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Submitting WG/Project/Implementer Group


Track Resources

Track Webinar

General CMS Connectathon Participant Information:

Justification and Objectives

The purpose of this track is to test integration of CMS assessment data elements from the Data Element Library (DEL) into health IT systems using FHIR APIs.

Post-acute care (PAC) providers are required to submit patient data to CMS for all patients using specific CMS assessments, at both admission and discharge, and at other points in between. These assessments include administrative and clinical data elements, which are used for quality measurement, payment, survey and certification, and public reporting.  In addition, providers can use the data elements found within CMS assessments to support quality improvement efforts, care planning, and for health information exchange when a person transitions between healthcare settings, including hospitals, outpatient services, home and community based services, PAC settings (Hospices, Home Health Agencies (HHA), Inpatient Rehabilitation Facilities (IRF), Long-term care Hospitals (LTCH), Skilled Nursing Facilities), and others. CMS assessment data elements are not limited to PAC settings; other healthcare settings outside of PAC also can use them to improve care.

CMS created the DEL to support standardization and interoperability of patient assessment data elements found on the following CMS assessments:

  • Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)
  • Long-Term Care Hospital Continuity Assessment Record & Evaluation (CARE) Data Set (LCDS)
  • Resident Assessment Instrument (RAI) Minimum Data Set (MDS)
  • Outcome and Assessment Information Set (OASIS)

The CMS DEL is the centralized repository of CMS assessment questions and response options (data elements), along with their related mappings to nationally accepted health IT standards (e.g. LOINC, SNOMED-CT), to support electronic data exchange to improve care coordination, health outcomes, and healthcare efficiencies.

This Connectathon track will allow us to confirm the quality of the IG materials, gain experience with testing, and show us where additional revisions to the IG may be helpful for implementers.

This track will use what version of FHIR.

This track will use version R4 of FHIR.

Clinical input requested (if any)

CMS assessments are developed by CMS with guidance from multiple sources, including clinical subject matter experts, measure developers, and others. While CMS is not seeking clinical input for assessment content as part of this Connectathon, clinical input is welcome regarding the process of integrating CMS assessment content into clinical IT workflows.

Related tracks

PACIO Functional Status Track

PACIO Cognitive Status Track

Proposed Track Lead

Jessica Skopac,

Expected participants

Jessica Skopac (MITRE), Beth Connor (CMS), Lorraine Wickiser (CMS), Liz Palena Hall (ONC), Sean Mahoney (MITRE), Tim Shaffer (MITRE), Dave Hill (MITRE), Michelle Dougherty (RTI), Zabrina Gonzaga (Lantana Group)

Track Orientation

A webinar, scheduled on December 17th at 3pm EST, will provide further information about participation in this track.

Access Information

  1. Please call the following number:

          WebEx: 1-877-267-1577

  1. Follow the instructions you hear on the phone.

Your WebEx Meeting Number: 996 198 039


To join from a Cisco VoIP enabled CMS Region or from CMS Central Office

  1. Dial ext. 63100

Enter Meeting Number: Use Meeting WebEx Number provided above.


To join this meeting online

  1. Go to
  2. If requested, enter your name and email address.
  3. If a password is required, enter the meeting password: (This meeting does not require a password.)
  4. Click “Join”.
  5. Follow the instructions that appear on your screen.

System Roles

Data Element Library (DEL) – will provide CMS standardized assessment data elements via FHIR API
Health IT system – client will pull data from DEL, streamlining CMS assessment integration into health IT systems

The FHIR implementation guide for the DEL can be found at

Role 1 Name


Scenario 1- CMS releases a new PAC assessment version scheduled for October 2020 implementation in the DEL. Health IT vendor will integrate the new PAC assessment content into existing software to support clinician completion of patient assessment for every patient at admission and discharge.

Step 1: Integrate new assessment version into health IT systems using DEL FHIR API.

Step 2: Complete patient assessment prior to patient discharge from healthcare setting A.

Scenario 2- CMS releases new LOINC and SNOMED mappings for PAC assessments in the DEL in December 2019. Health IT systems integrate new mappings into their systems to support health information exchange between providers.

Precondition: HIT system has previous LOINC and SNOMED mappings in the system; DEL content is integrated into HIT system.

Step 1: Retrieve new LOINC and SNOMED mappings from DEL.

Step 2: Integrate new mappings. For example, demonstrate how mappings would be incorporated into data tables.

Success Criteria: Read, store, and use new LOINC/SNOMED mappings in HIT system.

Bonus point: Complete CMS assessment and selective auto-population of patient standardized assessment data between systems to reduce provider burden.


Testing will be done through ONC Inferno.  Test scripts can be found at

Security and Privacy Considerations

This track will not use any PII/PHI, only synthetic data.

The DEL contains no PII/PHI.

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