Transcript The Basic Patient Privacy Consents

Patient Care
Coordination
IHE Europe Workshop 2007
IHE Patient Care Coordination
Charles Parisot, GE Healthcare
September, 2005
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What IHE Delivers
Content Profile Roadmap
Year 2005-2006 (Trial Implementation)
 Medical Summary [MS] – Acute Care Discharge to
PCP, PCP Referral to Specialist
 Unstructured Document – CDA-wrapped PDF
Year 2006-2007 (Development & Testing)
 Medical Summary [MS] – ED Referral [EDR]
 Pre-procedure H&P [PPHP]
 Basic Patient Privacy Consents [BPPC]
 Exchange Personal Health Record [XPHR]
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PCC Content Integration Profiles
XDS-MS
Consent
Medical
Documents
BCCP
History and
Physical
Preprocedure
History and
Physical
Antenatal
Care
Summary
Medical
Summaries
Discharge
Summary
Lab Report
XD*-LAB
Care
Assessments
ACS
Referral
Emergency
Department
Note
Emergency
Department
Referral
PHR Extract
EDN
EDR
PHR Update
CA
PPHP
2005-2006
2006-2007
2007-2008
XPHR
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PCC Content Integration Profiles
Content using a Specific Standard
 CDA Release 2.0
 HL7 Care Record Summary
 HL7/ASTM Continuity of Care Document
Library of Reusable Parts
 Document Types
 Sections
 Entries
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Basic Patient Privacy
Consents (BPPC)
IHE Vendors Workshop 2006
IHE Patient Care Coordination Education
John Moehrke, Robert Horn, Lori Fourquet, Keith W. Boone
September, 2005
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What IHE Delivers
Basic Patient Privacy Consents
Abstract
The Basic Patient Privacy Consents
(BPPC) profile provide mechanisms to:
 Record the patient privacy consent(s),
 Mark documents published to XDS with the patient
privacy consent that was used to authorize the
publication,
 Enforce the privacy consent appropriate to the
use.
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Basic Patient Privacy Consents
Scope
Document Sources and Document
Consumers in an XDS Affinity Domain
Document Sources and Document
Receivers using Cross Enterprise Pointto-Point Document Sharing
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Basic Patient Privacy Consents
Value Proposition
an Affinity Domain can
 develop privacy policies,
 and implement them with role-based or other
access control mechanisms supported by EHR
systems.
A patient can
 Be made aware of an institutions privacy policies.
 Have an opportunity to selectively control access
to their healthcare information.
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Basic Patient Privacy Consents
Key Technical Properties
Human Readable Consents
Machine Processable
Support for standards-based Role-Based
Access Control
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Basic Patient Privacy Consents
Standards and Profiles Used
CDA Release 2.0
XDS Scanned Documents
Document Digital Signature
Cross Enterprise Document Sharing
Cross Enterprise Point-to-Point Document Sharing
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Basic Patient Privacy Consents
Example
Consent A
Consent B
Encounter 1
(Requires A)
Encounter 2
(OK with B)
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Pre-procedure History
and Physical (PPHP)
IHE Development Team Workshop 2006
IHE Patient Care Coordination Education
Dan Russler, MD, co-chair PCC Technical Committee
September, 2005
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What IHE Delivers
Use Case
H&P documentation required prior to
procedure that is designed to assess:
 Procedure Risk
 Anesthesia Risk
 Factors influencing procedure after-care decisions
Desired outcomes
 Minimize injury during procedure
 Optimize procedure after-care
Pre-procedure H&P
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Scope
To identify the required and optional PPHP
document content templates including:
 CDA Document Header
 CDA Document Type(s)
 CDA Section Types
 CDA Entry Types
Pre-procedure H&P
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Value Proposition
A procedure risk assessment must be present
and evaluated by the operative and after-care
teams before the patient is allowed to have the
procedure. Missing information is frequently a
reason for canceling the procedure for the day,
which leads to expensive underutilization of
resources and dissatisfied patients. Further,
incomplete information about the patient’s
clinical or home status may create a situation
where a procedure is performed that ultimately
results in an injury, inadequate aftercare or other
undesirable outcome.
Pre-procedure H&P
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Key Technical Properties
PPHP Profile inherits specifications required for
other IHE PCC Medical Documents
PPHP Profile follows documentation practices for
all IHE PCC Medical Documents
PPHP Profile emphasizes re-usability of CDA
template identifiers in order to reduce unnecessary variability in IHE Content Profiles
Pre-procedure H&P
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Standards Used
IHE Medical Document Content Profiles
HL7 Reference Information Model ANSI Standard
HL7 CDA R2 ANSI Standard
HL7 Care Provision Domain DSTU (in process)
Implementation Guides
 HL7 Care Record Summary CDA R2 Implementation Guide
(in process)
 HL7/ASTM Continuity of Care Document Implementation
Guide (in process)
Pre-procedure H&P
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Emergency Department
Referral
Todd Rothenhaus, MD FACEP
American College of Emergency Physicians
September, 2005
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What IHE Delivers
Emergency Department Referral
Value Proposition
Nearly 5000 EDs in US or in Europe
Significant percentage of ED visits are referrals
Shortage of critical health data for emergency
department patients
Need to improve communication of intended patient
care plans to ED providers and ensure that no
pertinent data is lost
Streamline workflow by obviating telephone calls
between busy clinicians
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Emergency Department Referral
Scope
EHR system capable of creating a care record
summary would be capable of creating a
referral package for a receiving system
The emergency department information
systems (EDIS) will need to retrieve and read
and display this data.
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Emergency Department Referral
Use Case
1.
Health care provider determines that a
patient needs to go to the ED
2.
Provider creates an ED referral package
using his or her EHR
3.
Upon arrival, the ED provider identifies
the patient as a referral
4.
The posted referral package is imported
into the Emergency Department
Information System (EDIS)
Provide access to critical health information
to ED information systems in a standard manner.
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Exchange of PHR Content
(XPHR)
IHE Vendors Workshop 2006
IHE Patient Care Coordination Education
Keith W. Boone, GE Healthcare [co-chair PCC Technical Committee]
September, 2005
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What IHE Delivers
Exchange of PHR Content
XDS-MS
Medical
Documents
History and
Physical
Medical
Summaries
Consent
PHR Extract
Preprocedure
History and
Physical
PPHP
BCCP
PHR Extract
CDA Lab
PHR Update
Referral
Discharge
Summary
Emergency
Department
Referral
EDR
PHR Update
XDS
LAB
XPHR
XPHR
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Abstract
The Exchange of Personal Health Record
Content (XPHR) provides a standardsbased specification for managing the
interchange of documents between a
Personal Health Record and an EHR
System to enable better interoperability
between these systems.
Exchange of PHR
Content
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Scope
Personal Health Record (PHR) Systems
Electronic Health Record (EHR) Systems
PHR System
Portable Media Creator
EHR System
Portable Media Importer
Distribute Document Set on Media [ITI-B]
Portable Media Importer
Portable Media Creator
Distribute Document Set on Media [ITI-B]
Exchange of PHR
Content
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Value Proposition
Supports interchange of PHR Information
 Demographics
 Insurance Information
 Medications, Problems, Allergies
 Health History
 Other Information
Exchange of PHR
Content
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Standards Used
CDA Release 2.0
ASTM Continuity of Care Data Set
ASTM/HL7 Continuity of Care Document
HL7 Care Record Summary
AHIMA PHR Common Data Elements
XDS, XDR
Document Digital Signature
Exchange of PHR
Content
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Key Technical Properties
Information is Human Readable
and Machine Processable
Support Static and Dynamic Information
Sharing Domains (XDS and XDR)
Protects Information using Digital Signature
Update Model for EHR to PHR Changes
Exchange of PHR
Content
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Key Profiles for Document Content and Exchange
Doc Content Profiles
Pre
Surgery
PPHP
Consent
Emergency
Scanned Doc
BPPC
EDR
XDS-SD
Imaging
Laboratory
XDS-I
XD*-Lab
Discharge &
Referrals
PHR
Exchange
XDS-MS
XPHR
Doc Sharing
Pt-Pt Doc
Interchange
Media
Interchange
XDS
XDR
XDM
Doc Exchange Integration Profiles
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PCC Content Integration Profiles
XDS-MS
Consent
Medical
Documents
BCCP
History and
Physical
Preprocedure
History and
Physical
Antenatal
Care
Summary
Medical
Summaries
Discharge
Summary
Lab Report
XD*-LAB
Care
Assessments
ACS
Referral
Emergency
Department
Note
Emergency
Department
Referral
PHR Extract
EDN
EDR
PHR Update
CA
PPHP
2005-2006
2006-2007
2007-2008
XPHR
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Rossi-Mori EU survey mapping to XDS-MS
No of
Countries
all
not
asked
all - BE
12
11
9
5
13
Section
details about patient
identifier, name
(date of birth, gender)
address
history
medication history
immunisations
family history
allergies, alerts, risks, special
needs
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ongoing medications
10
test results (lab and images)
10
details about family doctor
9
active problems
6
details about insurance
6
emergency contact (next of kin)
4
care plans
not asked
(exemptions)
Structured and Coded Header
Patient, Author, Authenticator, Institution,
etc.
Structured Content with coded
sections:
 Reason for Referral
 Vital Signs
 Medication
Structured Text
Section
 Studies
 Allergies
Structured Text
Section
 Social History
 Problems
Structured Text
Section
 Care Plan
Coded Section
Entries
Coded Section
Entries
Coded Section
Entries 31
Example of XDS-MS Options
Actor
Content Source
Options
Discharge Summary
Option(1)
Referral Option (1)
Vol &
Section
PCC TF-1:
3.4.1
PCC TF-1:
3.4.2
PCC TF-1:
3.4.3
PCC TF-1:
3.4.4
PCC TF-1:
3.4.5
PCC TF-1:
3.4.6
Content
Consumer
View Option (2)
Document Import Option(2)
Section Import Option (2)
Discrete Data Import
Option (2)
Document
Registry
No Options
Document
Repository
No Options
-
Patient Identity
Feed
No Options
-
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IHE flexibility in leveraging standards for
Document Format
Content Format leverages Specific Standards
 HL7 CDA Release 2.0
 HL7/ASTM Continuity of Care Document
 LOINC, SNOMED (if applicable)
 Others as Needed (e.g. PDF)
IHE is defining a library of Reusable Parts
 Document Types
 Sections (only title is coded)
 Entries (clinical info semantically coded)
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In Conclusion
IHE is experienced with patient summaries.
IHE ready to engage in fostering a consistent
family of patient summary documents and a
sharing infrastructure between countries and
regions in Europe.
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