Longitudinal Coordination of Care (LCC) Workgroup (WG)

LCC All Hands Meeting

June 4, 2013

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Meeting Etiquette

• Remember: If you are not speaking, please keep your phone on mute

• Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call o Hold = Elevator Music = frustrated speakers and

participants• This meeting is being recorded

o Another reason to keep your phone on mute when not speaking

• Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know.o Send comments to All Participants so they can

be addressed publically in the chat, or discussed in the meeting (as appropriate).

From S&I Framework to Participants:Hi everyone: remember to keep your phone on mute

All Participants

Agenda

• Summary of LCC WG Accomplishments for May 2013

• LCC WG Timeline

• LCC Use Case 2.0

• HL7 Ballot Tiger Team

• eLCC – CDA IG Development

• Next Steps

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Summary of LCC WG Accomplishments• Continued development LCC Use Case 2.0 focused on

Interoperable Care Plan Exchange• LCC HL7 Tiger Team

– Aligning the Patient Care WG Care Plan DAM to LCC

• HITPC MU3 SWG Meetings– Agreement to reference IMPACT ‘Transfer of Care’ dataset:

consult note, transfer summary and consultation request– Reviewing LCC Care Plan Recommendations for MU3

• Lantana C-CDA Revisions Project (HL7 ToC Implementation Guidance development)– HL7 Project Scope Statement approved by HL7 Structured

Documents WG– ‘Transfer of Care’ dataset harmonization activities currently

being reviewed with LTPAC SWG– ‘Care Plan/HHPoC’ harmonization activities to start in June

• Reorganized LCC WG Structure and Meetings

Summary of LCC WG Accomplishments (cont’d)• Continued LCC Stakeholder & Pilot Engagement

Activities– Call for Pilot Participation!– Outreach to Vendors (Caradigm, GetRealHealth)– Outreach to State HIE Grantees: MD, CT, TN– Outreach to IDNs: Wellmont Health System (TN), Life Centers of

America– HIMSS Analytics: Care Coordination Model– VA / DOD: HHPoC alignment

Longitudinal Coordination of Care

Workgroup

Longitudinal Coordination of Care

Workgroup

Patient Assessment

Summary (PAS SWG

LTPAC Care Transition SWG

Longitudinal Care Plan SWG

• Engage directly with HL7 to establish the standards for the exchange of patient assessment summary documents

• Inform the development of the Keystone Beacon PAS Document Exchange

• Identify the key business and technical challenges that inhibit LTC data exchanges

• Define data elements for long-term and post-acute care (LTPAC) information exchange using a single standard for LTPAC transfer summaries

• Identify standards for an interoperable, longitudinal care plan* which aligns, supports and informs person-centric care delivery regardless of setting or service provider

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LCC Sub Workgroups (SWG)

*Care Plan standards will enable providers to create, transmit and incorporate care plans and needed content for the benefit of medically complex and/or functionally impaired individuals, their families and caregivers.

COMMUNITY-LED INITIATIVE

HL7 Tiger Team SWG

• Educate the LCC Community on related HL7 processes, framework and evolving standards relevant to LCC

• Gather and generate comments for HL7 Care Plan related evolving standards (Care Coordination Services & Care Plan Domain Analysis Model (DAM))

Work Group SchedulesLCC WG

SWG Meeting LCC Leads Date/ Time Projects

LTPAC SWG Larry GarberTerry O'Malley

Weekly Mondays11am - 12pm EST

C-CDA: Transfer Summary, Consult Note, Referral Note

LCC HL7 Tiger Team

Russ Leftwich Weekly Wednesdays 11am - 12pm EST

LCC WG comments for HL7 Care Plan DAM

LCP SWG Bill RussellSue MitchellJennie Harvell

Weekly Thursdays 5pm - 6pm EST (starting June 6)

C-CDA: Care Plan, Home Health Plan of Care

HL7 WGSWG Meeting HL7 Lead Participating LCC

MembersDate/ Time Projects

HL7 Patient Care WG Russ LeftwichElaine Ayers Stephen Chu Michael Tan Kevin Coonan

Susan Campbell Laura H Langford Lindsey Hoggle

Bi-weekly Weds5pm - 6pm EST

Care Plan DAMCare Coordination Services (CSS)

HL7 Structured Documents WG

Bob DolinBrett Marquard

Sue MitchellJennie Harvell

Weekly Thursdays10am - 12pm EST

CDA (various)

HL7 SOA WG CCS Project Jon Farmer Enrique Meneses (facilitators) Stephen Chu

Susan Campbell Weekly Tuesdays 5pm - 6pm EST

Care Coordination Services (CSS)

HL7 Patient Generated Document

  Leslie Kelly Hall Weekly Fridays12pm - 1pm EST

Patient-authored Clinical Documents

LCC WG Timeline: Mar 2013 – Dec 2013

Mile

ston

es

Pilot Site Identification & Engagement

Care Plan IG Complete

Lantana Contract Awarded for

Development of ToC IG

HL7 Project Scope Statement Due

HL7 Intent to Ballot Due

HL7 Fall Ballot Open

NY Pilots Monitoring

LCC Care Plan Use Case 2.0 Development & Consensus

IMPACT ToC Pilot Monitoring

IMPACT Care Plan Pilot Monitoring

HL7 Ballot Publication

ToC IGs Development (Transfer Summary, Referral Note, Consult Note)

ToC IGs Complete

HL7 Final Ballot Due

LCC Stakeholder Engagement: Lantana, IMPACT, ASPE, NY, CMS

Care Plan/ Home Health Plan of Care IG Development

HL7 Ballot Package Development

HL7 Ballot & Reconciliation

FACA LCC WG Briefings

LCC & HL7 Care Plan Coordination

IMPACT Go-Live

NY Care Coordination Go-Live

Lantana Contract Awarded for Care

Plan IG Development

LCP SWG LCC Use Case 2.0 –

Interoperable Care Plan Exchange

Use Case 2.0 – Interoperable Care Plan Exchange• Focus on the functional requirements for an

Interoperable Care Plan exchange– Will feed into the Care Plan component of the work Lantana is doing for

the Aug/Sept HL7 Ballot

• This work is being performed under the LCC Longitudinal Care Plan (LCP) SWG

– Meetings are held on Thursdays from 5pm-6pm ET

• LCC Use Case 2.0 Wiki Page (http://wiki.siframework.org/LCC+WG+Use+Case+2.0)

– We have a comment form to provide feedback on UC sections (http://wiki.siframework.org/LCC+Use+Case+2.0+Comments)

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LCC Use Case 2 Development Schedule

Date Item

Feb 2013 10.1 User Stories

Mar 2013 10.0 Scenario (Base Flow, Alternate Flow)

3.0 Use Case Scope (In Scope / Out of Scope)

3.4 Communities of Interest

Apr 2013 5.0 Use Case Assumptions

6.0 Pre-Conditions

7.0 Post Conditions

8.0 Actors and Roles

11.0 Risks, Issues, and Obstacles

May 2013 9.0 Use Case Diagrams

10.4 Sequence Diagram

10.3 Functional Requirements

Appendices

12.0 Dataset Requirements

Jun 2013 12.0 Dataset Requirements

End-to-End Review (Includes 1.0, 2.0, 4.0)

Consensus Period and Voting

• 1.0 Preface and Introduction**

• 2.0 Initiative Overview– 2.1 Initiative Challenge Statement**

• 3.0 Use Case Scope– 3.1 Background**– 3.2 In Scope– 3.3 Out of Scope– 3.4 Communities of Interest

• 4.0 Value Statement**

• 5.0 Use Case Assumptions

• 6.0 Pre-Conditions

• 7.0 Post Conditions

• 8.0 Actors and Roles

• 9.0 Use Case Diagram

Use Case Outline

•10.0 Scenario: Generic Provider Workflow– 10.1 User Stories– 10.2 Activity Diagram

o 10.2.1 Base Flowo 10.2.2 Alternate Flow

– 10.3 Functional Requirementso 10.3.1 Information Interchange Requirementso 10.3.2 System Requirements

– 10.4 Sequence Diagram

•11.0 Risks, Issues and Obstacles

•12.0 Dataset Requirements

•Appendices

– Related Use Cases– Previous Work Efforts– References– Glossary

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** Leverage content from Charter

Draft sections complete

Content available for review

LCC HL7 Tiger Team SWG Update

Lead: Dr. Russ Leftwich

Overview

• Tiger Team Objectives

• Importance of LCC Engagement with HL7

• Establish artifacts and ballot comments

• Harmonize Care Plan DAM

• Schedule

Tiger Team Objectives

• Educate the LCC Community on the HL7 processes and framework

• Educate the LCC Community on the HL7 Ballots relevant to LCC

• Generate comments to the Care Coordination Service and Care Plan Domain Analysis Model (DAM) Ballots for May and September 2013 to align LCC Objectives with HL7 Work Products

Importance of LCC and HL7 Coordination

• Care Plan Domain Analysis Model September Ballot (HL7 Patient Care WG)

– Shared glossary of terms– Alignment of the various care plan components between LCC

and HL7 (Risks, Barriers, Relationships, Prioritization, etc)

Establish Tiger Team Artifacts and Ballot Comments

• Comments in MS Excel Ballot Package

• Presentations for updates to HL7 Workgroups

• HL7 Care Plan Domain Analysis Model ballot artifacts are due for submission on August 4

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• The Domain Analysis Model (DAM) was created by the HL7 Patient Care WG (PCWG)

• The goal of LCC is to review the DAM and provide input from a provider perspective and to harmonize elements that overlap with LCC efforts around care plan exchange and workflow• LCC Tiger Team is presenting recommendations and

comments during PCWG meetings prior to when the DAM goes to ballot in September

Harmonize Care Plan DAM

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• Define differences between Risks and Health Concerns, make recommendations on how to designate/categorize them

• Define Barriers, make recommendations on how to designate/categorize them

• Define Goals, Interventions, Outcomes and Assessments and make recommendations on how to designate/categorize them

• Past Meeting Artifacts available on the LCC Wiki:http://wiki.siframework.org/LCC+-+Meeting+Artifacts

Discussions To-Date

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• Discuss methods of prioritization and who prioritizes

• Discuss how to assign Care Team Members to prioritized Goals, Concerns and Interventions

• Discuss how to reconcile differing prioritizations

• Discuss mitigation of irrational patient choices

• Align terminologies, definitions and Use Cases between PCWG and LCC

Continuing Discussions

Schedule – May 2013SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

1 2 3 411 AM ET Overview of HL7 LCC Domain

Analysis Model

5 6 7 8 9 10 1111 AM ET HL7 LCC DAM: Risks, Health Concerns, Barriers,

Preferences

12 13 14 15 16 17 1811 AM ET HL7 LCC DAM: Risks, Health Concerns, Barriers,

Preferences

5 PM ET Touch Point with PCWG

19 20 21 22 23 24 2511 AM ET HL7 LCC

DAM: How to designate and/or

model Prioritizations

26 27 28 29 30 3111 AM ET: HL7 LCC DAM: Assignment

of Care Team Members to

Prioritizations

Schedule – June 2013SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

2 3 4 5 6 7 8

11 AM ET: Discussion

Prioritization

9 10 11 12 13 14 1511 AM ET

Discussion cont’d Prioritization

5 PM ET Tentative Discussion with

PCWG (TBD)

16 17 18 19 20 21 2211 AM ET

Discussion TBD

23 24 25 26 27 28 2911 AM ET

Discussion TBD

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Participate in the Tiger Team

• If you are interested in joining the LCC HL7 Ballot Tiger Team, please:– Participate in the Wednesday meetings at 11:00am EST– Check out the wiki:

http://wiki.siframework.org/LCC+HL7+Tiger+Team+SWG

LTPAC SWGeLCC CDA IG Development

Leads: Mike Tushan & Zabrina Gonzaga (Lantana)

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Objective

• Develop national data standards for information exchange of a Longitudinal Coordination of Care Dataset.

• Expand on the document types and templates to include HL7 Implementation Guides (IGs) for new and enhanced document types:

• New: Transfer Summary

• New: Consultation Request

• Enhanced: Consult Note

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Background

• Improving Massachusetts Post Acute Care Transfer (IMPACT) project

• Resulted in a Transfer of Care Dataset: 500 data elements that are necessary during a patient transfer of care

• Data set is organized into 5 groups:

• Transfer of Care

• Consultation Request

• Shared Care Encounter Summary

• Care Plan

• Home Health Plan of Care

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Stakeholders and Participants

• NYeC: New York eHealth Collaborative

• CCITI NY: Continuum of Care Improvement Through Information New York

• Healthix, Inc

• ONC S&I Framework

• IMPACT Project team

• HL7 International Structured Documents Work Group/ Patient Care WG

• ASPE (Care Plan)

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Deliverables

• Project Scope Statement (approved by Structured Docs WG)

• Functional Specification

• Templates: create up to 30 new CDA templates

• Sample Files: sample files to accompany each document type

• Schematron: validation rules

• HL7 CDA IG(s): final implementation guide(s) for DSTU*

• HL7 Ballot Package

• HL7 Ballot Reconciliation

• Published HL7 CDA IG

*Draft Standard for Trial Use

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Project Timeline

AprTask 1: Background

Analysis• S&I stakeholder meetings• Identify relevant precedentTask 2: Functional

Specifications/Setting Specific Rules

• S&I stakeholder meetings• Develop mapping sheet• Define setting specific

rules

May Jun Jul Aug Oct Nov DecSep

Task 4: Templates• Develop templates

Meetings

Deliverables

LEGEND:

Task 6: Ballot Material• Produce schematron

validation rules• Develop IG• Review IG with Tiger Team• Deliver IG to S&I• Update and submit IG and

materials for ballotTask 7:

Reconciliation/Publication

• Develop ballot comment tracking table

• Lead reconciliation meetings

• Publish IG

HL7 Reconciliation meeting frequency and dates TBD

DraftDraft

Next Steps

• Lantana to continue work on eLCC CDA Implementation Guide for ToC

– Care Plan/HHPoC IG development scheduled to start in June

• Monitor IMPACT Project Go-Live in July

• Continue outreach to key LCC Stakeholder groups

– Professional Associations, EHR vendors, CMS Care Planning Programs

– Coordination with other Care Plan Initiatives: DoD/VA, HIMSS

• Develop/Execute on Pilot Engagement Plan (Call for Participation!)

– MA and NY entities have committed to pilot pre-balloted LCC standards before end of year

– Engage TN LTPAC Entities and Life Centers of America

• Develop and submit Tiger Team Recommendations to HL7 WGs

• Continue participation in HITPC SWG MU3 #3 Care Coordination

• Participate in LTPAC HIT Summit (June)

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