Longitudinal Coordination of Care WG

Roadmap Discussion

1

The S&I Framework LCC Roadmap

• S&I process produces Use Case Requirements, Harmonized Standards, Implementation Guidance, Reference Implementations/Pilots and potential certification testing criteria– These can be reviewed by HITSC, approved by ONC and adopted by

Secretary DHHS

• The HITSC cannot adopt white papers but white papers might help HITPC define priorities

• The S&I white paper should, at a minimum, inform the HITPC of the S&I status, i.e. baseline UC complete, harmonization starting with potential of Implementation Guidance, Reference Implementations/ Pilots by end of year

• The white paper should explain what this baseline UC will drive and secondarily propose what the S&I will tackle as next UC (new settings, new functionality, new documents/transactions)

The Baseline Use Case

• Leverage S&I Transitions of Care Initiative and existing LTPAC reports

• Add representative LTC business actors and systems (NF and HH)

• Modify transactions and content to support LTPAC

• Extend to HH Plan of Care• Learning for next iteration

Some Issues Uncovered

• Capability and differences between LTPAC clinical systems– Home Healthcare– Nursing Facility– Inpatient Rehabilitation– Behavioral Health– Community Care

• Role of PCP/PCMH EHR systems compared to LTPAC clinical systems• Requirements for synchrony between distributed systems, e.g., orders, plan of care• Patient ability to view, download and transmit all information (portals and PHRs)• Differences between LTPAC clinical documents

– Plan of care is different in (S)NF institution versus PCMH community care versus home health care and likely to be consolidated in ACO

– Longitudinal Care Plan not defined as care process or positioned with existing EHR systems

• Assessment process treated ex deus machine and not part of S&I UC defined requirements

• Others– ?

Possible Next LCC Targets

• New care settings:– Behavioral– Inpatient Rehab– Community Care

• Extension of Care Plan Settings and Functions– Nursing Facilities– Care managers and payors– Shared longitudinal care plan

• Alignment of Patient Assessments with Plans of Care and Transitions

• Others

UC 2 Pre-Discovery

• We have a Baseline Use Case.  Identify and engage experts in Behavioral Health, Community-based, etc…. Experts review the requirements developed for UC 1 and come back with a view of:– Do we need a trading partner-specific focus? – Do we need points of view that inform a universally-applicable plan or

transactions?– How applicable are UC 1 transactions is to the new trading partner - ~% similar?– What is missing from UC1 transactions - ~% different?– Survey tools? How distributed? Look at limitations of Federal Govt..– What key transaction types are missing?– Does this care setting have a formal or informal Plan of Care, Care Plan?– How engaged is the community of interest for the trading partner in developing

and utilizing health information exchange standards– 3 questions/ criteria:

• Who’s going to be involved in the care plan and actively managing complex patients?

• How IT enabled are these settings?• How well are the needs currently being met?

S&I Process Milestones

• LCC Baseline S&I Requirements (#1) – Requirements complete – June 2012– Harmonization and Implementation Guidance – Dec ???– Initial R/I and Pilots for Baseline Use Case – Q1 2013

• LCC Version 2 S&I Requirements (#2)– Present to HITPC for validation of next priorities – July 2012– Use Case 2 begins – September/October 2012– Harmonization, Implementation Guidance by Q1/Q2– RI/Pilots in Q3

• Preliminary HITSC recommendations for MU3 to ONC – Sept 2013 for NPRM by end of 2013