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S&I FrameworkTransitions of Care Initiative
All Hands Meeting
June 18, 2012
Agenda
• Welcome & Announcements – John Feikema & Russ Ott
• Pilot Achievement & Next Steps – John Feikema
• State HIE Closed Loop Referral Project – Guest: Richard Eshbach
• Implementation Guidance Update – Harmonization Team
2
Welcome & Announcements
3
Transitions of Care Initiative Timeline
Pilot Achievement & Next Steps
5
Pilot Achievements
• Volunteer Lead: Mark Bamberg
• Influenced the contents for proposed 2014 Edition Meaningful Use
• Developed open-source tooling that can accelerate progress towards demonstrating meaningful use objectives
6
Pilot Logistical Updates
• For now, no further Pilot Work Group calls are scheduled
• In the future, the Transitions of Care Initiative will likely reach out to the Pilots via the mailing list
• What’s next?
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State HIE ProgramClosed Loop Referral Project
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• The Closed Loop Referral (CLR) project is an ONC sponsored initiative (not S&I).
• Promote the accelerated development and pilot-to-production of proposed MU/S2 functionality for CLR.
• The big focus will be on ubiquitous interoperability between players (different EHR, HISPs)…..
• And Direct workflow integration within the EHRs.
Sponsorship
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As quickly as possible using proposed MU Stage 2 standards, enable providers to exchange patient information for referrals from their EHR workflow, regardless of the EHR systems and/or HISP services used (i.e., allowing information to move point-to-point between unaffiliated organizations, differing EHRs, and differing HISPs) and with at least the same quality of workflow integration providers currently experience when referring between homogeneous EHR systems.
Mission
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• What we know…– CLR is technically possible today– Happens in homogenous EHR environments (Vendor A Vendor A)
• To what degree is a little unclear… – Doesn’t happen (much) in heterogeneous HIT environments (Vendor A Vendor B)
• Requires intermediaries and/or one-off implementations
• What we believe…– Standards exist to facilitate these exchanges
• Examples: Direct, consolidated CDA, etc.
– End-to-end implementation guidance and ‘gap-filling’ does not exist– Workflow of clinicians must be central concern– Common cross-vendor, industry-wide approach best path to widespread adoption
Key observations
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• Some initial examples:– Patient matching– Referral matching/linking– SMTP vs. XD*– Provider directories– Management of multi-format documents– Direct integration to EHR– Direct (HISP) interoperability / trust framework(s)
Potential issues/gaps to explore
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• Operating model is a mash-up– Direct Project / S&I Framework + “Labs over Direct” Pilot Program
• Approach– Group modeled on the Direct Project’s community-style forum and
operating practices– Engage vendors at the national level, seeking to define a minimum set of
common implementation guidance that may be widely deployed – Remain Agile throughout project– Have diverse group of stakeholders participate– Instantiate a series of pilot-to-production projects– Cross-community exchange will be a required success factor
How we (plan to) roll…
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• Broad email communication announcing launch to be disseminated this week
• Kick-off: first workgroup meetings in early July• Target: real-world implementations by HIMSS 2013• Timeline estimates (phased-approach)
– 1-2 months of requirements definition and gap analysis– 1-2 months of writing implementation guidance– 1-x months of implementation
• Vendor dependent on starting point
– Identify pilot-to-production sites during guidance development phase
Timeline
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• Identify workgroup leaders from the community• Define scope, use case, requirements– What does “success” look like?
• Inventory and assess existing capabilities• Perform gap analysis
First steps…
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• Confirmed participants:– Allscripts– Athena– GE– McKesson– MedAllies– NextGen– Siemens
• We’re recruiting more… • Would appreciate your involvement…
Who’s in?
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• Contact:– Paul Tuten ([email protected])– Richard Eshbach ([email protected])– Megan McMenamin ([email protected])– Wiki and project e-mail address forthcoming
• Likely a subdomain of the existing State HIE Resources site.
Want more info or to join?
Recent Progress
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Implementation Guidance Sub-Workgroup Activities• Volunteer Leads: David Tao, Dr. Holly Miller & Dr. Russell Leftwich
• Completing work of Transitions of Care Initiative efforts through the development of a Companion Guide
– Establishes clear guidance on the usage of the core clinical elements in common care transition scenarios
– Provides supplemental guidance as part of the tools and resources to lower the barrier to implementation
• Purpose is to develop clear guidance for the implementation of regulatory requirements on care transition exchange packages to meet clinician needs and Meaningful Use requirements.
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IG SWG Timeline
Initiative Companion Guide
• The ToC Companion Guide acts as a supplement to the Initiative’s recommended standard: HL7 CDA Consolidation Implementation Guide
– Contains supplemental guidance that is traditionally outside the scope of HL7 balloted standards
– Uses clinical scenarios to provide contextual information for business analysts and references for Physician Champions
– Contains XML examples based on the clinical examples for real-world care transition implementation guidance
– Describes HL7 CDA concepts which implementers may not have extensive knowledge of
– Provides specific implementation specifications for stakeholders to meet regulatory requirements
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ToC IG SWG Meetings• Implementation Guidance SWG meeting schedule
– Mondays 5:30PM – 7:00PM EST
– Wednesdays 2:00PM – 3:00PM EST **New**
• Current Activities:– Refining data elements for inclusion in the clinical scenarios– “Key Information
Exchanges”
• Completed Closed-Loop Referral: PCP to Specialist & Specialist to PCP
• Finishing Discharging Physician in Hospital Setting to PCP today
• To be completed: PCP to Patient, Discharging Physician in Hospital Setting to Patient
– Analysis on current C-CDA documents to determine “best fit” document recommendation for each clinical scenario
• Completed mapping of ToC CEDD data elements to Consolidated CDA
• To be completed: analysis of C-CDA document requirements to accommodate MU2 requirements and ToC recommendations
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VIRTUAL ROUND – QUESTIONS, COMMENTS, CONCERNS?
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