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4 Things to Know About CMS’ PACIO Advance Directive Interoperability Project

Aimed at producing Fast Healthcare Interoperability Resource (FHIR) implementation guidance (IG) for the interoperability of vital Advance Care Planning (ACP) documents, the Post-Acute Care Interoperability (PACIO) community’s Advance Directive Interoperability (ADI) project seeks to enhance the delivery of person-centered, quality serious illness care through innovative health technology. The project is currently in progress and will conclude in the Fall of 2021. 

PACIO’s collaborative ADI project is led by MITRE and Maria D. Moen, ADVault Inc.’s Director of Platform Innovation, and includes prominent clinical and technical health organizations, patient representatives, and government agencies related to health information technology. We recently connected with Maria to learn more about the scope of the interoperability project, the impact it will have on serious illness care, and how our members can get involved. We’re sharing 4 key things we learned from our conversation that our members should know about this project.

The ADI project stems from the ongoing work of the PACIO project, a collaborative effort aimed at advancing interoperable health data exchange between post-acute care and other providers, patients, and key stakeholders across health care.

PACIO’s ADI efforts to improve health data exchange encompass more than the project’s namesake of Advance Directives. Maria D. Moen, the project’s leader, affirms that the technical resources produced by the ADI project will work for the interoperability of various advance care planning documents. These efforts will ensure that the complex and fluctuating needs, preferences, and priorities of people living with serious illness can be fulfilled during all stages of care, through easily generated, updated, and communicated advance care planning documents. 

This project was born out of necessity and shifting priorities resulting from the COVID-19 pandemic. The unique conditions shaping healthcare since the onset of the pandemic underscored the immense need for the availability of verifiable digital advance directive information. 

The COVID-19 pandemic created conditions in which ACP interoperability became an undeniable priority for our health systems and as Ms. Moen sees it, “necessity became the mother of invention in the truest sense. Innovation wasn’t a nice-to-have any longer, it was a survival strategy for many providers.” The role of technology and expanded adoption by the aging population, providers, and care teams emphasized the need for seamless accessibility of advance care plans, precisely the aim of the PACIO ADI project. 

The use of FHIR for ADI will enhance the efficiency of health information retrieval from existing standards, such as Clinical Document Architecture (CDA). 

The use of Fast Healthcare Interoperability Resources (FHIR) for ADI will enhance portability and accessibility for providers and patients accessing ACP documents. The FHIR standard defines how healthcare information can be exchanged between different computer systems regardless of how it is stored in those systems. It allows healthcare information, including clinical and administrative data, to be available securely to those who have a need to access it, and to those who have the right to do so for the benefit of a patient receiving care. According to Ms. Moen, features of FHIR documents include standard data vocabulary mapping capabilities for ACP documents, targeted data retrieval, and an ability to lift limitations on content being created, exchanged, and retrieved.

Though the PACIO ADI project is open for all to get involved, C-TAC members are uniquely positioned to contribute to this work and advance efforts to create a more person-centered healthcare system.

The project’s development relies on the participation, guidance, and thought leadership of all who are involved in the process of health information exchange. Maria underscored the significance of this work for the serious illness care community, and provided us with some ways our movement can take action on the ACP interoperability front:

“We need to advocate for modernization of advance care planning, we need to incite movement in the solution provider space, we need to educate our patients about how they information can move WITH them and inform care so as to increase confidence in the healthcare system, and we need to be the rising tide that lifted all boats.”

Membership in this interoperability project within the PACIO Community is open to any participant willing to commit to the roles and responsibilities identified by the working group to support the overall success of the initiative.  

Contributions may include, but are not limited to:

  • Knowledge of the subject matter
  • Scalability of implementing the eventual solution
  • Willingness to assist in the delivery of key outputs and working group artifacts
  • Developing a testing framework for reference implementations
  • Testing

Join the PACIO Project by reaching out to info@PACIOproject.org

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