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Toolkit: Transitions of Care Management Technology

Basic Terminology

Pharmacists working in the hospital are at a distinct advantage to community pharmacists with respect to having access to patient's health information and reason for hospitalization. Community pharmacists however are no longer working with an isolated pharmacy dispensing software system alone, and either this system, or other patient management systems are increasingly available to send, receive and access patient health information from other systems. The health information once inaccessible to community pharmacists is now becoming available.  Here is some general information about technology that you might want to be familiar with.  Also, please talk with your pharmacy technology vendors about ways you could electronically connect to health systems and doctor offices in your area (A note: you do not need access to their EHR directly, simply inquire with your pharmacy software vendors about mechanisms to connect to regional health information exchanges, transfer alerts and direct secure messaging)


HISP (Health Information Service Provider)

  • A Health Information Services Provider (HISP) is an organization that manages security and transport for health information exchange among health care entities or individuals using the Direct standard for transport.  There is no specific legal designation for a HISP, nor are HISPs specifically regulated by Meaningful Use certification rules.  The term HISP was coined to describe specific message transport functions that need to be performed to support scaled deployment of the Direct standard in the market.  HISP functions can be performed by existing organizations (such as EHR vendors or hospitals or HIE organizations) or by standalone organizations specializing in HISP services.
    From <http://geekdoctor.blogspot.com/2014/03/a-primer-on-meaningful-use-and-hisps.html>
  • Example: companies who are HISP, include Surescripts, Dr.First, First Databank, Orion Health


  •   "HIE (or Health Information Exchanges) allows health care professionals and patients to appropriately access and securely share a patient’s vital medical information electronically. There are many health care delivery scenarios driving the technology behind the different forms of health information exchange available today." https://www.healthit.gov/HIE
  • Typically there is an HIE in each state.  Unfortunately, Pennsylvania is one with multiple HIE's (the State refers to these local HIE's as health information organizations (HIO).  They do all belong to the PA HIE group called the PA Patient & Provider Network (P3N). 
    You could learn more at:

Secure Messaging

  • Secure messaging is a mechanism to send (push) messages (e-mail) to other secure servers (e-mails).  Think of it like a secure fax that is sent from a physician office to a pharmacy, only this is happening through e-mail.  This is NOT a yahoo account, but an account set up with a HISP provider and that are increasingly available within pharmacy clinical and dispensing software.  It is HIPAA compliant and therefore you could send patient sensitive information via this mechanism.  Also, with coding standards, structured information (e.g. medications, problems, labs, etc.) can be identified within the e-mail and populate respective areas within receiving computer programs (see CDA and C-CDA below).  https://www.healthit.gov/policy-researchers-implementers/direct-project



  • Clinical Document Architecture (CDA) is a popular, flexible markup standard developed by Health Level 7 International (HL7 ) that defines the structure of certain medical records, such as discharge summaries and progress notes, as a way to better exchange this information between providers and patients. These documents can include text, images and other types of multimedia -- all integral parts of electronic health records (EHRs).



  • C-CDA is one of the most widely implemented implementation guides for CDA and covers a significant scope of clinical care. Its target of the 'common/essential' elements of healthcare is closely aligned with FHIR's focus on the '80%'. There is significant interest in industry and government in the ability to interoperate between CDA and FHIR and C-CDA is a logical starting point. Implementers and regulators have both expressed an interest in the ability to map between FHIR and C-CDA.


  • Admission, discharge, or transfer (ADT) messages are the vehicle for communicating updates about a patient’s care transitions. The messages provide each patient’s personal or demographic information (such as name, insurance, next of kin, and attending physician) and notes when that information has been updated. They also indicate when an ADT status has changed — an admission or discharge, for example. Here’s how ADT alerts work:
  • The alerts are triggered by an admission, discharge, or transfer (ADT) event in a hospital information system that sends a message to the health information exchange system
  • The health information exchange system processes the message and transforms it into an alert sent to the primary care practice or community-based care manager


Technology Information

Websites for more information:

  • HealthIT.gov - Provides a comprehensive look at Health IT as it is now in the United States, and the vision for the future.  This is a good resource for the ins-and-outs of health IT in the United States.  https://www.healthit.gov/

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