The Interoperability Proving Ground has been archived and is no longer actively maintained. All information identified as archived is provided for reference, research or recordkeeping purposes.

Interoperability Proving Ground (IPG) submissions within the ONC Tech Lab are submitted by healthcare, technology and development organizations that are invested in Health IT and Interoperability and want to share, learn and collaborate with similar stakeholders in the US, and around the world.

To view all submissions, please view the IPG link located within the ONC Techlab.


360X strives to define implementation guidance to enable EHR interoperability in support of patient transitions of care. To date, the 360X work group has two use cases approved as Integrating the Healthcare Enterprise (IHE) approved Profiles.  These Profiles are: 
•	Referral Management and 
•	Ambulatory/Acute transfer to a Skilled Nursing Facility (SNF).  
A third use case: Transfer from SNFs to acute emergency departments (EDs) has been submitted for IHE Profile approval.

The group is currently focused on the pandemic relevant use cases of: 
•	Social Determinants of Health (SDOH) needs-based referrals and 
•	eConsults (a provider asking a specialist provider a question regarding a specific patient without, at least initially, referring the patient to the specialist).

360X requires the robust exchange of patient information between two providers using disparate EHR systems, or different instances of the same EHR system, by leveraging existing ubiquitously deployed industry standards, including: 
-	HL7® C-CDA for clinical content
-	The Direct Standard™ (often referred to as Direct) for transport
-	XD for establishing context (metadata)
-	HL7® V2 messages for referral/transfer status messages across care environments.  

The overarching goals of 360X are to improve patient, caregiver and provider satisfaction, enhance the efficiency and value of patient care while decreasing provider burden, transcription errors and the cost of care.  This will be accomplished by EHR vendors developing this functionality into their systems and making this generally available to their provider customers who in turn broadly deploy and adopt 360X functionality for their patients as they transition across the spectrum of care.

360X goals for 2021 include:
-	Pilot of 360X Referral Management with one or more vendors in two or more clinical environments – in   process
-	General availability of 360X Referral Management and/or 360XL SNF Transfer in one or more EHR vendor systems – in process
-	Completion of defining at least one additional use case and submitting for IHE balloting - achieved
-	Live demonstration involving multiple vendors to several interested groups of clinicians and HIT professionals – achieved: HIMSS 2021 Interoperability Showcase Las Vegas with the following companies participating: eClinicalWorks, Epic, MatrixCare, MedAllies, Mettles Solutions, Netsmart and NextGen
Start Date
Projected End Date
Project Tags
  • 360X
  • C-CDA
  • EMDI
  • Enhanced Patient Transitions of Care
  • HIE
  • HL7
  • IHE
  • IHE approved standard
  • interoperability
  • ONC-led
  • Provider Burden Reduction
Project Point of Contact:
Project Results
A survey, conducted immediately following a demo of 360X on 4/14/2020 to a group of clinicians, HIT vendors and other HIT professionals (approximately 200 attendees) yielded the following results:
Approximately 59% of the audience responded to the survey questions.
Question 1: Do you think 360X would improve the referral process in your healthcare organization?
Yes/Maybe         98%
Yes                     88%
Maybe                10%
No                        2%
Question 2: Do you think 360X would improve referral tracking from start to finish (Close the loop)?
Yes/Maybe         99%
Yes                     92%
Maybe                  7%
No                        1%
Question 3: Do you think 360X would decrease provider and staff documentation burden?
Yes/Maybe         94%
Yes                     67%
Maybe                27%
No                        6% 
Question 4: Do you think 360X would decrease duplicate clinical diagnostic testing?
Yes/Maybe         93%
Yes                     49%
Maybe                44%
No                        7%
Question 5: Do you think 360X would decrease the cost of duplicate testing?
Yes/Maybe         92%
Yes                     46%
Maybe                46%
No                        8% 
Question 6: Do you think 360X would ease the reconciliation of patient information post transition of care?
Yes/Maybe         96%
Yes                     78%
Maybe                18%
No                        4%
Question 7: Do you think 360X would decrease provider and staff scheduling burden?
Yes/Maybe         92%
Yes                     67%
Maybe                25%
No                        8% 
Question 8: Do you think 360X would improve access to patient information at the point of care?
Yes/Maybe         99%
Yes                     92%
Maybe                  7%
No                        1%

To join or learn more about the 360x Transitions of Care project please contact:
Brett Andriesen
[email protected]