1c. Is Your Project an Investigative Project (aka PSS-Lite)?
1d. Is your Project Artifact being Reaffirmed or proceeding to Normative directly after being either Informative or STU?
1e. Today's Date
Sep 20, 2019
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
2b. Co-Sponsor WG
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.)
2c. Co-Sponsor Update Periods
2d. Project Facilitator
2e. Other Interested Parties (and roles)
Patient Administration Work Group, PACIO Project
2f. Modeling Facilitator
2g. Publishing Facilitator
2h. Vocabulary Facilitator
2i. Domain Expert Representative
2j. Business Requirements Analyst
Mary Anne Schultz
2k. Conformance Facilitator
2l. Other Facilitators
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.
Required assessment content includes standardized questions and response options (aka “data elements”) for assessing a patient’s cognitive status.
This project seeks to:
(1) determine the data model required to comprehensively exchange functional status information between health care settings,
(2) develop FHIR Implementation Guides, Profiles, and necessary Extensions to specify how to syntactically and semantically exchange that data between care settings, (3) develop client and server reference implementations to validate the Implementation Guide, Profiles, and Extensions work in a software system, (4) develop automated test suites to validate operation, and (5) build real world pilots that successfully demonstrate the new capabilities in production.
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
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
Project Scope Statement Due: 2019 Oct 4
FHIR IG Proposals Due: 2020 Feb 16
Notice of Intent to Ballot: 2020 Mar 1
FHIR Ballot Core Substantive Freeze: 2020 Mar 13
Initial Content Deadline: 2020 Mar 15
Reconciliation Deadline and Ballot Preview Period: 2020 Mar 22
Final Content Deadline: 2020 April 5
Ballot Readiness Sign Off: 2020 Apr 10-11
Ballot Open for Voting: 2020 Apr 10 – 2020 May 11
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)