Longitudinal Coordination of Care (LCC) Workgroup (WG)

LCC All Hands Meeting

May 7, 2013

1

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 recorded

o 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 April 2013

• LCC WG Timeline

• LCC Use Case 2.0

• HL7 Ballot Tiger Team

• eLCC – CDA IG Development

• Next Steps

3

Summary of LCC WG Accomplishments• Continued development LCC Use Case 2.0 focused on

Interoperable Care Plan Exchange• Presented LCC WG update to HITPC (03APR13)• Kicked off LCC HL7 Tiger Team

– Developed and submitted comments for HL7 CSS Comment only Ballot

• Kicked off Lantana C-CDA Revisions Project (HL7 ToC Implementation Guidance development)

• Reorganized LCC WG Structure and Meetings• Continued LCC Stakeholder & Pilot Engagement Activities

– State HIE F2F Presentation – NY Department of Health Presentation– Outreach to Vendors (EHR, HIE, Care Coordination)– Outreach to LTPAC Organizations & Vendors (Life Centers of

America)– Outreach to Provider Organizations (ANA)

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

5

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))

LCC WG Timeline: Mar 2013 – Dec 2013

Mile

ston

es

Pilot Site Identification & Engagement

Care Plan IG Complete

Lantana Contract Awarded for

Development of ToC IG

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 IGs 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

Lantana Contract Awarded for

Development of Care Plan IG

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

• LCC Use Case 2.0 Wiki Page (http://wiki.siframework.org/LCC+WG+Use+Case+2.0)

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

8

LCC Use Case 2 Development Schedule

Items 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 Friday 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

Review: Actors and RolesFinalize: 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, Functional Requirements10.3 Functional Requirements

10.4 Sequence Diagram

5/2 10.3 Functional Requirements Finalize: Sequence DiagramsReview: Functional Requirements, Use Case Diagrams

5/9 9.0 Use Case DiagramsAppendices

Finalize: Functional Requirements, Use Case DiagramsReview: Appendices

5/16 12.0 Dataset Requirements End-to-End Review (preliminary)

Use Case Outline

• 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

10

•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 Dataset Requirements

•12.0 Risks, Issues and Obstacles

•Appendices

– Related Use Cases– Previous Work Efforts– References ** Leverage content from Charter

Draft sections complete

Content available for review

LCC HL7 Tiger Team Update

Lead: Dr. Russ Leftwich

Overview

• HL7 Tiger Team Issues/Topics

– Tiger Team Objectives

– Importance of LCC Engagement with HL7

• Care Coordination Service (CCS) May Ballot (sponsored by HL7 Patient Care WG, co-sponsors Clinical Decision Support WG, Service Oriented Architecture WG)

• Care Plan Domain Analysis Model (DAM) September Ballot (sponsored by HL7 Patient Care WG, co sponsored by Structured Documents WG)

• Structured Documents WG

– Establish artifacts and ballot comments

– Harmonize Care Plan DAM

– Schedule

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 Coordination Service and Care Plan Domain Analysis Model (DAM) Ballots for May and September 2013 to align LCC Objectives with HL7 Work Products

Importance of LCC and HL7 Coordination

• Care Coordination Service May Comment Ballot (HL7 Patient Care and Service Oriented Architecture WGs)– This is being balloted separately from the Care Plan DAM, so

LCC comment is necessary to harmonize the two work products

• Care Plan Domain Analysis Model September Ballot (HL7 Patient Care WG)

– Shared glossary of terms– Alignment of the various care plan components between LCC

and HL7 (Risks, Barriers, Relationships, Prioritization, etc)

Establish Tiger Team Artifacts and Ballot Comments

• Comments in MS Excel Ballot Package

• Presentations for updates to HL7 Workgroups

• HL7 SOA CCS Ballot comments were submitted April 29

• HL7 Care Plan Domain Analysis Model ballot artifacts are due for submission on August 4

16

• Care Coordination Service Comments ballot• Comments aggregated from last 3 weeks TT calls• Submitted to HL7 for ballot close April 29• Aggregated comments will be posted on wiki for

review• Comments to be reviewed by CCS in coming weeks• HL7 CCS project has offered to review with LCC • Target to have normative ballot for functional model

Sept 2013• CCS will have dependency on Care Plan DAM• CCS ballots functional model, not Care Coordination

Service

HL7 Ballot Comments Debrief

17

• The Domain Analysis Model (DAM) was created by the HL7 Patient Care WG (PCWG).

• The goal of LCC is 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.• Ideally comments will be rolled into the DAM before it

goes to ballot in September.

Harmonize Care Plan DAM

18

• Define differences between Risks and Health Concerns, map out how to categorize them

• Define Barriers, map out how to categorize them

• Define Goals, Concerns and Interventions, map out how to designate prioritization of each

• Map out how to mitigate irrational choices (this could fall under Risk discussion, as well)

• Map out how to assign Care Team Members to prioritized Goals, Concerns and Interventions

• Patient priorities vs. Care Team Member priorities

• Align terminologies, definitions and Use Cases between PCWG and LCC

Points for Discussion

Schedule – April 2013SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

1 2 3 4 5 6

7 8 9 10 11 12 13

11 AM ET: HL7 Care Coordination Services Overview

to LCC

14 15 16 17 18 19 20

11 AM ET: LCC Tiger Team

Meeting for CCS Ballot

Preliminary CCS Ballot

Comments Due

21 22 23 24 25 26 27

11 AM ET: Final LCC CCS Ballot

Review Meeting

Final CCS Ballot

Comments Due

28 29 30

LCC CCS Ballot

Comments Due to HL7

Schedule – May 2013SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

1 2 3 411 AM ET Overview of HL7 LCC Domain

Analysis Model

5 6 7 8 9 10 1111 AM ET HL7 LCC DAM: Risks, Health Concerns, Barriers,

Preferences

12 13 14 15 16 17 1811 AM ET HL7 LCC DAM: Risks, Health Concerns, Barriers,

Preferences

5 PM ET Tentative Touch Point with

PCWG

19 20 21 22 23 24 2511 AM ET HL7 LCC

DAM: How to designate and/or

model Prioritizations

26 27 28 29 30 3111 AM ET: HL7 LCC DAM: Assignment

of Care Team Members to

Prioritizations

Participate in the Tiger Team

• If you are interested in joining the LCC HL7 Ballot Tiger Team, please:– Participate in the Wednesday, April 10th meeting at 11:00am

EST– Check out the wiki:

http://wiki.siframework.org/LCC+HL7+Tiger+Team+SWG

eLCC CDA IG Development

Leads: Mike Tushan & Zabrina Gonzaga (Lantana)

23

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: Referral Note

• Enhanced: Consult Note

24

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

25

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)

26

Deliverables

• 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

27

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

Next Steps

• Lantana developing scope statement for eLCC CDA Implementation Guide development

– Care Plan/HHPoC IG development scheduled to start in May

• Monitor IMPACT Project Go-Live in June

• Continue outreach to key LCC Stakeholder groups

– Professional Associations, EHR vendors, CMS Care Planning Programs

– Coordination with other Care Plan Initiatives: DoD/VA, HIMSS

• Develop/Execute on Pilot Engagement Plan (Call for Participation!)

– MA and NY entities have committed to pilot pre-balloted LCC standards before end of year

– Engage TN LTPAC Entities and Life Centers of America

• Develop and submit Tiger Team Recommendations to HL7 WGs

• Continue participation in HITPC SWG MU3 #3 Care Coordination

• Participate in LTPAC HIT Summit (June)

28