LHS – Care Team Value Sets Dr Stephen Chu Lisa Nelson January HL7 Working Group Meeting January 2018

Objectives To define harmonized care team value sets to support the delivery of patient-centered healthcare by multi-disciplinary care teams across multiple care settings The value sets will be used in the following: HL7 Care Plan Domain Analysis Model (DAM) v2.0 HL7 Care Coordination Services Functional Model HL7 Care Team Domain Analysis Model HL7 CCDA IG FHIR Care Plan and Care Team Resources IHE Care Plan, Dynamic Care Planning, Dynamic Care Team Management technical profiles

Care Team Types & Participants Care Settings: e.g. community (including healthcare home), acute care (including tertiary/quaternary care) Care Context: e.g. event, encounter, episode of care related, etc Clinical domains: e.g. cardiology, oncology, respiratory, etc Participants Participant roles Participant functions

Care Team Types Care Context Includes patient-centered Healthcare home Encounter – Focused Episode – Focused Care Coordination Condition-Focused Acute-care Setting Community-care Setting Event – Clinical Research Includes tertiary & quaternary care

Care Team Types – care context Definitions (sourced from FHIR Care Team Resource – Build 3.2.0) Term Definition Event-focused   This type of team focuses on one specific type of incident, which is non-patient specific. The incident is determined by the context of use. For example, code team (code red, code blue, medical emergency treatment) or the PICC line team. Encounter-focused This type of team focuses on one specific encounter. The encounter is determined by the context of use. For example, during an inpatient encounter, the nutrition support care team Episode-focused This type of team focuses on one specific episode of care with a defined time period or self-limiting process (e.g. 10 visits). The episode of care is determined by the context of use. For example, a maternity care team over 9 months. Condition-focused This type of team focuses on one specific condition. The condition is determined by the context of use. For example, a disease management team focused on one condition (e.g. diabetes). Longitudinal care-coordination focused This type of team focuses on overall care coordination managing one or more conditions across the continuum of care ensuring there are smooth transitions of care. The members of the team are determined or selected by an individual or organization. When determined by an organization, the team may be assigned or based on the person's enrolment in a particular program. For example, disease management team or patient centered medical home team. Clinical research Focused This type of team is responsible for establishing, conducting, coordinating and monitoring the outcomes of clinical trials. The team focuses on research, clinical care and education.

Care Team Type Clinical Domains Clinical Context Focused Care Team Types Event focused Encounter focused Episode of care focused Condition focused Longitudinal care coordination focused Clinical research focused The concept definitions in LOINC are not quite right. We need to get this changed in LOINC. Clinical Domain Focused Care Team Types Examples: Oncology care team medical oncology surgical oncology allied health oncology social service home care team support service team Cardiology care team Respiratory - CF care team Palliative care … This value set needs to be specified. We don’t have a valid concept list yet. Add Home & Community Based Services (HCBS) Focused Care Team Public Health Focused Care Team

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Value Set usage in C-CDA For Practioners For RelatedPersons code