LTPAC+Care+Transitions+SWG+Minutes+2012-01-23

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**Meeting Agenda:**

 * **Topic** || **Time Allotted** ||
 * Merging Excel versions of User Stories || 15 mins ||
 * Linking steps in user stories in Excel to supporting documents || 10 mins ||
 * Modify Section 10 of Use Case to be "Receiver-centric" || 10 mins ||
 * Suggest issues that need to be addressed in Use Case || 15 mins ||
 * Reconcile edited versions of Use Case || 10 mins ||

Attendance
Larry Garber, Terry O'Malley, Charlotte Weaver, Kris Cyr, Sue Mitchell, Susan Campbell, Paul Burnstein, Elizabeth Milton, Emma Jones, Rhonda York, Russell Ott, Saunya Williams, Shalina Wadhwani, Jennie Harvell, Meredith Lewis, Allen Hobbs, Jennifer Sisto

Action Items

 * **#** || **Action** || **Owner** || **Status** || **Due Date** ||
 * 1 || Post the transitions that match the priority grid for the User Story on the SWG wiki || Terry O'Malley || Complete || 1/24/12 ||
 * 2 || Set up space on the SWG wiki to post narratives || Kris Cyr || In progress || 2/10/12 ||
 * 3 || Post data elements from the IMPACT project to the SWG wiki || Terry O'Malley || In progress || 2/10/12 ||

**Key Discussion Points:**

 * Terry has begun development of a User Story with 47 transitions of care in a patient episode that spans 6 months. 35 of these transitions match the priority grid.
 * The User Story is included in Section 10 of the Transitions of Care SWG Use Case.
 * A spreadsheet with the transitions was displayed for discussion and will be posted on the SWG wiki.
 * A narrative of the User Story is also being written.
 * As the Use Case is further developed the SWG may need to consider transitions where the information (data) moves but the patient may not move.

**Key Discussion Points:**

 * Scenarios should include transitions among the following types of facilities:
 * Acute Care Hospital (ACH)
 * LTPAC
 * LTAC
 * IRF
 * SNF/ECF
 * HHA
 * Hospice
 * How does the SWG eventually include Behavioral Health in the Use Case? Transitions among BH providers as well as transitions BH providers and otehr types of providers (see above)

**Key Discussion Points:**

 * 4 Significant components of a Transition of Care:
 * Information (data)
 * Timing
 * Process of Information Exchange (e.g. phone, fax, EHR, etc.)
 * Format of the data
 * There was discussion about whether the Use Case should include current state vs. future state information.
 * A suggestion was made to start with the data elements and then document the process of informaiton exchange.
 * It will be important to show the complexities of care transitions in the LTPAC environment, such as multiple senders and receivers in one transition of care.
 * Narratives could be included int he User Story describing the Actors at various receiving sites.

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