LTPAC+Care+Transitions+SWG+2012+04+02

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**Meeting Agenda:**

 * = **ID** ||= **Key Discussion Items** ||= **Duration** ||= **Presenter** ||
 * = 1 ||< Review Updated Use Case ||= 40 Minutes ||= Kris Cyr, All Team ||
 * = 2 ||= Discuss Functional Requirements ||= 20 Minutes ||< All Team ||

Attendance
Ann Clarke, Ed Larsen, Jim Brennan, Larry Garber, Paul Burnstein, Sandy Stuart, Shalina Wadhwani, Terry O’Mally, Kris Cyr, Rhonda Oaks, Liz Milton, Sue Mitchell, Susan Campbell

Meeting Notes
Work group finished drafting suggestions for cognition, function and pressure ulcers, which were put into spreadsheets and sent to Don Mon at RTI Workgroup to consider how to consult in Use Case

Face to Face Agenda Planning - Discuss alignment with ToC 1.1 transactions and their extension Determine how these things move in the direction of supporting the Longitudinal Care Plan Condition, procedure, medication-specific data elements and ensuring standards can accommodate this level of detailed breakdown Vision for ToC/Next level of detail – laying out future Top 10 CMS conditions – identify the data that needs to be included Align with work that has already been done CEDD did attempt to categorize data elements as required for all transitions, and then took deeper dives with additional levels CHF and Anti coagulation as a starting point Use Case Visioning Patient-specific/procedure based information Everyone bring as many resources to the Face to Face as possible – use CMS list as a starting point, additional the CDC information Larry – high risk medications, Terry – knowledge needed for procedures HEDIS, e measures in the data dictionary (QH – Kim Nolan, Lindsay Hoggle, Susan Nedza) Advance Directives – Data elements that refer to code status/goals of care; need to make this more granular More nuance in decisions around life sustaining treatments than can be currently captured in our data set; also wide range of data sets that exist for POLST and MOLST in state systems MA/NY merged data set to serve as a starting point

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