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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.

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Automated push event notifications and care plan updates to home health using Direct messages

Description
Reliant Medical Group (RMG) relays event notifications received from their local hospitals by pushing Direct messages to the Home Health Agency whenever a shared patient is seen in the ED or admitted to hospital.  This facilitates avoiding unnecessary home health visits when a patient has been admitted, and enables immediate home health to follow up when a patient returns home after an ED encounter.  RMG has also automated a pushed CCD with visit note to the Home Health Agency whenever a shared patient is seen by the PCP or a specialist, facilitating the home health nurse to always be aware of updates to the patient’s treatment plan.
Start Date
01/01/2018
Projected End Date
06/30/2018
Project Tags
  • active care relationship
  • Care Coordination
  • CCD
  • DIRECT
  • Direct Interoperability
  • interoperability
  • Interoperability
Project Point of Contact: kelly.gwynnremove@removedirecttrust.org
Project Results
Reliant Medical Group (RMG) recognizes how important home health agencies are in getting our sickest patients better and keeping them out of the ER.  But they can only do their job if they know changes to the treatment plans (so they can reinforce them) or changes in status (e.g. an ER visit) so they can more urgently do a follow-up visit.  Direct Interoperability makes that possible.