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2017-03-03 Learning Health Systems Call

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Meeting Information

Facilitator Russell Leftwich Note taker(s) Emma Jones
Attendee Name Affiliation

X Russell Leftwich InterSystems
X John Roberts Tennessee Department of Health
X Stephen Chu Individual
X Evelyn Gallego ONC
X Kathy Walsh LabCorp
X Asim Muhammad Philips Research Europe
X Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
X Jeff Brown Cancerlinq
X Lisa Nelson Individual
X Dave Carlson VA
X Chris Melo Phillips Healthcare
X Michele Miller Cerner


  • Call out
    • Need to incorporate past calls initiative with this group
    • TSC have not officially approved the PSS. Anticipate it's just a matter of getting around to it
    • Action: Russ will f/u with next week TSC call

Review of previous minutes/Conclusions Reached:

  • Care Team (CT) roles being fulfilled by an organized group
    • Specialty service
    • Specialty practice - nutritional clinic
    • Some organization refers to such a group as a care team (groups that fullfill a rolw on the care team)
    • Home care servide or vendors that provide a service where not based on individuals
  • Care team role fulfilled by an indiv - coverage group
    • Will be need for consent and access to be able to cover for another indiv
    • Adhoc care team members and how to represent them
      • Specialists that have one time encounter
  • Urgent care clinician
  • Out of town emergency department. How do these become documented as part of a care team or do they?
  • Is alternative medicine providers in scope
  • Lab corp provides patient educational materials to patient based on lab test results - is time care team activity?
    • Question of whether asynchronous engagement with some entity or individuals should be considered a care team member.
  • Stephen: comment on number 4 (care team roles fulfilled by organized group) and number 5 (Care team role usually fulfilled by a coverage group id the usual member is unvailable) - ONC CT project have done some work on this. This work can inform these points. Would be useful to continue those discussion here.
  • Russ: agree this is what we dhoule do and get the information posted on the wiki
  • Stephen: #6 (Adhoc care team members) - would adhoc emergency response teams be considered as care team members?
  • Emma: need to take into consideration that folks use the ED for routine HC services
  • Russ: retail clinics use is growing and more folks are using them for primary care. Out town folks can use the ED as a care team
  • Evelyn: How does research care team fall into the fold?
  • Russ: would group it with the organized groups that fulfill a role on the care team.
  • Evelyn: how can the research team - may be directly engaged or may be the recipient of the data. Will that put them out of scope?
  • Russ: anybody that touches the individual electronically and asynchronously is considered. But these are all questions we need to answer. Although, Will not consider secondary use of the patient data - that researcher use -as contributor to the care team. Not having access to the researcher data and researcher not having access to the patient clinical data is contrary to a learning health system.
  • Evelyn: will see that that is a feedback loop when looking at interventions and evaluating outcomes of care. Along with their roles and responsibility.
  • Stephen: in the ideal world, the PCP will have a care plan that will be shared worth the research team. And if the research establish a research plan will share that with the research team. Care Plan DAM addresses this so should be covered on the CT DAM.
  • Lisa: We need to determine how to integrate the value set work with the CT DAM work. The previous activity approaches the problem from the bottom up where this is approaching it from the top down.
  • Stephen: Couple of approaches
  1. we continue the work initiated by the ONC group and bring it close to completion. The work is being done based on the data points of the FHIR resource where it's good to use as a starting point. Then come at the DAM and look at aligning the two.
  2. pause the value set work and know that it will change based on the DAM work. Then continue it after we have a better idea of what a logical model will look like.
  3. run it in parallel with the DAM. Even if we have two separate calls the two groups will need to align.
  • Evelyn: suggest we finish the value set work as a project knowing that it will need to be revised.
  • Russ: option 1 does not align with the PSS
  • Evelyn: we need to get to the value set work as a building block. It may be a matter of updating the PSS
  • Russ: updating the PSS is a possibility and will be necessary to align with the HL7 rules. What is a reasonable estimate of the time to finish the value set work?
  • Stephen: need another 4-6 weeks of work max. at least to get the started set.
  • Lisa: would be exciting to keep the momentum going and get finished
  • Laura: agree and the logistic around HL7 and process will just need to be worked thru
  • Stephen: we struggle with bandwith and don't have the luxury of having both projects happening concurrently
  • Russ: Motion to modify the PSS to allow for 4-6 weeks of value set work to continue
    • Moved: Laura -
    • Second: Lisa -
    • No Further discussion
    • Abstain: 0 - Against: 0 - Affirmative: 10
    • Russ will work off line on modification to the PSS
  • Stephen: Has PC been added back to the PSS as co-sponser? (Russ: yes)
  • Russ: will plan on taking the valueset work up next week. Can use this conference call.
    • Call adjourned

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