1. Longitudinal Coordination of Care LCP SWG Thursday, June 27, 2013

2. TopicPresenterTime Allotted ONC S&I UpdateEvelyn5 minutes Announcements and RemindersEvelyn5 minutes Care Plan - CDA Document Type DevelopmentLantana15 minutes ONC S&I Consensus ProcessBecky10 minutes Use Case 2.0 - End to End ReviewBecky25 minutes Agenda 2

3. The Care Plan/Home Health Plan of Care Contract with Lantana has been signed!! –This contract will bring the functional requirements of Use Case 2.0 into the C-CDA Revisions planned for the HL7 fall ballot Next Thursdays call is cancelled due to the holiday –Propose meeting on Monday July 1 st at 3pm or 4pm ET ONC Report to Congress on Health IT Adoption and HIE 2012: http://www.healthit.gov/sites/default/files/rtc_adoption_of_healt hit_and_relatedefforts.pdfhttp://www.healthit.gov/sites/default/files/rtc_adoption_of_healt hit_and_relatedefforts.pdf –Provides updates on adoption of HIT from 01JAN12 to 20APR13 –Describes CMS and ONC efforts to facilitate nationwide adoption and exchange of electronic health information –Identifies barriers to adoption and exchange –Calls out work of State HIE Challenge Grantees and S&I LCC WG Call for Pilot Participation! –LCC Pilot Wiki PageLCC Pilot Wiki Page –Pilot SurveyPilot Survey ONC S&I Update 3

4. Review and Submit Comments to the IHE Patient Care Plan Supplement –The document is available for download at http://www.ihe.net/Technical_Framework/public_comment.cfm http://www.ihe.net/Technical_Framework/public_comment.cfm –Comments can be submitted by July 3rd at http://www.ihe.net/pcc/pcccomments.cfm http://www.ihe.net/pcc/pcccomments.cfm Meeting Reminders (next week) –LTPAC SWG meeting – Monday at 11am ET –LCP SWG meeting – Monday at 4pm or 5pm ET –LCC HL7 Tiger Team SWG meeting – Wednesday at 11am ET –LCP SWG meeting – Thursday at 5pm ET - Cancelled Visit the LCC Use Case 2.0 Wiki Page for all current artifacts to review: (http://wiki.siframework.org/LCC+WG+Use+Case+2.0)http://wiki.siframework.org/LCC+WG+Use+Case+2.0 –Use the comment form to provide feedback on UC sections (http://wiki.siframework.org/LCC+Use+Case+2.0+Comments)http://wiki.siframework.org/LCC+Use+Case+2.0+Comments 4 Announcements & Reminders

5. © 2011 Lantana Consulting Group, www.lantanagroup.com 5 Care Plan - CDA Document Type Development Project Overview Sarah Gaunt Gaye Dolin RN, MSN June 27, 2013

6. © 2011 Lantana Consulting Group, www.lantanagroup.com 6 Objective Develop CDA Care Plan Framework for information exchange of instances of a Patient Care Plan in the C-CDA IG Add a Care Plan document type New section templates to convey Care Plan structure Modify existing or create new entry templates to represent relationships between Care Plan Activities Create new templates where key Care Plan concepts are not already represented by existing templates.

7. © 2011 Lantana Consulting Group, www.lantanagroup.com 7 Background

8. © 2011 Lantana Consulting Group, www.lantanagroup.com 8 Background S&I Frameworks Longitudinal Coordination of Care Work http://wiki.siframework.org/LCC+Longitudinal+Care+Plan+%2 8LCP%29+SWG http://wiki.siframework.org/LCC+Longitudinal+Care+Plan+%2 8LCP%29+SWG HL7 Patient Care Work Group – Care Plan Project Project wiki: http://wiki.hl7.org/index.php?title=Care_Plan_Project_2012 http://wiki.hl7.org/index.php?title=Care_Plan_Project_2012 Care Plan DAM (soon to be updated): http://wiki.hl7.org/images/2/24/CpDetailedModelImg.png http://wiki.hl7.org/images/2/24/CpDetailedModelImg.png IHE Patient Care Plan Content Profile (PtCP) http://www.ihe.net/Technical_Framework/upload/IHE_PCC_S uppl_PtCP_Rev1-0_PC_2013-06-03.pdf http://www.ihe.net/Technical_Framework/upload/IHE_PCC_S uppl_PtCP_Rev1-0_PC_2013-06-03.pdf

9. © 2011 Lantana Consulting Group, www.lantanagroup.com 9 Stakeholders and Participants ASPE/HHS – Assistant Secretary for Planning and Evaluation ONC S&I Framework HL7 International Structured Documents Work Group HL7 International Patient Care Work Group HL7 International Child Health Work Group IHE Patient Care Coordination Work Group

10. © 2011 Lantana Consulting Group, www.lantanagroup.com 10 Project Deliverables Project Scope Statement (already submitted) HL7 Ballot Package Published HL7 in Consolidated CDA IG V2 Limited to 20+ New templates (up to 35 if needed and time allows) Schematron and Sample Files

11. © 2011 Lantana Consulting Group, www.lantanagroup.com 11 Timelines The timelines are EXTREMELY short for this ballot with final material to be reviewed by stakeholders and submitted to HL7 HQ prior to August 16 th Cross dependency with 2 other projects also to be submitted in the C-CDA ballot: eLCC (Transfer, referral and Consult Notes) SMART – Updates to MU2 C-CDA templates More specific time lines to be discussed next call

12. © 2011 Lantana Consulting Group, www.lantanagroup.com 12 Next Steps: Utilize this Thursdays meeting for CDA design sessions Determine Next Week's Open Stakeholder Meeting On July 11 th determine if 2 meetings per week are needed Review HL7 Submitted Project Scope Statement next call Discuss design heuristics in more detail next call Translate HL7 Patient Care DAM into CDA Framework sample file and start template development After the S&I Care Plan Use Case is voted on – begin incorporating requirements

13. © 2011 Lantana Consulting Group, www.lantanagroup.com 13 High Level Overview of Care Plan "Framework" Map LCC data elements to HL7 Care Plan model and C-CDA (reference IHE PtCP) LCC Goals LCC Evaluation of Health Status C-CDA Problem Concern Act with subject C-CDA Problem Observation C-CDA Possible New "Goal" Template

14. © 2011 Lantana Consulting Group, www.lantanagroup.com 14 High Level Overview of Care Plan "Framework" Map relationships between Care Plan model classes in CDA LCC Goals LCC Evaluation of Health Status C-CDA Problem Concern Act with subject C-CDA Problem Observation C-CDA Possible New "Goal" Template C-CDA New "Relationship" Template

15. © 2011 Lantana Consulting Group, www.lantanagroup.com 15 High Level Overview of Care Plan "Framework" "Relationship" templates are the key to unlocking the power of C-CDA for use with Care Plan Many (most?) required templates already exist in C-CDA Any template can be used in any section or be related to any other template in C-CDA "Relationship" templates with descriptions will form a "Framework" on which to hang Care Plan More details to come on later calls

16. © 2011 Lantana Consulting Group, www.lantanagroup.com 16 Questions?

17. On July 8th, Committed members will be asked to cast a vote on the LCC Care Plan Exchange Use Case –Yes A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Initiative Member, but that it is better to move forward than to block the deliverable –Yes with comments If a Consensus Process attracts significant comments (through Yes with comment votes), it is expected that the comments be addressed in a future revision of the deliverable. –Formal Objection- with comments indicating a path to address the objection in a way that meets the known concerns of other members of the Community of Interest. "Formal Objection" vote without such comments will be considered Abstain votes. A Formal Objection means that the objector cannot proceed with the project unless the objections are met. It is acceptable and expected to use a Formal Objection in a first consensus round to communicate a point of view or process issue that has not been addressed in the drafting of the initial deliverable. Should a Consensus Process attract even one "Formal Objection" vote with comments from an Initiative Member, the deliverable must be revised to address the "Formal Objection" vote (unless an exceptional process is declared). –Abstain (decline to vote) Consensus on the Use Case 17 Note: Each Organization, no matter the number of Committed Members only receives 1 Vote. If there are multiple committed members from your organization please verify your collective vote with them

18. http://wiki.siframework.org/LLC+Care+Pla n+Exchange+Use+Case+Consensus 1.Review the Care Plan Exchange Use Case: –Final document will be available 6/28/2013 2.Complete the Voting Form: –NOTE: You must be a Committed Member to Vote Yes Yes with comments. Formal Objection Abstain (decline to vote) 3.Submit your Vote 4.A Message is displayed verifying your vote was recorded 18 2 2 3 3 4 4 1 1 Submitting Your Vote

19. 5. You can view and track your Vote (located directly below the Voting Form) Note: you may need to refresh your browser a few times to see your vote 19 Note: All Consensus Votes are due July 15 th by 8:00 pm EST 5 5 Viewing Your Vote

20. DateItem 6/20Open End-to-End Review 6/27Review End-to-End Comments 7/5Close End-to-End Review 7/8Open Consensus Voting 7/15Close Consensus Voting at 8:00pm ET 7/16-7/17Consolidate Votes and Address No Votes 7/18Review Final Comment Dispositions and Complete all Outstanding Votes Verbally 7/19Publish Consensus Voting Results Consensus Timeline 20

21. LCC Use Case 2 Development Schedule DateItemHomework (Due Wednesday COB) 3/201310.0 Scenario (User Stories, Base/Alternate Flow), 3.2 In Scope, 3.3 Out of Scope Finalize: User Stories, Base Flows, In / Out of Scope Review: Communities of Interest, Assumptions 4/20133.4 Communities of Interest, 5.0 Assumptions, 6.0 Pre- Conditions, 7.0 Post Conditions, 8.0 Actors and Roles, 11.0 Risks, Issues, and Obstacles, 10.4 Sequence Diagram Finalize: Communities of Interest, Assumptions, Pre / Post Conditions, Actors and Roles, Risks, Issues and Obstacles Review: Use Case Diagrams 5/201310.3 Functional Requirements, 9.0 Use Case Diagrams, Appendices, 12.0 Dataset Requirements Finalize: Sequence Diagrams, Functional Requirements, Use Case Diagrams, Appendices Review: Dataset Requirements 6/6/131.0 Preface and Introduction, 2.0 Initiative Overview, 3.0 Scope, 3.1 Background, 3.1.1 Care Plan Definitions and References, 4.0 Value Statement End-to-End Review (preliminary), Dataset Requirements 6/13/1312.0 Dataset RequirementsEnd-to-End Review (preliminary), Dataset Requirements 6/20/1312.0 Dataset RequirementsEnd-to-End Review Period is 6/20-7/5 6/27/13Review End-to-End CommentsEnd-to-End Review – Submit Comments 7/4/13Meeting CanceledEnd-to-End Review – Submit Comments 7/8-7/15Consensus Voting PeriodVOTE!! 7/18/13 Review Final Comment Disposition and Complete all Outstanding Votes Verbally 7/19/13 Publish Consensus Vote Results

22. 1.0 Preface and Introduction** 2.0 Initiative Overview –2.1 Initiative Challenge Statement** 3.0 Use Case Scope –3.1 Background** 3.1.1 Care Plan Definitions and References –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 10.2.1 Base Flow o 10.2.2 Alternate Flow –10.3 Functional Requirements o 10.3.1 Information Interchange Requirements o 10.3.2 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 22 ** Leverage content from Charter Draft sections complete Content available for review