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

12/01/2011

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

CMS requires that the OASIS assessment instrument be completed on a routine schedule for each Medicare or Medicaid client of a home health agency over the age of 18 receiving skilled services. Nationally, there are approximately 9,200 Medicare and/or Medicaid home health agencies providing services to over 3 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 OASIS data items of highest value to clinicians providing services across the continuum of care.

  2. Mapping the subset of OASIS 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 OASIS concepts in a one-to-one exact representation using a standardized, computable terminology.
    3. Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) codes expressing OASIS concepts in a “best available” representation using a standardized, computable terminology.
OASIS Patient Assessment Summary for Health Information Exchange -- Content*
Tab 2   Toolkit Overview This tab presents a description of the Toolkit: OASIS-C Patient Assessment Summary for Health Information Exchange.
Tab 3 CCD Sequence -- OASIS Summary Items Using the CCD section assigned by the project team as the primary sort order, this tab presents OASIS Patient Assessment Summary questions and answers (based on the CMS OASIS data specifications v2.00, Revision 3, October 2009) and corresponding HITSP, HL7 CCD and HL7 CDA requirements. Content of this tab is listed below.

Note: Due to limitations of the OASIS data specifications, several “question” rows have been added to better represent OASIS question/answer pairs and to facilitate formatting in a CDA-based message. These added rows are identified by the use of italicized textfor the description of the question.

  • Column A: CCD section as assigned by the project team. This column is the primary sort order for the tab.
  • Columns B - D: OASIS question and answer ID numbers and descriptions based on CMS data specifications v2.00, Revision 3, October 2009.

    Column B = CMS Question ID for each OASIS Summary data item
    Column C = CMS Answer ID for each OASIS Summary data item
    Column D = CMS Description for each OASIS Summary data item
    Note: This tab has been filtered to display only the OASIS Patient Assessment questions or “check all that apply” listings. Responses to question have been filtered from this view since analysis against HITSP specifications was conducted at the question/check list level.

  • Columns E - I: Contain internal tracking/comments regarding review teams evaluation of the appropriateness of OASIS questions/answers for the OASIS 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.
  • Column J: Contains final review team determination regarding the appropriateness of items for the OASIS Patient Assessment Summary. This tab has been filtered so that only those items selected for inclusion in the Patient Assessment Summary are displayed.
  • Column K: Contains the OASIS response(s) that would indicate a “normal” status and trigger omission of the OASIS 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, OASIS questions/responses should not be displayed if the item indicated a “normal” status. For example, a response of “0” for OASIS question M1710 (When Confused) would indicate the client is not confused and therefore the question/response would not be displayed in the Summary. However, a response of 1 through 4 for OASIS question M1710 would indicate increasing levels of confusion and would be displayed on the Summary.

  • Columns L - N: HITSP C32 Content Module requirements for CCD based Summary Documents.

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

  • Columns O - S: HITSP C83 Data Mapping and other requirements for Content Modules.

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

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

    Column T = Data Element definition
    Column U = Data Element constraints

  • Column V: Issues/comments related to mapping requirements and OASIS Patient Assessment Summary data items. Comments labeled “Issue” pose a challenge to creating a HITSP/C32 compliant CCD.
Tab 4 OASIS Summary Items to C32-CCD Using the OASIS section and question ID as the primary sort order, this tab presents OASIS Patient Assessment Summary questions and answers (based on the CMS OASIS data specifications v2.00, Revision 3, October 2009) and corresponding HITSP, HL7 CCD and HL7 CDA requirements. Content of this tab is listed below:

Note: Due to limitations of the OASIS data specifications, several “question” rows have been added to better represent OASIS question/answer pairs and to facilitate formatting in a CDA-based message. These added rows are identified by the use of italicized text for the description of the question.

  • Column A - C: OASIS question and answer ID numbers and descriptions based on CMS data specifications v2.00, Revision 3, October 2009.

    Column A = CMS Question ID for each OASIS Summary data item (This column is the primary sort order for the tab.)
    Column B = CMS Answer ID for each OASIS Summary data item
    Column C = CMS Description for each OASIS Summary data item
    Note: This tab has been filtered to display only the OASIS 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 D - H: Contain internal tracking/comments regarding review teams evaluation of the appropriateness of OASIS questions/answers for the OASIS 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 OASIS 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 OASIS response(s) that would indicate a “normal” status and trigger omission of the OASIS 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, OASIS questions/responses should not be displayed if the item indicated a “normal” status. For example, a response of “0” for OASIS question M1710 (When Confused) would indicate the client is not confused and therefore the question/response would not be displayed in the Summary. However, a response of 1 through 4 for OASIS question M1710 would indicate increasing levels of confusion and 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: CCD Section Mapping.

    Column U = CCD section as assigned by the project review team

  • Column V: Issues/comments related to mapping requirements and OASIS Patient Assessment Summary data items. Comments “Issue” pose a challenge to creating a HITSP/C32 compliant CCD.
Tab 5 OASIS Summary -- Model of Meaning Using the OASIS section and question ID as the primary sort order, this tab presents OASIS Patient Assessment Summary questions and answers (based on the CMS MDS 2.0 data specification v1.01.0, December 2010) and the 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.
  • CVX (September 30, 2010 update) codes for MDS 3.0 vaccination data items.

Notes:

  1. CAP SNOMED Terminology Solutions provided the SNOMED CT mapping of OASIS data items. AHIMA provided the CVX mapping of OASIS data items.
  2. Due to limitations of the OASIS data specifications, several “question” rows have been added to better represent OASIS Patient Assessment Summary question/answer pairs and to facilitate formatting in a CDA-based message. These added rows are identified by the use of italicized text for the description of the question.
  • Columns A - C: OASIS question and answer ID numbers and descriptions based on CMS OASIS specifications v2.00, Revision 3, October 2009.

    Column A = CMS Question ID for each OASIS Summary data item (This column is the primary sort order for the tab.)
    Column B = CMS Answer ID for each OASIS Summary data item
    Column C = CMS Description for each OASIS Summary data item

  • Column D - G: Contain internal tracking/comments regarding review teams evaluation of the appropriateness of OASIS questions/answers for the OASIS 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 H: Contains final review team determination regarding the appropriateness of items for the OASIS Patient Assessment Summary. This tab has been filtered so that only those items selected for inclusion in the Patient Assessment Summary are displayed.
  • Column I: Contains the OASIS response(s) that would indicate a “normal” status and trigger omission of the OASIS 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, OASIS questions/responses should not be displayed if the item indicated a “normal” status. For example, a response of “0” for OASIS question M1710 (When Confused) would indicate the client is not confused and therefore the question/response would not be displayed in the Summary. However, a response of 1 through 4 for OASIS question M1710 would indicate increasing levels of confusion and would be displayed on the Summary.

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

    Column L = SNOMED CT code for each mapped OASIS Patient Assessment Summary data item
    Column M = SNOMED CT Fully Specified Name (FSN) for each assigned SNOMED code

  • Column N: Contains CDC Race and Ethnicity Codes for the OASIS Patient Assessment Summary race/ethnicity data items.
  • Column O: Contains CVX for the OASIS Patient Assessment Summary vaccination data items.
Tab 6 OASIS Summary -- Model of Use Using the OASIS section and question ID as the primary sort order, this tab presents OASIS Patient Assessment Summary questions and answers (based on the CMS OASIS data specifications v2.00, Revision 3, October 2009) and corresponding Model of Use representation as described in Appendix B.

Content of this tab is listed below.

Notes: 1) LOINC representations and codes have been provided by Indiana University of Regenstrief Institute, Inc. 2) Due to limitations of the OASIS data specifications, several “question” rows have been added to better represent OASIS Patient Assessment Summary question/answer pairs and to facilitate formatting in a CDA-based message. These added rows are identified by the use of italicized text for the description of the question.

  • Columns A - C: OASIS question and answer ID numbers and descriptions based on CMS OASIS data specifications v2.00, Revision 3, October 2009.

    Column A = CMS Question ID for each OASIS Summary data item (This column is the primary sort order for the tab.)
    Column B = CMS Answer ID for each OASIS Summary data item
    Column C = CMS Description for each OASIS Summary data item

  • Column D - G: Contain internal tracking/comments regarding review teams evaluation of the appropriateness of OASIS questions/answers for the OASIS 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 H: Contains final review team determination regarding the appropriateness of items for the OASIS Patient Assessment Summary. This column has been filtered so that only those items selected for inclusion in the Patient Assessment Summary are displayed.
  • Column I: Contains the OASIS 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, OASIS questions/responses should not be displayed if the item indicated a “normal” status. For example, a response of “0” for OASIS question M1710 (When Confused) would indicate the client is not confused and therefore the question/response would not be displayed in the Summary. However, a response of 1 through 4 for OASIS question M1710 would indicate increasing levels of confusion would be displayed on the Summary.

  • Column J: Contains some general guidance related to data mapping.
  • Column K - M: Contain LOINC representation of the OASIS Patient Assessment Summary data items.

    Column K = LOINC question code for each OASIS Summary data item
    Column L = LOINC answer code for each OASIS Summary data item
    Column M = LOINC answer set object identified (OID) for each OASIS Summary data item

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

 

Toolkit Resources
CMS Outcome & Assessment Information Set (OASIS) OASIS:
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
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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