Domain Expert Working Session

1. Domain Expert Working Session caEHR Analysis Team August 4, 2010

2. Agenda • Announcements • Release Cycle 2 Activities • Medication Management/Chemo Scheduling (including Meaningful Use criteria) • Narrative Development

3. caEHR Announcements

4. Announcements • August Face-to-Face Meeting Logistics • September Face-to-Face • Washington, DC • Analysis Team on-boarding complete – Introduction to team members

5. caEHR Release Cycle 2 Activities

6. Release Cycle 2 Activities • Now – October 4, 2010 (2 months left) • Analysis Activities will be scheduled to support the Release Cycle 2 Goals (see next 3 slides) • Domain Expert meetings will be established to meet the requirements discussions/information gathering necessary to support the analysis artifact development

7. Key Analysis Milestones For RC 2 • Project Scope and Vision (includes final list of business capabilities) will be finalized • Project Road Map – this is the timeline for getting the business capabilities completed • EHR Platform to support business capabilities will be determined • Continue work on the following topics: • Outcomes Management • Medication Management

8. Release Cycle 2 Themes

9. Release Cycle 2 Themes

10. caEHR – Medication Management Medication Management Capability Scope

11. Medication ManagementCapability Scope Document • The 5/31/10 version appears to have been reviewed by the DE group based on edits and comments. • Beginning to integrate straight-forward edits, evaluating comments. • Finding potential items for re-organization or removal.

12. Possible Changes (1) • Address Comments/Suggestions for improvement: • Remove descriptions of other Business Capabilities in the Background • Remove part of “Business Vision” section (2.1 and 2.2) • Move HIT Policy Committee Table to an Appendix • Move AO-FP Requirements to an Appendix • Remove Immunization material per previous discussions

13. Possible Changes(2) • New Content • Integrate Meaningful Use Final Rule • Additional Scope Inclusion Items (to consider) • Medication Plan Development • Medication Information Exchange • Related Non-Medication Items

14. Scope Questions • Devices used to administer medications, such as infusion pumps, don’t appear to be in scope based on the current document. • Is this the intent of the DE group? • DE comment against the exclusion of fees and costs associated with medications as part of the medication management plan. • This is possibly coverable under a Financial Management capability, but it is possible there special considerations. • Does anyone have any detail that would help identify fee and cost activity unique in chemotherapy scheduling that should kept in scope?

15. Questions on Scope Comments • Chemotherapy visibility in the document • What can we do to improve the visibility from the DE perspective? • Would this possibly be helped by working on a chemotherapy-specific narrative storyboard? • Meaningful Use (MU) • DE comment regarding how realistic the MU objectives and measures are; Given that the final rules for Stage 1 are in place, is there anything we should document? • Tracking it as risk may be an option.

16. caEHR – Medication Management Narrative Decomposition

17. Narrative “Decomposition” • This activity is reading the AO-FP Narrative Storyboard and identifying all of the people and their roles, [type of] systems being used, the actions taken, and the information created, changed, or exchanged. • The parts most likely to be relevant to Medication Management and Chemotherapy Scheduling are being identified. • This activity helps validate or revise any work produced to date and move forward. • Decomposition will result in asking DE’s questions very soon to fill in blanks or identify alternate scenarios (e.g., patient does not adhere to treatment plan). • Decomposition also helps to validate the business capability scope document(s).

18. Decomposition Example • Dr. Trudy Tumor discusses a proposed treatment plan with Eve Everywoman… . She documents the specific  treatment plan for neo-adjuvant chemotherapy (including dose, route and time intervals): 4 cycles of Adriamycin and 4 cycles of Taxol. • (Green = actors, Red = Actions, Blue = information objects, Orange = detail in an object) • This approach is just an example and will not be part of any standard document.

19. Glossary • Artifacts – this concepts includes all products or deliverables developed by the caEHR project team. Examples include, but are not limited to: documents, models, notes, spreadsheets, discussion forums, technical specifications and any other format which aims to provide the stakeholders with evidence of the business capabilities and/or requirements are adequately documented for the caEHR project • AO-FP – Ambulatory Oncology Functional Profile, which is the artifact that provides requirements for an Ambulatory Oncology Electronic Health Record (i.e., extensions to an EHR)

20. Glossary • CCB – Change Control Board, which is the governance body responsible for reviewing change requests for the caEHR project. • EHR – Electronic Health Record • MU – Meaningful Use