2018-02-21 Learning Health Systems Call

Facilitator	Russell Leftwich	Note taker(s)	Emma Jones
Attendee	Name	Affiliation
X	Russell Leftwich	InterSystems
	John Roberts	Tennessee Department of Health
X	Stephen Chu	Individual
	Evelyn Gallego	ONC
	Kathy Walsh	LabCorp
	Asim Muhammad	Philips Research Europe
	Laura Heermann-Langford	Intermountain Healthcare
X	Emma Jones	Allscripts
	Jeff Brown	Cancerlinq
X	Lisa Nelson	Individual
	Dave Carlson	VA
x	Chris Melo	Phillips Healthcare
	Michelle Miller	Cerner
	Benjamin Kummer	Columbia University
	Matt Rhan
X	Michael Padula
	Joseph Quinn
	Thomson Kuhn
	Rob Hausum
	Serafina Versaggi	VA
	Ann Whiz
	Kathleen Conner
X	Bridget McCabe
X	Lisa Gonzalez
X	Bridget Burke

Minutes

• Chair: Russell Leftwich
• Scribe: Emma Jones

• Motion to approve Feb 14 call minutes: Russ moved ,Stephen second
  • A few updates needed - Emma will fix
    • Need date fixed
    • Note taker change to Stephen

Agenda

• Care Team Governance
• CIMI Introduction Feb 28 - Claude Nanjo
• SNOMED codes for starter value set
• Other business

Care Team Governance

• The care team authorizing physician should be a role
• Another example - Home health plan authorization for payment
• Care Planners vs service providers (categories related to activities)
• Patient veto power and preferences. Patient can:
  • refuse an activity
  • refuse a care team member - dismiss them or not engage them
  • refuse to share information
  • Legal authority of proxies
• Providers on the team have ability to Request (order) authority for activities
• Authorizaton of payment
  • prior authorization
• Business relationship between care team members
  • Can be based on employment
• Discussion
  • What do we mean by care team governance?
  • Suggestion to define what we mean by 'governance' first
    • Suggest governance should be limited to the relationship of the patient and the team members. Payment should not be part of the governance
  • Need to consider what is care plan governance
  • Suggest using RACI matrix to determine the need to be engaged. Authorization is more of a type of a role.
  • Need to stretch the concept of governance to fit what we need. In which case we need to come up with a broader definition.
  • Many care team does not have the concept of formal governance - it's organic. Patient sees a specialist, the specialist becomes an organic member of the care team
  • How does authorization of payment fit?
  • admitting physician is a function; authorizing physician is a function or a role
  • Authorization of care provision - can be tied to payment and or access to care or pre-requisites - This makes it clearer. This is used in other regions as well- e.g. Australia
    • In other jurisdiction, it can be tied to limited resources

SNOMED codes for starter value set

• Stephen updated and fixed the definitions
• Who owns driving a change process thru SNOMED CT? Rob McClure. Turn around time not clear but deadline for US is March and SNOMED Int'l is sept. Russ will forward this list to Rob.
• Stephen move for this document to be accepted as the started value set for the care team member concepts. Will include the whole list - both the available SNOMED started set and the requested SNOMED started set.

Lisa second - 0 abstain - 0 against - 8 for.

• Support in SDWG to develop another supplemental template to include a care team section and a care team member entry. Lisa is working on a PSS and will bring back to this group for possible co-sponsoring.