Longitudinal Coordination of Care (LCC) Workgroup (WG) LCC All Hands Meeting June 4,

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 May 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 LCC HL7 Tiger Team –Aligning the Patient Care WG Care Plan DAM to LCC HITPC MU3 SWG Meetings –Agreement to reference IMPACT Transfer of Care dataset: consult note, transfer summary and consultation request –Reviewing LCC Care Plan Recommendations for MU3 Lantana C-CDA Revisions Project (HL7 ToC Implementation Guidance development) –HL7 Project Scope Statement approved by HL7 Structured Documents WG –Transfer of Care dataset harmonization activities currently being reviewed with LTPAC SWG –Care Plan/HHPoC harmonization activities to start in June Reorganized LCC WG Structure and Meetings

Summary of LCC WG Accomplishments (contd) Continued LCC Stakeholder & Pilot Engagement Activities –Call for Pilot Participation! –Outreach to Vendors (Caradigm, GetRealHealth) –Outreach to State HIE Grantees: MD, CT, TN –Outreach to IDNs: Wellmont Health System (TN), Life Centers of America –HIMSS Analytics: Care Coordination Model –VA / DOD: HHPoC alignment

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 6 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. GOALSGOALS 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))

Work Group Schedules LCC WG SWG MeetingLCC LeadsDate/ TimeProjects LTPAC SWGLarry Garber Terry O'Malley Weekly Mondays 11am - 12pm EST C-CDA: Transfer Summary, Consult Note, Referral Note LCC HL7 Tiger Team Russ LeftwichWeekly Wednesdays 11am - 12pm EST LCC WG comments for HL7 Care Plan DAM LCP SWGBill Russell Sue Mitchell Jennie Harvell Weekly Thursdays 5pm - 6pm EST (starting June 6) C-CDA: Care Plan, Home Health 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 5pm - 6pm EST Care Plan DAM Care Coordination Services (CSS) HL7 Structured Documents WG Bob Dolin Brett Marquard Sue Mitchell Jennie Harvell Weekly Thursdays 10am - 12pm EST CDA (various) HL7 SOA WG CCS ProjectJon Farmer Enrique Meneses (facilitators) Stephen Chu Susan CampbellWeekly Tuesdays 5pm - 6pm EST Care Coordination Services (CSS) HL7 Patient Generated Document Leslie Kelly HallWeekly Fridays 12pm - 1pm EST Patient-authored Clinical Documents

LCC WG Timeline: Mar 2013 – Dec 2013 Mar 13Apr 13May 13Jun 13Jul 13Aug 13Sep 13Oct 13Dec 13 Milestones 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 Care Plan IG Development

LCP SWG 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 –Will feed into the Care Plan component of the work Lantana is doing for the Aug/Sept HL7 Ballot This work is being performed under the LCC Longitudinal Care Plan (LCP) SWG –Meetings are held on Thursdays from 5pm-6pm ET LCC Use Case 2.0 Wiki Page ( –We have a comment form to provide feedback on UC sections ( ts) ts 10

LCC Use Case 2 Development Schedule DateItem Feb User Stories Mar Scenario (Base Flow, Alternate Flow) 3.0 Use Case Scope (In Scope / Out of Scope) 3.4 Communities of Interest Apr Use Case Assumptions 6.0 Pre-Conditions 7.0 Post Conditions 8.0 Actors and Roles 11.0 Risks, Issues, and Obstacles May Use Case Diagrams 10.4 Sequence Diagram 10.3 Functional Requirements Appendices 12.0 Dataset Requirements Jun Dataset Requirements End-to-End Review (Includes 1.0, 2.0, 4.0) Consensus Period and Voting

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 12 ** Leverage content from Charter Draft sections complete Content available for review

LCC HL7 Tiger Team SWG Update Lead: Dr. Russ Leftwich

Overview Tiger Team Objectives Importance of LCC Engagement with HL7 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 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 Care Plan Domain Analysis Model ballot artifacts are due for submission on August 4

18 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 LCC Tiger Team is presenting recommendations and comments during PCWG meetings prior to when the DAM goes to ballot in September Harmonize Care Plan DAM

19 Define differences between Risks and Health Concerns, make recommendations on how to designate/categorize them Define Barriers, make recommendations on how to designate/categorize them Define Goals, Interventions, Outcomes and Assessments and make recommendations on how to designate/categorize them Past Meeting Artifacts available on the LCC Wiki: Discussions To-Date

20 Discuss methods of prioritization and who prioritizes Discuss how to assign Care Team Members to prioritized Goals, Concerns and Interventions Discuss how to reconcile differing prioritizations Discuss mitigation of irrational patient choices Align terminologies, definitions and Use Cases between PCWG and LCC Continuing Discussions

Schedule – May 2013 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY AM ET Overview of HL7 LCC Domain Analysis Model AM ET HL7 LCC DAM: Risks, Health Concerns, Barriers, Preferences AM ET HL7 LCC DAM: Risks, Health Concerns, Barriers, Preferences 5 PM ET Touch Point with PCWG AM ET HL7 LCC DAM: How to designate and/or model Prioritizations AM ET: HL7 LCC DAM: Assignment of Care Team Members to Prioritizations

Schedule – June 2013 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY AM ET: Discussion Prioritization AM ET Discussion contd Prioritization 5 PM ET Tentative Discussion with PCWG (TBD) AM ET Discussion TBD AM ET Discussion TBD 30

Participate in the Tiger Team If you are interested in joining the LCC HL7 Ballot Tiger Team, please: –Participate in the Wednesday meetings at 11:00am EST –Check out the wiki:

LTPAC SWG eLCC CDA IG Development Leads: Mike Tushan & Zabrina Gonzaga (Lantana)

25 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: Consultation Request Enhanced: Consult Note

26 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

27 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)

28 Deliverables Project Scope Statement (approved by Structured Docs WG) 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

29 Project Timeline Apr Task 1: Background Analysis S&I stakeholder meetings Identify relevant precedent Task 2: Functional Specifications/Setting Specific Rules S&I stakeholder meetings Develop mapping sheet Define setting specific rules MayJunJulAugOctNovDecSep 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 ballot Task 7: Reconciliation/Publication Develop ballot comment tracking table Lead reconciliation meetings Publish IG HL7 Reconciliation meeting frequency and dates TBD Draft

Next Steps Lantana to continue work on eLCC CDA Implementation Guide for ToC –Care Plan/HHPoC IG development scheduled to start in June Monitor IMPACT Project Go-Live in July 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) 30