Comprehensive HIE Transaction Scenarios

The purpose of this document is to provide a simple example scenario in which current NHIN transactions and those being developed by the NHIN Direct project apply to a series of patient encounters.

Provider / Scenario	NHIN Direct Transactions	Local HIE Services	NHIN Exchange
Dr. PCP is a primary care physician. Ms. Patient, a Medicare beneficiary, schedules an appointment with Dr. PCP. She is a new patient.	Dr. PCP does not participate in or does not have access to a local Health Information Exchange. His EHR technology allows him to connect to a HISP. The HISP offers information exchange transactions defined by the NHIN Direct Project.	Dr PCP participates in a local Health Information Exchange	Dr. PCP’s local HIE is a participant in the NHIN Exchange.
As part of the workflow prior to a patient encounter, Dr. PCP’s, staff seeks medical information which may be available from sources outside his own practice.	N/A	Dr. PCP’s staff conducts a patient search and able to view and/or retrieve patient information locally available from other HIE participants.	Dr. PCP is able to locate and retrieve information not available from the local HIE. Examples include information regarding treatment at the local VA Hospital or from a provider located in a state from which Ms. Patient has relocated.
During the course of the examination, Dr. PCP decides to refer Ms. Patient to Dr. Specialist.	Dr. PCP’s office maintains a list of providers to which Dr. PCP commonly refers patients. Dr. Smith instructs his staff to generate a CCD with a summary of the encounter along with other information needed for the referral and to send the information to Dr. Specialist via their HISP. May be local or non local.	If intra-HIE, Dr. PCP’s staff generates a CCD and other referral information and uses the capabilities provided by the local HIE to send the referral within the HIE to the Dr. Specialist.	NHIN Exchange includes a push transaction but lacks an addressing specification needed to allow one provider to target another for information exchange. Unless intra-HIE, Dr. PCP’s staff makes the referral information available for Dr. Specialist’s retrieval and informs Dr. Specialists practice of the referral and availability of documents in an out of band communication.

Provider / Scenario	NHIN Direct Transactions	Local HIE Services	NHIN Exchange
Ms. Patient has been referred by Dr. PCP to Dr. Specialist and schedules and appointment.	Dr. Specialist does not participate in or does not have access to a local Health Information Exchange. His EHR technology allows him to connect to a HISP. The HISP offers information exchange transactions defined by the NHIN Direct Project.	Dr Specialist participates in a local Health Information Exchange	Dr. Specialist’s local HIE is a participant in the NHIN Exchange.
As part of the workflow prior to a referred patient encounter, the PT clinic staff seeks the information provided by the referring physician.	The PT clinic staff retrieves the referral information from the HISP which serves the clinic. The referral information is made available for the PT’s review.	If intra-HIE, the referral information is delivered by the applicable services provided by the local HIE.	Unless intra-HIE, Dr. Specialist’s staff are able to use NHIN Exchange services to request and retrieve Ms. Patient’s medical information made available by Dr. PCP.
During the examination, Dr. Specialist prescribes various medications, physical therapy, and advises Ms. Patient to follow up with Dr. PCP.	Dr. Specialist’s staff generates a referral to a local PT to which they commonly refer patients. They send a patient encounter summary and other relevant referral information to the clinic. Dr. Specialists staff, generate a patient encounter summary and other relevant information and send it back to Dr. PCP.	If intra-HIE, Dr. Specialists staff use their HIE’s services to refer Ms. Patient to a local PT clinic. Dr. Specialists staff use their HIE’s services to respond to Dr. PCP summary encounter and other relevant information.	Unless intra-HIE, Dr. PCP’s staff makes the encounter summary and other information available for Dr. PCP’s retrieval and informs Dr. PCP’s practice of the availability of documents in an out of band communication.

Provider / Scenario	NHIN Direct Transactions	Local HIE Services	NHIN Exchange
Ms. Patient has been referred by Dr. to a physical therapy clinic and instructed to follow up with Dr. PCP.	The clinic does not participate in or does not have access to a local Health Information Exchange. His EHR technology allows him to connect to a HISP. The HISP offers information exchange transactions defined by the NHIN Direct Project.	The clinic participates in a local Health Information Exchange	The clinic’s local HIE is a participant in the NHIN Exchange.
As part of the workflow prior to an encounter with a patient referred by a physician, Dr. Specialist’s, staff seeks the information provided by the referring physician.	Clinic staff retrieves the referral information from the HISP which serves the clinic. The referral information is made available for in the practice EHR technology for the PT’s review.	The referral information is delivered to the clinic by the applicable services provided by the local HIE.	Clinic staff is able to use NHIN Exchange services to request and retrieve Ms. Patient’s medical information made available by Dr. Specialist.
The physical therapist measures Ms Patient’s range of motion, strength and functionality at the beginning and at the end of her course of treatment. The facility enters her baseline and end of treatment information in to a Continuity Assessment Record Evaluation (CARE).	N/A	N/A	The clinic is able to submit CARE report to CMS via NHIN Document Submission.