ToC+Clinical+Scenario+2

include component="page" wikiName="siframework" page="TOC Header" =Clinical Scenario 2= 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 2: Discharging Physician in Hospital Setting to PCP (PCMH)**
 * **Applicable Requirement** || **Description** ||
 * MU2 NPRM 170.314(b)(1) || Transitions of Care: Incorporate Summary of Care Record ||
 * MU2 NPRM 170.314(b)(2) || Transitions of Care: Create and Transmit Summary of Care Record ||
 * ToC Use Case Scenario 1 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 1, User Story 1: The Exchange of Information to Support the Transfer of Patient Information from One Provider to Another **

A patient is discharged from the hospital or ED. Discharge instructions are given to the patient by 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, or electronically). The acknowledgement triggers the physical discharge sequence of events and patient transport out of the facility. The discharge summary (which includes the discharge instructions) is also sent 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 (or instructions) and, once she has approved it, 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. Audit logs of the exchange are retained according to the hospitals, PCP’s, and any intermediaries’ policies, procedures, and agreements.
 * Setting 1: Hospital or Emergency Department from where patient is discharged (sends discharge summary to PCP or Care Team)**

Discharge summary/instructions are received into the PCP practice’s EHR system. Patient generally will be known in the EHR system in which case an automated EHR match may occur). Discharge summaries/instructions that are not automatically matched to a patient are reconciled manually, which may include the process of creating a new patient record and registering the patient. Once the discharge summary/instructions have become part of the PCP’s EHR system, additional practice variable activities may occur: new tasks may be directed to a front desk staff EHR work queue, as well as to additional staff EHR work queues as appropriate to the practice workflows. Follow-up/plan of care is managed according to established PCP workflow. For example, upon receiving notification of the patient’s status, the care manager is now aware that the patient has been discharged from the hospital. The Care Manager may be aware that the patient becomes confused when medications are altered and calls the patient to ensure the patient is taking the correct medications post discharge and is following the discharge instructions.The PCP may review and promote into the EHR the newly reconciled active medications, updated problem lists, new procedures and other discrete data elements. The hospital (or ED) discharge summary/instructions are retained in its entirety as a permanent part of the patient’s record.
 * Setting 2: Patient's PCP or Care Team (receives discharge summary from Hospital or ED clinical system).**
 * User Story 1 could also be applied to a specialist sending reports back to PCP for follow-up post op or post discharge.

2. Information Exchanged (Data Elements)

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

3b. Recommended Document Template
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