2017-04-07 Learning Health Systems Call

Facilitator	Russell Leftwich	Note taker(s)	Michelle Miller
Attendee	Name	Affiliation
X	Russell Leftwich	InterSystems
X	John Roberts	Tennessee Department of Health
	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	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
	SWAPNA Abhyankar

Minutes

• Chair: Russell Leftwich
• Scribe: Emma Jones

• Motion to approve previous call minutes, 2017-03-31_Learning_Health_Systems_Call: Stephen/Lisa

Topics

• 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 be not 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 is chosen
      • Consider how different category impacts the model- will certain aspects of the model get populated where one category or another category is used.The ability to do data analysis based on the categories. Most important is when the care team 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 deciging this that another way to do this by associating the care team life with another attribute.
      • Clinically it has a role to play in that is 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
      • Would episode be needed for pregnancy
      • LHS because 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. 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.
      • Multiple pregnancies that can be linked so can still be managed that way in the clinical and logistical purpose
  • With population health considerations, do we need another category. Agreed 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.