Care Team Management

Care Team Management Profile

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Volume 1 Call #1 - Dec 5th, 2016

• Addendees*
  • Emma Jones
  • George Cole
  • Lisa Nelson
  • Chris Melo

• Changed the colors on the CareTeamFlow_chronicCOndition vsd diagram to match the chronic condition story board care team summarization analysis - see [1]here for these documents
• Ideally there should be Sub care teams with an overall team. Need to support - see submitted FHIR Change request with supporting documentation - 11342 [2]
  • Condition-focused team may span multiple episodes
  • Need to have care team referencing other care teams - gforge item submitted to support this.
  • Need to have the same structure as care plan
  • Need Care team relationship
  • Share care team is a view that would make up a representative of the overarching care team for the patient and will be able to get at a shared care team structure.
  • Will be able to get to the sub teams from the care plan.
• Should we pick one from the green set and one from the yellow set - see slide 3 of [here]
• Need some use cases - encode the rules by picking one from the green list and one from the yellow list.
• Lisa main use case is to be able to take people off a team when the provider is no longer providing care- if need to ask the machine who was on the care team for the purpose of coordinating care and in the context of value-based care - who's getting paid to take care of you, need to be consistent - payor need
• If condition changes need to have a current care team that provides effective care - clinical need - care coordination
• Will share "Care team" references with Stephen Chu - [3]

• Payer - need brief examples of when Payer will need types of care teams
• Clinical - need brief examples of when clinical will need types of care teams
• IT - - need brief examples of when systems will need types of care teams
• Care coordination - - need brief examples of when care coordination will need types of care teams