ToC+Clinical+Scenario+3

include component="page" wikiName="siframework" page="TOC Header" =Clinical Scenario 3= The clinical scenarios are based on the proposed requirements for MU Stage 2 and the requirements specified by the Transitions of Care Key Information Exchanges.

**Scenario 3: Discharging Physician in Hospital Setting to Patient**
 * **Applicable Requirements** || **Description** ||
 * MU2 NPRM 170.314(e)(1)(b)(2) || View, download and transmit to 3rd party (EH) ||
 * ToC Use Case Scenario 2 User Story 1 || ToC Key Information Exchanges: ToC Discharge Instructions & ToC Discharge Summary ||

1. Summary of Scenario
The following is an excerpt from the Transitions of Care Initiative Use Case.


 * Use Case Scenario 2, User Story 1: The Exchange of Discharge Instructions and Discharge Summary between a Provider and Patient to Support the Transfer of a Patient from One Care Setting to Another**

A patient is discharged from the hospital or ED. Discharge instructions are given to the patient by his hospital personnel at the time of discharge. The instructions may be generic, patient specific, or disease specific depending on the facility’s practices and the patient’s needs. The patient acknowledges that he has received the instructions from the hospital personnel (verbally, in writing, and/or electronically). The acknowledgement triggers the physical discharge sequence of events and patient transport out of the facility. The discharge instructions are sent to the patient’s PHR and to the patient's primary care physician (PCP) or Care Team (as the instructions may contain information necessary for the PCP or Care Team to follow up with the patient before the discharge summary is available). Upon discharge, the discharge summary is prepared within the Hospital EHR system. The attending physician of record (APoR) reviews the discharge summary and, once approved, the discharge summary is sent to the PCP. The summary may arrive in the PCP’s EHR system even before the patient has left the hospital. A copy of the message may be retained in the hospital EHR per the hospital’s policies and workflow rules. The discharge summary, or portions thereof, may also be sent to the patient’s PHR system.
 * Setting 1: Hospital or ED from where patient is discharged**
 * NOTE:** The discharge instructions described above are also part of the discharge summary. Depending on the workflow, and the policies at the hospital or ED, the patient and patient’s PHR may receive only the discharge instructions at discharge. The discharge summary may be provided later upon request and within 36 hours of discharge. Audit logs of the exchange are retained according to the hospital’s PHR systems, and any intermediaries’ policies, procedures, and agreements.

The patient discharge instructions and discharge summary are received by the patient’s PHR system. Depending on the specific PHR application, the patient or home health agency (HHA) receives a notification to access and review the PHR. The patient (or patient’s authorized proxy) accesses the PHR and may review the patient discharge instructions. Again, depending on the PHR system's functionality the patient or proxy may be able to select sections within the discharge instructions (discrete data elements) to automatically populate the appropriate fields in the PHR. For example, the newly reconciled medication list is selected to upload to the active medication list section of the PHR and the patient uploads any new problems to the problem list. Some information may be selected to initiate the agency workflow process. The PHR system may also receive the discharge summary. In that case please see the "Closed Loop Referral" User Story about handling the receipt of a medical summary in the PHR system.
 * Setting 2: Patient**

2. Information Exchanged (Data Elements)

 * **Applicable Requirement** || **Data Element** ||
 * MU2 NPRM 170.314(e)(1)(b)(2) ||  ||
 * ToC Use Case Scenario 2 User Story 1 ||  ||

3b. Recommended Document Template
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