Longitudinal Coordination of Care Pilots WG

1. Longitudinal Coordination of Care Pilots WG Monday, April 14, 2014

2. Meeting Etiquette Remember: If you are not speaking, please keep your phone on mute Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call • Hold = Elevator Music = frustrated speakers and participants This meeting is being recorded • Another reason to keep your phone on mute when not speaking Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know. • Send comments to All Panelists so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute  All Panelists

3. ReminderJoin the LCC WG & Complete Pilot Survey • http://wiki.siframework.org/Longitudinal+CC+WG+Committed+Member+Guidance • http://wiki.siframework.org/LCC+Pilots+WG ** If your contact information has recently changed, please send your updated information to Becky Angeles at becky.angeles@esacinc.com

4. Agenda

5. Pilot Work Group Purpose and Goals • Purpose • Provide tools and guidance for managing and evaluating LCC pilot Projects • Create a forum to share lessons learned and best practices • Provide subject matter expertise • Leverage existing and new partnerships • Goals • Bring awareness on available national standards for HIE and care coordination • Real world evaluation of parts of most recent HL7 C-CDA Revisions Implementation Guide (IG) • Validation of ToC and Care Plan/HHPoC datasets

6. Meeting Reminders S&I Framework Hosted Meetings: http://wiki.siframework.org/Longitudinal+Coordination+of+Care LCC Pilot WG meetings are every other Monday from 11:00– 12:00 pm Eastern • Focus on validation and testing of LCC Standards for Transitions of Care & Care Plan exchange LCC All Hands WG meetings are Mondays & Thursdays from 5:00– 6:00 pm ET - CURRENTLY ON HOLD HL7 Structured Documents WG Meetings Thursdays from 10:00 – 12:00pm Eastern • WebEx: https://iatric.webex.com/iatric/j.php?ED=211779172&UID=0&RT=MiMxMQ%3D%3D • Dial In: 770-657-9270; Access Code: 310940 • Focus on block voting of HL7 C-CDA R2 Ballot comments • ALL 1013 comments have been reconciled. Ballot reconciliation package was voted on 4/10.

7. HL7 Patient Care WG Meeting Reminders Coordination of Care Services Specification Project • Submitted ballot materials for the HL7 May 2014 Ballot Cycle • Voting closes Monday, April 28th • Provide SOA capabilities/models to support coordination of patient care across the continuum • Current working documents found here: http://wiki.hl7.org/index.php?title=Coordination_of_Care_Services_Specification_Project • Meetings every Tuesday 5:00 – 6:00pm ET • Meeting Information: • Web Meeting URL: https://meetings.webex.com/collabs/meetings/join?uuid=M55ZKYUA35CE2U3J4SV41XMZR3-3MNZ • Meeting Number: 193 323 052 • Phone: 770-657-9270, Participant Code: 071582

8. HL7 Patient Care WG Meeting Reminders, cont’d... Care Plan Project • Completed ballot reconciliation • Submitted updated Care Plan Storyboards and Domain Analysis Model for the HL7 May 2014 ballot Cycle • Voting closes Monday, April 28th • Current working documents found here: http://wiki.hl7.org/index.php?title=Care_Plan_Project_2012 • Meetings every other Wednesday from 4:00 – 5:30pm ET • Next meeting scheduled for April 16th • Meeting Information: • Web Meeting URL: nehta.rbweb.com.au • Phone: 770-657-9270, Participant Code: 943377

9. HL7 Patient Care WG Meeting Reminders, cont’d... Health Concern Topic • Developing user stories highlighting the following: What is a Health Concern Observation; How Health Concern Tracker is Used; How Health Concern is different from Problem Concern • Current working documents found here: http://wiki.hl7.org/index.php?title=Health_Concern • Meetings every other Thursday from 4:00 – 5:00pm ET • Next meeting scheduled for April 17th • Meeting Information: • Web URL: https://meetings.webex.com/collabs/#/meetings/joinbynumber • Meeting Number: 236424669 • Phone: 770-657-9270, Participant Code: 943377

10. AHIMA 2014 LTPAC Health IT Summit WHAT: Provides thought-provoking, interactive sessions aimed at advancing HIT Priorities; showcases implementation successes; and puts the spotlight on LTPAC technologies WHEN: June 22nd to June 24th, 2014 WHERE: Hyatt Regency Baltimore on the Inner Harbor Register at: http://www.ahima.org/events/2014june-ltpac For further information, contact Exhibits Manager: sarah.lawler@ahima.org

11. FACA Meeting Reminders (see end of deck for updates) HIT Policy Committee Meaningful Use WG Next meeting scheduled for April 16th from 10:00am – 12:00pm ET http://www.healthit.gov/facas/calendar/2014/04/16/policy-meaningful-use-workgroup HIT Policy Accountable Care WG Next meeting scheduled for April 17th from 1:00pm – 2:30pm ET http://www.healthit.gov/FACAS/calendar/2014/04/17/policy-accountable-care-workgroup HIT Standards Committee Next meeting scheduled for April 24th from 9:00am – 3:00pm ET http://www.healthit.gov/facas/calendar/2014/04/24/hit-standards-committee HIT Policy Committee Certification and Adoption WG Next meeting scheduled for April 28th from 11:00am – 1:00pm ET http://www.healthit.gov/FACAS/calendar/2014/04/28/policy-certificationadoption-workgroup HIT Policy Committee Next meeting scheduled for May 6thfrom 9:30am – 3:00pm ET http://www.healthit.gov/FACAS/calendar/2014/05/06/hit-policy-committee

12. LCC Pilot WG Timeline: Aug 2013 – Sept 2014 LCC Pilot Proposal Review LCC Pilot Monitoring & Evaluation LCC Pilot WG LCC Pilot Wrap-Up HL7 Ballot & Reconciliation HL7 Ballot HL7 C-CDA IG Revisions LCC Pilot WG Launch Revisions for HL7 CCDA IG Complete HL7 Ballot Publication HL7 Fall Ballot Close IMPACT Go-Live LCC Pilots Close LCC Pilot Test Spec. Complete Milestones GSI Health Go-Live NY Care Coordination Go-Live

13. HL7 CCS Overview of Ballot Artifacts • Enrique Meneses • enrique@careflow.com

14. NPRM Open Discussion • Larry Garber • Lawrence.Garber@reliantmedicalgroup.org

15. NPRM Open Discussion Submitted comment summary: When new 2015 Edition-certified EHRs start sending the new Consolidated CDA document types (C-CDA R2.0), it’s unclear if existing 2014 Edition-certified EHRs will be able to display them, let alone use them for reconciliation. The issue this causes is referred to as “Bilateral Asynchronous Cutover” 2015 certified EHRs must do 3 things: • Send both C-CDA R2.0 and R1.1 versions in the same message. • Receive either C-CDA R2.0 and R1.1 but only display latest • Establish an understanding of how Template IDs in the future will denote levels of compatibility

16. NPRM Open Discussion 2015 certified EHRs should by default send BOTH C-CDA R2.0 AND R1.1 versions in the same message. This will guarantee backward compatibility to the fullest degree and at worst cause a duplicate report in the receiver’s EHR. 2015 certified EHRs should be able to receive, display all parts of, and incorporate/reconcile problems/meds/allergies from both R1.1 and R2.0 C-CDAs. 2015 certified EHRs that receive multiple version of the same document (e.g. they receive both a C-CDA R2.0 AND R1.1 version from another 2015 certified EHR) should display/reconcile the latest version that they can support (i.e. not show both).

17. Given the format of template IDs in CDA documents as <templateId root=OID extension="Vx.y"/> 2015 certified EHRs should have an understanding how they will deal with C-CDA future versions that they receive • Always display the entire document, at a minimum, using the standard CDA Stylesheet (or equivalent) so that any CDA document can be displayed to the recipient. • If the root OID and extension of a Section template is identical to a known section, the Section’s entry-level templates and discrete data can be interpreted and incorporated as usual. These sections are 100% backwards compatible. • If the OID of a Section template shares the root of a known section but now has extra digits added to the OID (and no change in the extension), it is assumed to be a constrained version of that original template (i.e. a subset with perhaps a limited vocabulary) so it can be interpreted entirely like the old template and entry-level templates, including all of the discrete data. These sections are 100% backwards compatible.

18. Given the format of template IDs in CDA documents as <templateId root=OID extension="Vx.y"/> If the root OID of a Section template is identical to a known section (or has extra digits added to the OID), but there is an extension showing versioning which are not recognized by the EHR, then it can be assumed that there may be entry level templates in that section that were not described in the prior version of C-CDA so discrete data cannot be assumed to represent the entire section. In that case, the human-readable text of that entire section should be displayed and whichever entry-level templates that are recognized as being where expected in the template hierarchy could also be incorporated as discrete data. • If the root OID of a Section template does not resemble a known section, then it should just be displayed as human-readable text regardless of what entry level templates it contains (because the context may change their meaning)

19. NPRM Open Discussion, continued… It doesn’t matter what C-CDA R2.0 does for versioning because it was too late when the 2014 EHR edition came out without an understanding of how to handle future versions. Our opportunity is to get an understanding in the 2015 edition and have future versions of the C-CDA to follow these guidelines. It should also be clear that a 2015 Edition certified EHR should be able to create, send, receive, display all parts of, and incorporate/reconcile problems/meds/allergies all of the document types in C-CDA R1.1 and R2.0.

20. NPRM Open Discussion, continued… Where to find NPRM documentation: • Proposed Rule 2015 document: http://www.gpo.gov/fdsys/pkg/FR-2014-02-26/pdf/2014-03959.pdf • Proposed Rule 2014 Correction Notice: http://www.gpo.gov/fdsys/pkg/FR-2014-03-19/pdf/2014-06041.pdf How to comment: • ONC will accept comments on the proposed rule through April 28, 2014 • Formulate your comments using the public comment template: http://www.healthit.gov/sites/default/files/2015editionnprm_public_comment_template_final.docx • Submit comments (use the “Comment Now!” button) here: http://www.regulations.gov/#!documentDetail;D=HHS_FRDOC_0001-0532

21. esMD Home Health User Story Presentation • Dr. Mark Pilley • m.pilley@strategichs.com

22. Next Steps • Homework Assignments: • Complete Pilot Survey • Sign up as an LCC Committed Member • Submit Pilot Documentation Proposals • Available on the LCC Pilot SWG Wiki: http://wiki.siframework.org/LCC+Pilots+WG • Email to Lynette Elliott (Lynette.elliott@esacinc.com)

23. FACA Updates • As of 04/14/2014

24. LCC Initiative: Contact Information • LCC Leads • Dr. Larry Garber (Lawrence.Garber@reliantmedicalgroup.org) • Dr. Terry O’Malley (tomalley@partners.org) • Dr. Bill Russell (drbruss@gmail.com) • Sue Mitchell (suemitchell@hotmail.com) • LCC/HL7 Coordination Lead • Dr. Russ Leftwich (Russell.Leftwich@tn.gov) • Federal Partner Lead • Jennie Harvell (jennie.harvell@hhs.gov) • Initiative Coordinator • Evelyn Gallego (evelyn.gallego@siframework.org) • Project Management • Pilots Lead: Lynette Elliott (lynette.elliott@esacinc.com) • Use Case Lead: Becky Angeles (becky.angeles@esacinc.com) LCC Wiki Site: http://wiki.siframework.org/Longitudinal+Coordination+of+Care

25. FACA Updates: HIT Standards Committee, Standards Task Force (24MAR14) Discussion and consensus on the remaining seven recommended objectives which included: • Improving Care Coordination, specifically Summary of Care of Transitions, Notifications, and Medication Reconciliation as well as Improving Population and Public Health, specifically Immunization History, Registries, Electronic Lab Reporting, and Syndromic Surveillance. • John will present at the HIT Standards Committee and reflect in his report that each one of these objectives is noble and could stand on its own as a doable project, but not collectively at the same time as ACA and HIPAA Omnibus Rule

26. FACA Updates: HIT Policy Committee: CAWG 19MAR14 Reviewed feedback from the HITPC on the group’s LTPAC/BH Certification Charge Next Steps from HITPC • Incremental updates, report back and timeline extension • More public input on recommendations needed • New format for review of recommendation Discussed what needs to be done and what areas should be focused on for commenting on the Voluntary 2015 Edition Electronic Health Record (EHR) Certification Criteria (2015 NPRM). Next steps to be determined by ONC and committee chairs.

27. FACA Updates: HIT Policy Committee 08APR14 Presentation of proposed NEW HITPC Workgroup restructure plan • Restructuring due to end of ARRA funding and to more align with the Federal HIT Strategic Plan and ONC priorities • Transitions will most likely occur in May Proposed Workgroup Restructure • HIT Strategic Planning • Advanced Health Models & Meaningful Use • HIT Implementation, Usability & Safety • Interoperability & Health Information Exchange • Privacy and Security (spans all workgroups mentioned above) • Consumer (spans all workgroups mentioned above) Send any feedback to Karen or Michelle directly

28. HITPC Meeting Updates, continued… Accountable Care Workgroup provided set of recommendations regarding how to advance priority health IT capabilities in a variety of accountable care arrangements to support improvements in care and health while reducing costs LCC-Relevant Recommendations: • Create task force to accelerate development and adoption of standards-based electronic shared care plans across federal programs • Develop pilots to test different shared care plan models • Establish provisions within the Medicare Shared Savings program under which ACOs can receive incentives in the form of additional shared savings for partnering with entities such as LTPAC, behavioral health, and home health providers