ToC+IG+CDA+Consolidation+Companion+Guide+Section+1

include component="page" wikiName="siframework" page="TOC Header" This page will contain the introductory component of the Transitions of Care Initiative CDA Consolidation Companion Guide

=Introduction= In support of the national objectives for healthcare reform, the Office of the National Coordinator for Health Information Technology (ONC) Standards and Interoperability (S&I) Framework has sponsored the development of harmonized interoperability specifications. These specifications are designed to support national health initiatives and healthcare priorities, including Meaningful Use, the Nationwide Health Information Network, and the ongoing mission to improve health care delivery, advance care coordination, and reduce costs to realize better population health.

The S&I Framework is comprised of several initiatives, each focusing on a single challenge with a set of value-creating goals and outcomes to enhance the efficiency and effectiveness of healthcare delivery. Among the first initiatives launched by the S&I Framework is the Transitions of Care (ToC) Initiative, which focuses on improving the 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.

The ToC CDA Consolidation Companion Guide captures the efforts of Initiative workgroups to provide contextual and purposeful implementation guidance for the health care community.

1.1. Purpose
As part of an effort to align standards cited by national regulations, the S&I Framework launched the CDA Consolidation Project and worked alongside of Health Level Seven (HL7), Integrating the Healthcare Enterprise (IHE), and the Health Story Project to produce a single source for implementing CDA documents defined by [|Final Rules for Stage 1 Meaningful Use] and [|45 CFR Part 170 – Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Final Rule]. The resulting HL7 Implementation Guide for CDA R2: IHE Health Story Consolidation R1 is an implementation guide for CDA documents including the Clinical Care Document (CCD), Consultation Notes, and Discharge Summary.

//The Transitions of Care CDA Consolidation Companion Guide aims to supplement the HL7 Implementation Guide for CDA Release 2: IHE Health Story Consolidation, Release 1 through providing additional clinical and functional context to assist the implementation community in their efforts to provide practical guidance that is outside the scope of the HL7 balloted standard.//

This companion guide enables the exchange of key clinical information among providers in the instance of a transition of patient care. Adoption and implementation of transition of care specifications provides the following benefits:

1. Establishes a common standard for the exchange of clinical information. By adherence to a common semantic model, the standard provides semantically consistent information across instances of exchange.

2. Implementation of the clinical constructs defined by the Transitions of Care Initiative ensures compliance with the following Meaningful Use criteria: Electronic Copy of Health Information, Electronic Copy of Discharge Instructions, and Clinical Summary for each Office Visit.

3. Facilitates the ease of adoption of Meaningful Use 1 and anticipated Stage 2, for which eligible providers receive a monetary incentive.

1.2. Audience
The audience of this companion guide includes, but is not limited to, software developers, vendors, the ToC Reference Implementation and Pilots Workgroup, and other HIT implementer parties. While this guide includes informative content intended to educate the audience on recommended HL7 Clinical Document Architecture, Release 2 (CDA R2) standard implementation specifications, the guide remains a supplement to the HL7 Implementation Guide for CDA Release 2: IHE Health Story Consolidation, Release 1 available through the HL7 Structured Documents WG page. The HL7 CDA R2 standard serves as the authoritative source for the complete specification for implementation and development and may be accessed through the HL7 site by HL7 members.

1.2.1. Requisite Knowledge
Readers of this guide are assumed to have functional knowledge of HL7 concepts including Clinical Document Architecture (CDA) and Reference Information Model (RIM) terminology. Readers must have knowledge of Extensible Markup Language (XML) and XPath syntax. Additionally, readers should have an understanding of user-controlled terminologies such as SNOMED CT, LOINC, CPT, ICD, and RxNorm. Resources for these concepts are available in the Additional Guidance section of this document.

1.3. Organization of this Guide
Guidance is organized in a manner to facilitate the assembly of ToC constructs through contextual explanations and functional guidance dictated by ToC Use Case priorities in support of health information exchange. There are four critical care transition constructs which are composed of CDA Consolidation templates at the section-level and entry-level. Please note that this companion guide does not replace the HL7 CDA Release 2: IHE Health Story Consolidation Implementation Guide, but rather references the guide where ToC functional priorities align with the standard specification.

The companion guide is organized in the following manner to guide implementations of Meaningful Use and 45 CFR 170 compliant transitions of care documents as dictated by the ToC Use Case:


 * ToC Functional Requirements
 * Use of ToC constructs and data elements
 * Clinical relevance and workflow applications
 * ToC Implementation Guidance
 * CDA examples
 * MDHT resources and examples
 * Additional Guidance
 * Specification and educational resources
 * Links to tool resources

1.4. Scope
The scope of the transition of patient care is defined in the use case as two scenarios, both supported by key outputs or constructs that contain specific patient information to facilitate the exchange of information in the event of a care transition.

1.5. ToC CEDD Overview
The four key information exchanges, or constructs, are supported by the Transition of Care Clinical Element Data Dictionary (ToC CEDD). The ToC CEDD provides a concise and defined vocabulary for the sharing of care transition information used to generate the constructs. The ToC CEDD provides the reference vocabulary for consistent and reusable care transition information exchanges. For more information on the ToC CEDD, see Section 2.

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