Longitudinal Coordination of Care LCP SWG Thursday, June 27, 2013.

Longitudinal Coordination of Care

LCP SWGThursday, June 27, 2013

Topic Presenter Time Allotted

ONC S&I Update Evelyn 5 minutes

Announcements and Reminders Evelyn 5 minutes

Care Plan - CDA Document Type Development Lantana 15 minutes

ONC S&I Consensus Process Becky 10 minutes

Use Case 2.0 - End to End Review Becky 25 minutes

Agenda

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• The Care Plan/Home Health Plan of Care Contract with Lantana has been signed!!– This contract will bring the functional requirements of Use Case 2.0 into

the C-CDA Revisions planned for the HL7 fall ballot• Next Thursday’s call is cancelled due to the holiday

– Propose meeting on Monday July 1st at 3pm or 4pm ET• ONC Report to Congress on Health IT Adoption and HIE 2012:

http://www.healthit.gov/sites/default/files/rtc_adoption_of_healthit_and_relatedefforts.pdf– Provides updates on adoption of HIT from 01JAN12 to 20APR13– Describes CMS and ONC efforts to facilitate nationwide adoption and

exchange of electronic health information– Identifies barriers to adoption and exchange– Calls out work of State HIE Challenge Grantees and S&I LCC WG

• Call for Pilot Participation!– LCC Pilot Wiki Page– Pilot Survey

ONC S&I Update

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http://www.healthit.gov/sites/default/files/rtc_adoption_of_healthit_and_relatedefforts.pdf

http://www.healthit.gov/sites/default/files/rtc_adoption_of_healthit_and_relatedefforts.pdf

http://wiki.siframework.org/LCC+Pilot+Plan

http://wiki.siframework.org/LCC+Pilot+Interest+Survey

• Review and Submit Comments to the IHE Patient Care Plan Supplement– The document is available for download at

http://www.ihe.net/Technical_Framework/public_comment.cfm– Comments can be submitted by July 3rd at

http://www.ihe.net/pcc/pcccomments.cfm

• Meeting Reminders (next week)– LTPAC SWG meeting – Monday at 11am ET – LCP SWG meeting – Monday at 4pm or 5pm ET– LCC HL7 Tiger Team SWG meeting – Wednesday at 11am ET– LCP SWG meeting – Thursday at 5pm ET - Cancelled

• 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 & Reminders

http://www.ihe.net/Technical_Framework/public_comment.cfm

http://www.ihe.net/pcc/pcccomments.cfm

http://wiki.siframework.org/LCC+WG+Use+Case+2.0

© 2011 Lantana Consulting Group, www.lantanagroup.com5

Care Plan - CDA Document Type Development

Project Overview

Sarah Gaunt

Gaye Dolin RN, MSN

June 27, 2013


Objective

Develop CDA Care Plan Framework for information exchange of instances of a Patient Care Plan in the C-CDA IG

•Add a Care Plan document type

•New section templates to convey Care Plan structure

•Modify existing or create new entry templates to represent relationships between Care Plan Activities

•Create new templates where key Care Plan concepts are not already represented by existing templates.


Background


Background

• S&I Framework’s Longitudinal Coordination of Care Work

• http://wiki.siframework.org/LCC+Longitudinal+Care+Plan+%28LCP%29+SWG

• HL7 Patient Care Work Group – Care Plan Project

• Project wiki: http://wiki.hl7.org/index.php?title=Care_Plan_Project_2012

• Care Plan DAM (soon to be updated): http://wiki.hl7.org/images/2/24/CpDetailedModelImg.png

• IHE Patient Care Plan Content Profile (PtCP)

• http://www.ihe.net/Technical_Framework/upload/IHE_PCC_Suppl_PtCP_Rev1-0_PC_2013-06-03.pdf


Stakeholders and Participants

• ASPE/HHS – Assistant Secretary for Planning and Evaluation

• ONC S&I Framework

• HL7 International Structured Documents Work Group

• HL7 International Patient Care Work Group

• HL7 International Child Health Work Group

• IHE Patient Care Coordination Work Group


Project Deliverables

• Project Scope Statement (already submitted)

• HL7 Ballot Package

• Published HL7 in Consolidated CDA IG V2

• Limited to 20+ New templates (up to 35 if needed and time allows)

• Schematron and Sample Files


Timelines

• The timelines are EXTREMELY short for this ballot with final material to be reviewed by stakeholders and submitted to HL7 HQ prior to August 16th

• Cross dependency with 2 other projects also to be submitted in the C-CDA ballot:

• eLCC (Transfer, referral and Consult Notes)

• SMART – Updates to MU2 C-CDA templates

• More specific time lines to be discussed next call


Next Steps:

• Utilize this Thursday’s meeting for CDA design sessions

• Determine Next Week's Open Stakeholder Meeting

• On July 11th determine if 2 meetings per week are needed

• Review HL7 Submitted Project Scope Statement next call

• Discuss design heuristics in more detail next call

• Translate HL7 Patient Care DAM into CDA Framework sample file and start template development

• After the S&I Care Plan Use Case is voted on – begin incorporating requirements


High Level Overview of Care Plan "Framework"

• Map LCC data elements to HL7 Care Plan model and C-CDA (reference IHE PtCP)

class Preferences

CarePreference

+ acceptance :AcceptanceReview [0..*]+ activationCriteria :Criterion [0..*]+ alternatePreferences :CarePreference [0..*] {ordered}+ comments :String+ effectiveDate :DateTime+ expressedBy :Role [1..*]+ media :URL [0..*]+ preference :Code+ reason :Code- strength :LevelType- unfulfi l ledReason :Reason [0..1]

ClinicalObjectReference

Activ ity

+ applicability :TimeRecord [0..1]+ classification :Code+ description :Code+ endDate :DateTime+ frequency :Frequency [0..1]+ functionalArea :Code [0..*]+ postcondition :Criterion [0..*]+ precondition :Criterion [0..*]+ priority :Priority+ startDate :DateTime+ supportiveContent :ClinicalObjectReference [0..*]

Plan

+ clinicalSpecialty :Code [0..*]+ completeDate :DateTime+ confidentiality :ConfidentialityType+ createDate :DateTime+ displayName :String+ effectiveDate :DateTime+ id :Identifier+ latestUpdateDate :DateTime+ planClass :PlanClassType+ version :String

A

Common::ActCareBarrier

+ comments :String+ effectiveDate :DateTime+ observer :Role+ resolvedDate :DateTimeClinicalObjectReference

HealthConcern

+ description :Code+ effectiveTime :DateTime+ expressedBy :Role [1..*]+ priority :Priority [1..*]+ reason :ClinicalObjectReference [0..*]+ resolvedTime :DateTime

Observation

HealthGoal

+ goal :Code+ milestoneGoal :HealthGoal [0..*] {ordered}+ narrative :String+ planStatus :ExecutionStatusType+ priority :Priority [1..*]+ successCriteria :Criterion [0..*]+ targetDate :DateTime

HealthRisk

+ description :Code+ effectiveTime :DateTime+ levelOfRisk :LevelType+ observer :Role+ resolvedTime :DateTime

+replace 0..*

+activePreferences

0..*

+actionStep 0..*{ordered}

+carePreference 0..*

+careBarrier

0..*

+concern

0..*

+targetOutcome 0..*

blocks health goal

+blockedGoal 0..*

addressesConcern

+targetConcern 0..*

+goal

0..*

+presentingRisk

0..*

+presentingRisk *

LCC Goals

LCC Evaluation of Health Status

C-CDA Problem Concern Actwith subjectC-CDA Problem Observation

C-CDA Possible New "Goal" Template



• Map relationships between Care Plan model classes in CDA

class Preferences

CarePreference

+ acceptance :AcceptanceReview [0..*]+ activationCriteria :Criterion [0..*]+ alternatePreferences :CarePreference [0..*] {ordered}+ comments :String+ effectiveDate :DateTime+ expressedBy :Role [1..*]+ media :URL [0..*]+ preference :Code+ reason :Code- strength :LevelType- unfulfi l ledReason :Reason [0..1]

ClinicalObjectReference

Activ ity

+ applicability :TimeRecord [0..1]+ classification :Code+ description :Code+ endDate :DateTime+ frequency :Frequency [0..1]+ functionalArea :Code [0..*]+ postcondition :Criterion [0..*]+ precondition :Criterion [0..*]+ priority :Priority+ startDate :DateTime+ supportiveContent :ClinicalObjectReference [0..*]

Plan

+ clinicalSpecialty :Code [0..*]+ completeDate :DateTime+ confidentiality :ConfidentialityType+ createDate :DateTime+ displayName :String+ effectiveDate :DateTime+ id :Identifier+ latestUpdateDate :DateTime+ planClass :PlanClassType+ version :String

A

Common::ActCareBarrier

+ comments :String+ effectiveDate :DateTime+ observer :Role+ resolvedDate :DateTimeClinicalObjectReference

HealthConcern

+ description :Code+ effectiveTime :DateTime+ expressedBy :Role [1..*]+ priority :Priority [1..*]+ reason :ClinicalObjectReference [0..*]+ resolvedTime :DateTime

Observation

HealthGoal

+ goal :Code+ milestoneGoal :HealthGoal [0..*] {ordered}+ narrative :String+ planStatus :ExecutionStatusType+ priority :Priority [1..*]+ successCriteria :Criterion [0..*]+ targetDate :DateTime

HealthRisk

+ description :Code+ effectiveTime :DateTime+ levelOfRisk :LevelType+ observer :Role+ resolvedTime :DateTime

+replace 0..*

+activePreferences

0..*

+actionStep 0..*{ordered}

+carePreference 0..*

+careBarrier

0..*

+concern

0..*

+targetOutcome 0..*

blocks health goal

+blockedGoal 0..*

addressesConcern

+targetConcern 0..*

+goal

0..*

+presentingRisk

0..*

+presentingRisk *

LCC Goals

LCC Evaluation of Health Status

C-CDA Problem Concern Actwith subjectC-CDA Problem Observation

C-CDA Possible New "Goal" Template

C-CDA New "Relationship" Template



• "Relationship" templates are the key to unlocking the power of C-CDA for use with Care Plan

• Many (most?) required templates already exist in C-CDA

• Any template can be used in any section or be related to any other template in C-CDA

• "Relationship" templates with descriptions will form a "Framework" on which to hang Care Plan

• More details to come on later calls


Questions?

• On July 8th, Committed members will be asked to cast a vote on the “LCC Care Plan Exchange Use Case”– Yes

• A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Initiative Member, but that it is better to move forward than to block the deliverable

– Yes with comments• If a Consensus Process attracts significant comments (through Yes with

comment votes), it is expected that the comments be addressed in a future revision of the deliverable.

– Formal Objection- with comments indicating a path to address the objection in a way that meets the known concerns of other members of the Community of Interest. "Formal Objection" vote without such comments will be considered Abstain votes.

• A Formal Objection means that the objector cannot proceed with the project unless the objections are met. It is acceptable and expected to use a Formal Objection in a first consensus round to communicate a point of view or process issue that has not been addressed in the drafting of the initial deliverable.

• Should a Consensus Process attract even one "Formal Objection" vote with comments from an Initiative Member, the deliverable must be revised to address the "Formal Objection" vote (unless an exceptional process is declared).

– Abstain (decline to vote)

Consensus on the Use Case

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Note: Each Organization, no matter the number of Committed Members only receives 1 Vote. If there are multiple committed members from your organization please verify your collective vote with them

http://wiki.siframework.org/LLC+Care+Plan+Exchange+Use+Case+Consensus1.Review the Care Plan Exchange Use Case:

– Final document will be available 6/28/2013

2.Complete the Voting Form:– NOTE: You must be a Committed

Member to Vote• Yes• Yes with comments.• Formal Objection• Abstain (decline to vote)

3.Submit your Vote

4.A Message is displayed verifying your vote was recorded 18

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33

44

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Submitting Your Vote

5. You can view and track your Vote (located directly below the Voting Form)

• Note: you may need to refresh your browser a few times to see your vote

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Note: All Consensus Votes are due July 15th by 8:00 pm EST

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Viewing Your Vote

Date Item

6/20 Open End-to-End Review

6/27 Review End-to-End Comments

7/5 Close End-to-End Review

7/8 Open Consensus Voting

7/15 Close Consensus Voting at 8:00pm ET

7/16-7/17 Consolidate Votes and Address “No” Votes

7/18 Review Final Comment Dispositions and Complete all Outstanding Votes Verbally

7/19 Publish Consensus Voting Results

Consensus Timeline

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LCC Use Case 2 Development ScheduleDate Item Homework (Due Wednesday COB)

3/2013 10.0 Scenario (User Stories, Base/Alternate Flow), 3.2 In Scope, 3.3 Out of Scope

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

4/2013 3.4 Communities of Interest, 5.0 Assumptions, 6.0 Pre-Conditions, 7.0 Post Conditions, 8.0 Actors and Roles, 11.0 Risks, Issues, and Obstacles, 10.4 Sequence Diagram

Finalize: Communities of Interest, Assumptions, Pre / Post Conditions, Actors and Roles, Risks, Issues and ObstaclesReview: Use Case Diagrams

5/2013 10.3 Functional Requirements, 9.0 Use Case Diagrams, Appendices, 12.0 Dataset Requirements

Finalize: Sequence Diagrams, Functional Requirements, Use Case Diagrams, AppendicesReview: Dataset Requirements

6/6/13 1.0 Preface and Introduction, 2.0 Initiative Overview, 3.0 Scope, 3.1 Background, 3.1.1 Care Plan Definitions and References, 4.0 Value Statement

End-to-End Review (preliminary), Dataset Requirements

6/13/13 12.0 Dataset Requirements End-to-End Review (preliminary), Dataset Requirements

6/20/13 12.0 Dataset Requirements End-to-End Review Period is 6/20-7/5

6/27/13 Review End-to-End Comments End-to-End Review – Submit Comments

7/4/13 Meeting Canceled End-to-End Review – Submit Comments

7/8-7/15 Consensus Voting Period VOTE!!

7/18/13 Review Final Comment Disposition and Complete all Outstanding Votes Verbally

7/19/13 Publish Consensus Vote Results

• 1.0 Preface and Introduction**

• 2.0 Initiative Overview– 2.1 Initiative Challenge Statement**

• 3.0 Use Case Scope– 3.1 Background**

• 3.1.1 Care Plan Definitions and References

– 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

Longitudinal Coordination of Care LCP SWG Thursday, June 27, 2013.

Documents

care plan dam

care plan structure

care plan activities

cda care plan framework

swg http

hl7 patient care dam

key care plan concepts

lantana consulting group