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Longitudinal Coordination of Care (LCC) Workgroup (WG)HL7 Tiger TeamPatient Care WG Care Plan DAM
July 31, 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 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
• Goals
• Schedule
• Review of recommendations made to PCWG for Care Plan DAM
– Items implemented in time for ballot
– Items not implemented in time for ballot
– Items not included in the DAM
• Next Steps
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• For this Tiger Team:• Alignment of HL7 artifacts with LCC artifacts to
support care plan exchange
• HL7 CCS provides Service Oriented Architecture
• Care Plan DAM provides informational structure
• LCC Implementation Guides provide functional requirements
• Ongoing comments can be submitted and viewed on wiki:
http://wiki.siframework.org/LCC+HL7+Tiger+Team+SWG
Goals
Work Group SchedulesLCC WG
SWG Meeting LCC Leads Date/ Time Projects
LTPAC SWG Larry GarberTerry O'Malley
Weekly Mondays, 11-12pm EST
C-CDA: Transfer Summary, Consult Note, Referral Note
LCC HL7 Tiger Team
Russ Leftwich Weekly Wednesdays, 11- 12pm EST
LCC WG comments for HL7 Care Plan DAM
LCP SWG Bill RussellSue MitchellJennie Harvell
Weekly Mondays and Thursdays 5-6pm EST
C-CDA: Care Plan, HomeHealth 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 Weds, 5 -6pm EST
Care Plan DAMCare Coordination Services (CSS)
HL7 Structured Documents WG
Bob DolinBrett Marquard
Sue MitchellJennie Harvell
Weekly Thursdays, 10-12pm EST
CDA (various)
HL7 SOA WG CCS Project Jon Farmer Enrique Meneses (facilitators) Stephen Chu
Susan Campbell Weekly Tuesdays 5 - 6pm EST
Care Coordination Services (CSS)
HL7 Patient Generated Document
Leslie Kelly Hall Weekly Fridays, 12-1pm EST
Patient-authored Clinical Documents
Schedule – July 2013SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY
1 2 3 4 5 611 AM ET
Discussion Plan Activity Data
Element Attributes
7 8 9 10 11 12 1311 AM ET
Discussion Team Member
Relationship to Patient
14 15 16 17 18 19 201:30 PM ET Continued
Discussion Team Member
Relationship to Patient
21 22 23 24 25 26 2711 AM ET
Meeting Cancelled
28 29 30 3111 AM ET Review
of DAM Recommendations
Overview
• Recommendations were formulated as a result of discussions involving the following subjects:
– Patient and Provider Roles in Plans of Care and Care Plan
– Preferences
– Priorities
– Levels of Association
– Team Member Acceptance/Acknowledgment
– Care Team Member Role
– Care Team Member Cardinality
– Team Member Responsibility – Care Plan
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Patient and Provider Roles in Plan of Care and Care Plan• Discussion: What role does the Provider play and what role
does the Patient play in both the Care Plan and the Plan of Care?• Recommend that DAM should support both the Care
Plan and Plan of Care, sequential and multi-threaded workflows; needs to define the buckets of all the information for all of these.
• Recommend adding attribute to Goals that can indicate that the goals have been agreed to by both the Provider and the Patient or that there is not agreement between the two.
• Recommend adding another attribute that supports specific health concern and intervention related goals (who has agreed to these goals).
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Patient and Provider Roles in Plan of Care and Care Plan, cont’d…• Recommend allowing for variance analysis with levels of
intervention.• Recommend adding/supporting an ability to harmonize
multiple treatments and Plans of Care and to create a Master Care Plan in the care of complex Patients in complex organizations.
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Preferences
• Discussion: How to represent preferences in DAM; how to show changes have occurred in a patient’s preferences• Recommend adding a separate Advance Directives
section that contains all preference information including advance directive preferences, which are linked to a repository or separate document.
• Recommend listing out and defining “Other preferences” under Types of Preferences.
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Priority
• Discussion: What data elements should have priority attributes and whether interventions should be prioritized, as well.• Recommend not including Priority in interventions.
Actions that were considered and not chosen as part of the intervention should be included elsewhere in the Care Plan.
• Recommend adding a text field with Priority so that comments can be captured with priority rankings.
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Levels of Association
• Discussion: Is it sufficient to associate one or more Care Team Members with a data element or should the model include levels of association?• If so, what is the value set for those role/relationship
levels? How many levels should there be and how are they represented (e.g. primary/secondary,/tertiary, or lead/support, or other)• Recommend including associations in model for
traceability (assignment of responsibility, payment, etc.): provide a bucket for association/responsibility level, bucket for functional role, and bucket for identification of responsible/associated individual or entity• Recommend that High, Medium, Low be used
as association/responsibility level designators for both Health Concerns and Interventions.
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Levels of Association, cont’d…
• Recommend that association should include individual and organization under functional role (Care Team Members may have more than one role inside an organization)
• Recommend that Health Concerns and Interventions also include type of association (e.g., fee for service, consent, other)
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• Discussion: Does the Care Team Member need to accept/acknowledge their association? • Recommend including the ability in the model for a Care
Team Member to accept/acknowledge their association
Team Member Acceptance/Acknowledgment
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Care Team Member Role
• Discussion: Current model includes “Role” attribute in Health Concern but not in Health Goal or Plan Activity.• Recommend establishing a taxonomy to support how
the association/relationship will be used (e.g., as a messaging filter to only send information to certain entities and/or showing who is involved and their sub-roles and/or other).
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• Discussion: Can Health Concerns, Goals and Interventions be associated with zero care team members within the DAM (other than the patient, who would be associated by default)?• Health Concerns to Team Member
• Recommend Health Concern can be zero to many cardinality, with SHOULD conformance
• Goals to Team Member• Recommend Goal can be zero to many cardinality,
with SHOULD conformance• Interventions to Team Member
• Recommend Intervention (Plan Activity) can be zero to many cardinality with SHOULD conformance
Team Member Cardinality
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• Discussion: Is Team Member’s responsibility for the Care Plan represented in the model?• Care Planning• Care Plan Governance
• Recommend a way to account for facilitation of the Care Plan (“steward” role or other)
Team Member Responsibility – Care Plan
Proposed Next Steps
• Next meeting is TBD and will be a full review of the final Domain Analysis Model
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Contact Information
We’re here to help. Please contact us if you have questions, comments, or would like to join other projects.
• S&I Initiative Coordinator• Evelyn Gallego [email protected]
• Sub Work Group Lead• Russ Leftwich [email protected]
• Program Management• Lynette Elliott [email protected]• Becky Angeles [email protected]