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

2. 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

3. 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

4. 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

5. 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.

6. 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

7. CareTeam.participant.role

8. Practitioner.qualification.code

9. RelatedPerson.relationship

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