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2018-02-21 Learning Health Systems Call

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

X Russell Leftwich InterSystems
John Roberts Tennessee Department of Health
X Stephen Chu Individual
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
Michelle Miller Cerner
Benjamin Kummer Columbia University
Matt Rhan
X Michael Padula
Joseph Quinn
Thomson Kuhn
Rob Hausum
Serafina Versaggi VA
Ann Whiz
Kathleen Conner
X Bridget McCabe
X Lisa Gonzalez
X Bridget Burke


  • Chair: Russell Leftwich
  • Scribe: Emma Jones
  • Motion to approve Feb 14 call minutes: Russ moved ,Stephen second
    • A few updates needed - Emma will fix
      • Need date fixed
      • Note taker change to Stephen


  • Care Team Governance
  • CIMI Introduction Feb 28 - Claude Nanjo
  • SNOMED codes for starter value set
  • Other business

Care Team Governance

  • The care team authorizing physician should be a role
  • Another example - Home health plan authorization for payment
  • Care Planners vs service providers (categories related to activities)
  • Patient veto power and preferences. Patient can:
    • refuse an activity
    • refuse a care team member - dismiss them or not engage them
    • refuse to share information
    • Legal authority of proxies
  • Providers on the team have ability to Request (order) authority for activities
  • Authorizaton of payment
    • prior authorization
  • Business relationship between care team members
    • Can be based on employment
  • Discussion
    • What do we mean by care team governance?
    • Suggestion to define what we mean by 'governance' first
      • Suggest governance should be limited to the relationship of the patient and the team members. Payment should not be part of the governance
    • Need to consider what is care plan governance
    • Suggest using RACI matrix to determine the need to be engaged. Authorization is more of a type of a role.
    • Need to stretch the concept of governance to fit what we need. In which case we need to come up with a broader definition.
    • Many care team does not have the concept of formal governance - it's organic. Patient sees a specialist, the specialist becomes an organic member of the care team
    • How does authorization of payment fit?
    • admitting physician is a function; authorizing physician is a function or a role
    • Authorization of care provision - can be tied to payment and or access to care or pre-requisites - This makes it clearer. This is used in other regions as well- e.g. Australia
      • In other jurisdiction, it can be tied to limited resources

SNOMED codes for starter value set

  • Stephen updated and fixed the definitions
  • Who owns driving a change process thru SNOMED CT? Rob McClure. Turn around time not clear but deadline for US is March and SNOMED Int'l is sept. Russ will forward this list to Rob.
  • Stephen move for this document to be accepted as the started value set for the care team member concepts. Will include the whole list - both the available SNOMED started set and the requested SNOMED started set.

Lisa second - 0 abstain - 0 against - 8 for.

  • Support in SDWG to develop another supplemental template to include a care team section and a care team member entry. Lisa is working on a PSS and will bring back to this group for possible co-sponsoring.