Transcript Care Plan

Longitudinal Coordination of Care
LCP SWG
Thursday, July 11, 2013
Agenda
Topic
Presenter
Time Allotted
Announcements and Reminders
Evelyn
5 minutes
Review of Use Case Baseflow (from Comments)
Evelyn
15 minutes
Care Plan C-CDA Revisions
Lantana
40 minutes
2
Announcements & Reminders
•
Voting Period is OPEN for the LCC Care Plan Exchange Use Case. Please
cast your vote by Monday, July 15th at 8pm ET.
•
•
•
•
Upcoming HITPC MU Meetings to review Care Plan Recommendations. Final
recommendations to be presented to HITPC in August
•
•
•
•
HITPC MU: July 16th 2013 11:00 to 1:00pm EST http://www.healthit.gov/policyresearchers-implementers/policy-meaningful-use-wg-36
HITPC MU: July 30th 2013 10:00 to 12:00pm EST http://www.healthit.gov/policyresearchers-implementers/policy-meaningful-use-workgroup-2
HITPC: Aug 7 2013 9:30 to 3:00pm EST http://www.healthit.gov/policy-researchersimplementers/hit-policy-committee-19
Call for Pilot Participation!
•
•
•
http://wiki.siframework.org/LCC+Care+Plan+Exchange+Use+Case+Consensus
Reminder that only LCC Committed Members can vote on the Use Case
Become a Committed Member
Presentation to ONC State HIE LTPAC CoP on 17 Jul 13
LCC Pilot Wiki Page & Pilot Survey: http://wiki.siframework.org/LCC+Pilot+Plan
Meeting Reminders (next week)
– LTPAC SWG meeting – Monday at 11am ET
– *NEW* LCP SWG MEETING – Monday at 5pm ET
– LCC HL7 Tiger Team SWG meeting – Wednesday at 11am ET
3
Discussion
• Review of UC Alternative Baseflow
4
Care Plan - CDA Document
Type Development
Sections Proposal
Sarah Gaunt
Gaye Dolin RN, MSN
July 11, 2013
© 2011 Lantana Consulting Group, www.lantanagroup.com
5
Objective
• Review revised timeline
• Discuss/Decide on CDA Sections for Care Plan Document Type
© 2011 Lantana Consulting Group, www.lantanagroup.com
6
Revised Timeline
• 29th July to technical writers
• 8th August to post to HL7 listserv for review
• 15th August approval to go to ballot
• 16th August ballot cycle opens
© 2011 Lantana Consulting Group, www.lantanagroup.com
7
Paper Based Care Plan Documents
© 2011 Lantana Consulting Group, www.lantanagroup.com
8
Care Plan in an EHR
9
© 2011 Lantana Consulting Group, www.lantanagroup.com
9
Care Plan in an EHR
10
© 2011 Lantana Consulting Group, www.lantanagroup.com
10
Actual Care Plan Documents
• Care Plan format that clinicians are used to dealing with all
look remarkably similar
• Rather than being broken into many sections, the information
is grouped into a few major/key sections
• These include:
• Assessment
• Diagnosis
• Planning
• Expected Outcomes
• Interventions
• Actual Outcome/Goal Evaluation
© 2011 Lantana Consulting Group, www.lantanagroup.com
11
LCC Care Plan Components
• Health Concerns
• Interventions/Instructions
• Goals
• Health Status Evaluations/Outcomes
• Care Team Members (CDA participations)
© 2011 Lantana Consulting Group, www.lantanagroup.com
12
LCC Components easily align to "traditional"
Care Plan sections
• Health Concerns  Diagnosis, Problems, Symptoms, etc.
• Interventions/Instructions  Interventions/Plans
• Goals  Expected Outcomes/Goals
• Health Status Evaluations/Outcomes  Evaluation
© 2011 Lantana Consulting Group, www.lantanagroup.com
13
LOINC Codes (document-level)
• Care Plan
• No suitable (generic) code exists in LOINC
• 61145-9: Patient Plan of Care (CLASS: DOC.MISC)
• 64295-9: Plan of Care: (Nursing) (CLASS: DOC.CLINRPT)
• 52521-2: Overall Plan of Care &or Advance Care Directives
(CLASS:SURVEY.CARE)
• 56447-6: Plan of Care (CLASS: DOC.MISC)
• Etc.
• Need to request a code or valueSet
• Do we need a valueSet for the Care Plan document code?
© 2011 Lantana Consulting Group, www.lantanagroup.com
14
LOINC Codes (section-level)
• Health Concerns
• 46030-3: Health Conditions Section (Class:
SURVEY:MDS)
• Goals
• 61146-7: Goals (Class: DOC.MISC)
• 61147-5: Expected outcomes (Class: DOC.MISC)
• Health Status Evaluations/Outcomes
• 11383-7: Patient Problem Outcome (Class: H&P.HX)
© 2011 Lantana Consulting Group, www.lantanagroup.com
15
LOINC Codes (section-level)
• Interventions/Instructions
• Intervention Section is an existing C-CDA Section
• 62387-6: Interventions (Class: DOC.MISC)
• Instructions Section is an existing C-CDA Section
• 69730-0: Instructions (Class: DOC.MISC)
• Discuss options
© 2011 Lantana Consulting Group, www.lantanagroup.com
16
Additional Sections?
• Problem Section
• Assessment Section
• Medications
• Others?
© 2011 Lantana Consulting Group, www.lantanagroup.com
17
Sample CDA Rendering
© 2011 Lantana Consulting Group, www.lantanagroup.com
18
Discussion
© 2011 Lantana Consulting Group, www.lantanagroup.com
19
Back-up Slides
CONSENSUS PROCESS
20
Consensus on the Use Case
•
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)
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
21
Submitting Your Vote
http://wiki.siframework.org/LLC+Care+Pl
an+Exchange+Use+Case+Consensus
1. Review the Care Plan Exchange
Use Case
2. Complete the Voting Form:
1
– NOTE: You must be a Committed
Member to Vote
•
•
•
•
3.
4.
Yes
Yes with comments.
Formal Objection
Abstain (decline to vote)
Submit your Vote
A Message is displayed verifying
your vote was recorded
2
3
4
22
Viewing Your Vote
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
5
Note: All Consensus Votes are due July 15th by 8:00 pm EST
23
Consensus Timeline
Date
Item
6/20
Open End-to-End Review
6/27
Review End-to-End Comments
7/5
Close End-to-End Review
7/8
Open Consensus Voting
7/15
Close Consensus Voting at 8:00pm ET
7/16-7/17 Consolidate Votes and Address “No” Votes
7/18
Review Final Comment Dispositions and Complete all Outstanding Votes
Verbally
7/19
Publish Consensus Voting Results
24
LCC Use Case 2 Development Schedule
Date
Item
Homework (Due Wednesday COB)
3/2013
10.0 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
4/2013
3.4 Communities of Interest, 5.0 Assumptions, 6.0 PreConditions, 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
5/2013
10.3 Functional Requirements, 9.0 Use Case Diagrams,
Appendices, 12.0 Dataset Requirements
Finalize: Sequence Diagrams, Functional Requirements, Use Case
Diagrams, Appendices
Review: Dataset Requirements
6/6/13
1.0 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
6/13/13
12.0 Dataset Requirements
End-to-End Review (preliminary), Dataset Requirements
6/20/13
12.0 Dataset Requirements
End-to-End Review Period is 6/20-7/5
6/27/13
Review End-to-End Comments
End-to-End Review – Submit Comments
7/4/13
Meeting Canceled
End-to-End Review – Submit Comments
7/8-7/15
Consensus Voting Period
VOTE!!
7/18/13
Review Final Comment Disposition and Complete all
Outstanding Votes Verbally
7/19/13
Publish Consensus Vote Results