ToC+-+Success+Metrics+Meeting+Minutes+06-28-2011

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 * Date:** 06/28/11
 * Name:** Transition of Care (ToC) Success Metrics


 * Agenda/ Objectives:**
 * **Topic** || **Time Allotted** ||
 * Welcome and Introductions-John Donnelly and Holly Miller, MD || 3:00 – 3:10 EDT ||
 * Purpose of ToC Success Metrics WG || 3:10 – 3:15 EDT ||
 * Discussion of ToC Success Metrics Categories || 3:15 – 3:55 EDT ||
 * Next Steps || 3:55 - 4:00 EDT ||
 * Adjourn || 4:00 EDT ||

__Panelist Attendees:__ John Donnelly, Holly Miller, MD, Amy Berk, Smriti Singal, Brandy Hays
 * Attendees:**

__Sub-Workgroup Attendees:__ Allen Hobbs, Andriy Selivenonko, Arien Malec, Bob Dolin, Cindy Levy, Doug Pratt, Laura Hermann, Meredith Lewis, Mayuri Patel, Russ Leftwich, Sandy Stewart


 * Action Items:**
 * **Action Item** || **Next Steps / Status** || **Lead** || **Contributors** || **Due Date** ||
 * Update the ToC Metrics Matrix with proposed Categories as discussed during the Meeting || Completed || Smriti Singal || Amy Berk || 06/28/11 ||
 * Review and Comment on the ToC Metrics Matrix as posted to the Wiki || In Progress || SWG Members || Smriti Singal || 07/05/11 ||
 * Explore the research and come back with prioritization and then come back with the timelines || In Progress || SWG Members || N/A ||  ||

Statement of Purpose: To assess the success of the ToC Initiative through measureable improvements in quality, clinical workflow and adoption for patients undergoing clinical care transitions
 * Notes from Discussion:**
 * Measurable success factors here
 * Not quantitative enough to build measure around; the uptake and adoption of ToC; both requirements on the vendor side and uptake of use by the vendor side

Metrics Matrix Table: The table looks at four different areas;
 * 1) Uptake
 * 2) Workflow
 * 3) End User Experience
 * 4) Quality
 * What is the baseline at Year 0, Year 1, Year 2?
 * Want to see metrics that we can track over two years; what the actual measurement is and what the goal for the measurement is
 * May have some iterative nature for all of the categories
 * The goal that we set for year 1 could be different then what we set for Year 2

Metric Categories; Uptake
 * What do we need to do in terms of Uptake?
 * Vendor’s uptake?
 * Utilization
 * Industry in general
 * Certificates and Directories

Workflow and User Experience;
 * This might be in the EHR
 * The User stories and discussion to date has been around the end user experience and affect clinical workflow in a positive way
 * Reduction in cycle time or utilization; the patient might get more efficient care because the recipient clinician might recognize the tests needed
 * DIRECT reduces time in terms of reading the message or providing care to the patient
 * Wondering if DIRECT has impact on the availability of information at point of care

Meaningful Use;
 * Harmonization; if we have ToC we look at Stage I objectives for MU; is about electronic data exchange in the interest of treatment of a patient
 * Look at how MU Stage I has described things and blend into success metrics for ToC
 * Same for Stage II: Core Data Elements (CIM workgroup working on those data elements pertains to ToC
 * Metrics with requirements of MU

Quality;
 * Holy Grail category; healthcare transformation has been improving outcomes
 * Two areas; preventing adverse events
 * If clinician trying to take care of patient without any information about that patient; it is very difficult
 * Preventing adverse events by having information at the POC would be great
 * As a recipient clinician; if they receive too much data, it is hard for them to focus on the data that is appropriate to take care of the patient; no data overload; this will enhance the patient care experience

General;
 * We will probably have multiple goal columns; especially in the uptake area
 * Are you prioritizing the End User Experiences with research? No priority in mind as we place these on these page
 * For data overload; where is the evidence to suggest that there is an overload? Not grounded in research
 * Most of what we have here is not grounded in research; there is no subset of pre-direct users
 * **Before going too far, would it be helpful to explore the research and come back with prioritization and then come back with the timelines

Arien’s suggestions for organization;
 * Dividing in terms of:
 * Availability metrics
 * Process metrics
 * Outcomes metrics
 * Cost/efficiency outcomes
 * Clinical quality outcomes
 * What % of providers have these capabilities?


 * Available market in terms of number of providers?


 * Usage:
 * Core metrics in terms of number of and percent of ToC; information at POC
 * Subdivide those in terms of classifications; acute care admits, acute/ED discharge, LTC
 * Quality; data overload into end user experience
 * Readmits is a key quality outcome measure; work with ONC beacon team as well as CMS
 * In terms of MU
 * There is a MU ToC; there may be a way of taking MU category and looking at number of ToC; where clinical use summary ToC
 * Policy committee in at least one of the iterations have looked at Meds, Problems, and Allergies lists; availability at time of care of updated lists; as subset metrics of availability of information at point of care
 * Contemplating reconciliationupdated med list is an outcome of reconciliation
 * Patient consumer interaction
 * Consumer satisfaction in the context of ToC---it is the consumer side in which the metrics will be extremely powerful
 * Are there metrics done for DIRECT project?
 * There are existing DIRECT project, but take out Direct Availability from ToC Data Metrics
 * If the push approach is the one that gives us the potential measurement of uptake, may still want to keep an eye on it and use as a starting point
 * Uptake; workflow or quality area; should belong; have projects underway
 * Availability of information at POC
 * Adoption is a better term for uptake; how much activity going on for pieces of information for ToC
 * Having direct capability provided by an HER/PHR vendor
 * Adoption of what? What is live in test, what is live in production
 * Availability
 * Process (End User Experience/Workflow) Data Overload
 * Outcomes---Cost/Efficiency (Re-admits) and Clinical Outcomes
 * Usage---Adoption
 * Quality
 * Is readmit being correlated to a ToC? YES; CMS Partnership for Patient is concentrating on---getting updated information to the ambulatory care clinician; coordination of care post d/c is a key enabler of readmissions
 * Also need to think about admissions and not just re-admissions
 * Title of Column should just say “Metric Categories”
 * Try to get MU into one of these three---Consider MU under Outcomes


 * Next Steps:**
 * Measurable parameters of what we can look at across the period
 * Approach
 * Comments should be posted to the Wiki

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