Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. Toolkit Overview Of MDS 3.0 Patient Assessment Summary

12/01/2011

The Toolkit: MDS3.0 Patient Assessment Summary for Health Information Exchange was designed for ASPE/HHS as a tool to facilitate inclusion of nursing home data in health information exchange (HIE) activities.

CMS requires that the MDS 3.0 assessment instrument be completed on a routine schedule for each resident of a nursing home participation in Medicare and/or Medicaid. Nationally, there are approximately 16,000 Medicare and/or Medicaid nursing homes providing services to well over 2 million individuals on an annual basis. This toolkit helps HIEs to tap this well-spring of information on a population with numerous encounters and contacts with acute care and ambulatory providers by:

  1. Identifying a subset of MDS 3.0 data items or highest value to clinicians providing services across the continuum of care.

  2. Mapping the subset of MDS 3.0 data items to:

    1. Healthcare Information Technology Standards Panel (HITSP) C32, Health Level 7 (HL7) Continuity of Care Document (CCD) and HL7 Clinical Document Architecture (CDA) requirements.
    2. Logical Observation Identifiers Names and Codes (LOINC) expressing MDS 3.0 concepts in a one-to-one exact representation using a standardized, computable terminology.
    3. Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) codes expressing MDS 3.0 concepts in a “best available” representation using a standardized, computable terminology.
MDS 3.0 Patient Assessment Summary for Health Information Exchange Context*
Tab 2   Toolkit Overview This tab presents a description of the Toolkit: MDS 3.0 Patient Assessment Summary for Health Information Exchange.
Tab 3 CCD Sequence -- MDS Summary Items Using the CCD section assigned by the KeyHIE project review team as the primary sort order, this tab presents MDS 3.0 Patient Assessment Summary questions and answers (based on the CMS MDS 3.0 data specification v1.01.0, December 2010) and corresponding HITSP, HL7 CCD and HL7 CDA requirements. Content of this tab is listed below:
  • Columns A: CCD section as assigned by the KeyHIE project review team. The KeyHIE CCD section assignment reflects mapping at the assessment question level versus mapping at the assessment section level. This column is the primary sort order for the tab.
  • Columns B: CCD Section as assigned in the MDS CCD Representation Guide (July 2010). The assignment of CCD Sections in this guide reflects mapping at the assessment section level versus mapping at the assessment question level.
  • Columns C - F: MDS 3.0 question and answer ID numbers and descriptions based on CMS data specifications v1.01.0, December 2010.

    Column C = CMS Question ID for each MDS 3.0 data item
    Column E = CMS Answer ID for each MDS 3.0 data item
    Column F = CMS Description for each MDS 3.0 data item
    Notes :

    1. Column D contains a sort indicator for internal use and has been hidden
    2. Column E has been filtered to display only the MDS 3.0 Patient Assessment Summary questions or “check all that apply” listings. Responses to questions have been filtered from this view since HITSP specifications was conducted at the question/check list level
  • Columns G-J: Contain internal tracking/comments regarding review teams evaluation of the appropriateness of MDS question/answers for the MDS 3.0 Patient Assessment Summary. These columns track the review process for selection of Patient Assessment Summary items and have been hidden for normal viewing of this tab.
  • Columns K: Contains final review team determination regarding the appropriateness of items for the MDS 3.0 Patient Assessment Summary. This column has been filtered so that only those items selected for inclusion in the Patient Assessment Summary are displayed.
  • Columns L: Contains the MDS response(s) that would indicate a “normal” status and trigger omission of the MDS question from the MDS 3.0 Patient Assessment Summary.

    Note: The review team determined that, in order to make the Patient Assessment Summary more easily consumable by receiving clinicians, MDS questions/responses should not be displayed if the item indicated a “normal” status. MDS question B0100 (Comatose) was selected for inclusion in the MDS 3.0 Patient Assessment Summary. A “0” for MDS question B0100 would indicate the resident is not comatose and therefore the question/response would not be displayed in the Patient Assessment Summary. However, a response of “1” for MDS question B0100 would indicate the resident was comatose and the question/response would be displayed on the Summary.

  • Columns M - O: HITSP C32 Content Module requirements for CCD based Summary Documents.

    Column M = Name of Content Module and C32 Constraint ID
    Column N = Optionality of Module (R = Required, R2 = Required if Known, O = Optional)
    Column O = Repeatable Entry (Y = Yes, N = No)

  • Column P - T: HITSP C83 Data Mapping and other requirements for Content Modules.

    Column P = Content Module Data Element Identifiers and names
    Column Q = Optionality of Data Element (R = Required, R2 = Required if Known, O = Optional)
    Column R = Data Element Repeatable (Y = Yes, N = No)
    Column S = Additional Data Element Constraints/Specifications
    Column T = Rules for Implementing Component Module in CDA

  • Columns U and V: HITSP C154 Data Definition and Terminology requirements.

    Column U = Data Element definition
    Column V = Data Element constraints

  • Column W: Issues/comments related to mapping requirements and MDS 3.0 Patient Assessment Summary data items. Comments labeled “Issue” pose a challenge to creating a HITSP/C32 component CCD.
Tab 4 MDS Summary Items to C32-CCD Using the MDS3.0 section and question ID as the primary sort order, this tab presents MDS3.0 Patient Assessment Summary questions and answers (based on the CMS MDS 2.0 data specification v1.01.0, December 2010) and corresponding HITSP, HL7 CCD and HL7 CDA requirements. Content of this tab is listed below.
  • Column A - D: MDS 3.0 question and ID numbers and descriptions based on CMS data specifications v1.01.1, December 2010.

    Column A = CMS Section IDs for each MDS 3.0 Summary section
    Column B = CMS Question ID for each MDS 3.0 Summary data item (This column is the primary sort order for the tab.)
    Column C = CMS Answer ID for each MDS 3.0 Summary data item
    Column D = CMS Description for each MDS 3.0 Summary data item
    Note: Column C has been filtered to display one the MDS 3.0 Patient Assessment Summary questions or “check all that apply” listings. Responses to questions have been filtered from this view since analysis against HITSP specifications was conducted at the question/check list level.

  • Column E - H: Contain internal tracking/comments regarding review teams evaluation of the appropriateness of MDS questions/answers for the MDS 3.0 Patient Assessment Summary. These columns track the review process for selection of Patient Assessment Summary items and have been hidden for normal viewing of this tab.
  • Columns I: Contains final review team determination regarding the appropriateness of items for the MDS 3.0 Patient Assessment Summary. This column has been filtered so that only those items selected for inclusion in the Patient Assessment Summary are displayed.
  • Column J: Contains the MDS response(s) that would indicate a “normal” status and trigger omission of the MDS question from the MDS 3.0 Patient Assessment Summary.

    Note: The review team determined that, in order to make the Patient Assessment Summary more easily consumable by receiving clinicians, MDS questions/responses should not be displayed if the items indicated a “normal” status. MDS question B0100 would indicate the resident is not comatose and therefore the question/response would not be displayed in the Patient Assessment Summary. However, a response of “1” for MDS question B0100 would indicate the resident was comatose and the question/response would be displayed on the Summary.

  • Column K - M: HITSP C32 Content Module requirements for CCD based Summary Documents.

    Column K = Name of Content Module and C32 Constraint ID
    Column L = Optionality of Module (R = Required, R2 = Required if Known, O = Optional)
    Column M = Repeatable Entry (Y = Yes, N = No)

  • Column N - R: HITSP C83 Data Mapping and other requirements for Content Modules

    Column N = Content Module Data Element identifiers and names
    Column O = Optionality of Data Element (R = Required, R2 = Required if Known, O = Optional)
    Column P = Data Element Repeatable (Y = Yes, N = No)
    Column Q = Additional Data Element Constraints/Specifications
    Column R = Rules for Implementing Component Module in CDA

  • Column S and T: HITSP C154 Data Definition and Terminology requirements.

    Column S = Data Element definition
    Column T = Data Element constraints

  • Column U and V: CCD Section Mapping

    Column U = CCD section as assigned by the KeyHIE project review team. The KeyHIE CCD section assignment reflects mapping at the assessment question level versus mapping at the assessment level
    Column V = CCD Section as assigned in the MDS CCD Representation Guide (July 2010). The assignment of CCD Sections in this guide reflects mapping at the assessment section level versus mapping at the assessment question level

  • Column W: Issues/comments related to mapping requirements and MDS 3.0 Patient Assessment data items. Comments labeled “Issue” pose a challenge to creating a HITSP/C32 compliant CCD.
Tab 5 MDS Summary Items by Assess Type Using the MDS 3.0 section and question ID as the primary sort order, this tab presents MDS 3.0 Patient Assessment Summary questions and answers (based on the CMS MDS 2.0 data specification v1.01.0, December 2010) and the corresponding MDS 3.0 assessment type(s) in which they are transmitted.
  • Columns A - D: MDS 3.0 question and answer ID numbers and descriptions based on CMS data specifications v1.01.0, December 2010.

    Column A = CMS Section IDs for each MDS 3.0 Summary section
    Column B = CMS Question ID for each MDS 3.0 Summary data item (This column is the primary sort order for the tab.)
    Column C = CMS Answer ID for each MDS 3.0 Summary data item
    Column D = CMS Description for each MDS 3.0 Summary data item
    Note: Column C has been filtered to display only the MDS 3.0 Patient Assessment Summary questions or “check all that apply” listings. Responses to questions have been filtered from this view to match the question/check list level mapping to MDS assessment types provided by CMS.

  • Column E - H: Contain internal tracking/comments regarding review teams evaluation of the appropriateness of MDS questions/answers for the MDS 3.0 Patient Assessment Summary. These columns track the review process for selection of Patient Assessment Summary items and have been hidden for normal viewing of this tab.
  • Columns I: Contains final review team determination regarding the appropriateness of items for the MDS 3.0 Patient Assessment Summary. This column has been filtered so that only those items selected for inclusion in the Patient Assessment Summary are displayed.
  • Column J: Contains the MDS response(s) that would indicate a “normal” status and trigger omission of the MDS question from the Patient Assessment Summary.

    Note: The review team determined that, in order to make the Patient Assessment Summary more easily consumable by receiving clinicians, MDS questions/responses should not be displayed if the item indicated a “normal” status. MDS question B0100 (Comatose) was selected for inclusion in the MDS 3.0 Patient Assessment Summary. A “0” for MDS questions B0100 would indicate the resident is not comatose and therefore the question/response would not be displayed in the Patient Assessment Summary. However, a response of “1” for MDS question B0100 would indicate the resident was comatose and the question/response would be displayed on the Summary.

  • Column K - AA: Contains the mapping of MDS Patient Assessment Summary questions/check list items to the 17 MDS assessment types defined by CMS.
Tab 6 MDS Summary -- Model of Meaning Using the MDS 3.0 section and question ID as the primary sort order , this tab presents MDS 3.0 Patient Assessment Summary questions and answers (based on the CMS MDS 2.0 data specification v1.01.0, December 2010) and corresponding Model of Meaning standard terminology as described in Appendix B, including:
  • SNOMED CT (version 20100731) representations and codes for semantically mappable MDS 3.0 data items.
  • ICD-9-CM (October 1, 2010 update) codes for MDS 3.0 Section I (Active Diagnoses) data items.
  • ICD-10-CM (2011 release) codes for MDS 3.0 Section I (Active Diagnoses) data items.
  • Codes for Vaccines Administered (CVX) (September 30, 2010 update) codes for MDS3.0 vaccination data items.

Note: CAP SNOMED Terminology Solutions provided the SNOMED-CT mapping of MDS 3.0 data items. The AHIMA provided the ICD-9-CM, ICD-10-CM, and CVX mapping of MDS 3.0 data items.

  • Columns A - D: MDS 3.0 question and answer ID numbers and descriptions based on CMS data specifications v1.01.0, December 2010.

    Column A = CMS Section IDs for each MDS 3.0 section
    Column B = CMS Question ID for each MDS 3.0 data item (This column is the primary sort order for the tab.)
    Column C = CMS Answer ID for each MDS 3.0 data item
    Column D = CMS Description for each MDS 3.0 data item

  • Column E - H: Contain internal tracking/comments regarding review teams evaluation of the appropriateness of MDS questions/answers for the MDS 3.0 Patient Assessment Summary. These columns track the review process for selection of Patient Assessment Summary items and have been hidden for normal viewing of this tab.
  • Columns I: Contains final review team determination regarding the appropriateness of items for the MDS 3.0 Patient Assessment Summary. This column has been filtered so that only those items selected for inclusion in the Patient Assessment Summary are displayed.
  • Column J: Contains the MDS response(s) that would indicate a “normal” status and trigger omission of the MDS question from the Patient Assessment Summary.

    Note: The review team determined that, in order to make the Patient Assessment Summary more easily consumable by receiving clinicians, MDS questions/responses should not be displayed if the item indicated a “normal” status. MDS question B0100 (Comatose) was selected for inclusion in the MDS 3.0 Patient Assessment Summary. A “0” for MDS questions B0100 would indicate the resident is not comatose and therefore the question/response would not be displayed in the Patient Assessment Summary. However, a response of “1” for MDS question B0100 would indicate the resident was comatose and the question/response would be displayed on the Summary.

  • Column K: Contains some general guidance related to data mapping.
  • Columns L: Contains the pattern used for mapping the SNOMED-CT representation of the MDS 3.0 Patient Assessment Summary data items. SNOMED mapping was based on either an “assertion pattern” or “question & answer pattern”.
  • Column M - N: Contain SNOMED-CT representation of semantically mappable MDS Patient Assessment Summary data items.

    Column M = SNOMED-CT code for each mapped MDS 3.0 Patient Assessment Summary data item
    Column N = SNOMED-CT Fully Specified Name (FSN) for each assigned SNOMED code

  • Column O: Contains ICD-9-CM codes for the MDS 3.0 Patient Assessment Summary active diagnoses (selected from MDS 3.0 Section I data items).
  • Column P: Contains ICD-10-CM codes for the MDS 3.0 Patient Assessment Summary active diagnoses (selected from MDS 3.0 Session 1 data items).
  • Column Q: Contains CDC Race and Ethnicity codes for the MDS 3.0 Patient Assessment Summary race/ethnicity data items.
  • Column R: Contains CVX for the MDS 3.0 Patient Assessment Summary vaccination data items.
Tab 7 MDS Summary -- Model of Use Using the MDS 3.0 section and question ID as the primary sort order, this tab presents MDS 3.0 Patient Assessment Summary questions and answers(based on the CMS MDS 2.0 data specification v1.01.0, December 2010) and corresponding Model of Use representation as described in Appendix B, including:
  • LOINC representations and codes (provided by Indiana University of Regenstrief Institute, Inc.).
  • CDA pattern per HL7 Implementation Guide for CDA Release 2, CDA Framework for Questionnaire Assessments and CDA Representation of the Minimum Data Set Questionnaire Assessment (hereafter referred to as the MDS CDA Implementation Guide). Content of this tab is listed below.
  • Columns A - D: MDS 3.0 question and answer ID numbers and descriptions based on CMS data specifications v1.01.0, December 2010.

    Column A = CMS Section IDs for each MDS 3.0 Summary section
    Column B = CMS Question ID for each MDS 3.0 Summary data item (This column is the primary sort order for the tab.)
    Column C = CMS Answer ID for each MDS 3.0 Summary data item
    Column D = CMS Description for each MDS 3.0 Summary data item

  • Column E - H: Contain internal tracking/comments regarding review teams evaluation of the appropriateness of MDS questions/answers for the MDS 3.0 Patient Assessment Summary. These columns track the review process for selection of Patient Assessment Summary items and have been hidden for normal viewing of this tab.
  • Columns I: Contains final review team determination regarding the appropriateness of items for the MDS 3.0 Patient Assessment Summary. This column has been filtered so that only those items selected for inclusion in the Patient Assessment Summary are displayed.
  • Columns J: Contains the MDS response(s) that would indicate a “normal” status and trigger omission of the MDS question from the Patient Assessment Summary.

    Note: The review team determined that, in order to make the Patient Assessment Summary more easily consumable by receiving clinicians, MDS questions/responses should not be displayed if the item indicated a “normal” status. MDS question B0100 (Comatose) was selected for inclusion in the MDS 3.0 Patient Assessment Summary. A “0” for MDS questions B0100 would indicate the resident is not comatose and therefore the question/response would not be displayed in the Patient Assessment Summary. However, a response of “1” for MDS question B0100 would indicate the resident was comatose and the question/response would be displayed on the Summary.

  • Column K: Contains some general guidance related to data mapping.
  • Columns L - N: Contain relevant CDA mapping information per the HL7 Implementation Guide for CDA Release 2, CDA Framework for Questionnaire Assessments and CDA Representation of the Minimum Data Set Questionnaire Assessment.

    Column L = Contains the Model of Use question/answer pattern for each MDS 3.0 Patient Assessment Summary items in accordance with the MDS CDA Implementation Guide
    Column M = Contains the data type for each MDS 3.0 Patient Assessment Summary item in accordance with the MDS CDA Implementation guide
    Column N = Contains the type of unit the MDS 3.0 Patient Assessment Summary question requires if the data type is Physical Quantity (PQ) in accordance with the MDS CDA Implementation Guide

  • Columns O - Q: Contain LOINC representation of MDS 3.0 Patient Assessment Summary data items.

    Column O = LOINC question code for each MDS 3.0 Summary data item
    Column P = LOINC answer code for each MDS 3.0 Summary data item
    Column Q = LOINC answer set object identifier (OID) for each MDS 3.0 Summary data item
    Note: LOINC codes were not assigned if the MDS CDA Implementation Guide required the data element be coded to another code sets (e.g., HL7 administrative codes for gender and marital status)

Tabs correspond to Excel file available at http://aspe.hhs.gov/daltcp/reports/2011/StratEng-K.xlsx.

 

Toolkit Resources
CMS Minimum Data Set 3.0 (MDS3.0) MDS3.0:
Codes for Vaccine Administered (CVX) CVX codes:
HITSP Summary Documents Using HL7 Continuity of Care Document (CCD) Component (HITSP/C32); Version 2.5; July 8, 2009
HITSP Clinical Document and Message Terminology Component (HITSP/C80); Version 2.0; January 25, 2010
HITSP CDA Content Modules Component (HITSP/C83); Version 2.0; January 25, 2010
HITSP Data Dictionary Component (HITSP/C154); Version 1.0; January 31, 2010
International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) ICD-9-CM codes:
  • Are maintained by the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services
  • Are updated in October (yearly) and April (if needed)
  • Can be accessed at http://www.cdc.gov/nchs/icd/icd9cm.htm
International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) ICD-10-CM codes:
  • Are maintained by the National Center for Health Statistics (NCHS)
  • Are not valid for any purpose or use until October 1, 2013 (effective date per HIPAA requirements)
  • Can be accessed at http://www.cdc.gov/nchs/icd/icd10cm.htm
Logical Object Identifiers Names and Codes (LOINC) LOINC codes:
  • Are maintained by Regenstrief Institute, Inc.
  • Are updated as needed
  • Can be accessed through the Regenstrief LOINC Mapping Assistant (RELMA) at http://loinc.org/relma
Standardized Nomenclature of Medicine - Clinical Terms (SNOMED CT) SNOMED CT codes:
  • Are maintained by the International Health Terminology Standards Development Organisation (IHTSDO)
  • Are updated twice a year in January and July
  • Can be accessed through a variety of free browsers listed by the Unified Medical Language System (UMLS) at http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html

 

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