Longitudinal Coordination of Care LCP SWG Thursday, May 16, 2013

S&I Update Reminders Use Case 2.0 –Schedule and Outline –10.3 Functional Requirements – Incorporate –Digital vs. Electronic Signature Requirement –David Taos Comments on Base Flow, Alternate Flow, Assumption sections –9.0 Use Case Diagrams –Appendices 2 Agenda

LCC Collaboration with HIMSS Request to move LCP WG call to Thursdays 5 to 6pm EST Call for Pilot Participation! Register for the 2013 LTPAC HIT Summit –Date: June 16 to 18 –Location: Baltimore, MD – 011a0-3d9f-45cc c37baafhttp:// 011a0-3d9f-45cc c37baaf 3 ONC S&I Update

The Monday LTPAC SWG calls are being used by Lantana for the development of the C-CDA Implementation Guides Meeting Reminders (next week) –LTPAC SWG – Monday at 11am ET –LCC HL7 Tiger Team SWG – Wednesday at 11am ET –LCP SWG – Thursday at 11am ET Visit the LCC Use Case 2.0 Wiki Page for all current artifacts to review: ( –Use the comment form to provide feedback on UC sections ( 4 Reminders

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 DateItemHomework (Due Friday COB) 3/11 – 3/ Scenario (User Stories, Base/Alternate Flow, Functional Requirements) Review: User Stories 3/25 – 3/ Use Case Scope (Background, In / Out of Scope, Communities of Interest) Finalize: User Stories, Base Flows, In / Out of Scope Review: Communities of Interest, Assumption 4/1 – 4/2 3.4 Communities of InterestFinalize: Communities of Interest, Assumptions, Pre- Conditions, Post-Conditions Review: Actors and Roles 5.0 Use Case Assumptions 6.0, 7.0 Pre-Conditions, Post Conditions 4/8 - 4/11 Finalize: Assumptions, Pre-Conditions, Post- Conditions, Communities of Interest 8.0 Actors and Roles Finalize: Assumptions, Pre-Conditions, Post- Conditions, Actors and Roles 4/15 – 4/18 Finalize: Communities of Interest, Assumptions, Actors and Roles Review: Base/Alternate Flows, User Stories Activity Diagrams Review: Base Flows, Activity Diagrams Finalize: Base Flows, Activity Diagrams 4/22 – 4/ Risks, Issues, and ObstaclesFinalize: Risks, Issues and Obstacles Review: Sequence Diagrams 10.4 Sequence Diagram 5/2 – 5/ Functional RequirementsFinalize: Sequence Diagrams, Functional Requirements Review: Use Case Diagrams, Appendices 9.0 Use Case Diagrams Appendices 5/16Discuss: Incorporate Functional Requirements, Digital vs. Electronic Signature Requirement Finalize: Use Case Diagram Review: Appendices Finalize: Use Case Diagrams, Appendices Review: Dataset Requirements 5/ Dataset RequirementsEnd-to-End Review (preliminary)

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 Use Case Outline 10.0 Scenario: Generic Provider Workflow –10.1 User Stories –10.2 Activity Diagram o Base Flow o Alternate Flow –10.3 Functional Requirements o Information Interchange Requirements o System Requirements –10.4 Sequence Diagram 11.0 Risks, Issues and Obstacles 12.0 Dataset Requirements Appendices –Related Use Cases –Previous Work Efforts –References –Glossary 6 ** Leverage content from Charter Draft sections complete Content available for review

Show Jims Word Doc Jim Thompsons Comments on Incorporate in the Functional Requirements section 7

Based upon Jims information on the ONC 2014 Final Rule, I agree 100% with Jim that the word incorporate is not the correct verbiage for us to use in Table 9 as it stands right now. The term definitely implies that the data elements are being integrated into the EHR. Prior to finalizing any text, I would recommend that we agree on the action we would like implementers to take. –#1 – The original Care Plan needs be stored in the EHR system so it can be referenced. (Store the Care Plan document intact for retrieval) –#2 – The Care Plan data elements supported by the EHR should be incorporated into the EHR as appropriate. (Incorporate Data Elements) Recipient EHR has the option to incorporate individual data elements. The Care Plan document could be viewed and modified in an electronic way This statement requires additional explanation in order for it to stand. Here are my recommendations: –Assumption: EHR Systems shall incorporate the data elements from the Care Plan into EHR as supported by the System –In-Scope: Incorporation of supported Care Plan data elements into the EHR –Out of Scope: It is understood at this time that most EHR Systems are not capable of incorporating all of the Care Plan data elements. Although it is the long-term desire for all of the Care Plan data elements to be incorporated into the EHR, it is not a requirement of this Use Case that additional Care Plan data elements be incorporated by the EHR. –Placement of the Care Plan data elements is currently out of scope because the model in which elements are created and placed into an EHR may be changed as data models for Care Plan gets finalized. Cindy Levys Response to Jim Thompsons Incorporate Comments 8

It is possible to include a Digital Signature directly in a CDA. There is a RIM field for this (signature_text) which could be introduced as an extension in Consolidated CDA. The Consolidated CDA ballot will describe the field, and will reference the sister ballot being developed by Bob Dieterle and Security WG. –Bob Dieterle also remarked that given the convergence between LCCs work and that of the HL7 security work group, the prospects are good for a successful ballot (of the esMD standard) in Sept 2013 timeframe. CDA already has an electronic signature solution. So we'll be reviewing and also using that. –Summary: the care plan (including HH PoC) standard will be developed to accommodate both an electronic and digital signature. This approach will support the near-tem interoperable exchange of care plans, and also support CMS requirements as they evolve. Bob Dieterle can join the S&I LCC calls on Thurs. from 11:30 to 12:00. We should try to (i) save signature discussions until he joins and (ii) get an update from him about esMD activities when he joins. Digital vs. Electronic Signature Requirement 9

Show Use Case 2.0 document – – Multi-member care team Change to Care Team – – Base Flow for Scenario 1 comments – – Alternate Flow Text comments –5.0 – Assumptions (already modified) David Taos Comments from the Wiki 10

%20Case%20Diagrams% pptx/ /LCC%20Care%20Plan%20Use%20Case%20Di agrams% pptxhttp://wiki.siframework.org/file/view/LCC%20Care%20Plan%20Use %20Case%20Diagrams% pptx/ /LCC%20Care%20Plan%20Use%20Case%20Di agrams% pptx Use Case Diagrams 11

06.docx/ /Appendices% docxhttp://wiki.siframework.org/file/view/Appendices% docx/ /Appendices% docx Appendices 12