LCC -Proposal for Next Steps

August 28, 2012

Discussion Points

• Recap of Whitepaper Recommendations• Critical milestones and activities driving LCC

activities• IMPACT Project deadlines and their impact on

LCC activities• Scope for Potential LCC Use Case 2.0• Scope for developing Stage 3 MU Comments• Proposed key activities and timelines for LTPAC

and LCP SWGs

Recap: Whitepaper Recommendations

Recommendation Responsible Team Proposed Timeline

1. Harmonize S&I LCC WG Use Case 1.0 (conduct standards analysis and standards development)

S&I Harmonization Team

SEPT-OCT 2012

2. Develop Implementation Guide (IG) for LCC Use Case 1.0

S&I Harmonization Team

DEC 2012

3. Leverage IG for Stage 3 MU Comment Period LCC WG DEC 2012

4. Ballot IG through HL7 for LCC Use Case 1.0 S&I HL7 Balloting Team JAN 2013

5. Extend LCC IG to develop new use case (Use Case 2.0) for exchange of Collaborative Care Plans. Use case will describe 2-3 scenarios.

LCP SWG JAN 2013

6. Harmonize S&I LCC WG Use Case 2.0 (conduct standards analysis and standards development)

S&I Harmonization Team

FEB 2013

7. Develop and ballot through HL7 IG for LCC Use Case 2.0

S&I Harmonization Team/ HL7 Balloting Team

MAY 2013

8. Provide S&I Framework resources for WG Support ONC/OSI Leadership SEPT 2012

External Drivers

Sept ‘12 Oct ‘12 Nov’12 Dec ’12 Jan’13 Feb ’13 Mar ’13 Apr ’13 May’13

HIT

PC S

tage

3 M

UH

L7 B

allo

tsIM

PAC

T

HITPC Pre-RFC Meeting

Standards Analysis & Recommendation (1-2months)

HL7 Fall Ballot Closes

IMPACT Go-Live

Implementation Guidance Development (1- 2 months)

Stage 3 RFC Distributed

RFC Deadline (Dec 21)

ONC Synthesis of RFC Comments (1- 2 months)

WGs reconcile RFC comments (1 month)

Draft stage 3 Recs due

Final stage 3 Recs due to HHS

HL7 Spring Ballot OpenHL7 January Ballot Open

IMPACT Project Deliverables For Consideration

Deliverable Description Due Date Alignment with WP Recommendation

Standards Analysis & Recommendation

Map ~450 Data Elements to Consolidated CDA. Vendor will conduct gap analysis as preliminary step to develop IG.

OCT 2012 Aligns with #1 and #5—standards analysis for Use Case 1.0 and 2.0

Implementation Guide Development

Develop CDA templates and sample files incorporating the ~450 data elements. IG will not be developed with level of detail required for HL7 balloting. Missing elements will be identified as Free Text.

NOV 2012 Partial alignment with #2—IG development for Use Case 1.0. Additional harmonization work required from S&I Framework.

IMPACT Project Go-Live

Pilot CDA Transfer of Care document based on CCD templates from IG

DEC 2012 Outcomes of pilot can inform IG for Use Case 2.0 and Stage 3 MU recommendations

Key Questions for LCC WGs

• Is there value in developing the IG for LCC Use Case 1.0 given the IMPACT Project Scope of Work?

• If yes, how do we reconcile use case 1.0 with the IMPACT project data sets?

• If no, let’s consider…

…How to leverage IMPACT work for LCC WG activities• Build from IMPACT standards analysis work and IG to

create LCC Use Case 2.0 (contains all ~450 data elements)– LCC Use Case 1.0 may no longer be relevant for S&I

harmonization given additional data elements identified since LCC Use Case 1.0 consensus (June 2012)

• LCC Use Case 2.0 will be handed off to S&I Harmonization Team (Deloitte). Deloitte team will then create ‘Care Plan IG’ which will be submitted for HL7 balloting

• Monitor and review IMPACT contract work (standards analysis) as part of weekly LTPAC SWG call

Scope for LCC Use Case 2.0

• LCC Use Case 2.0 and IG may not contain all data elements for the exchange of Collaborative Care Plans

• LCC WG should revisit ‘baseline transaction and build’ presented during June LTPAC Collaborative Summit– Versions 2.0 to Version X.0 of LCC Use Case are built

incrementally to add requirements of other trading partners (i.e. IRF, Behavioral Health, CBO)

• Care Plan is built out from most simple to most complex (i.e. treatment plan, care plan…to collaborative care plan)

From LTPAC Summit: Baseline Transaction and Build

Master Longitudinal Care Use Case

Version 1: Baseline Developed HH-POCCreates base Use Case Structure and focuses on HHA/ SNF as the starting point that gives the best overall coverage of

data elements.

Version 2: Include ~450 elements identified by the IMPACT Project (potential Use Case 2.)

Version 3: (IRF, Behavioral Health, CBO, ???)White Paper Roadmap lays out priority order to

incrementally add requirements of other trading partners

Version …: Other trading partnersRound out full longitudinal picture

Now:Foundation

Future:Full LCP Support

Building Incrementally

9June 2012, Baltimore, MD

Building a Common Terminology for the Care Plan

The WP acknowledges there are at least 10 recognized nursing care plan models and vocabularies. The concepts, vocabularies and value sets are not standardized.

A process which allows for robust, standards based exchange of assessment data and leading to standards based exchange and update of the Care Plan Document

Collaborative Care Plan

Care Plan created through a process of communication, prioritization and negotiation leading to a consensus list of care plan HC’s, G’s and I’s

Interdisciplinary Care Plan

Cumulative Care Plans for all involved health professionals or disciplines

Multidisciplinary Care Plan

A plan of care which contains all required elements in association: Health Concern; Intervention; Desired Outcome or Goal; Milestones or Time Line; Responsible Party

Care Plan

Cumulative set of plans of care by all involved health professionals or disciplines.

Multidisciplinary Plan of Care

Cumulative Set of interventions and instructions for all health concerns addressed by a health professional or discipline

Plan of Care

Interventions and instructions intended to address a health concern by a health professional or discipline

Treatment Plan

Most resembles HHPoC

MOST SIMPLE MOST COMPLEX

Scope for Stage 3 MU comments

• Map whitepaper recommendations against Stage 3 Preliminary Recommendations for ‘Improve Care Coordination’

• Leverage gap analysis to develop LCC Use Case 2.0

Out of Scope• Mapping WP to Stage 2 MU Final Rule

– Part of Deloitte Scope of Work for ‘ToC Companion Guide’

• Mapping WP to S&I Framework CEDD– Use Case 2.0 will need to be mapped to ToC CEDD

Summary of Proposed Key Activities for LCC SWGs• Finalize and get consensus on ~450 Data Elements

List - LTPAC• Monitor and review progress of IMPACT Project

Standards Analysis and IG Development work - LTPAC• Update LCC Use Case to develop LCC Use Case 2.0

based on ~450 Data Elements List - LCP• Map Whitepaper recommendations against Stage 3

MU Preliminary recommendations – LCC and LCP

Discussion Point: Which activities will be led by LTPAC SWG and which will be led by LCP SWG?

LCC WG Timeline: Sept 2012 – May 2013

Sept‘12 Oct ‘12 Nov ’12 Dec’12 Jan’13 Feb ’13 Mar ’13 May ’12

Mile

ston

esPA

S SW

GLT

PAC

SW

GLC

P SW

G

Use Case 2.0 Standards Analysis & Development

Ballot Reconciliation

Stage 3 MU RFC Deadline

IMPACT Contract Awarded

HL7 Fall Ballot Closes

Finalize: Use Case Data Elements List (07SEP2012)

Fall Ballot Prep

HL7 JanuaryBallot Opens

Implementation Guidance

IMPACT Project Go-Live

Monitor IMPACT Project Pilot (1-2 months)

Development: Use Case 2.0 Implementation Guide

S&I Framework Contracts Expire

Development: Stage 3 MU Recommendations

Monitor: IMPACT Project Standards Analysis & IG Development (3-4 months)

Mapping: Whitepaper to Stage 3 Preliminary Recommendations

Development: Use Case v2.0 (2 to 3 months)

HL7 SpringBallot Opens

Other Discussion Points

• Timeline for reconciling Use Case 1.0 or developing Use Case 2.0 and submitting to S&I Harmonization team

• Timeline for S&I Harmonization Team to develop IG and put through HL7 balloting cycle– What version of Use Case will be developed to ensure

submission of IG for January cycle? For May cycle?

• Contract end dates for S&I Framework Support Contracts (end of Feb 2013)