Transitions+of+Care+Initiative+CEDD

=Transitions of Care Initiative Clinical Element Data Dictionary (CEDD)=

To provide feedback on the latest release of the Transitions of Care CEDD, please access the feedback form though the Transitions of Care CEDD 2.0 wiki page.

Version History of Transitions of Care CEDD

 * = **Document** ||= **Version** ||= **Upload Date** ||= **Notes** ||
 * < [|Transitions of Care CEDD] ||= 2.0 ||= February 2012 ||< Includes "A, B and C" objects and data elements, approved by the Transitions of Care Initiative ||
 * [|Transitions of Care CEDD] || 1.0 ||= December 2011 || Includes "A" objects and data elements, approved by the Transitions of Care Initiative ||
 * TOC Clinical Information Model (CIM) || 1.5 ||= October 2011 || Transitions of Care Clinical Information Model ||

Overview of Transitions of Care CEDD
A data dictionary is a repository of data elements, their corresponding definitions, and attributes of the clinical information that is used in a clinical context. The dictionary lists the data elements and corresponding definitions that are needed to convey the clinical perspective in a manner that is understandable to a variety of stakeholders, including functional and technical experts. Additionally, these data elements support the electronic exchange of health information through a core set of unambiguously-defined data elements that promote semantic compatibility. The Transitions of Care (ToC) Clinical Element Data Dictionary (CEDD) represents the clinician perspective of clinical data required in care transitions to fulfill the ToC Use Case. In this document, the initial sections are to provide explicit guidance to stakeholders who may not have any exposure to the ToC initiative or the underlying mission of the ToC CEDD. Subsequent sections are focused on the more technical specifications recommended for the exchange of ToC CEDD Data Elements, including data types, references to HL7 CDA, and applicable value sets.

Audience
The intended audience for the ToC CEDD includes the following stakeholders:
 * **Providers and Specialists:** Provides a clinical perspective and view into care transition data relevant to providers and specialists
 * **Care Coordinators:** Ensures that in each care transition, the relevant clinical data that is needed by the care coordinator is available
 * **Electronic Health Record (EHR) Vendors:** Provides EHR vendors a view into the type of the clinical data needed to support each care transition
 * **Personal Health Record (PHR) Vendors:** Provides PHR vendors a view into the type of patient-level data that care transitions produce and that may be requested from patients

Requisite Knowledge
Readers are encouraged to have knowledge of the following concepts in order to best understand the intended usage of the ToC CEDD:
 * Knowledge of Health Level Seven International (HL7) Clinical Document Architecture (CDA) R2. This is critically important as CDA served as the foundation for ToC CEDD.
 * Knowledge of the ISO 21090 HL7 data type and CDA specifications. An overview of applicable data types is provided in the Usage of HL7/ISO Data Types section of Transitions of Care CEDD, Version 2.0.
 * Knowledge and functions of the Transitions of Care Initiative

=Introduction=

S&I Framework Background
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. The Transitions of Care (ToC) Initiative was among the first initiatives launched by the S&I Framework. The ToC Initiative focuses on empowering patients, engaging the clinician, and enabling health information exchange in support of national health initiatives.

Transitions of Care Initiative Overview
The purpose of the Transitions of Care initiative is to improve 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 Initiative is motivated by one very compelling question: What if every care transition was accompanied by an unambiguously-defined core set of high-quality clinical data?


 * Key Functions of the ToC Initiative:**
 * Focus on core clinical content that could inform complete reconciled medication, problem, medication reaction, laboratory results, etc.;
 * Build on existing standards to accelerate results;
 * Work with the healthcare community to lower the implementation burden; and
 * Guide decision-making based on the requirements of meaningful use and IOM-identified needs for improvement in the quality of care.


 * Key Outputs of the ToC Initiative:**
 * Unambiguous definition of the core clinical elements that should be included in care transitions
 * Definition of four key clinical Constructs that provide guidance on the exchange of information in the event of a patient care transition
 * Agreement on a single standard in support of Meaningful Use requirements, which minimizes interoperability errors and streamlines patient care coordination
 * Tools and resources to lower the barrier for implementation

ToC CEDD Primer
In addition to addressing the need for an unambiguously-defined core set of clinical data, the ToC CEDD is intended to serve as a logical overlay and neutral representation of the data needed to support care transitions. The value proposition inherent in the ToC CEDD is that it:
 * Provides a view for clinicians into the type of data needed to support each care transition
 * Provides implementers and vendors an idea of how to store and exchange that data
 * Serves as a logical view of the common data model that underlies all care transitions

In practice, it will manifest itself as physical data within an organization engaged in care transitions. The work on the ToC CEDD was guided by practicing clinicians and other implementers who were interested in creating a simple, easy-to-understand model for functional stakeholders to use. The ToC CEDD also draws heavily from best practices and models defined by several organizations supporting the S&I Framework mission, including:
 * National E-Health Transition Authority (NEHTA)
 * Federal Health Information Model (FHIM)
 * HL7 Version 3
 * GE/Intermountain Healthcare Clinical Element Models (CEM)
 * Quality Data Model (QDM)

Specific sources of information were drawn from the existing work of these organizations to create ToC CEDD Objects and to help define the structure of the dictionary. It was not the intention in the development of the ToC CEDD to specifically adopt an information model already in use, nor to redefine existing information models – the objective was to leverage previous work to create a new type of representation specifically targeted to the requirements of clinicians who may not have a deep understanding of care transition data, its structure, and its flow.

ToC CEDD Origin
Throughout the development of ToC Initiative specifications, the need for a common information model became apparent during analysis of existing standards and barriers to electronic exchange of information. While common data elements existed between the ToC Selected Standard, HL7 Clinical Document Architecture (CDA), other applicable standards, and various health care information models, ambiguous definitions prevented accurate harmonization for an interoperable standard. To best demonstrate the complex relationships between data elements and objects, the Initiative initially pursued the development of a Clinical Information Model (CIM), which combined the traditional data dictionary model with a logical model. The resulting CIM was the harmonization of the clinical requirements for the ToC Use Case Scenarios, the CDA, and other applicable standards for a harmonized care transition information model. As an important output of the ToC Initiative, the CIM is best represented in the form of a data dictionary. The transition ensured a clear representation of data elements supporting the ToC Use Case, while maintaining the level of abstraction necessary to support various business needs. In congruence with this change in representation, the ToC CIM is now referred to as the ToC CEDD, but maintains the important modeling properties to best serve as an artifact for reuse and a tool for implementers.