Longitudinal Coordination of Care LCP SWG Thursday, May 30, 2013.

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Longitudinal Coordination of Care LCP SWG Thursday, May 30, 2013

Transcript of Longitudinal Coordination of Care LCP SWG Thursday, May 30, 2013.

Page 1: Longitudinal Coordination of Care LCP SWG Thursday, May 30, 2013.

Longitudinal Coordination of Care

LCP SWGThursday, May 30, 2013

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• S&I Update• Announcements and Reminders• Use Case 2.0

– Schedule and Outline– 12.0 Dataset Requirements– David Tao’s Comments on Base Flow, Alternate Flow,

Assumption sections

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Agenda

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• LCC WG participation in HITPC MU SWG #3 Care Coordination– Summary of May 24th meeting– Care Plan discussion scheduled for June 4th, 2013

• 11:30am – 1:30pm ET• Participate online: https://altarum.adobeconnect.com/mu; Audio:

1-877-705-2976

• Reminder to register for 2013 LTPAC HIT Summit– Date: June 16-18, 2013– Location: Baltimore, MD– http://www.ahima.org/Events/EventCalendar/Event.aspx?Id=b88011a0-3d9f-45cc

-8454-60837c37baaf

• Call for Pilot Participation!– If you or someone you know is interested in piloting Transitions of Care and/or

Care Plan Exchange, please contact us at: [email protected], [email protected], [email protected]

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ONC S&I Update

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• Next week’s Thursday LCP call will be at 5:00-6:00pm ET

• Meeting Reminders (next week)– LTPAC SWG meeting – Monday at 11am ET– LCC HL7 Tiger Team SWG meeting – Wednesday at 11am ET– LCP SWG meeting – Thursday at 5pm ET

• Visit the LCC Use Case 2.0 Wiki Page for all current artifacts to review: (http://wiki.siframework.org/LCC+WG+Use+Case+2.0)

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

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Announcements and Reminders

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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 Thursdays 5 - 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 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

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LCC Use Case 2 Development ScheduleItems in italics will drawn directly from the LCC Project Charter or created offline directly from other sections and will be included in the end-to-end review

Date Item Homework (Due Wednesday COB)

3/11 – 3/18

10.0 Scenario (User Stories, Base/Alternate Flow, Functional Requirements)

Review: User Stories

3/25 – 3/26

3.0 Use Case Scope (Background, In / Out of Scope, Communities of Interest)

Finalize: User Stories, Base Flows, In / Out of ScopeReview: Communities of Interest, Assumption

4/1 – 4/2

3.4 Communities of Interest Finalize: Communities of Interest, Assumptions, Pre-Conditions, Post-ConditionsReview: Actors and Roles5.0 Use Case Assumptions

6.0, 7.0 Pre-Conditions, Post Conditions

4/8 - 4/11

Finalize: Assumptions, Pre-Conditions, Post-Conditions, Communities of Interest8.0 Actors and Roles

Finalize: Assumptions, Pre-Conditions, Post-Conditions, Actors and Roles

4/15 – 4/18

Finalize: Communities of Interest, Assumptions, Actors and RolesReview: Base/Alternate Flows, User StoriesActivity Diagrams

Review: Base Flows, Activity DiagramsFinalize: Base Flows, Activity Diagrams

4/22 – 4/25

11.0 Risks, Issues, and Obstacles Finalize: Risks, Issues and ObstaclesReview: Sequence Diagrams

10.4 Sequence Diagram

5/2 – 5/16

10.3 Functional Requirements Finalize: Sequence Diagrams, Functional Requirements, Use Case Diagrams, AppendicesReview: Community Feedback, Dataset Requirements9.0 Use Case Diagrams

Appendices

5/23 Community Feedback12.0 Dataset Requirements

Review: Dataset Requirements

5/30 12.0 Dataset Requirements End-to-End Review (preliminary)

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• 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

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• Care Plan Document Descriptive Data Elements – Document Description– Document Change– Presentation– Question

• Context• Privacy and Security• Patient

– Patient Data– Encounter Event – Keep?– Observation Event – Keep?

12.0 Dataset Requirements

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• Care Plan Data Elements– Health Concerns

• Active issues affecting health and well-being that require management• Inactive issues that provide context to proposed interventions (example: hx +PPD and proposed steroid use)• Type 

– Med/Surg Issues

– Nursing diagnoses

– Function

– Behavioral: mood, cognition, DSM IV, V

– Environmental (housing, community supports, employment, transportation, legal

– Health maintenance, prevention

– Risks

– Barriers to intervention

• Descriptive Data– Current Management

» Active

» Inactive

– Status

» USE LIST OF CODES TO BE PROVIDED BY BILL

– Impact on Health or Wellbeing

» High

» Medium

» Low

» Unknown

– Severity (SOMEONE TO PROVIDE THE ICD10 structure for the dimensions of severity/progression/stability/etc)

– Priority Type

» Patient

» Physician

» Result

– Priority Level

» High

» Medium

» Low

12.0 Dataset Requirements

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• Care Plan Data Elements– Interventions

• Status• Assessments

– Goals or Desired Outcome of Interventions to address Health Concerns

• Status• Timeline • Milestones

– Overall Goals for Care– Longitudinal Care Team

• Members (Patient, Principle Care Physician, Care Plan Manager, Principle Healthcare Provider, Principle Care Giver, Others (Relevant Specialists, Therapists, SW, etc)

– Identification and Contact Information– Responsibility to Health Concern Set / Responsibility for Intervention

(includes assessment)

12.0 Dataset Requirements

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• Care Plan Process Elements– Input data

• All potential Health Concerns– Problems– Risks– Barriers

• All potential Interventions

• All potential Goals

– Prioritization• Decision Making

– Probabilities– Preferences– Overarching Goals– Potential Interventions

12.0 Dataset Requirements

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• Show Use Case 2.0 document– 10.2.1.1 – Base Flow for Scenario 1 comments– 10.2.2 – Alternate Flow Text comments– 5.0 – Assumptions (already modified)

David Tao’s Comments from the Wiki

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