LTPAC+Care+Transition+Data+SWG+Charter

include component="page" wikiName="siframework" page="LCC Header" =Exchange of LTPAC Care Transition Data SWG Charter=

Challenge Statement
Improving care by improving safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity are national health goals that are threatened by the lack of clinical data standards for transitions of care. Many individuals receive services from multiple acute and post-acute sites during episodes of care. Because there are no shared standards concerning the clinical content required for a safe and effective transition, nor standards for the timing, process or format of the information, the clinical data available to the receiving clinicians during a transition of care is often inadequate. Failed transitions are at best inefficient and at worst unsafe. As a result, care may be provided that is unnecessary at additional cost and without additional benefit. Care may not be provided that is required resulting directly in patient harm.
 * [A statement of how a standards and interoperability challenge currently limits the achievement of a national health goal].**

Additionally, the lack of clinical data standards creates significant inefficiencies for both the "senders" and the "receivers" and adds unnecessary costs to the healthcare system. Senders do not know what receivers need and may send too little which results in inadequate care, or too much which takes more time and effort with no additional benefit. For receivers, inadequate information forces them to find the essential clinical data from other sources in order to provide safe and appropriate care which requires time otherwise better spent managing the patient's needs. Removing these inefficiencies would reduce the costs of care and is expected to improve the quality and continuity of care.

In aggregate, the population receives far more services from post-acute care providers than from acute care providers. Not only is the volume of services greater in post-acute care, but the sites of care are more varied and less integrated than are services within an acute care hospital. Transitions of care both between acute and post-acute care sites and among post-acute care sites often occur without the support of electronic records. During an episode of care, individuals often receive care at multiple sites and require multiple transitions of care. The risks posed by acute post-acute care transitions to health, safety and efficiency require a broad approach to improving transitions of care across the health care system. The critical first step to improve transitions of care is to define the essential clinical information required by receivers to provide safe and efficient care.

Goal and Scope
This sub-workgroup will create the data sets required for the most clinically relevant and common transitions of care with a completion date of March 2012. It is expected that these data sets will significantly improve the quality, safety, efficiency and effectiveness of care during clinical transitions, resulting in better care at lower cost with reduced adverse events.
 * [A statement of the value the SWG will create, in specific, measurable, attainable, relevant, and time-bound terms].**

This Sub-Work Group will create the following:
 * Sub-Workgroup Deliverables**
 * [A high-level outline of the SWG deliverables/outputs].**
 * Describe use cases, prioritization of transitions, and prioritization of data elements (Building off of prior ToC and CIM work)
 * Roadmap of Phasing/Milestones/Timeline
 * Success Metrics (Based on ToC work)
 * A priority list of acute-post acute transitions based on volume, clinical instability and acuity of the required information
 * Inventory of, and coordination with, existing standard data sets for these priority transitions (including CIM/CEDD, HL7 consolidated CDA, greenCDA, ONC Standards Committee)
 * Standard and prioritized clinical content defined by the receiving clinicians for all high priority transitions (probably developed in phases)
 * Mapping of this clinical content to existing vocabularies, including CIM/CEDD, Consolidated CDA, etc
 * Creation of an Implementation Guide
 * Steps towards standards acceptance (CIM/CEDD(S&I Harmonization), HL7 CDA (S&I Standards), ONC Standards Committee for MU Stage 3)
 * Piloting of standard
 * Keep Standards groups aware of this work, update periodically

Out of Scope for now:
 * Coordination of appropriateness of transition (what site is appropriate, interested, available) not concerned with pre-transition assessment
 * Facilitating communications between sites

General Operating Principles:
 * Interoperability of data sets across all LCC SWGs

Timeline
(Milestones/dates details is a deliverable)
 * [A high-level time, including key milestones and deliverable dates].**
 * High priority transitions data set drafts: 1/1/2012
 * Final drafts of data sets: 3/2012
 * Implementation guide: 4/2012

This workgroup is seeking participants who have any of the following interests or skills:
 * Request for Participants**
 * anyone interested in this topic and willing to work
 * content experts on clinical transitions
 * able to refine draft data sets
 * able to solicit feedback from "receivers" regarding proposed content
 * represent any large group of "receivers" including inpatient staff, ED personnel, outpatient test areas, LTAC, IRF, SNF, HHA, Hospice or patient advocacy groups

include component="page" wikiName="siframework" page="space.template.inc_contentleft_end"