1. Longitudinal Coordination of Care LCP SWG Thursday, July 11, 2013

2. TopicPresenterTime Allotted Announcements and RemindersEvelyn5 minutes Review of Use Case Baseflow (from Comments)Evelyn15 minutes Care Plan C-CDA RevisionsLantana40 minutes Agenda 2

3. Voting Period is OPEN for the LCC Care Plan Exchange Use Case. Please cast your vote by Monday, July 15 th at 8pm ET. http://wiki.siframework.org/LCC+Care+Plan+Exchange+Use+Case+Consensus Reminder that only LCC Committed Members can vote on the Use Case Become a Committed Member Upcoming HITPC MU Meetings to review Care Plan Recommendations. Final recommendations to be presented to HITPC in August HITPC MU: July 16th 2013 11:00 to 1:00pm EST http://www.healthit.gov/policy- researchers-implementers/policy-meaningful-use-wg-36http://www.healthit.gov/policy- researchers-implementers/policy-meaningful-use-wg-36 HITPC MU: July 30th 2013 10:00 to 12:00pm EST http://www.healthit.gov/policy- researchers-implementers/policy-meaningful-use-workgroup-2http://www.healthit.gov/policy- researchers-implementers/policy-meaningful-use-workgroup-2 HITPC: Aug 7 2013 9:30 to 3:00pm EST http://www.healthit.gov/policy-researchers- implementers/hit-policy-committee-19http://www.healthit.gov/policy-researchers- implementers/hit-policy-committee-19 Call for Pilot Participation! Presentation to ONC State HIE LTPAC CoP on 17 Jul 13 LCC Pilot Wiki Page & Pilot Survey: http://wiki.siframework.org/LCC+Pilot+Planhttp://wiki.siframework.org/LCC+Pilot+Plan Meeting Reminders (next week) –LTPAC SWG meeting – Monday at 11am ET –*NEW* LCP SWG MEETING – Monday at 5pm ET –LCC HL7 Tiger Team SWG meeting – Wednesday at 11am ET 3 Announcements & Reminders

4. Review of UC Alternative Baseflow 4 Discussion

5. © 2011 Lantana Consulting Group, www.lantanagroup.com 5 Care Plan - CDA Document Type Development Sections Proposal Sarah Gaunt Gaye Dolin RN, MSN July 11, 2013

6. © 2011 Lantana Consulting Group, www.lantanagroup.com 6 Objective Review revised timeline Discuss/Decide on CDA Sections for Care Plan Document Type

7. © 2011 Lantana Consulting Group, www.lantanagroup.com 7 Revised Timeline 29 th July to technical writers 8 th August to post to HL7 listserv for review 15 th August approval to go to ballot 16 th August ballot cycle opens

8. © 2011 Lantana Consulting Group, www.lantanagroup.com 8 Paper Based Care Plan Documents

9. © 2011 Lantana Consulting Group, www.lantanagroup.com 9 Care Plan in an EHR 9

10. © 2011 Lantana Consulting Group, www.lantanagroup.com 10 Care Plan in an EHR 10

11. © 2011 Lantana Consulting Group, www.lantanagroup.com 11 Actual Care Plan Documents Care Plan format that clinicians are used to dealing with all look remarkably similar Rather than being broken into many sections, the information is grouped into a few major/key sections These include: Assessment Diagnosis Planning Expected Outcomes Interventions Actual Outcome/Goal Evaluation

12. © 2011 Lantana Consulting Group, www.lantanagroup.com 12 LCC Care Plan Components Health Concerns Interventions/Instructions Goals Health Status Evaluations/Outcomes Care Team Members (CDA participations)

13. © 2011 Lantana Consulting Group, www.lantanagroup.com 13 LCC Components easily align to "traditional" Care Plan sections Health Concerns  Diagnosis, Problems, Symptoms, etc. Interventions/Instructions  Interventions/Plans Goals  Expected Outcomes/Goals Health Status Evaluations/Outcomes  Evaluation

14. © 2011 Lantana Consulting Group, www.lantanagroup.com 14 LOINC Codes (document-level) Care Plan No suitable (generic) code exists in LOINC 61145-9: Patient Plan of Care (CLASS: DOC.MISC) 64295-9: Plan of Care: (Nursing) (CLASS: DOC.CLINRPT) 52521-2: Overall Plan of Care &or Advance Care Directives (CLASS:SURVEY.CARE) 56447-6: Plan of Care (CLASS: DOC.MISC) Etc. Need to request a code or valueSet Do we need a valueSet for the Care Plan document code?

15. © 2011 Lantana Consulting Group, www.lantanagroup.com 15 LOINC Codes (section-level) Health Concerns 46030-3: Health Conditions Section (Class: SURVEY:MDS) Goals 61146-7: Goals (Class: DOC.MISC) 61147-5: Expected outcomes (Class: DOC.MISC) Health Status Evaluations/Outcomes 11383-7: Patient Problem Outcome (Class: H&P.HX)

16. © 2011 Lantana Consulting Group, www.lantanagroup.com 16 LOINC Codes (section-level) Interventions/Instructions Intervention Section is an existing C-CDA Section 62387-6: Interventions (Class: DOC.MISC) Instructions Section is an existing C-CDA Section 69730-0: Instructions (Class: DOC.MISC) Discuss options

17. © 2011 Lantana Consulting Group, www.lantanagroup.com 17 Additional Sections? Problem Section Assessment Section Medications Others?

18. © 2011 Lantana Consulting Group, www.lantanagroup.com 18 Sample CDA Rendering

19. © 2011 Lantana Consulting Group, www.lantanagroup.com 19 Discussion

20. CONSENSUS PROCESS Back-up Slides 20

21. 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 21 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

22. http://wiki.siframework.org/LLC+Care+Pl an+Exchange+Use+Case+Consensus 1.Review the Care Plan Exchange Use CaseCare Plan Exchange Use Case 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 22 2 2 3 3 4 4 Submitting Your Vote 1 1

23. 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 23 Note: All Consensus Votes are due July 15 th by 8:00 pm EST 5 5 Viewing Your Vote

24. DateItem 6/20Open End-to-End Review 6/27Review End-to-End Comments 7/5Close End-to-End Review 7/8Open Consensus Voting 7/15Close Consensus Voting at 8:00pm ET 7/16-7/17Consolidate Votes and Address “No” Votes 7/18Review Final Comment Dispositions and Complete all Outstanding Votes Verbally 7/19Publish Consensus Voting Results Consensus Timeline 24

25. LCC Use Case 2 Development Schedule DateItemHomework (Due Wednesday COB) 3/201310.0 Scenario (User Stories, Base/Alternate Flow), 3.2 In Scope, 3.3 Out of Scope Finalize: User Stories, Base Flows, In / Out of Scope Review: Communities of Interest, Assumptions 4/20133.4 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 Obstacles Review: Use Case Diagrams 5/201310.3 Functional Requirements, 9.0 Use Case Diagrams, Appendices, 12.0 Dataset Requirements Finalize: Sequence Diagrams, Functional Requirements, Use Case Diagrams, Appendices Review: Dataset Requirements 6/6/131.0 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 6/13/1312.0 Dataset RequirementsEnd-to-End Review (preliminary), Dataset Requirements 6/20/1312.0 Dataset RequirementsEnd-to-End Review Period is 6/20-7/5 6/27/13Review End-to-End CommentsEnd-to-End Review – Submit Comments 7/4/13Meeting CanceledEnd-to-End Review – Submit Comments 7/8-7/15Consensus Voting PeriodVOTE!! 7/18/13 Review Final Comment Disposition and Complete all Outstanding Votes Verbally 7/19/13 Publish Consensus Vote Results