HIT Policy Committee: Long-term care needs better standards

A lack of definitions for plans of care and the limitations of current and proposed standards for care transitions are just two of the challenges facing long-term care providers when it comes to complying with Meaningful Use (MU).

Evelyn Gallego, Standards & Interoperability Initiative coordinator at the Office of the National Coordinator for Health IT, presented the longitudinal coordination of care (LCC) work group’s findings on the challenges and opportunities for long-term care during the April 3 meeting of the HIT Policy Committee.

There has been much discussion around transitions of care and exchange of care plans for MU Stage 3, but there are gaps in achieving MU Stage 3 proposed recommendations, she said.

Several elements are ambiguously defined in MU, she said, and impact the ability for interoperable exchange across the continuum of care for both eligible and ineligible provider groups. This is important because the average Medicare beneficiary sees seven providers from four different groups per year, she said. "The current standards do not support the requirements to exchange a care plan."

The work group said that when an eligible provider transitions a patient to a noneligible provider, it becomes the responsibility of the eligible provider to meet the information needs of that patient. "Hospitals play a critical role in conveying information needed by the recipient of a patient during care transitions." Gallego cited the IMPACT project in Massachusetts, which was an ONC Challenge grant recipient. The group identified a robust set of data elements needs for transitions of care and care plan exchange. To date, the project group has identified 483 data elements. Seventy percent of the elements can be mapped to clinical document architecture (CDA) templates with applied constraints, leaving 30 percent with no appropriate template.

The work group has done much work in the past few years to address standards gaps, Gallego said. Numerous stakeholders are coordinating efforts to ensure alignment and coordination when dealing with care plan standards. More than 200 groups are participating and are committed to supporting the broader community in health information exchange.

The work group’s three most recent deliverables are a development of care plan glossary, IMPACT project transition of care high level implementation guide and an evolving care plan use guide. There are five transition datasets included in the IMPACT transitions of care implementation guide. The work group found that care transitions can be grouped in five datasets with the transfer of care summary being the largest, and inclusive of all other datasets.

The IMPACT care project, focused on the transfer of care dataset, will go live in Massachusetts. IMPACT has contracted with Lantana to develop HL7and ballot implementation guides for the transfer of care, home health plan of care and care plan datasets. The group also is working toward the development of a digital signature standard, which will be balloted through the HL7 structured documentation work group’s September ballot cycle. Meanwhile, vendors across Massachusetts and New York have expressed their commitment to pilot preballoted versions of the LCC standards in their products this year.

One of the HIT Policy Committee members observed that this is “a rare case of standards coming before practice.”

Farzad Mostashari, MD, ScM, national coordinator of health IT, suggested the work group think about the largest contributing preventable causes of readmissions. “A lot of that information would constitute a perfect handoff. If we can focus on preventing those bad outcomes, and readmissions being a good marker of that, that may be a way of focusing the lens.”