Longitudinal Coordination of Care (LCC) Workgroup (WG)HL7 Tiger TeamPatient Care WG Care Plan DAM

July 31, 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

• Goals

• Schedule

• Review of recommendations made to PCWG for Care Plan DAM

– Items implemented in time for ballot

– Items not implemented in time for ballot

– Items not included in the DAM

• Next Steps

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• For this Tiger Team:• Alignment of HL7 artifacts with LCC artifacts to

support care plan exchange

• HL7 CCS provides Service Oriented Architecture

• Care Plan DAM provides informational structure

• LCC Implementation Guides provide functional requirements

• Ongoing comments can be submitted and viewed on wiki:

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

Goals

Work Group SchedulesLCC WG

SWG Meeting LCC Leads Date/ Time Projects

LTPAC SWG Larry GarberTerry O'Malley

Weekly Mondays, 11-12pm EST

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

LCC HL7 Tiger Team

Russ Leftwich Weekly Wednesdays, 11- 12pm EST

LCC WG comments for HL7 Care Plan DAM

LCP SWG Bill RussellSue MitchellJennie Harvell

Weekly Mondays and Thursdays 5-6pm EST

C-CDA: Care Plan, HomeHealth 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 Weds, 5 -6pm EST

Care Plan DAMCare Coordination Services (CSS)

HL7 Structured Documents WG

Bob DolinBrett Marquard

Sue MitchellJennie Harvell

Weekly Thursdays, 10-12pm EST

CDA (various)

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

Susan Campbell Weekly Tuesdays 5 - 6pm EST

Care Coordination Services (CSS)

HL7 Patient Generated Document

  Leslie Kelly Hall Weekly Fridays, 12-1pm EST

Patient-authored Clinical Documents

Schedule – July 2013SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

1 2 3 4 5 611 AM ET

Discussion Plan Activity Data

Element Attributes

7 8 9 10 11 12 1311 AM ET

Discussion Team Member

Relationship to Patient

14 15 16 17 18 19 201:30 PM ET Continued

Discussion Team Member

Relationship to Patient

21 22 23 24 25 26 2711 AM ET

Meeting Cancelled

28 29 30 3111 AM ET Review

of DAM Recommendations

Overview

• Recommendations were formulated as a result of discussions involving the following subjects:

– Patient and Provider Roles in Plans of Care and Care Plan

– Preferences

– Priorities

– Levels of Association

– Team Member Acceptance/Acknowledgment

– Care Team Member Role

– Care Team Member Cardinality

– Team Member Responsibility – Care Plan

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Patient and Provider Roles in Plan of Care and Care Plan• Discussion: What role does the Provider play and what role

does the Patient play in both the Care Plan and the Plan of Care?• Recommend that DAM should support both the Care

Plan and Plan of Care, sequential and multi-threaded workflows; needs to define the buckets of all the information for all of these.

• Recommend adding attribute to Goals that can indicate that the goals have been agreed to by both the Provider and the Patient or that there is not agreement between the two.

• Recommend adding another attribute that supports specific health concern and intervention related goals (who has agreed to these goals).

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Patient and Provider Roles in Plan of Care and Care Plan, cont’d…• Recommend allowing for variance analysis with levels of

intervention.• Recommend adding/supporting an ability to harmonize

multiple treatments and Plans of Care and to create a Master Care Plan in the care of complex Patients in complex organizations.

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Preferences

• Discussion: How to represent preferences in DAM; how to show changes have occurred in a patient’s preferences• Recommend adding a separate Advance Directives

section that contains all preference information including advance directive preferences, which are linked to a repository or separate document.

• Recommend listing out and defining “Other preferences” under Types of Preferences.

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Priority

• Discussion: What data elements should have priority attributes and whether interventions should be prioritized, as well.• Recommend not including Priority in interventions.

Actions that were considered and not chosen as part of the intervention should be included elsewhere in the Care Plan.

• Recommend adding a text field with Priority so that comments can be captured with priority rankings.

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Levels of Association

• Discussion: Is it sufficient to associate one or more Care Team Members with a data element or should the model include levels of association?• If so, what is the value set for those role/relationship

levels? How many levels should there be and how are they represented (e.g. primary/secondary,/tertiary, or lead/support, or other)• Recommend including associations in model for

traceability (assignment of responsibility, payment, etc.): provide a bucket for association/responsibility level, bucket for functional role, and bucket for identification of responsible/associated individual or entity• Recommend that High, Medium, Low be used

as association/responsibility level designators for both Health Concerns and Interventions.

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Levels of Association, cont’d…

• Recommend that association should include individual and organization under functional role (Care Team Members may have more than one role inside an organization)

• Recommend that Health Concerns and Interventions also include type of association (e.g., fee for service, consent, other)

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• Discussion: Does the Care Team Member need to accept/acknowledge their association? • Recommend including the ability in the model for a Care

Team Member to accept/acknowledge their association

Team Member Acceptance/Acknowledgment

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Care Team Member Role

• Discussion: Current model includes “Role” attribute in Health Concern but not in Health Goal or Plan Activity.• Recommend establishing a taxonomy to support how

the association/relationship will be used (e.g., as a messaging filter to only send information to certain entities and/or showing who is involved and their sub-roles and/or other).

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• Discussion: Can Health Concerns, Goals and Interventions be associated with zero care team members within the DAM (other than the patient, who would be associated by default)?• Health Concerns to Team Member

• Recommend Health Concern can be zero to many cardinality, with SHOULD conformance

• Goals to Team Member• Recommend Goal can be zero to many cardinality,

with SHOULD conformance• Interventions to Team Member

• Recommend Intervention (Plan Activity) can be zero to many cardinality with SHOULD conformance

Team Member Cardinality

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• Discussion: Is Team Member’s responsibility for the Care Plan represented in the model?• Care Planning• Care Plan Governance

• Recommend a way to account for facilitation of the Care Plan (“steward” role or other)

Team Member Responsibility – Care Plan

Proposed Next Steps

• Next meeting is TBD and will be a full review of the final Domain Analysis Model

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Contact Information

We’re here to help. Please contact us if you have questions, comments, or would like to join other projects.

• S&I Initiative Coordinator• Evelyn Gallego evelyn.gallego@siframework.org

• Sub Work Group Lead• Russ Leftwich cmiotn@gmail.com

• Program Management• Lynette Elliott lynette.elliott@esacinc.com• Becky Angeles becky.angeles@esacinc.com