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Longitudinal Coordination of Care Use Case Scoping Discussion 3/19/2011

Longitudinal Coordination of Care Use Case Scoping Discussion 3/19/2011. Contents. Describe community work streams Use Case and Policy Whitepaper approach Recommendation for Use Case scoping. Matching Appropriate Artifacts to WG Needs.

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Longitudinal Coordination of Care Use Case Scoping Discussion 3/19/2011

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  1. Longitudinal Coordination of CareUse Case Scoping Discussion3/19/2011

  2. Contents • Describe community work streams • Use Case and Policy Whitepaper approach • Recommendation for Use Case scoping

  3. Matching Appropriate Artifacts to WG Needs • Need 1: Advance interoperability for the LTPAC community. • S&I process (Use Case, Harmonization, IG) provides actionable implementation path for the LTPAC community • LLC WG would like implementable specifications to support pilots before the end of 2012 • Need 2: Influence and impact ongoing policy discussions • LCC WG has a strong set of LTPAC interoperability policy stakeholders at the table • White paper would allow for the articulation of a vision and objectives that would be in a format that is familiar to policy-makers. • Need 3: Support specific WG objectives • Continue to use LCC WG as the working forum to support the Challenge, Beacon and VNSNY project objectives • Project-specific deliverables • Need 4: Serve as a platform for responding to important and related standards activities • CARE Tool work (C-CDA structure review, Data Elements Review) • Analysis-supporting deliverables

  4. Driving the Use Case vs. Driving Policy Interop Policy Whitepaper • Detailed articulation of environment • Detailed articulation of current efforts • CARE Tool work implications • NPRM response and implications • Vision for Longitudinal Coordination of Care • Articulate how S&I first LCC Use Case supports vision and what will come next Use Case Principles • Stay focused on specific transactions • All sections directly support the selected transactions • Document designed for business and technical implementers (not policy makers) • Get the best possible coverage of likely overall data elements with the least number of specifically defined transactions

  5. Broad Array of Overall Transactions • 169 Total Transactions across 13 identified trading partners • 91 Priority Transactions identified (Green) • 20 Second priority identified (Blue) • 58 transactions out of Scope (Red) • Would represent over 91 user stories in Use Case • ToC Use Case 1.1 had 5 user stories and 4 defined data exchanges (discharge instructions, discharge summary, clinical summary, specialist clinical summary)

  6. Complex Longitudinal View of Transitions

  7. Scoping Proposal • Initial Use Case reuses as much of the transition summaries as possible • 5 total transactions • Only data necessary for receiving clinician to begin safe care and/ or data available in current summaries • Examine Consolidated CDA document templates for discharge/instructions and referrals (see next slide) • Review CEDD core data elements • Identify essential but missing data elements • Reuse consultation request and consultation summary • Use subset of Home Health Agency and SNF transactions to inform the first version of LTPAC transactions • Includes a Scenario 3 to articulate 485 requirements • Continue to add incrementally and improve LTPAC transactions

  8. Initial Transactions Scenario 1: Transitions • Acute care to LTPAC: • Build on ToC Discharge Summary and Discharge Instructions • This will ALSO serve as first incremental step for LTPAC to LTPAC • LTPAC to acute care: • Build on ToC Discharge Summary and Discharge Instructions • Utilize MDS, OASIS Patient Assessment Summaries as basis and add detail incrementally Referral • LTPAC to specialist or outpatient services (build on ToC Referral and Results Summaries for PCP to specialist) Scenario 2 - Patient Communications: • Copy all summaries above to patient/care giver PHR Scenario 3 - Homecare Plan of Care: • HHA to Physician, Physician to HHA (Initial, Ongoing, Recertification)

  9. Summary of Essential Data Elements • Core data elements common to all transitions of care • Demographics/Patient Identifiers • Contact information for the Sending site and Clinician • Allergies • Medications • Current active problems • Alerts and Precautions • Advance Directives • Reason for transfer • Receiving Site-specific data elements • Role-specific data elements required by designated receivers (MD, RN, Therapist, etc) • Reason for transfer • Emergent evaluation and treatment • Ability to comprehend and consent to treatment • Baseline function and cognition with observed changes • Specific clinical issues requiring evaluation/treatment • Elective evaluation and treatment • Sufficient information to manage an unanticipated change in clinical condition • Permanent transfer • HHA specific data elements • Facility specific data elements • Patient specific data elements with detail as required by each site

  10. Proposed Scope of LCC Use Case Transaction 2 T 4 Scenario 2: Patient receives copies of all transactions Scenario 1: Informed by these transactions Transaction 1 T 3 LTPAC to LTPAC utilizes ACH to LTPAC as a starting point Transaction 5 Scenario 3: Transactions and functional requirements identified based on Homecare Use Case (485)

  11. How does this strategy promote the LCC WG Vision?

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