longitudinal coordination of care (lcc) workgroup (wg) lcc all hands meeting august 6, 2013 1
TRANSCRIPT
Longitudinal Coordination of Care (LCC) Workgroup (WG)
LCC All Hands Meeting
August 6, 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 recordedo 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 June and July 2013
• LCC WG Timeline
• LCC Use Case 2.0
• HL7 Ballot Tiger Team
• eLCC – Transition of Care C-CDA Revisions
• Care Plan C-CDA Development
• Next Steps
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Summary of LCC WG Accomplishments• Achieved consensus voting on LCC Use Case 2.0: Care Plan
Exchange• LCC HL7 Tiger Team developed and submitted recommendations
on Care Plan DAM to HL7 Patient Care WG• HITPC MU3 SWG Meetings
– MU3 recommendations for Care Summary reference IMPACT ‘Transfer of Care’ dataset: consult note, transfer summary and consultation request
– Recommendations to be presented to HITPC on August 7th
• Lantana C-CDA Revisions Project (Transitions of Care and Care Plan/ Home Health Plan of Care)– Developed draft Implementation Guide/ Ballot Package for ‘Transfer of
Care’ and ‘Care Plan/HHPoC’– Ballot Package to be submitted for HL7 Balloting on August 15th
Summary of LCC WG Accomplishments (cont’d)• Continued LCC Stakeholder & Pilot Engagement Activities
– Participated in LTPAC HIT Summit June 16 to 18
– Call for Pilot Participation! New wiki site and pilot planning documents posted at: http://wiki.siframework.org/LCC+Pilot+Plan
– Conducted Pilot Overview Session for ONC State HIE LTPAC CoP (Community of Practice)
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 Mondays AND Thursdays 5pm - 6pm EST
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 C-CDA Revisions Complete
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 C-CDA Revisions 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
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
• Achieved Consensus on July 24, 2013
– 28 total votes (LCC has 111 Committed Organizations)
• 19 Yes
• 8 Yes with Comments
• 1 Objection with Comments
• LCC Use Case 2.0 Wiki Page: To view Consensus and Votes (http://wiki.siframework.org/LCC+WG+Use+Case+2.0)
– Final Use Case Available here
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LCC HL7 Tiger Team SWG Update
Lead: Dr. Russ Leftwich
Overview
• Tiger Team Objectives
• Importance of LCC Engagement with HL7
• Harmonize Care Plan DAM and provide comments
• Care Plan DAM has been submitted for ballot
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 Plan Domain Analysis Model (DAM) for September 2013 ballot to align LCC Objectives with HL7 Work Products
Importance of LCC and HL7 Coordination
• Shared glossary of terms• Alignment of the various care plan components between LCC and
HL7 (Health Concerns, Goals, Interventions, Risks, Barriers, Associations, Priorities, etc.)
• Recommendations of data elements/components to be added to or updated within DAM in order to support care plan exchange across multiple disciplines
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• The Domain Analysis Model (DAM) was created by the HL7 Patient Care WG (PCWG)
• The goal of LCC was 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 presented ongoing recommendations and comments
during PCWG meetings prior to ballot submittal• The majority of comments/recommendations presented by the LCC
Tiger Team were implemented in the DAM by the PCWG
Harmonize Care Plan DAM
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• Review of final balloted Domain Analysis Model:
Wednesday, Aug. 14 at 11am ET (NOTE: This will be the final LCC Tiger Team meeting)
• Overview of final DAM recommendations made to PCWG available on LCC Tiger Team wiki:
http://wiki.siframework.org/LCC+HL7+Tiger+Team+SWG• Past Meeting Artifacts available on the LCC Wiki:
http://wiki.siframework.org/LCC+-+Meeting+Artifacts
Balloted DAM Review
LTPAC SWGeLCC – Transitions of Care C-
CDA Revisions
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
© 2011 Lantana Consulting Group, www.lantanagroup.com23
LCC LTPAC Meeting Timeline
Jul 22: Nutrition & Plan of Care Artifacts
Jul 29: Documents-Transfer, Consult, Referral
Jul 29: C-CDA to Technical Writers (Lantana)
Aug 5: Highlight Incorporated Feedback
Aug 8: Post to C-CDA to HL7 List-Serv for review (HL7)
Aug 12: Ballot “How to”
Aug 15: Approval to go to ballot (HL7)
Aug 16: Ballot cycle opens(HL7)
LCP SWGCare Plan C-CDA
Development
Leads: Sarah Gaunt & Gaye Dolin (Lantana)
Overview
• Care Plan Document Type (NEW)– Goals Section (NEW)– Health Concerns Section (NEW)– Health Status Evaluations/Outcomes Section (NEW)– Interventions Section (V2)
• Discussed the following NEW Entry-Level Templates:– Act Reference– Author Participant– Goal Observation
• Patient Priority Preference• Provider Priority Preference
– Health Concern Act– Intervention Act– Outcome Observation– Prognosis Observation– Progress Toward Goal Observation
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© 2011 Lantana Consulting Group, www.lantanagroup.com26
IS CAUSE OF
HAS SU
PPORT
HAS
REA
SON
Relationships (Happy Path)
Health Concern
[mood EVN]
Goal [mood GOL]
Outcome Observation [mood EVN]
Intervention [mood: INT/ RQO/ etc.]
[mood: EVN]
Observation [mood EVN]
REFERS TOREFERS TO
HAS COMPONENT
EV
ALU
ATES
Progress Toward Goal Observation[mood EVN]
SUPP
ORTS
REFERS TO EVALUATIONS/OUTCOMES
HAS COMPONENT
© 2011 Lantana Consulting Group, www.lantanagroup.com27
• The following slides give a high level overview of the Care Plan templates that have been developed
• For further details, please see the latest C-CDA IG
Care Plan templates
© 2011 Lantana Consulting Group, www.lantanagroup.com28
• Care Plan
Care Plan Document-Level Template
Contained By: Contains:
Goals Section (NEW) Health Concerns Section (NEW) Health Status Evaluations/ Outcomes Section (NEW) Interventions Section (V2)
© 2011 Lantana Consulting Group, www.lantanagroup.com29
• Goals Section
• Health Concerns Section
• Health Status Evaluations/Outcomes Section
• Interventions Section
Contained By: Contains:
Care Plan (NEW) (required)
Outcome Observation (NEW)
Contained By: Contains:
Care Plan (NEW) (required)
Health Concern Act (NEW) Health Status Observation (V2)
Contained By: Contains:
Care Plan (NEW) (required) Goal Observation (NEW)
Care Plan Section-Level Templates
Contained By: Contains:
Care Plan (NEW) (required) Progress Note (V2) (optional)
Intervention Act (NEW)
© 2011 Lantana Consulting Group, www.lantanagroup.com30
• Goal Observation
Care Plan Entry-Level Templates
Contained By: Contains:
Goals Section (NEW) (required) Intervention Act (NEW) (optional) Outcome Observation (NEW) (optional)
Act Plan (V2) Author Participant (NEW) Encounter Plan (V2)
Health Concern Act (NEW) Observation Plan (V2) Outcome Observation (NEW)
Patient Priority Preference (NEW) Procedure Plan (V2) Provider Priority Preference (NEW)
Substance Administration Plan (V2) Supply Plan (V2)
© 2011 Lantana Consulting Group, www.lantanagroup.com31
• Health Concern Act (truncated – see C-CDA IG for full list of Contained templates)
Care Plan Entry-Level Templates
Contained By: Contains:
Health Concerns Section (NEW) (required)
Goal Observation (NEW) (optional)
Act Reference (NEW) Allergy - Intolerance Observation (V2) Assessment Scale Observation
Author Participant (NEW) Caregiver Characteristics Characteristics of Home Environment (NEW)
Cognitive Abilities Observation (NEW) Cognitive Status Observation (V2) Cultural and Religious Observation (NEW)
Current Smoking Status (V2) Diet (NEW) Encounter Diagnosis (V2)
Family History Organizer Functional Status Observation (V2) Highest Pressure Ulcer Stage
Hospital Admission Diagnosis (V2) Mental Status Observation (NEW) Number of Pressure Ulcers Observation
Nutritional Status Observation (NEW) Patient Priority Preference (NEW) Postprocedure Diagnosis (V2)
Pregnancy Observation Preoperative Diagnosis (V2) Problem Concern Act (Condition)
Problem Observation (V2) Provider Priority Preference (NEW) Reaction Observation (V2)
Result Observation (V2) Result Organizer (V2) Self-Care Activities (ADL and IADL) (NEW)
Sensory and Speech Status (NEW) Social History Observation (V2) Substance or Device Allergy - Intolerance Observation (V2) Tobacco Use (V2)
Vital Sign Observation (V2) Wound Observation (NEW)
© 2011 Lantana Consulting Group, www.lantanagroup.com32
• Outcome Observation
Care Plan Entry-Level Templates
Contained By: Contains:
Health Status Evaluations/ Outcomes Section (NEW) (required) Goal Observation (NEW) (optional)
Act Reference (NEW) Author Participant (NEW) Goal Observation (NEW) Progress Toward Goal Observation (NEW)
© 2011 Lantana Consulting Group, www.lantanagroup.com33
• Intervention Act (truncated – see C-CDA IG for full list of Contained templates)
Care Plan Entry-Level Templates
Contained By: Contains:
Interventions Section (V2) (optional)
Act Plan (V2) Act Reference (NEW) Advance Directive Observation (V2)
Author Participant (NEW) Encounter Activity (V2) Encounter Plan (V2)
Goal Observation (NEW) Immunization Activity (V2) Instruction (V2)
Medication Activity (V2) Non-Medicinal Supply Activity (V2) Nutrition Recommendations (NEW)
Observation Plan (V2) Procedure Activity Act (V2) Procedure Activity Observation (V2)
Procedure Activity Procedure (V2) Procedure Plan (V2) Substance Administration Plan (V2)
Supply Plan (V2)
© 2011 Lantana Consulting Group, www.lantanagroup.com34
• Blog post by Grahame Grieve
• Identifiers in CDA Documents
• Act Reference template
Referencing Objects internally
LCC WGNext Steps
Initiative Coordinator: Evelyn
Next Steps
• Lantana to publish Transitions of Care and Care Plan C-CDA Implementation Guide for HL7 Ballot Voting
– Fall Ballot Opens August 16th
– Ballot Reconciliation starts end of September
• Launch LCC Pilot WG on Sept. 16th
– LCC Committed Pilots: MA and NY
– Continue to conduct outreach to potential pilot sites: MD, CT, TN
• Monitor IMPACT Project Go-Live in September
• Monitor NY Downstate Care Coordination Project Go-Live in October
• Review final Patient Care WG Care Plan DAM and submit any necessary ballot comments
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