Use of standards to focus on transitions of care

Transitions of care (e.g. from a nursing home to an emergency room) are often difficult due to the COVID-19 pandemic, but even more dangerous for patients and service providers. ONC works with innovators from the private sector to find unique and fast ways to help patients get from hospital to nursing home or vice versa.

the 360X project was launched by ONC to define implementation guidelines that enable healthcare IT interoperability to support patient transition. 360X is a series of Integrating the Health Care Enterprise (IHE) International profiles that leverage readily available technology standards to manage the patient care transition. So far, the IHE project has coordinated profiles for two transitions of care use cases: outpatient referrals and acute / outpatient referrals to qualified care facilities.

With new 360X use cases being considered by the 360X group over the past year, the group agreed to focus on the transitions of care most needed due to the pandemic. The group also wanted to identify use cases that, following the IHE voting process, could be deployed quickly and would have a significant impact on those most affected by the pandemic. With a focus on patients in nursing homes and people with social needs that affect their health, including the many unemployed as a result of the pandemic, the group focused on these new use cases:

• Transfers from qualified nursing homes to acute emergency units, where critical information from the health IT system of the sender to the recipient of the recipient is critical to patient care and the protection of clinical staff.
• Needs-Based Referrals through Social Determinants of Health (SDOH); Closing the referral loop with social services to ensure patient needs such as transportation and nutrition were met, all as part of the clinical staff’s health IT-based workflow.

The 360X group plans to identify and tune these protocols later this year for rapid deployment. The group has also been working closely with the existing work HL7 gravity project in the SDOH space, with a focus on the identification of coded data elements and associated value sets in order to represent SDOH screening, diagnosis, planning and interventions in health IT systems.

As a founding member of the Direct Project working group, MedAllies helped develop the direct messaging protocols as a “simple, secure, scalable, standards-based way for participants to deliver authenticated, encrypted health information directly to known and trusted participants over the Internet”, says Holly Miller, MD of MedAllies. One of the primary goals is to ensure that orders and messages are tracked to completion, “close the clinical supply loop,” and ensure that patients receive the care they need.

To learn more about SDOH, the 360X and Gravity projects, or to attend recurring workgroup meetings, visit 360X Project Wiki page.