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2017-04-07 Learning Health Systems Call

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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
Kathy Walsh LabCorp
Asim Muhammad Philips Research Europe
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Jeff Brown Cancerlinq
X Robert McClure ONC
X Lisa Nelson Individual
Dave Carlson VA
X Chris Melo Phillips Healthcare
Michele Miller Cerner
Benjamin Kummer Columbia University
Matt Rhan
Michael Padula
Serafina Versaggi VA
X Swapna Abhyankar


  • Chair: Russell Leftwich
  • Scribe: Emma Jones


  • Categorization of care teams
    • Have Five categories. The question is what to do with Longitudinal Care Coordination Focused
      • Background info: Longitudinal history relates to the S&I Framework initiative to define care plan. Looking at the details, care plan referenced the hosp discharge care plan which is typically focused on the reason for hospitalization and the expected recovery period. This did not correspond with patients with complex needs that required care coordination. This lead to the longitudinal coordination of care initiative.
    • Recap from last call. Spreadsheet has axis worked on by Lisa and Stephen.
      • event focused is not patient focused
      • patient focused is episode of care, condition, encounter and longitudinal.
      • debate on if the concept is inherent.
        • Chronic conditions can be life long so is inherent in condition focused.With that understanding, the concept of longitudinal will not appear in the value set.
      • care team members using the data for research. Need to add research focused (inadvertently left off the list)
        • We recognized that there may be a member on the team whose role is research focused
        • Public health reporting (secondary use of the data although for the purpose of outbreaks may not be only secondary use of the data) and interventions will be supported
        • What is the computable differences that the system will do that will effect whether one or the other category if chosen?
        • Consider how different category impacts the model- will certain aspects of the model get populated where one category or another category is used?
          • Consider the ability to do data analysis based on the categories. Most important is when the care team of a type of category is over, it goes away. There is no residual of it hanging around. Note that everything does not hang off this. Also need to keep in mind when deciding that there may be another way to do this by associating the care team life with another attribute.
        • Agree that clinically it has a role to play in that it has an indication for encounter and episode of care to go away - with the condition focus and care coordination focus will make it a point to continue to follow the patient
        • Example provided where if the patient was pregnant, would be episode episode focused. If the patient becomes pregnant again at a later time, may need to know who the care team members were from the previous pregnancy to support continuity of care.
        • From a LHS perspective, there is a virtual team that touches the patient. There may be one dynamic team with members that comes and goes. Some of these categories exists for business purposes - not for clinical reasons. Take team members in the pregnancy example - the OB will be in the member's care team even when she isn't pregnant. Members may be in the longitudinal set over a number of years.
        • Consider multiple pregnancies that can be linked so can still be managed that way for the clinical and logistical purposes.
    • With population health considerations, do we need another category? Agreement it can be folded into the condition focused team where some of the team member can be pop specialist. Research focus to remain as a separate category.
  • Proposed Care setting oriented Care Team
  • Care Settings
    • Community
      • Primary Care Team - team only from the perspective of the patient who is 'touched' by those team members. Team can only be defined from the perspective of the individual - a patient.
      • what is "setting" capturing? Sense of categorization of the kinds of care. Need to separate the differences and figure out distinctions. A dis-joint-ness about the ordinal value. Need more discussion if this is the place to capture it and what is being communicated about care team so it's computable.
        • primary setting, secondary setting, tertiary care setting - captures that the diabetes care team is primary care-centric, versus tertiary care-centric.
        • captures complexity. Individual can receive all their care delivery in a tertiary setting that provides all their primary care. Intensity and acuity in nature. People tend to treat information coming from certain settings in a different way.
        • Think thru the resource intensity of it's focus. Suggest not calling it setting.
        • This is a business analysis and not a clinical approach.
        • May need to ditch the care setting approach. It was included in the ONC process of Axis and it was raised in last week discussion. Struggling with acute and non-acute. Primary care can be acute and non-acute. **** Might want to query how many diabetic patients managed in a primary care setting. What's the business requirements that is driving this? People doing resource planning and health care policies would do this type of query.
        • Not clear if this is characteristics of the team or the patient. Would know where this patient is being managed by asking other questions of the model. May be valuable as a concept of the team. Can't always look at the care setting and know about the resource intensity. May be useful to know the high or low intensity team that is being utilized.
        • Motion made to drop setting as part of the analysis - Lisa moved/Evelyn second
          • further discussion - this was dropped because it's unclear with physical location, resource intensity or if used will only live in the care team. Stephen - not just resource intensity but also complexity. - ***** Vote: 1 abstain - 1 against - 5 for
  • Next week - 10-15 mins to wrap up the domain discussion. Stephen will update the spreadsheet to the wiki page. Next will work on the starter value set.