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1a. Project Name

Centers for Medicare and Medicaid Services (CMS) Data Element Library (DEL)

1c. Is Your Project an Investigative Project (aka PSS-Lite)?


1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?


2a. Primary/Sponsor WG

Patient Care

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballotRequest periodic project updates; specify period in text box below (e.g. 'Monthly', 'At WGMs', etc.)

2d. Project Facilitator

Dave Hill

2e. Other Interested Parties (and roles)

Office of the National Coordinator (ONC)

2f. Modeling Facilitator

Tim Shaffer

2g. Publishing Facilitator

Hibah Qudsi

2h. Vocabulary Facilitator

Siama Rizvi

2i. Domain Expert Representative

Sean Mahoney

2j. Business Requirements Analyst

Sean Mahoney

2k. Conformance Facilitator

Tim Shaffer

2m. Implementers

Sean Mahoney, Tim Shaffer, Jake O'Donnell, Dave Hill

3a. Project Scope

Poor quality discharge information is a major barrier to safe and effective transitions. With 45% of Medicare beneficiaries requiring post-acute care (PAC) services after hospitalization, the need for a seamless exchange of health information is great.

In 2014, the Social Security Act was amended to include the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, which required the standardization and interoperability of patient assessment in specific categories for post-acute care (PAC) settings, including long-term care hospitals (LTCHs), home health agencies (HHAs), skilled nursing facilities (SNFs), and inpatient rehabilitation facilities (IRFs). It focuses on standardizing data elements in specified quality measure domains and patient assessment domains for cross setting comparison and clinical information exchange, respectively. The Act requires:

• Reporting of standardized patient assessment data through commonly used PAC assessment instruments for LTCHs, SNFs, HHAs, and IRFs
o Minimum Data Set (MDS)for SNFs
o Inpatient Rehabilitation Facility – Patient Assessment Information (IRF – PAI) for IRFs
o LTCH Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) for LTCHs
o Outcome and Assessment Information Set (OASIS) for HHAs
• Implementation of data elements specified in each assessment domain using standardized data elements to be nested within the assessment instruments currently required for submission by LTCH, IRF, SNF, and HHA providers
• Data to be standardized and interoperable to allow exchange of data between PAC providers, among others, using common standards and definitions to provide access to longitudinal information and facilitate coordinated care.

The CMS Data Element Library (DEL) supports IMPACT Act requirements by serving as the centralized repository for CMS PAC assessment data elements and their associated health information technology (IT) standards to promote interoperability of patient data.

Required assessment content includes standardized questions and response options (aka “data elements”) for assessing a patient’s functional status, cognitive function/mental status, special services/treatments/interventions, medical conditions/co-morbidities and impairments.

The mission of the Data Element Library (DEL) is to create a comprehensive, electronic, distributable, and centralized resource of CMS assessment instrument content. In support of the IMPACT Act, the goals of the DEL are to:
• Serve as a centralized resource for CMS assessment data elements (questions and response options)
• Promote the sharing of electronic CMS assessment data sets and health information technology standards; and
• Influence and support industry efforts to promote Electronic Health Record (EHR) and other health IT interoperability

PAC providers are required to submit data for all patients at admission and discharge , using PAC assessments, to the CMS Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system. This data is used for quality measurement, payment, survey and certification, public reporting, and other CMS and provider activities. Furthermore, because providers are required to submit this data to CMS for all patients at both admission and discharge, it can be reused and exchanged during care transitions to inform patient care.

3b. Project Need

Despite the development of the DEL, interoperability challenges persist; providers are not receiving complete and accurate information in a timely manner, leading to patient harm. Failure to exchange accurate, timely data often leads to inefficient workflows, duplicative data entries, and increased risk of patient harm attributable to missing or inaccurate information. Health IT can significantly alleviate this administrative burden by incorporating PAC assessments and DEL content into electronic health records (EHRs) to facilitate health data exchange and therefore improved patient outcomes, reduced provider burden, improved cost efficiencies, and improved workflows. Moreover, it would allow for advanced computability, standardization, usability, and real-time analytics of the DEL via FHIR interfaces for PAC facilities, enabling broader use by health IT developers, researchers, providers, and payers. As the PAC assessments are updated on a regular basis, a DEL FHIR API could ensure EHRs had access to the most current data sets.

Starting in FY 2018, MITRE developed prototype source definitions for a set of FHIR profiles that describe how to use FHIR to convey the DEL patient assessment information defined by the IMPACT Act. The proof-of-concept prototype demonstrated that the DEL patient assessment information could be fully described by a generated FHIR Implementation Guide (IG), through FHIR profiles and extensions, which will allow Health IT implementers easy access to the information to the DEL. Further work is underway to provide a complete IG and reference implementation for DEL resources and data. The success of the reference implementation could inform future efforts defining FHIR IGs for all PAC data that would also harmonize with other interoperability initiatives across the healthcare spectrum, including acute and ambulatory care.

3c. Security Risk


3d. External Drivers


3e. Objectives/Deliverables and Target Dates

Project Scope Statement Due: 2019 Aug 16
FHIR IG Proposals Due: 2019 Nov 3
Notice of Intent to Ballot: 2019 Nov 17
FHIR Ballot Core Substantive Freeze: 2019 Nov 29
Initial Content Deadline: 2019 Dec 1
Reconciliation Deadline and Ballot Preview Period: 2019 Dec 8
Final Content Deadline: 2019 Dec 22
Ballot Readiness Sign Off: 2019 Dec 27-28
Ballot Open for Voting: 2019 Dec 27 – 2020 Jan 27

3f. Common Names / Keywords / Aliases:

PAC Assessments 1) Resident Assessment Instrument (RAI) Minimum Data Set (MDS) used by Skilled Nursing Facilities (SNFs) 2) Inpatient Rehabilitation Facility – Patient Assessment Information (IRF-PAI) used by IRFs 3) LTCH Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) used by Long-Term Care Hospital (LTCHs) 4) Outcome and Assessment Information Set used by Home Health Agencies (HHAs)

3g. Lineage


3h. Project Dependencies

To be determined

3i. HL7-Managed Project Document Repository URL:

3j. Backwards Compatibility


3l. Using Current V3 Data Types?


3m. External Vocabularies


3n. List of Vocabularies


3o. Earliest prior release and/or version to which the compatibility applies


4a. Products

FHIR Implementation Guide, FHIR Profiles, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

FHIR version R4

4c. FHIR Profiles Version

FHIR version R4

5a. Project Intent

Create new standard

5b. Project Ballot Type

Comment (aka Comment-Only)

5d. Joint Copyright


6a. External Project Collaboration

Center for Medicare and Medicaid Services (CMS), Office of the National Coordinator (ONC), Post-Acute Care Interoperability (PACIO) Project

6b. Content Already Developed


6c. Content externally developed?


6e. Is this a hosted (externally funded) project?


6f. Stakeholders

Quality Reporting Agencies, Regulatory Agency, Standards Development Organizations (SDOs)

6g. Vendors

EHR, PHR, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS



September 14, 2019 9:00 AM - 10:00 PM  &  September 15, 2019 9:00 AM to 5:00 PM

 at the Atlanta Marriott Marquis in Atlanta, Georgia.

The contact for this event is Sandy Vance who can be reached at or +1.614.273.5916


Plan a Track! by clicking here. Track Proposals are due July 31, 2019.

Early Bird Registration is available through Saturday, August 24, 2019.


If you or your company are interested in participating in the connectathon, please do the following:

  1. Read the Connectathon version of the FHIR Specification and the FHIR wiki if you haven't already done so, to become familiar with the concepts.
  2. Read the Track descriptions found in the drop down list on the left under Tracks for Connectathon 22.
  3. Register to attend the WGM, and make sure to select the Connectathon option when you do
  4. Complete the HL7 FHIR Pre-Connectathon Survey (Link available SOON!) for each member of your team to indicate their primary track.

Space at the venue is limited, so please register as soon as possible. Preference will be given to those who are participating in the technical event. Observers are welcome if space permits.

For any queries, either contact Sandy Vance at, a member of the planning team, or post your question in the FHIR list serve.

Helpful Links:

Pre Connectathon Survey

Con Man App

Connectathon Manager Orientation Video

Break Out Room Schedule

Connectathon Planning Team

FHIR Tutorials

  • There are several FHIR tutorials scheduled through-out the week and a full list can be found by clicking the word "Tutorials" in the upper right corner of the Event Brochure which can be found here.

FHIR Proficiency Exam

  • The FHIR proficiency test allows test takers to demonstrate their knowledge and understanding of the specification. This is a basic proficiency test, not a professional credentialing test. It will be multiple choice, multi-select, and true/false and based on the STU3 specification and not on field knowledge. Those who pass the test will receive the FHIR Proficiency Certificate, a Certificate of Knowledge.

Work Group Meetings

HL7 WGMs are where a lot of the development work on FHIR happens. Numerous work groups will be considering FHIR change proposals, working on FHIR profiles and resources, and debating other aspects of FHIR implementation. There will also be meetings of the FHIR Governance Board and FHIR Management Group discussing policies relating to FHIR. There are often ad-hoc meetings at breakfast, lunch and after-hours to discuss items of interest such as tooling, new domains, particular technical issues, etc.

You can take a look at the Event Brochure to get a sense of the breadth of discussions that will be taking place.

Participating in the WGM is a good way to get a sense of the people involved in building the spec, to form relationships, to get more deeply involved in the FHIR community and to influence how the standard evolves.

Location: Atlanta Marriott Marquis hotel (same as the HL7 Working Group Meeting occurring September 14-20)

Date of Training Workshops: September 11-13 2019

Training will occur 1-5pm on Wednesday and 9-5pm on Thursday and Friday

The FHIR Implementation Guide (IG) Workshop is for a series of three restricted, limited space workshops targeting IG publishers and new ballot reviewers.  All attendees will be nominated in advance by the FHIR Core team.  

The FHIR Core Team hasn’t identified a list of invitees yet, but if you’d like to suggest names to be included to the waiting list, just let us know and we’ll inform you when more details are available.

Entries below should select the appropriate workshops desired:

Workshop 1: Implementation Guide Creation (Wednesday afternoon and all day Thursday)
Workshop 2: Terminology considerations (Friday morning)
Workshop 3:  Implementation Guide Ballot Review Best Practices (Friday afternoon)

  • Indicates application email received by Wayne Kubick
NameOrganizationEmailWorkshop 1:
IG Creation

Workshop 2: Terminology Considerations

Workshop 3:
IG Ballot Review Best Practices
Linda Michaelson Optumlinda.michaelsen@optum.comXX
Email from Linda (to Wayne Kubick): 

Yes, please put me on this list.  I am copying in my Da Vinci team to promote me for the workshop – I am a co-lead on several workgroups and would like to be able to at least help in this process. From a scheduling perspective, when do you think it will be held? Linda

Lisa Nelson*MaxMDlnelson@max.mdXXXRecommended by Wayne. Lisa has a candidate who is willing to learn and offer significant in kind contributions for creation and review.  
Cheng Lui*MaxMD
XXXRecommended by Lisa
Benjamin Flessner

Recommended by Sean McIlvenna
George DixonAllScripts

XRecommended by Sarah Gaunt
Emma JonesAllScripts

XRecommended by Sarah Gaunt
John Hatem

XRecommended by Melva Peters
Andrew StatlerCernerAndrew.Statler@cerner.comX

Recommended by Sean McIlvenna
Reuben Daniels
Recommended by Sarah Gaunt
Micheal Lawley
Recommended by Sarah Gaunt
Smita HastackSamvit

XRecommended by Lloyd McKenzie
Robinette Renner

Recommended by Lloyd McKenzie
Rik Smithies
XRecommended by Lloyd McKenzie
Linda MichaelsenOptumlinda.michaelsen@optum.comX
XRecommended by Bryn Rhodes (Duplicate of Row 1)
Patrick WernerMOLIT Institutpw@molit.euXXX
José Costa Teixeira XXX
John Moehrke* XXXRecommended by José 

CDISC has a couple of people they'd like to send - need named individuals; and CDISC hasn't been participating in IG creation or ballot reviews.
Oliver Egger*ahdis / hl7 swtzerland

Christine (Christi) Denney
Christi_d@lilly.comXXXRecommended by BR&R and Trisha Simpson.  Author of 1 IG from BR&R for Sept 2019.  Will be assisting with IG development for Research.
Craig NewmanAltarumCraig.Newman@altarum.orgXXXIs working on Reference implementations and would like to attend (Recommended by Dave Pyke)
Becky AngelesCarradorabecky.angeles@carradora.comXXXWas the originator of the eLTSS project and would like to attend (Recommended by Dave Pyke)
Sheridan CookGevityscook@gevityinc.comXXXFormerly w/ MiHIN, lots of experience doing IG-type work w/ v2, has now done v3 publisher work with FHIR (Recommended by Lloyd McKenzie)
Joee GarciaGevity

XDeveloper/analyst who's been helping Lloyd with IG creation & review (Recommended by Lloyd McKenzie)
John BenderONCjohn.bender@hhs.govXXXRecommended by Matt Rahn and Wayne Kubick.
Paul KnappKnapp
Jamie ParkerCaradorrajamie.parker@carradora.comX
XRecommended by Dave Pyke
Scott Gordon FDAGideon.Gordon@fda.hhs.govXXXRequest to Wayne
Keith Boone*

Kathleen Connor*

Ben McCallister*Cerner

Corey Smith*

Yan Heras*

AbdulMalik Shakir*

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