The report of the ONC roundtable discussion, which was held in May, makes a number of specific recommendations to be considered in the formulation of the Meaningful Use Stage 3 criteria, now in an early stage of development. The report also highlights what the roundtable participants viewed as the serious shortcomings of the MU Stage 2 requirements in regard to LTPAC.
The proposed MU stage 2 criteria required hospitals and eligible professionals to make care summaries available in transitions of care, such as a hospital discharge. However, this information isn't sufficient for the care plans that long-term-care (LTC) facilities and home-care agencies require, the report said. In addition, the transitions of care definitions and related standards "do not fully support the information exchange needs of LTPAC patients and their providers during care transitions," according to some roundtable participants.
[ For the latest development on Meaningful Use criteria, see Meaningful Use Stage 2 Rules Finalized. ]
The roundtable participants--who included LTPAC executives, government officials, software vendors, and a consumer representative--made MU Stage 3 recommendations in these areas:
-- Transitions of care. Frame health IT needs around patients rather than providers. Consider a broader range of data elements and use cases in MU Stage 3. Transmit a core set of data and a care plan to all members of the care team in the receiver's preferred transmission method (even if not electronic), and use time stamps to record the time of receipt.
-- Patient assessments. Support the capture and exchange of patient assessment content, including cognitive status, functional status, and pressure ulcer data.
-- Quality measures. Support a new MU quality measure related to skin integrity and pressure ulcers.
-- Advance directives. Consider inclusion of advance directive content, including patient preferences and goals.
The Health IT Policy Committee and the Health IT Standards Committee--the advisory bodies that will make recommendations to ONC about MU stage 3 and EHR certification criteria--have been "very receptive" to the roundtable's viewpoints, according to John Derr, an LTPAC health IT expert who was formerly CIO of Golden Living, a leading operator of LTC facilities. Derr also is a member of the Health IT Standards Committee and a roundtable participant.
The roundtable considers the development of a "patient-centered longitudinal care plan" an immediate priority, said Derr in an interview with InformationWeek Healthcare. This plan, which would go beyond episodes of care, would be available to all members of a care team, including LTPAC providers, patients, families, and caregivers.
Hospitals and physicians typically send episode-based care plans and summaries to LTC facilities and home care agencies, Derr said. As a result, these documents might lack information, for example, about the meds that a patient was on before he or she was admitted to the hospital. Moreover, he said, it's imperative for LTPAC providers to have information about a patient's skin condition and cognitive status.
A committee of the National Quality Forum (NQF), he added, is working on a method to harmonize the data elements in care plans so that hospitals use the same terms that LTPAC providers do in describing conditions such as pressure ulcers and falls. "We've go to harmonize those things so we can track them longitudinally."
LTPAC providers could download clinical summaries and care plans from secure web sites, Derr noted. If they had an EHR and the documents were in the correct format, he added, the information could flow directly into the electronic record.
As for sending LTPAC data back to hospitals when patients have to be readmitted or sent to the ER, the Geisinger Healthcare System recently collaborated with software vendor Caradigm to develop a tool that converts the minimum data set (MDS) that LTC facilities must prepare for CMS into a continuity of care document (CCD), a clinical summary that is widely used in healthcare.
Derr said that the MDS-to-CCD transformer was a step in the right direction, especially for small facilities that lack health IT infrastructure. He also praised a Massachusetts program that has created data sets for a variety of care transitions.
"But I don't think that's the ultimate," he said. "The ultimate has to be this person-centric longitudinal care plan, which is comprehensive."
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