Coordination of Care Services Specification Project

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Project Information

Overiew

The Care Coordination service is a standards development/specification effort being undertaken by HL7 to be followed by SOA specification work at the OMG. This project falls under the Healthcare Services Specification Program (HSSP) and will be done in collaboration with the HL7 Patient Care and HL7 Clinical Decision Support work groups.

The objective is to provide SOA capabilities to support coordination of patient care across the continuum. The viewpoint of these capabilities is the patient as he or she crosses care settings and interacts with care givers with different focus and specialties. The context is episodes of care spanning multiple organizations, the interactions at the boundaries of care transitions, and the subset of information necessary and sufficient to support these interactions.

The CCS will support shared and coordinated care plans. The CCS will support multidisciplinary care team members to communicate changes resulting from care plan interventions and collaborate in removing barriers to care. The CCS will provide on demand synchronization of information to keep the virtual care team on the same page and prevent having the patient fall through the cracks of the silos of care.

Care Team members will collaborate around these shared plans, each contributing or reviewing items as local procedures and policies may dicate. Structurally, the shared Care Plan will serve to coordinate specialty care plans, and will have the ability to seamlessly navigate to them without requiring physical centralization of data storage.

Automated Clinical Decision Support systems will be first class participants in proposing and evaluating care plan actions.

Collaboration

This project is being developed in close collaboration with the HL7 Care Plan Project with many overlapping participants.

Status

Meeting Notes

May 2014 DSTU Ballot reconciliation in progress. Workgroup meetings notes are located here: CCS DSTU Ballot Reconciliation

Timeline

• March 2013: CCS SFM Comments ballot for May, 2013 Submitted
• April 2013: We are waiting for feedback from the comments ballot before resuming work group meetings
• Incorporate ballot comments feedback and prepare for Coordinated Care SFM DSTU ballot <== We are here: September 2013
  • The team decided to postpone the September 2013 DSTU submission. We need to re-plan for the ballot cycle after September 2013... more information to come.
• OMG technical specification work - 2014

Topics we still need to address

1. Use and consumption of the continuity of care record by CCS (problem list, allergies, medications, advanced directives, general observations, ...). We need requirements and input (Kevin had some ideas I am hoping we can expand on).
2. Interaction diagrams which illustrate how the capabilities work together (e.g. care plan harmonization process and care team negotiations - "metaprocess").
3. Better alignment with the care plan ballot story boards
4. Fill modelling gaps (orders, observations, assessment instruments)
5. Harmonization with S&I LCC [S&I Longitudinal Coordination of Care (LCC)]

In parallel there is also the S&I LCC harmonization with the Care Plan DAM which will be directly leveraged by CCS.

Working Wiki Areas

• Care Coordination Business Scenarios
• Care Coordination Capabilities
• Functional Profiles

Domain Model Dependencies

The Care Coordination Service SFM is defined in terms of models from the HL7 Patient Care workgroup. Of special importance is the care plan initiative which is defining a model to support collaborative care planning Care Plan Initiative Project. As a rule CCS will leverage standard domain models and not define new domain semantic content. The following power point provides an overview of the Care Plan domain analysis model.

Project Facilitator

• For questions about the project contact: Enrique.Meneses@careflow.com

Project Scope Statement

Link to project scope statement and details from Project Insight Searchable Database

Related Discussions Listserv

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Complementary Efforts

• HL7 Care Plan Initiative Project

• S&I Longitudinal Coordination of Care(LCC) Longitudinal Care Plan (LCP) SWG

Meeting Information

When	Every Tuesday at 5 PM US ET
Meeting URL	http://wiki.hl7.org/index.php?title=Care_Coordination_Service_Meeting#Care_Coordination_Service_Weekly_Meeting_Information
USA Call-in number	770-657-9270
Participant access code	071582

**Meeting date/time poll (closed)

Issues/Hot Topics

• CCS issues tracking at GForge repository.