As COVID-19 continues to put pressure on hospice, home health, and private duty, a new Standard is arising that will optimize the way care transitions are processed and resolved. The 360X initiative seeks to leverage existing processes and infrastructure to create a closed-loop referral system—a development that could be particularly helpful for post-acute care providers.

Sponsored by The Office of the National Coordinator for Health Information Technology (ONC) and spearheaded by Dr. Holly Miller, Chief Medical Officer of MedAllies, 360X is formally described as an “advance interoperable health care data exchange for closed-loop referrals from within health IT workflow.”

The description of 360X as a closed-loop referrals standard is apt. It’s a standard in the sense that it uses existing mechanisms and already-defined norms in healthcare interoperability. And it facilitates closed-loop referrals by using that infrastructure to create a new way for organizations to interact and close the loop when they transition care among providers.

This is powerful interoperability, and all the more so because it didn’t start last year or 10 years ago, or even 20 years ago. It’s been iterating upon itself for decades. But most of that activity has been done in the acute-care space, which is one reason why post-acute providers have some catching up to do—we simply don’t have the iterated capability or knowledge in our particular space.

Now, 360X is offering an opportunity for post-acute organizations to activate a more advanced closed-loop referrals system, and to receive all the benefits that come with that. According to the Official Website of The Office of the National Coordinator for Health Information Technology, those benefits are significant:

• Enabling “improved care coordination between providers and other entities utilizing disparate health IT systems”;
• “Enhancing the efficiency and value of patient care” and
• “Decreasing provider burden, transcription errors and the cost of care.”

How 360X works in a post-acute setting

When considering 360X, it’s important to bear in mind that this is not a branded system that’s for sale. It’s not a company, or software, or a feature. It is a method of doing things. As it relates to closed-loop referrals, it’s a standard that offers both the way that an organization structures and sends transition of care, and a defined method for a recipient organization to respond.

Here’s how it works. An organization sends out a direct message with a CCDA attached—standard procedure so far. A direct message with a CCDA attached is part of a certification requirement for EHRs to comply with meaningful use standards. They must support this direct secure messaging via CCDA.

The difference with 360X is that it takes that baseline, that initial functionality, and adds two more layers: It includes an HL7 V2 file to indicate that a referral is being sent. It then wraps everything up in XDM standard data model language that contains both the CCDA and the HL7 V2 file.

Next, the record gets sent to all recipient organizations, whether it’s a single organization or a variety of recipients. And each then uses the 360X model to respond with another HL7 V2 message that either says, yes, we can take this, or no, we can’t accept this at this time.

From there, if the patient does find a home or a location to be discharged to—whether it’s an outpatient clinic, a long-term care facility, or a home health or hospice provider—a final placement message is sent. And at that point, the agency can begin processing their referrals and transitioning those patients into their care.

As the patient progresses in the setting they’ve been referred to, and then as they ultimately complete their care and are discharged, a message is returned to the referring organization. That message contains a CCDA with the care provided by the given organization, as well as another HL7 V2 message notifying the completion, or the closure, of that admission with the referred-to-care setting.

Planning a better future for post-acute referrals

As you read this, you may be thinking that the 360X process sounds an awful lot like some of the market players that support referral management use cases and workflows. And that’s because it does—and it does so intentionally. A lot of the flow and function emulates, or is similar to, what you might expect out of case and referral management tools currently on the marketplace.

In effect, the 360X initiative aims to standardize what has become a whole market segment—the transition-of-care flow. By making it something that’s built into EHRs rather than offered by third parties, 360X is creating a standard model out of existing services. And it seeks to do this by using technical standards and transport methods that already exist in healthcare, and which are expected in most, if not all, certified EHRs.

Because these methods are standard for certified EHRs, it behooves post-acute providers and software vendors to invest in these same technologies. At MatrixCare, we’re proud to be an early adopter of the 360X model. We’ve long invested in direct secure messaging, and in the ability to construct CCDAs and ADTs. Putting all that together in the 360X method is just a new iteration of capabilities we’ve invested in for some time.

Our goal—and the goal of this initiative—is to make a standards-based transition of care methodology the norm in the industry, rather than more costly marketplace alternatives. So as 2021 and, ultimately, 2022 roll on, expect to see 360X getting significant adoption, notably with large organizations like EPIC and ECW and NextGen, and other large certified EHRs.

We’ll be doing our part to help advance this adoption. In accordance with an ONC Office of International Coordinator LEAP Grant, MatrixCare will be working with MedAllies and the 360X initiative to send and receive 360X referrals. We’ll also make it possible for our providers to send 360X referrals out to community service providers for patients with certain SDOH needs.

As the pandemic has revealed new challenges and undermined existing workflows in the home health space, the opportunity to embrace a new standard of efficiency isn’t just exciting, but potentially lifesaving for some organizations. And as we move further into 2022, you can continue to look to MatrixCare for guidance and insights into 360X and how it can be leveraged for the improvement of processes that are core to the post-acute business.

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