2017 - Competency CM-B - Revision history

Tim: /* CM 05 (Core): Provides a written care plan to the patient/family/caregiver for patients identified for care management */

2018-10-03T15:06:52Z

CM 05 (Core): Provides a written care plan to the patient/family/caregiver for patients identified for care management

← Older revision		Revision as of 15:06, 3 October 2018
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	=CM 05 (Core): Provides a written care plan to the patient/family/caregiver for patients identified for care management=		=CM 05 (Core): Provides a written care plan to the patient/family/caregiver for patients identified for care management=

	The practice provides the patient’s written care plan to the patient/family/caregiver. The practice may tailor the written care plan to accommodate the patient’s health literacy and language preference. (i.e., the patient version may use different words of formats from the version used by the practice team)		The practice provides the patient’s written care plan to the patient/family/caregiver. This can also be provided to the patient electronically. The practice may tailor the written care plan to accommodate the patient’s health literacy and language preference. (i.e., the patient version may use different words of formats from the version used by the practice team)

	Report or Record Review Workbook and patient examples are required.		Report or Record Review Workbook and patient examples are required.

	'''Use the EHR Component Builder to create a new Handout Order called "Written care plan provided". Add this order to your visit protocols and check it off when a written care plan is provided to patients during a visit. This will allow you to track whether the written care plan was provided.'''		'''Use the EHR Component Builder to create a new Handout Order called "Written care plan provided". Add this order to your visit protocols and check it off when a written care plan is provided to patients during a visit. This will allow you to track whether the written care plan was provided.'''

			'''Patients now have access to their care plan within their patient portal account. If the patient has a care plan and a portal account, their care plan is accessible electronically via the patient portal which will count toward meeting this component'''

	=CM 06 (1 Credit): Documents patient preference and functional/lifestyle goals in individual care plans=		=CM 06 (1 Credit): Documents patient preference and functional/lifestyle goals in individual care plans=

Tim: /* CM 09 (1 Credit): Care plan is integrated and accessible across settings of care */

2018-02-06T16:19:12Z

CM 09 (1 Credit): Care plan is integrated and accessible across settings of care

← Older revision		Revision as of 16:19, 6 February 2018
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	Sharing the care plan supports its implementation across all settings that address the patient’s care needs. The practice makes the care plan accessible across external care settings. It may be integrated into a shared electronic medical record, information exchange or other cross-organization sharing tool or arrangement.		Sharing the care plan supports its implementation across all settings that address the patient’s care needs. The practice makes the care plan accessible across external care settings. It may be integrated into a shared electronic medical record, information exchange or other cross-organization sharing tool or arrangement.

			Documented process and evidence of implementation is required.

	'''The patient Care Plan is accessible to patients within the Patient Portal. Consider using that as an example of providing accessibility of the Care Plan to patients in any clinical setting'''		'''The patient Care Plan is accessible to patients within the Patient Portal. Consider using that as an example of providing accessibility of the Care Plan to patients in any clinical setting'''

	~~Documented process and evidence of implementation is required.~~

Tim at 16:18, 6 February 2018

2018-02-06T16:18:53Z

@@ Line 22: / Line 22: @@
 =CM 05 (Core): Provides a written care plan to the patient/family/caregiver for patients identified for care management=
 =CM 06 (1 Credit): Documents patient preference and functional/lifestyle goals in individual care plans=
 =CM 07 (1 Credit): Identifies and discusses potential barriers to meeting goals in individual care plans=
 =CM 08 (1 Credit): Includes a self-management plan in individual care plans=
 =CM 09 (1 Credit): Care plan is integrated and accessible across settings of care=

Tim at 15:51, 6 February 2018

2018-02-06T15:51:51Z

← Older revision		Revision as of 15:51, 6 February 2018
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	Competency B: For patients identified for care management, the practice consistently uses patient information and collaborates with patients/families/ caregivers to develop a care plan that addresses barriers and incorporates patient preferences and lifestyle goals documented in the patient’s chart.		Competency B: For patients identified for care management, the practice consistently uses patient information and collaborates with patients/families/ caregivers to develop a care plan that addresses barriers and incorporates patient preferences and lifestyle goals documented in the patient’s chart.

	~~Refer to [http://learn.pcc.com/help/care-plan/ PCC's Care Plan tracking functionality] when working to meet these factors.~~

	=CM 04 (Core): Establishes a person-centered care plan for patients identified for care management=		=CM 04 (Core): Establishes a person-centered care plan for patients identified for care management=

Tim at 15:49, 6 February 2018

2018-02-06T15:49:36Z

@@ Line 6: / Line 6: @@
 Competency B: For patients identified for care management, the practice consistently uses patient information and collaborates with patients/families/ caregivers to develop a care plan that addresses barriers and incorporates patient preferences and lifestyle goals documented in the patient’s chart.
 =CM 04 (Core): Establishes a person-centered care plan for patients identified for care management=
 =CM 05 (Core): Provides a written care plan to the patient/family/caregiver for patients identified for care management=

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2018-02-06T15:37:48Z

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Competency B: For patients identified for care management, the practice consistently uses patient information and collaborates with patients/families/ caregivers to develop a care plan that addresses barriers and incorporates patient preferences and lifestyle goals documented in the patient’s chart.

=CM 04 (Core): Establishes a person-centered care plan for patients identified for care management=

=CM 05 (Core): Provides a written care plan to the patient/family/caregiver for patients identified for care management=

=CM 06 (1 Credit): Documents patient preference and functional/lifestyle goals in individual care plans=

=CM 07 (1 Credit): Identifies and discusses potential barriers to meeting goals in individual care plans=

=CM 08 (1 Credit): Includes a self-management plan in individual care plans=

=CM 09 (1 Credit): Care plan is integrated and accessible across settings of care=