ToC+Clinical+Scenario+1

include component="page" wikiName="siframework" page="TOC Header" =Clinical Scenario 1= 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 1: Closed-Loop Referral: PCP to Specialist, Specialist to PCP **
 * **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 2 || ToC Key Information Exchange: 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 1, User Story 2: Closed Loop Referral**

A PCP 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 for the specialist. The message is addressed to the appropriate specialist, specialty or provider organization and is sent to the specialist’s EHR system. In all cases the message will include the “Core” data and ideally will also include selective “Pertinent” data.
 * Setting 1: PCP's Office**

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 and 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 for the PCP. Once the consultation summary is prepared, it is addressed and sent to the PCP’s EHR system. A copy of the message is retained in the specialist’s EHR system.*User Story 2 could also be applied to a specialist sending reports back to PCP for follow-up post op or post discharge.
 * Setting 2: Specialist's Office**

The consultation summary is received into the PCP practices’ EHR system. Once the consultation summary is received into the EHR system, additional practice variable activities may occur: tasks can be directed to a front desk staff EHR system work queue for appropriate distribution to additional staff’s EHR system work queues, as appropriate to the practice workflows. For example, the front desk staff may schedule a follow-up visit with the patient and alert the PCP of the availability of the consultation summary. If the patient has an assigned Care Manager who follows the patient at an advanced practice care facility (such as a Patient-Centered Medical Home), review alerts may be sent to both the PCP and the Care Manager for appropriate compliance planning. Discrete data elements from within the consultation summary may be promoted to the PCP’s EHR system. In accordance with practice policies and EHR functionality, the PCP may review and promote to the EHR the specialist-reconciled active medication and problem lists, any new procedures may be accepted into the EHR, and any other new discrete data elements may become part the of the patient’s EHR 9all date/time/source stamped). The consultation summary may be retained in its entirety as a permanent part of the patient’s EHR record.
 * Return to Setting 1: PCP’s Office**

2. Information Exchanged (Data Elements)
For a complete list of the data elements to be exchanged, reference the. MU2 NPRM 170.314(b)(2) ||  ||
 * **Applicable Requirement** || **Data Element** ||
 * MU2 NPRM 170.314(b)(1)
 * ToC Use Case Scenario 1 User Story 2 ||  ||

3b. Recommended Document Template
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