Data Element
Risk Scores
Description
LACE - https://www.mdcalc.com/calc/3805/lace-index-readmission
Submitted By: Holly Miller, MD / MedAllies
Data Element Information
Use Case Description(s)
Use Case Description Use Case
These are data elements required to improve the safety of handoffs when clinical care responsibilities are passed to another care team member or care team either temporarily or permanently. Examples include hand offs at change of shift and permanent transitions of care to another care team or site of care. Handoffs occur in every health care setting and are a requirement whenever 24-hour care is provided, or care is provided intermittently in the patient’s home. This includes hospitals, LTPAC facilities, homes, and prisons. Although most handoffs occur between care providers using a common EHR/HIT system, many transitions of care from one site to another require exchange to occur between two different EHR/HIT systems. Even when handoffs occur within a single EHR system ease of access to these Special Alerts will significantly help to prevent medical errors and reduce the risk of injuries and harm.
Estimate the breadth of applicability of the use case(s) for this data element Estimate number of stakeholders
All providers of clinical care in 24-hour and home care settings will use these data elements at the beginning and at the end of their shifts. All providers of clinical care that receive patients in transfer from another site or team will use these data elements. This encompasses most providers.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) ICD 10, SNOMED, LOINC, RxNorm
Additional Specifications N/A
Current Use Extensively used in production environments
Supporting Artifacts These data elements are nearly universally captured in existing EHR systems but are not grouped and escalated to be readily utilized for patient care.
Extent of exchange 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns None
Estimate of Overall Burden The burden for collection is minimal given these observations are already collected in the EHR. The burden is to ensure that these data elements are captured and escalated to the alert level within an EHR system when they are applicable.
Other Implementation Challenges None
ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 1 - Data element is captured, stored, or accessed in at least one production EHR or HIT module.
Criterion #3
Maturity - Current Exchange		 Level 1 - Data element is electronically exchanged between two production EHRs or other HIT modules using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment This data element represents a narrow use case for data already represented by the broader Clinical Tests data elements, already part of USCDI.

Comment

Submitted by Steven.Lane on

Standard interoperable handoff alerts would improve transitions

Care transitions are typically challenging and filled with opportunities for a decrement in care quality.  The ability to document and exchange special alerts related to transitions and handoffs of care would help close a current gap in health information interoperability.  The implementation of this data element should ideally be coordinated and harmonized with the Care Plan (https://www.healthit.gov/isa/taxonomy/term/7596/level-2) which is also currently a Level 2 data element. 

Submitted by brosenntst on

Special Alerts use case comment

Commenting from the lens of mostly the Beh. Health and post acute landscape, I can say this is a very well thought out and strong use case that is needed as part of a larger transitions of care workflow.  Special alerts would be beneficial in a multitude of care settings, but a few specific examples stick out that we see our clients utilize/manage daily.  Some potential positive outcomes that would come from this data element being adopted are as follows:

- better transitions of care between internal and external care teams, alerts that would focus on potentially dangerous or sensitive information should be at the forefront of any Transition of Care. 

- Specific examples we see on our side are with forensic behavioral health cases, where prisoners/detained individuals are ordered to visit psych. care in some capacity.  Special Alerts would keep the safety of the patient and care team first.  Substance abusers, violent histories are a few other examples of where having an active urgent alert present upon transition or handoff will be beneficial.

As mentioned above by Dr. Miller, the capturing of these data elements are nearly universal between EHR's but there is not much weight being placed on the categorization of the elements.  The Interoperability mechanisms are present as well and with communication between EHR's growing steadily, this use case is something that lends well to the overall Interoperability landscape.  Seamless transitions between workflows of the care providers, both internal and external, is crucial to keeping the level of care at it's highest and most beneficial to the patient.       

 

 

Submitted by JohnDerr on

Data Element Information

Holly Miller, MD and Terrence O’Malley, MD have developed a set of data elements that fill the gaps between caregivers. These data elements allow a focus on longitudinal and holistic care. This has been accomplished by Drs Miller and O’Malley working with professional and technical workflow thought leaders and completes a person's chain of care. When examining the current EMR chain of data it is Person “Provider" Centric Care, not truly Person Centric. There are currently silos of EMR data that are beginning to be aggregated by IT vendors but are not focused in real life clinical/technological workflows. Multiple provider portals are not the answer. Person Centric Handoff Data Elements are essential in comorbidity requiring chronic care conditions making up a large percent of care, require holistic/longitudinal care documentation. Recognizing, coordinating, and documenting the required handoff care data elements are mandatory for Value Based Quality of care and clinical cost effective outcomes. Solutions like TEFCA are steps in the right direction, but the Special Alerts For Care Handoff Data elements have to be the guidelines and not boiling the ocean with irrelative data to a person's centric care.

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