The PACIO Project: Post-Acute Care on FHIR

Oct. 30, 2020
Project developing standards for exchange of clinical information derived from PAC patient assessments with the focus on the patient’s mental and physical function

A new collaborative effort hosted by standards organization HL7 is seeking to advance interoperable health data exchange between post-acute care and other providers, patients, and other stakeholders through standards-based application programming interfaces (APIs).

The Post-Acute Care Interoperability (PACIO) Project will seek to gain industry adoption by establishing a framework for the development of post-acute care FHIR implementation guides and reference implementations that will facilitate health data exchange.

The MITRE Corp. is serving as project leader, with the Centers for Medicare & Medicaid Services, in collaboration with the Office of the National Coordinator for Health IT, providing guidance and subject matter expertise. Participation in the PACIO Project is open to anyone and currently includes providers, health IT vendors, payers, patients and professional advocacy groups. There are 30 active members, with more than 100 organizations signed up to receive monthly updates to track the group’s progress.

The project grows out of a recognition that when a patient transitions from one healthcare setting to another, communication between providers often is incomplete, inaccurate, and not received in time to inform patient care planning. Lack of standardized communication leads to poor health outcomes, increased burden on the providers, and increased costs to the patients and payers associated with duplication of procedures or medications that can result in medical errors and readmissions.

Forty-five percent of patients who leave hospitals go into some kind of post-acute care, which accounts for $74 billion in Medicare payments annually. Electronic exchange of accurate information when a patient moves from one healthcare setting to another has the potential to reduce medical errors and costs associated with care, resulting in improved patient health outcomes.

Patients and their caregivers are also critical exchange partners in care coordination across the healthcare spectrum. Patients and providers stand to benefit significantly from digital applications that support electronic exchange of information between care settings.

The PACIO Project notes that digital applications can promote patient-centric care through improved transitions and care coordination, including shared care through the belief that patients should own their data. They also empower patients to be active participants in their care by working toward ownership of their own health data to help them make informed choices about their care.

According to an e-mail response from a CMS spokesperson, the PACIO Project began development of standards for the exchange of clinical information derived from PAC patient assessments with the focus on the patient’s mental and physical function. “This work began in May 2019. These standards currently are in the final phase of HL7 review, which on average takes about six months to complete, before they can be adopted by industry,” the spokesperson said. “We expect the initial standards related to mental and physical function to be ready for industry implementation around summer 2021.  The group continues to work on developing standards for additional clinical information for future submission to HL7.”

PACIO plans to test integration of CMS assessment data elements from the CMS Data Element Library   into health IT systems using FHIR APIs. It will also exchange patient-level cognitive and functional status data between multiple disparate health IT systems, incorporated with electronic Long-Term Services and Supports (eLTSS) care plan and patient goals data, in a consumable format for clinicians, patients, and family members.

The PACIO Project will hold regular public calls and meetings, which will be open to anyone interested in learning more about the working group’s activities. Final working group documents and FHIR implementation guides will be open source and shared on open, publicly available websites such as GitHub and HL7.

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