ToC+Clinical+Scenario+5

include component="page" wikiName="siframework" page="TOC Header" =Clinical Scenario 5= 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 5: Specialty Physician in Ambulatory Care Setting to Patient, PCP in Ambulatory Care Setting to Patient**
 * **Applicable Requirements** || **Description** ||
 * MU2 NPRM 170.314(e)(2) || Clinical Summary (EP)- Ambulatory Setting Only ||
 * ToC Use Case Scenario 2 User Story 2 || ToC Key Information Exchanges: ToC Consultation Request including Clinical Summary & ToC Consultation Summary ||

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


 * Use Case Scenario 2, User Story 2: The Exchange of Clinical Summaries between Provider and Patients to Support the Closed-loop Transfer of a Patient from One Care Setting to Another Consultation Referral**

Activity: Primary Care Physician is in the middle of an encounter (office visit) with a patient and determines that the patient needs to be referred to a specialist. The PCP is documenting the encounter in the EHR and within the EHR prepares the consultation request clinical summary to the specialist. The summary is addressed to the appropriate specialist, specialty or provider organization and is sent to the specialist’s EHR system. The consultation request, clinical summary, or portions thereof may also be sent to the patient’s PHR system.
 * Setting 1: PCP’s Office**

Activity: The consultation request clinical summary is processed according to the specific context of the referral. In accordance with practice policies and workflow the specialist reviews the document and orders any additional tests to be performed for the patient prior to the office visit. Discrete data elements from within the summary may be promoted to the specialist’s EHR system, date/time/source stamped. When the patient arrives at the specialist’s office he is registered in accordance with practice policies and workflow. The specialist documents the encounter in the EHR system and prepares the consultation summary to the PCP. Once the consultation summary is prepared it is addressed and is sent to the PCP’s EHR system. A copy of the summary is retained in the specialist’s EHR system. The consultation summary will include “Core” data, and may include “variable” data. The consultation summary may also be sent to the patient’s PHR System. **NOTE:** The return to PCP office is only needed in Scenario 1 for the receiving of the consultation summary by the PCP. In Scenario 2 there is not provider/patient exchange of information as part of Transition of Care in the return to Setting 1.
 * Setting 2: Specialist’s Office**

Activity: "Consultation summary" is received by the patient’s PHR system. Depending on the specific PHR system, the patient may receive a notification to access his PHR as there is new information available. The patient (or the patient’s authorized proxy) accesses the PHR and may review the consultation request clinical summary. The patient (or his proxy) may respond with questions. Again, depending on the PHR system's functionality the patient may be able to select sections of the consultation request clinical summary (that are discrete data elements) to automatically populate the appropriate fields in the PHR. For example, the patient may upload any new problems to the problem list. Other PHR systems may have “all or none” functionality allowing the patient to simply determine if he would like to retain or delete the consultation request clinical summary in the PHR system.
 * Setting 3: Patient**

2. Information Exchanged (Data Elements)

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

3b. Recommended Document Template
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