Harmonization Opportunities

Russell Leftwich

Past Harmonization Efforts

• Consolidated CDA (C-CDA)– IHE, Health Story, HITSP 32, HL7– 3,000 ballot comments

• 2013 C-CDA Update and Care Plan DAM– S&I Longitudinal Coordination of Care– HL7 Structured Documents WG– HL7 Patient Care WG– Joint calls and collaboration to produce ballot

Care Plan Domain Analysis Model

• Organizational Care Team– Team members and roles known to organization– System ID for individuals– Recognizes role of family caregiver

• Patient-Centered Longitudinal Care Team– Spans organizations and episodes of care– Includes family & community caregivers– Needs unique identifiers for professionals (NPI)

Care Team Attributes

• Role with respect to this patient– Role not obvious from license or job title– Frequency of involvement– Intensity of involvement– Task duty vs decision maker– Role in care planning and governance– Last encounter/activity status

Care Team Attributes

• Team member association with data elements– Health concern• Act of being concerned about a clinical concept• Priority of team members may not align

– Goals• Authorship/acceptance/acknowledgement

– Interventions• Preferences• Association or type of involvement

Importance of roles & associations

• Exchange of care plan across organizations• Documentation for patient & caregivers• Family who are not direct caregivers• Governance of care plan• Appropriate communication & hie • Provenance of data including PGHD

2013 C-CDA Update• C-CDA R1: CCD, Consult Note, Diagnostic Image

Report, D/C Summary, H&P, Op Note, Procedure Note, Progress Note

• C-CDA R2– Update Meds, results, problems, demographics,

vital signs, allergies, immunizations– New Documents:

• Transfer summary• Referral Note• Consult Note

– Updated and new sections• incl. Functional status, Cognitive status, Equipment

Path Forward

• 2013 C-CDA and Care Plan DAM current HL7 Ballot Cycle

• Care Coordination Service functional model– Synthesis and exchange of care plan elements– Anticipated in January 2014 ballot cycle– Dependent on Care Plan Domain Model

• Value sets for role with respect to patient, associations, preferences, priorities, etc

Questions?