Long-Term+&+Post-Acute+Care+WG+Meeting+11-10-2011

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Longitudinal Coordination of Care WG Meeting

 * Date:** 11-10-2011
 * Time:** 9:00-10:00am EDT
 * Dial-in:** 1-408-600-3600 | **Passcode:** 660 213 377

Attendance
Greg Alexander, Richard Brennan, Matt Cairns, Leigh Ann Campbell,Tom Check, Kris Cyr, Michelle Dougherty, Evelyn Gallego, Liz Palena Hall, Jennie Harvell, Stan Harter, Meredith Lewis, Deanna Loftus, Jim Logan, Kory Mertz, Teresa Mota, Terry O'Malley, Sue Mitchell, Eva Powell, Erik Pupo, Bill Russell, Smriti Singal, Larry Wolf, Clare Wrobel, Dana Voss, Jim Youngkin

Action Items

 * **#** || **Date Initiated** || **Action** || **Owner** || **Status** || **Date Closed** ||
 * 1 || 10-27-2011 || Review the Longitudinal Care WG Overview, posted under reference materials on the WG home page, and provide comments through the discussion tab on the Longitudinal Care WG Charter wiki page. || Participants || Open ||  ||
 * 2 || 11-10-2011 || Review the SWG Pages and submit any relevant content to Dev Dasgupta and post comments to the discussion pages || Participants || Open ||  ||
 * 3 || 11-10-2011 || WG leads need to define the Challenge statements for the various SWG wiki pages.

1. Longitudinal Care SWG 2. LTPAC Care Transition SWG 3. Patient Assessment Summary SWG
 * Terry O'Malley
 * Jim Youngkin, Leigh Ann Campbell || Bill Russell, Jennie Harvell, Susan Campbell, Terry O'Malley || Open ||  ||
 * 4 || 11-10-2011 || Create an excel document to capture and organize LCC related information with an environmental scan || Terry O'Malley, Teresa Mota || Open ||  ||
 * 5 || 11-10-2011 || Provide relevant scenarios to help create user stories and care summaries || Jim Logan, Tom Check, Bill Russell, Eva Powell || Open ||  ||

Agenda Items

 * 1) Welcome and Announcements
 * 2) Review WG Organizational Structure
 * 3) Review WG Charter
 * 4) Identify Next Steps

Meeting Notes

 * Announcements**
 * The ONC grantees meeting is next week where the majority of our participants will be attending
 * The decision was made to cancel next week's meeting
 * There will be action items derived from this morning's meeting to cover the next two weeks


 * Organization Structure**
 * Org. Chart was created by Workgroup Leads and was discussed over multiple calls
 * There have been various changes to the chart based of last WG meeting's comments and subsequent meetings.
 * Three Main SWG
 * Longitudinal Care Plan
 * Jennie Harvell made comments and they have been incorporated into the individual SWG page.
 * Exchange of LTPAC Care Transition Data
 * The majority of care transitions will be from provider to provider but the WG will need to focus on the transition points to and from the hospital.
 * This is conceptually more similar to a discharge summary.
 * Patient Assessment Summary
 * The point was made that the description needs to be more clear for the SWG
 * This SWG entails a component of the complete set of documents that illustrate the story of a patient.
 * The scope of the WG will need to be broader in terms of which transitions of care are incorporated
 * There will be a need to manage the care plan across a multitude of sites
 * There will need to be support from the entire WG to determine the coordination points and making sure that the federal partners are rightfully involved and working to support the progress of the WG
 * The point was made to incorporate a timeline detailing the short term work products as well as long term goals
 * The vision for the SWG is to provide an Implementation Guide that includes a background information and that could possibly include a spreadsheet tracking the process around the aligning the Challenge grants, Beacon communities and allow the overall WG to have the best knowledge of their work through a central location.
 * To mitigate against ambiguity of the work products it was proposed that Summary Documents, Care Plan documents, and Exchange documents could all be tracked through a spreadsheet that includes data groupings, status of plan, HL7 comments and proposed changes.
 * The vision statement should include a master care plan that other care plan pieces could interact with a future vision that every patient has a care plan accessible through a cloud computing network.
 * Although this "master care plan" won't be accomplished in the LCC WG, this overall WG effort could be a pathway to that vision
 * A concern was raised on what segments of information should flow and be defined within LCC and that the focus of the WG should be on information exchange
 * The more flexibility and openness that can be offered for an individual patient plan of care, the more difficult the challenge could be in terms of the
 * When data elements are identified, there needs to be a vetting process that aligns the data models to each SWG, and that all the SWG will need to aligned with how they specifically define and build-out data elements
 * Content that is created across the groups is structured in a similar format- the three SWGs should work in parallel to optimally determine resource need
 * Data elements that are built will need to be created within a standard format that can indicate future quality measures
 * Ultimately our goal is to create care transitions that are safe as well as a care transition plan that could help


 * Next Steps**
 * Review the Longitudinal Care Work Group and SWG wiki pages and provide comments through the discussion tab on the Longitudinal Care WG Charter wiki page and various SWG wiki pages

Next Meeting

 * Date:** 11-31-2011
 * Time:** 9:00-10:00am EDT

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