Clinical Information

360 Exchange Closed Loop Referrals (360X) is an ONC-supported specification for referrals that allows the exchange of patient referral data between different EHR environments. Epic and non-Epic organizations whose EHR systems meet the specification’s requirements can exchange 360X referrals.

In this scenario, an external system has a patient that it is attempting to match in an Epic system. The external system sends a subset of patient demographics and if Epic can find a unique high-confidence match, it returns the matching patient. Epic implements all transactions required in the IHE Technical Framework to support the IHE Cross-Community Patient Discovery Profile as a Responding Gateway.

In this scenario, a patient presents to an Epic system, and a user needs to match the patient in an external system. Epic sends a subset of patient demographics to the external system, which responds with the patient who matches the query. Epic confirms the match, usually through the user, and then report back the user's actions. Epic implements all transactions required in the IHE Technical Framework to support the IHE Cross-Community Patient Discovery Profile as an Initiating Gateway.

The process of exchanging clinical documents is handled through a series of messages exchanged via standards-based SOAP Web services. Because organizations that use Epic software are often the size of regional HIEs themselves, interoperability with the Epic EHR requires no centralized infrastructure. Instead, the EHR acts as a document repository itself for point-to-point queries. Specifically, the EHR supports IHE XCA and IHE XDS.b Query-Response.

Epic's EHR supports document exchange via the Direct protocol. Documents sent from an Epic EHR via Direct follow the XDR/XDM option, in which structured documents are sent in the message with structured metadata. Similarly, Epic receives structured documents to file to the appropriate chart. External provider directories containing Direct addresses can be imported into the Epic EHR using a standard format. While Epic software supports the full SMTP+S/MIME stack, organizations using Epic can alternatively choose to delegate duties to an external HISP. Providers use the EHR to push data using Direct, and patients can use their portal to send structured clinical summaries to any arbitrary Direct endpoint with which the organization has established trust.

When exchanging patient summary documents, we use Clinical Document Architecture (CDA) as the content standard. CDA is an XML-based markup standard defined by Health Level Seven (HL7), intended to specify encoding, structure and semantics of clinical documents for the purpose of exchange. Care Everywhere supports the exchange of document defined in the Consolidated CDA (C-CDA) framework, which is required for ONC 2015 Edition certification for Meaningful Use.

• Epic's EHR can consume any valid C-CDA or CDA document.
• Epic's EHR can create the following documents:
  • HL7/ASTM CCD (HITSP C32 Implementation)
  • HL7/IHE Consolidated CDA (CCD and Progress Notes Template)

Contact us if you have questions about our CDAs.

To facilitate closing the loop on referrals so referring providers can be kept up to date on the treatment received by their patients, Epic supports additional elements within Direct messaging using the XDR transport method. These additional elements indicate Direct messages which include a specialist report generated during the care of a patient who has been referred to an organization outside their primary care organization.

As organizations extend Epic to affiliated practices in their communities, there has been an increasing need to convert historical patient-level data from other vendors' systems into Epic. This interface allows organizations to load patient-level data from organizations that do not otherwise support standards-based data exchange.