This document summarizes a meeting held on October 14, 2011 to discuss improving care transitions through the use of health information technology. The meeting was sponsored by several foundations and organizations and included both in-person and online participants. It featured sessions on challenges with the discharge process, medication reconciliation, information flows, and patient/caregiver activation. The sessions identified priorities like developing comprehensive care plans and improving information sharing between providers. Near-term solutions discussed scaling interoperable health information exchange. Innovation opportunities included feedback loops when issues occur and integrating medication records across settings. Meeting organizers committed to following up on priorities over the next two weeks and updating progress on social media with the hashtag #ITrans.

1. Putting the IT in TransITions Sponsored by: The John A. Hartford Foundation, The Gordon and Betty Moore Foundation, and Kaiser Permanente with the Office of the National Coordinator for Health IT and Partnership for Patients Media Partners:Health Affairs and Health 2.0 Washington DC and Online (#ITrans) October 14, 2011 8am-3pm EST

3. Chris Langston, PhD, The John A. Hartford Foundation

4. George Bo-Linn, MD, The Gordon and Betty Moore Foundation

7. Donna Cryer, CryerHealth

9. Barbara Balik, IHI

12. “Open Space” workgroups:

13. Harvest the best IT enabled solutions available today—those ready for spread and scale-up now.

14. Recommend high-priority areas for IT-enabled innovation.

17. Near-term actions

18. Longer term innovation

19. Rapid input to consolidated priorities

20. SurveyMonkeyaccessible via wireless devices, or paper version

22. Putting the IT in TransITions Sponsored by: The John A. Hartford Foundation, The Gordon and Betty Moore Foundation, and Kaiser Permanente with the Office of the National Coordinator for Health IT and Partnership for Patients Media Partners:Health Affairs and Health 2.0 Washington DC and Online (#ITrans) October 14, 2011 8am-3pm EST

23. Read-Outs from Facilitated Sessions Reactions from Eric Coleman, MD, University of Colorado, Denver Discharge process Medication reconciliation 3A. Information flow and feedback: ambulatory care and medical home 3B. Information flow and feedback: across the medical home “neighborhood” Patient and care-giver activation

24. Discharge Process

25. 2. Medication reconciliation

26. 3A. Information Flow and Feedback

27. 3B. Information Flow and Feedback

28. 4. Patient and Care-giver Activation

30. Eric Coleman, MD, University of Colorado, Denver

31. Participants in the room: Please check your email, click the link to complete the group prioritization activity (you may do this from a laptop, smart phone, etc). Computers in the center may also be accessed.

34. Chris Langston, PhD, John A. Hartford Foundation

35. George Bo-Linn, MD, The Gordon and Betty Moore Foundation

36. Scott Young, MD, Kaiser Permanente

37. Susan Dentzer, Health Affairs

38. J.L. Neptune, Health 2.0

39. Paul McGann, HHS Partnership for Patients (invited)Round 1: What are we learning? Round 2: Where are we going? Getting the word out.

41. Jitin Asnaani, Coordinator of the ONC S&I Framework

42. Holly Miller, MD, Med Allies*Online Participants: refer to additional S&I Framework PowerPoint presentation on webcast page

44. Barbara Balik, RN, EdD, IHI Faculty

45. Roger Chaufournier, IHI Faculty

47. Prioritized agenda (from conversation and data)

50. Get a “model” that works and implement it consistently, and make sure activity is communicated with patients and providers and that you get it to scale with technology (43.0%)

53. ONC

54. Beacons

56. Use Twitter to describe your 2-week challenge. Start your Tweet “2WC”

58. The Gordon and Betty Moore Foundation

59. Kaiser Permanente*Recording and documents from this convening will be archived and available online. If you have any questions, feedback, or resources you’d like to share with the Planning committee, please email them to hit.caretransitions@gmail.com