Title: Home health nurse sends summary health content to the physician of record

State: Draft

Perspective: Home health or hospice nurse:

Story: Home health and hospice care is an increasingly important domain for care and care management. Prevention of unwanted or unnecessary ER visits and hospitalizations depends upon good continuity of care information, and coordination of care decisions, between members of the team, which usually includes a home health nurse(s), the primary care physician(s) of record for the patient, the patient, and/or her family and care givers.

Essential Data Exchange: Often the data are those involved in Meaningful Use, including demographics, problem/diagnosis list, medications, allergies, immunizations, recent lab results, and image or radiography procedures and results. At times, this informational content is more specific to hospice care, such as advance directives and treatment options.