Virtual C-CDA Implementation-a-Thon 5

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Event Date: Thursday, June 22, 2017

Planning Committee

Name	Affiliation
Calvin Beebe	Mayo Clinic
Benjamin Flessner	Redoxengine
Brett Marquard	River Rock
Dave Hamill	HL7
Matt Rahn	ONC
David Degandi	Cambia Health Solutions
Shawn Muer	Veterans Administration
William Ormerod	Cerner
Joe Lamy	Social Security Administration
Michael Clifton	Epic
Lisa Nelson	Life Over Time Solutions
John Donnelly	IntePro Solutions
Matt Blackmon	The Sequoia Project
Didi Davis	The Sequoia Project
Joe Quinn	Optum
Evelyn Gallego

Summary of Findings & Next Steps

Transitions of Care

• Use of multiple identifiers - Samples Taskforce
• Participants wanted to be in both tracks, but could not
• Need a way to visualize or quantify consistency in documents
• General guidance on effectiveTime and statusCode relationships
• General education needs on CDA and C-CDA

Care Plan

• Need enhancements to Scorecard for Care Plan
• IDs in Care Plan on how to use
• Clarify the use of value in goal observation
• Use of status for planned and completed interventions
• Guidance on the use of sub-headings (sub-sections)
• Guidance on linking across entries in different sections
• Guidance on use of codes (value sets) for Care Plans
• Need enhancements for Care Plan Scorecard rubrics

Agenda / Meeting Info / Notes

• 45 registered for the event; 63 joined the Main session at the conclusion of the event
• Implementation-A-Thon 5 Agenda
• DropBox for Registrants to Upload Scenarios & Documents
• Track 1 Session Notes please update if you have additional observations.

• Implementation-A-Thon 5 Registrant List As Of June 22, 2017
• Registrant Track Choices (link to the Doodle Poll)
• Survey Results as of July 14, 2017
• Notes recorded during Track2 As of June 22, 2017 (LRN)

Scenarios

Track 1 - Referral Note Scenario

• File:IAT-T1-REF.docx
  • Referral note
  • Medication & Immunization History
  • Problems (open and resolved) with author
  • Other misc. sections

Track 1 - Continuity of Care Scenario

• File:IAT-T1-CCS.docx
  • Load in content from earlier Referral note
  • Close a previous problem from referral
  • Update smoking history
  • Include a new current medication
  • Include a new Immunization
  • Include record of surgical procedure & implant
  • Include additional content in misc. section

Track 1 - Discharge Summary Scenario

• File:IAT-T1-DIS.docx
  • Update various medication references
  • Include CBC results
  • Include medical supply
  • Include additional content in misc. section

Track 2 - Care Plan -HANDS-ON-EXPLORATION
The Care Plan track provides participants with the opportunity to explore and share emerging capabilities with creating and consuming care plan information using C-CDA Care Plan Document exchange. Scenario 1 explores the general qualities of all Care Plan Documents. Scenario 2 explores the distinctive qualities present in Care Plan Documents that are "specialty" Care Plans.
Participants are encouraged to show and share C-CDA Care Plan Document samples that demonstrate current progress and implementer challenges. The goal of the Care Plan track is to get the conversation started and to learn collaboratively as the industry begins to share digital care plan information using guidance provided in the C-CDA Implementation Guide for Care Plan Documents.

• Blank Scenario Template: File:Scenario Template(Blank).docx

Track 2 - Care Plan Scenario 1 General Care Plans

• Scenario 1 data - General Care Plans: Care Plan Creators will be permitted to supply a scenario of their own choosing when creating a Care Plan document. A scenario description will be supplied with each provided Care Plan Document.
  • Sample #1: ZeOmega Jiva Care Plan Document
    • Scenario: File:Scenario - Jiva Care Plan Document.docx
    • XML Sample: File:Sample Jiva General Care Plan Documents.zip
  • Sample #2: Care Plan Document created to address Payer Use Case-Containerized design to hold multiple plans for one person
    • Scenario: File:Scenario - L3 Care Plan with multiple plans.docx
    • XML Sample: File:Sample L3 Care Plan.zip
  • Sample #3: Care Plan Document created to provide instructive wireframe visualization of intended Care Plan document
    • Scenario: File:Scenario - Care Plan with instructive content.docx
    • XML Sample: File:Sample Care Plan with Instructive Content.zip

• Participants acting as Care Plan Creators will supply documentation of the patient health story scenario they are supporting, and the associated C-CDA Care Plan Document generated for that scenario. CDA Schema and C-CDA Schematron testing will be performed on provided documents to review identified errors and warnings. The generated C-CDA Care Plan Document also will be reviewed to:
  • Examine Health Concerns
  • Examine Goals
  • Examine Interventions
  • Examine Health Status Evaluations and Outcomes
  • Examine other sections of content that may be present in the document

• Participants acting as Care Plan Consumers will process the created C-CDA Care Plan Document and demonstrate the extent to which they can:
  • Attach the care plan document to the participants record in their system
  • Render the contents of the document for human review
  • Process available machine entries from the document (to the extent they are available)
• All participants will address these questions:
  • In what ways does the Care Plan show patient health concerns?
  • In what ways does the Care Plan show patient goals?
  • In what ways does the Care Plan show the patient's goals for care?
  • In what ways does the Care Plan show the patient's treatment preferences for care?
  • In what way does the Care Plan show planned actions for specific goals or specific conditions?
  • In what way does the Care Plan show the progress or completion status associated with interventions or goals?
  • In what way does the Care Plan show or address a patient's self-management care plan?

Track 2 - Care Plan Scenario 2 Specialty Care Plans

• Scenario 2 data - Specialty Care Plans: Care Plan Creators will be permitted to supply a scenario of their own choosing when creating a Care Plan document. A scenario description will be supplied with each provided Care Plan Document.
  • Sample #1: CDC Early Hearing Detection and Intervention (EHDI) Hearing Plan of Care (HPoC) Document
    • Scenario: File:Scenario-Early Hearing Care Plan.docx
    • XML Sample: File:Sample EHCP Documents.zip
  • Sample #2: Personal Advance Care Plan (PACP) Document with Care Plan Document that links to the PACP
    • Scenario: File:Scenario - Care Plan with Link to PACP.docx
    • XML Sample: File:Sample Care Plan with Advance Directives.zip

• Participants acting as Care Plan Creators will supply documentation of the patient health story scenario they are supporting, and the associated C-CDA Care Plan Document generated for that scenario. CDA Schema and C-CDA Schematron testing will be performed on provided documents to review identified errors and warnings. The generated C-CDA Care Plan Document also will be reviewed to:
  • Examine Health Concerns
  • Examine Goals
  • Examine Interventions
  • Examine Health Status Evaluations and Outcomes
  • Examine other sections of content that may be present in the document

• Participants active as Care Plan Consumers will process the created care plan and demonstrate the extent to which they can:
  • Attach the care plan document to the participants record in their system
  • Render the contents of the document for human review
  • Process available machine entries from the document (to the extent they are available)
• All participants will address these questions:
  • In what ways does the Care Plan show patient health concerns?
  • In what ways does the Care Plan show patient goals?
  • In what ways does the Care Plan show the patient's goals for care?
  • In what ways does the Care Plan show the patient's treatment preferences for care?
  • In what way does the Care Plan show planned actions for specific goals or specific conditions?
  • In what way does the Care Plan show the progress or completion status associated with interventions or goals?
  • In what way does the Care Plan show or address a patient's self-management care plan?

Track 2 - Care Plan -DISCUSSION-

• What abilities does your system support to customize which of these elements are included within the care plan and how these elements are displayed?
• What kinds of triggers (e.g. a risk score or event) do you support to indicate different care management actions?
• How does you system handle care plan version control across care team members?
• Do you capture the date of the last review or change in plan?
• Do you generate a scheduled date for reviewing and updating the plan?
• How are gaps in care identified or planned to be identified?

Pre-Published Patient Information

• File:IAT2-Patient Demographics.xlsx

Pre-Published Practitioner Information

• File:IAT3-Practitioner Demographics.xlsx

Deliverables/Documents

• Virtual Implementation-A-Thon 5 Evaluation Survey Results