LCC -Proposal for Next Steps August 28, 2012

Discussion Points Recap of Whitepaper Recommendations Critical milestones and activities driving LCC activities IMPACT Project deadlines and their impact on LCC activities Scope for Potential LCC Use Case 2.0 Scope for developing Stage 3 MU Comments Proposed key activities and timelines for LTPAC and LCP SWGs

Recap: Whitepaper Recommendations RecommendationResponsible TeamProposed Timeline 1.Harmonize S&I LCC WG Use Case 1.0 (conduct standards analysis and standards development) S&I Harmonization Team SEPT-OCT Develop Implementation Guide (IG) for LCC Use Case 1.0 S&I Harmonization Team DEC Leverage IG for Stage 3 MU Comment PeriodLCC WGDEC Ballot IG through HL7 for LCC Use Case 1.0S&I HL7 Balloting TeamJAN Extend LCC IG to develop new use case (Use Case 2.0) for exchange of Collaborative Care Plans. Use case will describe 2-3 scenarios. LCP SWGJAN Harmonize S&I LCC WG Use Case 2.0 (conduct standards analysis and standards development) S&I Harmonization Team FEB Develop and ballot through HL7 IG for LCC Use Case 2.0 S&I Harmonization Team/ HL7 Balloting Team MAY Provide S&I Framework resources for WG SupportONC/OSI LeadershipSEPT 2012

External Drivers Sept ‘12Oct ‘12Nov’12Dec ’12Jan’13Feb ’13Mar ’13Apr ’13May’13 HITPC Stage 3 MU HL7 Ballots IMPACT HITPC Pre-RFC Meeting Standards Analysis & Recommendation (1-2months) HL7 Fall Ballot Closes IMPACT Go-Live Implementation Guidance Development (1- 2 months) Stage 3 RFC Distributed RFC Deadline (Dec 21) ONC Synthesis of RFC Comments (1- 2 months) WGs reconcile RFC comments (1 month) Draft stage 3 Recs due Final stage 3 Recs due to HHS HL7 Spring Ballot Open HL7 January Ballot Open

IMPACT Project Deliverables For Consideration DeliverableDescriptionDue DateAlignment with WP Recommendation Standards Analysis & Recommendation Map ~450 Data Elements to Consolidated CDA. Vendor will conduct gap analysis as preliminary step to develop IG. OCT 2012Aligns with #1 and #5— standards analysis for Use Case 1.0 and 2.0 Implementation Guide Development Develop CDA templates and sample files incorporating the ~450 data elements. IG will not be developed with level of detail required for HL7 balloting. Missing elements will be identified as Free Text. NOV 2012Partial alignment with #2—IG development for Use Case 1.0. Additional harmonization work required from S&I Framework. IMPACT Project Go- Live Pilot CDA Transfer of Care document based on CCD templates from IG DEC 2012Outcomes of pilot can inform IG for Use Case 2.0 and Stage 3 MU recommendations

Key Questions for LCC WGs Is there value in developing the IG for LCC Use Case 1.0 given the IMPACT Project Scope of Work? If yes, how do we reconcile use case 1.0 with the IMPACT project data sets? If no, let’s consider…

…How to leverage IMPACT work for LCC WG activities Build from IMPACT standards analysis work and IG to create LCC Use Case 2.0 (contains all ~450 data elements) – LCC Use Case 1.0 may no longer be relevant for S&I harmonization given additional data elements identified since LCC Use Case 1.0 consensus (June 2012) LCC Use Case 2.0 will be handed off to S&I Harmonization Team (Deloitte). Deloitte team will then create ‘Care Plan IG’ which will be submitted for HL7 balloting Monitor and review IMPACT contract work (standards analysis) as part of weekly LTPAC SWG call

Scope for LCC Use Case 2.0 LCC Use Case 2.0 and IG may not contain all data elements for the exchange of Collaborative Care Plans LCC WG should revisit ‘baseline transaction and build’ presented during June LTPAC Collaborative Summit – Versions 2.0 to Version X.0 of LCC Use Case are built incrementally to add requirements of other trading partners (i.e. IRF, Behavioral Health, CBO) Care Plan is built out from most simple to most complex (i.e. treatment plan, care plan…to collaborative care plan)

From LTPAC Summit: Baseline Transaction and Build Master Longitudinal Care Use Case Version 1: Baseline Developed HH-POC Creates base Use Case Structure and focuses on HHA/ SNF as the starting point that gives the best overall coverage of data elements. Version 1: Baseline Developed HH-POC Creates base Use Case Structure and focuses on HHA/ SNF as the starting point that gives the best overall coverage of data elements. Version 2: Include ~450 elements identified by the IMPACT Project (potential Use Case 2.) Version 3: (IRF, Behavioral Health, CBO, ???) White Paper Roadmap lays out priority order to incrementally add requirements of other trading partners Version 3: (IRF, Behavioral Health, CBO, ???) White Paper Roadmap lays out priority order to incrementally add requirements of other trading partners Version …: Other trading partners Round out full longitudinal picture Version …: Other trading partners Round out full longitudinal picture Now: Foundation Future: Full LCP Support Building Incrementally 8 June 2012, Baltimore, MD

Building a Common Terminology for the Care Plan The WP acknowledges there are at least 10 recognized nursing care plan models and vocabularies. The concepts, vocabularies and value sets are not standardized. A process which allows for robust, standards based exchange of assessment data and leading to standards based exchange and update of the Care Plan Document Collaborative Care Plan Care Plan created through a process of communication, prioritization and negotiation leading to a consensus list of care plan HC’s, G’s and I’s Interdisciplinary Care Plan Cumulative Care Plans for all involved health professionals or disciplines Multidisciplinary Care Plan A plan of care which contains all required elements in association: Health Concern; Intervention; Desired Outcome or Goal; Milestones or Time Line; Responsible Party Care Plan Cumulative set of plans of care by all involved health professionals or disciplines. Multidisciplinary Plan of Care Cumulative Set of interventions and instructions for all health concerns addressed by a health professional or discipline Plan of Care Interventions and instructions intended to address a health concern by a health professional or discipline Treatment Plan Most resembles HHPoC MOST SIMPLE MOST COMPLEX

Scope for Stage 3 MU comments Map whitepaper recommendations against Stage 3 Preliminary Recommendations for ‘Improve Care Coordination’ Leverage gap analysis to develop LCC Use Case 2.0 Out of Scope Mapping WP to Stage 2 MU Final Rule – Part of Deloitte Scope of Work for ‘ToC Companion Guide’ Mapping WP to S&I Framework CEDD – Use Case 2.0 will need to be mapped to ToC CEDD

Summary of Proposed Key Activities for LCC SWGs Finalize and get consensus on ~450 Data Elements List - LTPAC Monitor and review progress of IMPACT Project Standards Analysis and IG Development work - LTPAC Update LCC Use Case to develop LCC Use Case 2.0 based on ~450 Data Elements List - LCP Map Whitepaper recommendations against Stage 3 MU Preliminary recommendations – LCC and LCP Discussion Point: Which activities will be led by LTPAC SWG and which will be led by LCP SWG?

LCC WG Timeline: Sept 2012 – May 2013 Sept‘12Oct ‘12Nov ’12Dec’12Jan’13Feb ’13Mar ’13May ’12 Milestones PAS SWG LTPAC SWG LCP SWG Use Case 2.0 Standards Analysis & Development Ballot Reconciliation Stage 3 MU RFC Deadline IMPACT Contract Awarded HL7 Fall Ballot Closes Finalize: Use Case Data Elements List (07SEP2012) Fall Ballot Prep HL7 January Ballot Opens Implementation Guidance IMPACT Project Go-Live Monitor IMPACT Project Pilot (1-2 months) Development: Use Case 2.0 Implementation Guide S&I Framework Contracts Expire Development: Stage 3 MU Recommendations Monitor: IMPACT Project Standards Analysis & IG Development (3-4 months) Mapping: Whitepaper to Stage 3 Preliminary Recommendations Development: Use Case v2.0 (2 to 3 months) HL7 Spring Ballot Opens

Other Discussion Points Timeline for reconciling Use Case 1.0 or developing Use Case 2.0 and submitting to S&I Harmonization team Timeline for S&I Harmonization Team to develop IG and put through HL7 balloting cycle – What version of Use Case will be developed to ensure submission of IG for January cycle? For May cycle? Contract end dates for S&I Framework Support Contracts (end of Feb 2013)