Harmonization Opportunities Russell Leftwich

Past Harmonization Efforts Consolidated CDA (C-CDA) – IHE, Health Story, HITSP 32, HL7 – 3,000 ballot comments 2013 C-CDA Update and Care Plan DAM – S&I Longitudinal Coordination of Care – HL7 Structured Documents WG – HL7 Patient Care WG – Joint calls and collaboration to produce ballot

Care Plan Domain Analysis Model Organizational Care Team – Team members and roles known to organization – System ID for individuals – Recognizes role of family caregiver Patient-Centered Longitudinal Care Team – Spans organizations and episodes of care – Includes family & community caregivers – Needs unique identifiers for professionals (NPI)

Care Team Attributes Role with respect to this patient – Role not obvious from license or job title – Frequency of involvement – Intensity of involvement – Task duty vs decision maker – Role in care planning and governance – Last encounter/activity status

Care Team Attributes Team member association with data elements – Health concern Act of being concerned about a clinical concept Priority of team members may not align – Goals Authorship/acceptance/acknowledgement – Interventions Preferences Association or type of involvement

Importance of roles & associations Exchange of care plan across organizations Documentation for patient & caregivers Family who are not direct caregivers Governance of care plan Appropriate communication & hie Provenance of data including PGHD

2013 C-CDA Update C-CDA R1: CCD, Consult Note, Diagnostic Image Report, D/C Summary, H&P, Op Note, Procedure Note, Progress Note C-CDA R2 – Update Meds, results, problems, demographics, vital signs, allergies, immunizations – New Documents: Transfer summary Referral Note Consult Note – Updated and new sections incl. Functional status, Cognitive status, Equipment

Path Forward 2013 C-CDA and Care Plan DAM current HL7 Ballot Cycle Care Coordination Service functional model – Synthesis and exchange of care plan elements – Anticipated in January 2014 ballot cycle – Dependent on Care Plan Domain Model Value sets for role with respect to patient, associations, preferences, priorities, etc

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