Review+CIM+Scope+Statement


 * What would the scope of the Transitions of Care Clinical Information Model look like?**

__A clinically-centered model that describes the clinical information exchange needed for each care transition from the S&I Framework Transitions of Care Use Case and describes the meaning and interrelation of the information dealt with by clinicians and specialists. The objective of this model is to express each care transition in consistent, re-usable and standardized way, and to do so using an object view.__

Scope would be limited to **the use case care transitions (specifically, the EHR and supporting systems)** that reside in the clinician and specialist's offices, and the clinical workflow involved in each care transition. It would specifically cover the core clinical concepts of :
 * 1) Discharge Summaries - to include the following key information components:
 * Patient
 * Primary Care Providers
 * Facility
 * Encounter details
 * Problems/diagnoses
 * Clinical summary
 * Diagnostic investigations
 * Clinical interventions
 * Current medications on discharge
 * Reconciled medications
 * Allergies/adverse reactions
 * Alerts
 * Recommendations
 * Attachments
 * 1) Discharge Summary
 * 2) Discharge Instructions
 * 3) ADD FURTHER USER STORY TRANSITIONS BELOW

//**NOTE: Additional components to consider?**// Component as part of the CIM is defined as a grouping of key data elements


 * Why would it be needed?**

This model would serve as a supplement to any harmonized implementation specification that is developed as part of the S&I Framework. This CIM could be used to determine specific areas where simplification to an implementation guide could be made (by defining only the minimum data elements needed for each care transition).

This CIM will also need to be kept in full alignment with the activities being conducted in the Transitions of Care Standards Analysis SWG. Members of that SWG will also be participating in developing the Transitions of Care CIM.


 * What would it look like?**

The Transitions of Care CIM could be based on a single or multiple representations, based on a review of existing clinical information modeling efforts and the underlying information models of the standards being considered:
 * FHIM
 * NEHTA e-Discharge Summary DCM (Detailed Clinical Model)
 * HL7 V3 RIM (normative)
 * HL7 V3 RMIM
 * IHE PCC


 * Notes - April 21**


 * SWG agrees that the user stories are the foundation for this list of CIM components
 * Reviewing the superset and allow EHR vendors to work down into the necessary elements
 * Change in scope to focus on "clinical information exchange"
 * Evaluate the use of the word "standardized"
 * Focus on the minimum data elements needed for each care transition in the CIM - highlight variable or optional data elements as well
 * Make sure we try to incorporate the patient perspective
 * Alignment with AHRQ/USHIK
 * Focus on the word "minimum"
 * Semantic interoperability to PHR is out of scope (Stage 1 and possible Stage 2 MU requirements)
 * Scope of self-care is out of scope (Stage 1 and possible Stage 2 MU requirements)
 * Focus of the CIM would be on adoption
 * Focus on clinician-clinician and/or facility-facility
 * Holly Miller suggests the minimum scope be set in our 4 key areas
 * 1) Demographics
 * 2) Reconciled Active Medication List
 * 3) Active Allergies and Intolerances
 * 4) Active Problem List