1. Longitudinal Coordination of Care (LCC) Workgroup (WG) HL7 Tiger Team Patient Care WG Care Plan DAM July 19, 2013 1

2. 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

3. Agenda Goals Schedule Discussion of Team Members association with and level of involvement for Health Concerns, Interventions, Goals Discussion of how to represent Team Members relationship to the Patient Next Steps 3

4. 4 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

5. Schedule – July 2013 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 123456 11 AM ET Discussion Plan Activity Data Element Attributes 78910111213 11 AM ET Discussion Team Member Relationship to Patient 14151617181920 1:30 PM ET Continued Discussion Team Member Relationship to Patient 21222324252627 11 AM ET Discussion TBD 28293031 11 AM ET Discussion TBD

6. Work Group Schedules LCC WG SWG MeetingLCC LeadsDate/ TimeProjects LTPAC SWGLarry Garber Terry O'Malley Weekly Mondays, 11-12pm EST C-CDA: Transfer Summary, Consult Note, Referral Note LCC HL7 Tiger Team Russ LeftwichWeekly Wednesdays, 11- 12pm EST LCC WG comments for HL7 Care Plan DAM LCP SWGBill Russell Sue Mitchell Jennie Harvell Weekly Mondays and Thursdays 5-6pm EST C-CDA: Care Plan, HomeHealth Plan of Care HL7 WG SWG MeetingHL7 LeadParticipating LCC Members Date/ TimeProjects HL7 Patient Care WGRuss Leftwich Elaine Ayers Stephen Chu Michael Tan Kevin Coonan Susan Campbell Laura H Langford Lindsey Hoggle Bi-weekly Weds, 5 - 6pm EST Care Plan DAM Care Coordination Services (CSS) HL7 Structured Documents WG Bob Dolin Brett Marquard Sue Mitchell Jennie Harvell Weekly Thursdays, 10-12pm EST CDA (various) HL7 SOA WG CCS ProjectJon Farmer Enrique Meneses (facilitators) Stephen Chu Susan CampbellWeekly Tuesdays 5 - 6pm EST Care Coordination Services (CSS) HL7 Patient Generated Document Leslie Kelly HallWeekly Fridays, 12- 1pm EST Patient-authored Clinical Documents

7. 7 Continued discussion of how to represent Team Members association with and level of involvement for the following data elements (to align with LCC Use Case 2): Health Concerns Interventions Goals New discussion of how to represent Team Members relationship to the Patient Is this represented in current model? Does it need to be? Is it the individual involved in care planning process, do they have a role in updating the care plan, or do they simply have access to the Care Plan? Tiger Team Discussion Points

8. 8 How to represent Team Members association with and level of involvement for the following data elements: Health Concerns Interventions Goals How to represent these associations Primary, secondary? Other? Team Member Responsibility Discussion

9. 9 Identify Team Members association with and level of involvement for Health Concerns Team Member Responsibility – Health Concerns

10. 10 Identify Team Members association with and level of involvement for Interventions Team Member Responsibility – Interventions

11. 11 Identify Team Members association with and level of involvement for Goals Team Member Responsibility – Goals

12. 12 New discussion of how to represent Team Members relationship to the Patient Is this represented in current model? Does it need to be? Is it the individual involved in care planning process, do they have a role in updating the care plan, or do they simply have access to the Care Plan? Example: A patient might see a specialist (any care team member in a specialized domain – behavioral health, nutrition, physical therapy, etc.) once, or it might be intended that the patient will see the specialist only as needed, at intervals from years to days. Such a specialist seen only once or at intervals of years apart would not likely be involved in care plan updates or in all information exchange about the patient. Team Member Relationship to Patient

13. 13 What attributes should be captured? PCP, specialist acting as PCP, independent consultant, task specific care team member Intensity or level of engagement – one time, as needed, specified intervals frequent or infrequent Relationship to other care team members? Date of last encounter? Care plan governance or read only access Communications separate from governance? Team Member Relationship to Patient

14. 14 New discussion of how to represent Team Members relationship to the Patient Is this represented in current model? Does it need to be? Is it the individual involved in care planning process, do they have a role in updating the care plan, or do they simply have access to the Care Plan? Team Member Relationship to Patient

15. Proposed Next Steps Next Touch Point meeting with PCWG is July 24 Update discussion schedule Finalize LCCs Comments well before August 4, 2013 for submittal as part of September Ballot (HL7 PCWG needs time to incorporate any comments)

16. 16 Contact Information Were here to help. Please contact us if you have questions, comments, or would like to join other projects. S&I Initiative Coordinator Evelyn Gallego evelyn.gallego@siframework.orgevelyn.gallego@siframework.org Sub Work Group Lead Russ Leftwich cmiotn@gmail.comcmiotn@gmail.com Program Management Lynette Elliott lynette.elliott@esacinc.comlynette.elliott@esacinc.com Becky Angeles becky.angeles@esacinc.combecky.angeles@esacinc.com