needed for a wide variety of use cases -- transfer of care, quality reporting, decision support, and more. Structured representation for some of these domains is already required for ambulatory and hospital-based meaningful use certification. A patient assessment summary for MDS and OASIS should be prioritized to support immediate use of assessment content in a health information exchange environment.
Other CDA Implementation Guides: A basis in CDA R2, along with adoption of key CCD data elements, eases the ability to adopt other CDA Implementation Guides, which often reuse the CCD templates. Diagnostic imaging, discharge summary, and quality reporting documents are just a few of the many common clinical documents that can be implemented in a CDA R2 format.
HL7 CCD (for other domains): Other domains such as functional and cognitive status are called out above as significant gaps from a LTPAC perspective. As these gaps are standardized, corresponding CCD recommendations will emerge.
Other LTPAC Interoperability Tools: Other tools enable a broad array of functionalities, ranging from transformation between CDA and CMS XML format for MDS and OASIS, semi-automated construction of the CDA representation of the MDS and OASIS, etc.
Advance Directives: Other domains such as Advance Directives are called out above as significant gaps from a LTPAC perspective. Advance Directives are shown at the end of the roadmap only because of the time that will be required to fully standardize the representation.
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