PACIO Project: PSS for Personal Functioning and Engagement

1a. Project Name PACIO Project: PSS for Personal Functioning and Engagement 1b. Project ID 1731 1c. Is Your Project an Investigative Project (aka PSS-Lite)? No 1d. Is your Project Artifact being Reaffirmed or proceeding to Normative directly after being either Informative or STU? No 1e. Today's Date 1f. Name of standard being reaffirmed 1g. Project Artifact Information 1h. ISO/IEC Standard to Adopt 1i. Does the standard include excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption? 1j. Unit of Measure 2a. Primary/Sponsor WG Patient Care 2b. Co-Sponsor WG Community Based Care and Privacy 2d. Project Facilitator Monica Sampson, Dave Hill 2e. Other Interested Parties (and roles) Post-Acute Care Interoperability (PACIO) Community, Orders and Observations WG, Patient Administration WG 2f. Modeling Facilitator Tim Shaffer, Chris Pugliese, Brian Meshell 2g. Publishing Facilitator Dave Hill, Brian Meshell 2h. Vocabulary Facilitator Matt Elrod, Steve Buslovich 2i. Domain Expert Representative Monica Sampson, Joanne Wisely, Ashleigh Sheffield, Steve Buslovich, Matt Elrod 2j. Business Requirements Analyst Monica Sampson, Joanne Wisely, Ashleigh Sheffield, Mary Anne Schultz, Raj Mahajan 2k. Conformance Facilitator Chris Pugliese, Tim Shaffer 2l. Other Facilitators 2m. Implementers MITRE, Kno2, MaxMD, ESAC, MatrixCare, Patient Centric Solutions 3a. Project Scope An individual’s post-acute care information such as cognitive status, functional status, spoken language communication, swallowing, and hearing is crucial information to communicate for successful care coordination at transition of care and for on-going shared care. Information describing an individual’s post-acute care functioning across multiple domains is crucial information to communicate for successful care coordination at transitions of care and for on-going shared care. These domains include (but are not limited to) mental functions, sensory functions, voice and speech functions, and activities and participation concepts involving communication, mobility, and selfcare. Care coordination – when a patient transitions between healthcare settings, including ambulatory care, acute care, long-term post-acute care (LTPAC), and home- and community-based services (HCBS) – is often fragmented and can lead to poor health outcomes, increased burden, and increased costs. Interoperable health information exchange has the potential to improve patient and provider communications and supports access to longitudinal health information that enables improved efficiencies, improved quality of care, and improved health outcomes. Data should be usable across the continuum of care, and beyond the traditional healthcare system – into the community. The scope of this PACIO Personal Functioning and Engagement (IG) focuses on exchanging post-acute care observations primarily involving PAC transitions with various care settings and HCBS. The impetus for this focus is the amendment to the Social Security Act in 2014 to include the Improving Medicare Post-Acute Care Transformation (IMPACT) Act. IMPACT required the standardization and interoperability of patient assessment in specific categories for PAC settings, including long-term care hospitals (LTCHs), home health agencies (HHAs), 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. This IG is intended to include more broadly clinical domains in post-acute care observations (characteristics that can be tested, measured, or observed and are communicated with a name-value pair structure). We are using the conceptual framework of the International Classification of Functioning, Disability and Health (commonly known as ICF), to highlight areas of expansion in the future. More information on the concepts that may be included in this IG can be found in the ICF Browser. https://apps.who.int/classifications/icfbrowser/ The initial focus of this IG is on post-acute care observation data (not the representation of the condition, problem, diagnosis, or health concern) utilized by various settings by providing examples using observation data from a variety of observation-based data collection instruments, all of which have code system representation for the question/answer structure. This IG will be expanded to include other relevant observations utilized by health care settings and practitioners more broadly. A post-acute care observation is part of an evaluation or assessment of a patient’s status. The observation data, if present, will include supporting caregivers, non-medical devices, and the time period for which the assessment instruments were performed. In this IG a set of starter profiles based on some well-established FHIR resources is presented to define data models which specify data elements and coding standards to promote standardization and interoperability. Attachments 3b. Project Need Interoperability challenges persist in post-acute care; providers are not receiving complete and accurate information in a timely manner, leading to patient harm, adverse outcomes, and additional expense. 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 exchanging post-acute care assessments and associated clinical information between care settings to ensure that the receiving care setting has all of the relevant information they need to best treat the incoming patient, improving patient outcomes, reducing provider burden, improving cost efficiencies, and improving workflows. Moreover, it would allow for advanced computability, standardization, usability, and real-time analytics for PAC facilities, enabling broader use by health IT developers, researchers, providers, and payers. 3c. Security Risk No 3d. External Drivers The IMPACT Act requires 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. 3e. Objectives/Deliverables and Target Dates 6/16/2022 @ 5:00 pm ET: Present Project Scope Statement (PSS) to Patient Care Work Group 7/3/2022 Notice of Intent to Ballot (NIB) 8/21/2022 Final Content Deadline 8/23/2022 Ballot Readiness Sign Off 8/26/2022 to 9/26/2022 Ballot Open for Voting Tentatively end of Sept 2022 (but may postpone depending on progress): Begin ballot reconciliation Tentatively late 2023 (but may postpone depending on progress): Publish FHIR IG STU1 V1.0.0 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 (OASIS) used by Home Health Agencies (HHAs) 5) Functional Assessment Standardized Items (FASI) used among individuals receiving community-based long-term services and supports (CB-LTSS). Other Keywords: Cognitive skills, speech-language pathology, health literacy, feeding and swallowing, multi-modal functional communication, speech and voice 3g. Lineage This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile we will request approval from US Realm SC, and provide the US Realm approved rationale for deviation in the implementation guide where applicable. 3h. Project Dependencies PACIO Community schedules and participation 3i. HL7-Managed Project Document Repository URL: Personal Functioning and Engagement IG is currently available at: https://github.com/paciowg/functional-performance-ig Not yet published to an HL7-managed repository. 3j. Backwards Compatibility No 3k. Additional Backwards Compatibility Information (if applicable) 3l. Using Current V3 Data Types? N/A 3l. Reason for not using current V3 data types? 3m. External Vocabularies Yes 3n. List of Vocabularies TBD 3o. Earliest prior release and/or version to which the compatibility applies N/A 4a. Products FHIR Extensions, FHIR Implementation Guide, FHIR Profiles, Guidance (e.g. Companion Guide, Cookbook, etc) 4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to? FHIR R4 4c. FHIR Profiles Version FHIR R4 4d. Please define your New Product Definition 4d. Please define your New Product Family 5a. Project Intent Implementation Guide (IG) will be created/modified 5a. White Paper Type 5a. Is the project adopting/endorsing an externally developed IG? No 5a. Externally developed IG is to be (select one) 5a. Specify external organization 5a. Revising Current Standard Info 5b. Project Ballot Type STU to Normative 5c. Additional Ballot Info 5d. Joint Copyright No 5e. I understand I must submit a Joint Copyright Letter of Agreement to the TSC in order for the PSS to receive TSC approval. no 6a. External Project Collaboration Center for Medicare and Medicaid Services (CMS), Office of the National Coordinator (ONC), Department of Veteran Affairs (VA), American Speech-Language-Hearing Association (ASHA), APA (American Physical Therapy Association), AOTA (American Occupational Therapy Association), NASL (National Association for the Support of Long Term Care) 6b. Content Already Developed 20% 6c. Content externally developed? No 6d. List Developers of Externally Developed Content 6e. Is this a hosted (externally funded) project? Yes 6f. Stakeholders Clinical and Public Health Laboratories, Quality Reporting Agencies, Regulatory Agency, Standards Development Organizations (SDOs), Payors, Other 6f. Other Stakeholders Patients, Providers, Professional Organizations/Associations 6g. Vendors Pharmaceutical, EHR, PHR, Equipment, Health Care IT, Clinical Decision Support Systems, HIS 6g. Other Vendors 6h. Providers Clinical and Public Health Laboratories, Emergency Services, Local and State Departments of Health, Medical Imaging Service, Healthcare Institutions (hospitals, long term care, home care, mental health), Other 6h. Other Providers Physicians, Nurses, Respiratory Therapist, Audiologists, Speech Language Pathologists, Occupational Therapist, Physical Therapist, School Systems, Social Workers, and Dieticians 6i. Realm U.S. Realm Specific 7d. US Realm Approval Date Oct 12, 2021 7a. Management Group(s) to Review PSS FHIR 7b. Sponsoring WG Approval Date Sep 13, 2021 7c. Co-Sponsor Approval Date Aug 03, 2021 7c. Co-Sponsor 2 Approval Date 7c. Co-Sponsor 3 Approval Date 7c. Co-Sponsor 4 Approval Date 7c. Co-Sponsor 5 Approval Date 7c. Co-Sponsor 6 Approval Date 7c. Co-Sponsor 7 Approval Date 7c. Co-Sponsor 8 Approval Date 7c. Co-Sponsor 9 Approval Date 7c. Co-Sponsor 10 Approval Date 7e. CDA MG Approval Date 7f. FMG Approval Date Sep 29, 2021 7g. V2 MG Approval Date 7h. Architecture Review Board Approval Date 7i. Steering Division Approval Date 7j. TSC Approval Date Oct 18, 2021