S&I Framework Transitions of Care
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S&I Framework Transitions of Care

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  • (1) We are actively involved in the programs themselves (e.g., through the Direct Project Boot Camp);(2) We attend, participate and occasionally facilitate their CoPs (e.g., the REC FI-HIE CoP, the State HIE Provider Directory and Lab CoPs, etc);(3) We bring the CoPs to the table when S&I initiatives need input that will affect them, etc. 
  • NB: Having the right data at the right time is critical – but not in itself sufficient - to effective care transitions
  • Critically, clinical workflow considerations were an integral part of these deliverables, enhancing physician adoption: Data interoperability – for data to be uploaded as discrete data into disparate EHR systems- avoiding transcription (time waste and the inherent transcription errors) Data flow from EHR to EHR in a fashion completely consistent with a clinicians existing clinical workflow No data overload: Core data necessary for any ToC and other data to be added selectively
  • The community initially focused on specific care transitions user scenarios in support of Meaningful Use Stage 1, to identify and prioritize core clinical elementsIn each context, core clinical data is supplemented by information specific to the scenario:Discharge Summary is the clinical information exchanged in the ToC setting when a patient is discharged from a hospital, and contains reconciled core data and an overview of patient care information from the hospital stayDischarge Instructions contains the reconciled core data and dataset relevant to the Discharge Summary context, which includes follow up/plan of careConsultation Request (including Clinical Summary) contains information determined by the referring provider for the clinician that has been requested to consult on the patient, and includes core data and consultation context-relevant dataConsultation Summary is the information that the physician that has performed the consult prepares back to the referring physician and includes the reconciled core data and the consultation findings and recommendations

S&I Framework Transitions of Care S&I Framework Transitions of Care Presentation Transcript

  • S&I Framework Transitions of Care Initiative
    October 14, 2011
  • Standards are a critical enabler of effective care transitions
    +
    Components ofan Effective Care Transition
    Drivers
    Enablers
    Clinical Outcomes
    Financial Incentives
    Infrastructure
    Standards
    Data
    Timelines
    Technology

    Processes & Workflows
    People & Participants
    1
  • What is the S&I Framework?
    National Coordinator for Health IT
    Office of the Chief Scientist
    Office of the Deputy National Coordinator for Operations
    Office of the Chief Privacy Officer
    Office of Economic Analysis & Modeling
    Office of the Deputy National Coordinator for Programs & Policy
    Office of Policy & Planning
    • The Standards and Interoperability (S&I) Framework represents one investment and approach adopted by the Office of Standards & Interoperability to fulfill its charge of prescribing health IT standards and specifications to support national health outcomes and healthcare priorities
    • The S&I Framework is a forum – enabled by integrated functions, processes, and tools – for the open community* of implementers and experts to work together to standardize health information exchange
    Office of Standards & Interoperability
    Office of Provider Adoption Support
    Office of State & Community Programs
    * As of 14 Oct 2011, ~400 people representing ~300 organizations had committed to the S&I Framework
    2
  • S&I Transitions of Care (ToC) Initiative
    Motivation: what if every care transition was accompanied by an unambiguously-defined core set of high-quality clinical data?
    Mission: improve exchange of core clinical information among providers, patients and other authorized entities electronically in support of meaningful use and IOM-identified needs for improvement in the quality of care
    But wait… why can’t we do this today?
    No common, unambiguous, clinically-based definitions for the data
    Multiple existing standards for transmitting the clinical data
    Insufficient tools to implement the standards effectively
    3
  • So what did the community accomplish?
    The 150 Committed Members* of the S&I ToC Community reached consensus on several critical elements:
    Unambiguous, clinically-relevant definitions of the core data elements that should be included in care transitions
    Clear guidance on the usage of these core clinical elements in common care transitions scenarios
    Agreement on a single standard for clinical summary documents for Meaningful Use Stage 2
    Tools and resources to lower the barrier to implementation
    * Including care providers (physicians, nurses, others), technology vendors and implementers, informaticists, relevant SDOs and standards institutions, federal agencies, etc.
    4
  • Data Elements and Transitions of Care
    Discharge Summary & Instructions
    • Reconciled core data
    • Overview of patient care information from hospital stay
    • Follow-up/plan of care
    Hospital
    Primary Care Physician
    1
    Patient
    Consultation Request
    • Reconciled core data
    • Data relevant to consultation context
    2
    Consultation Summary
    • Reconciled core data
    • Consultation findings & recommendations
    3
    LTPAC Settings (SNF, Home Health, etc.)
    Specialist
    Examples of exchanges addressed through S&I LTPAC WG
    Addressed through S&I ToC Initiative
    5
  • A Single Standard for Transitions of Care
    Community reached consensus on ConsolidatedCDA* as the standard to transmit care transitions data. Presented to and accepted by HIT Standards Committee on September 28.
    For the first time in US history, there is a single, broadly-supported electronic data standard for patient care transitions
    So far, 10 HIT vendors and HIE organizations have committed to refine implementation guidance through 4 pilots
    1-2 pilots will demonstrate ConsolidatedCDA in conjunction with Direct Project transport specifications – making it possible for the “little guy” to cost-effectively exchange standardized care transition information
    *More formally, the “Implementation Guide for ConsolidatedCDA Templates”
    6
  • Coming Together: a standard for urgent needs today
    Beacon Program
    S&I Framework
    State HIE Program
    HIE/EHR Interoperability WG* (non-ONC)
    Existing programs have deadlines this year to demonstrate the value of care transitions in their communities
    Each has imposed its own constraints on the current (flexible) CDA standard
    These four programs aim to specify a single constrained version of the current CDA standard that meets each program’s immediate goals. This will enable vendors participating in these programs to have a common standard for care transitions today and a roadmap to ConsolidatedCDA
    * Self-described as a consortium of 7 States, 8 EHR Vendors, and 3 HIE Vendors aiming to increase adoption of EHRs and HIE services by eliminating significant interface implementation costs and time
    7
  • Pushing the ball over the goal line
    NPRM Comment Period Begins
    Comment Period Ends
    ENABLING
    HIMSS
    Tool Development
    Pilots
    Refinements to Guidance
    HIMSS Preparation
    LTPAC Guidance (est.)
    ConsolidatedCDA Pilots
    LTPAC WG
    8
  • Coming Together: a standard for urgent needs today
    Beacon Program
    S&I Framework
    State HIE Program
    HIE/EHR Interoperability WG* (non-ONC)
    Existing programs have deadlines this year to demonstrate the value of care transitions in their communities
    Each has imposed its own constraints on the current (flexible) CDA standard
    These four programs aim to specify a single constrained version of the current CDA standard that meets each program’s immediate goals. This will enable vendors participating in these programs to have a common standard for care transitions today and a roadmap to ConsolidatedCDA
    * Self-described as a consortium of 7 States, 8 EHR Vendors, and 3 HIE Vendors aiming to increase adoption of EHRs and HIE services by eliminating significant interface implementation costs and time
    9
  • Get Involved!
    ENABLING
    ToC ConsolidatedCDA Pilots
    Participate in Pilot Workgroup calls: http://wiki.siframework.org/ToC+Demos+%26+Pilots.
    Contact ONC support team member Ann Clarke: 443-348-2765, Ann.R.Clarke@lmco.com
    Other ToC Activities
    Everyone is welcome! Participate in discussions or provide comments.
    If you want to help drive an activity to success, become a Committed Member.
    Join the S&I Framework wiki and/or contact me
    10
  • 11
    Key Contacts
    Dr. Doug FridsmaDirector, ONC Office of Standards & Interoperability Email: doug.fridsma@hhs.gov
    Dr. Holly MillerCMO, MedAllies
    Email: hmiller@medallies.com
    Jitin AsnaaniCoordinator, ONC S&I FrameworkEmail: jitin.asnaani@siframework.org
    S&I Framework Website: http://www.siframework.org
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