1. Care Plan (CP) Team Meeting Notes (As updated during meeting) André Boudreau (a.boudreau@boroan.ca) Laura Heermann Langford (Laura.Heermann@imail.org) 2011-06-22 (No. 16) Care Plan wiki: http://wiki.hl7.org/index.php?title=Care_Plan_Initiative_project_2011 http://wiki.hl7.org/index.php?title=Care_Plan_Initiative_project_2011 HL7 Patient Care Work Group To join the meeting: Phone Number: +1 770-657-9270 Participant Passcode: 943377 WebEx link is on the wiki (link below) See post meeting notes from Kevin about Storyboards.

2. Page 2 Agenda for June 22nd Minutes of June 8 th Storyboards (Laura, Danny, Susan)  NOTE: this is our top priority deliverable  How will we vet our storyboards? Chronic Care Sequence Diagram (Luigi) Care Management Concept Matrix: update (Susan) Next meeting(s) agenda

3. Page 3 Agenda for July 6 Storyboard vetting process Storyboards  Perinatology: Laura  Stay healthy: Laura  Home care SB resolution Models (Luigi) Requirements (André)  Stakeholders expectations Next meeting agenda

4. Page 4 Meetings During the Summer Period We will move to a meeting every second week until the end of August. Schedule is:  July 6  July 20  August 3  August 17 We will keep the intermediate slot in place in case we want to use them for specific cases like…  Review of the ISO CONTSYS work on care plan aspects  Review of EHR-S FM R2 work by the HL7 EHR WG

5. Page 5 Future Topics Review of EHR-S FM R2 work by the HL7 EHR WG: Aug. 17, tentatively  John Ritter, Sue Mitchell, Pat Van Dyke, Lenel James Review of the ISO CONTSYS work on care plan aspects  André to contact ISO Lead Care Plan elements from KP, Intermountain, VA, etc. (Laura) Requirements (André) EA Vs Eclipse: EA is preferred by many: Luigi, +++ Comparison of care plan contents (Ian, Laura)  To inform the information model  Start of spreadsheet (Laura…) Overarching term to use (Ian M.) Care Plan Glossary Forward plan- first cut

6. Page 6 Participants- WGM Meetg of 2011-06-22 p1 Nameemail Country YesNotes André Boudreau a.boudreau@boroan.ca CA Yes Co-Lead- Care Plan initiative/HL7 Patient Care WG. B.Sc.(Physics), MBA. Owner Boroan Inc. Management Consultin. Chair, Individual Care pan Canadian Standards Collaborative Working Group (SCWG). Sr project manager. HL7 EHR WG. Laura Heermann Langford Laura.Heermann@imail.org US Yes Co-Lead- Care Plan initiative/HL7 Patient Care WG. Intermountain Healthcare. RN PhD,: Nursing Informatics; Emergency Informatics Association, American Medical Informatics Association; IHE Stephen Chu stephen.chu@nehta.gov.au AU NEHTA-National eHealth Transition Authority. RN, MD, Clinical Informatics; Clinical lead and Lead Clinical Information Architecture; co-chair HL7 Patient care WG; vice-chair HL7 NZ Peter MacIsaac peter.macisaac@hp.com AU HP Enterprise Services. MD; Clinical Informatics Consultant; IHE Australia; Medical Practitioner - General Practice Adel Ghlamallah aghlamallah@infoway-inforoute.ca CA Canada Health Infoway. SME at Infoway (shared health record); past architect on EMR projects William Goossen wgoossen@results4care.nl NL Results 4 Care B.V. RN, PhD; -chair HL7 Patient Care WG at HL7; Detailed Clinical Models ISO TC 215 WG1 and HL7 ; nursing practicioner Anneke Goossen agoossen@results4care.nl NL Results 4 Care B.V. RN; Consultant; Co-Chair Technical Committee EHR at HL7 Netherlands; Member at IMIA NI; Member of the Patient Care Working Group at HL7 International Ian Townsend ian.townend@nhs.net UK NHS Connecting for Health. Health Informatics; Senior Interoperability Developer, Data Standards and Products; HL7 Patient Care Co-Chair Rosemary Kennedy Rosemary.kennedy@jefferson.edu US Thomas Jefferson University School of Nursing. RN; Informatics; Associate Professor; HL7 EHR WG; HL7 Patient care WG; terminology engine for Plan of care; Jay Lyle jaylyle@gmail.com US JP Systems. Informatics Consultant; Business Consultant & Sr. Project Manager Margaret Dittloff mkd@cbord.com US The CBORD Group, Inc.. RD (Registered Dietitian); Product Manager, Nutrition Service Suite; HL7 DAM project for diet/nutrition orders; American Dietetic Association Audrey Dickerson adickerson@himss.org US HIMSS. RN, MS; Standards Initiatives at HIMSS; ISO/TC 215 Health Informatics, Secretary; US TAG for ISO/TC 215 Health Informatics, Administrator; Co-Chair of Nursing Sub-committee to IHE-Patient Care Coordination Domain. Ian McNicoll Ian.McNicoll@oceaninformatics.com UK Ocean Informatics. Health informatics specialist; Formal general medical practitioner; OpenEHR; Slovakia Pediatrics EMR; Sweden distributed care approach Danny Probst Daniel.Probst@imail.org US Intermountain Healthcare. Data Manager Kevin Coonan Kevin.coonan@gmail.com US Yes MD. Emergency medicine. HL7 Emergency care WG. Gordon Raup graup@datuit.com US CTO, Datuit LLC (software industry). Susan Campbell bostoncampbell@mindspring.com USYes PhD microbiologist. Principal at Care Management Professionals. HL7 Dynamic Care Plan Co-developer Elayne Ayres EAyres@cc.nih.gov US Yes NIH National Institutes of Health. MS, RD; Deputy Chief, Laboratory for Informatics Development, NIH Clinical Center ; Project manager for BTRIS (Biomedical Translational Research Information System), a Clinical Research Data Repository

7. Page 7 Participants- WGM Meetg of 2011-06-08 p2 Nameemail Country Yes Notes David Rowed david.rowed@gmail.com AU Charlie Bishop charlie.bishop@isofthealth.com UK Walter Suarez walter.g.suarez@kp.org US Peter Hendler Peter.Hendler@kp.org US Ray Simkus ray@wmt.ca CA Lloyd Mackenzie lloyd@lmckenzie.com CALM&A Consulting Ltd. Serafina Versaggi serafina.versaggi@gmail.com US Clinical Systems Consultant Sasha Bojicic SBojicic@infoway-inforoute.ca CALead architect, Blueprint 2015, Canada Health Infoway Agnes Wong awong@infoway-inforoute.ca CA RN, BScN, MN, CHE. Clinical Adoption - Director, Professional Practice & Clinical Informatics, Canada Health Infoway Cindy Hollister chollister@infoway-inforoute.ca CA RN, BHSc(N), Clinical Adoption -Clinical Leader, Canada Health Infoway Valerie Leung vleung@infoway-inforoute.ca CAPharmacist. Clinical Leader, Canada Health Infoway Luigi Sison lsison@yahoo.com USYes Information Architect at LOINC and at HL7. Enterprise Data Architect at VA. Developing standard for Detailed Clinical Models (DCM), information models for Electronic Health Record (EHR) Diabetes Project, etc. Brett Esler brett.esler@pencs.com.au AUPen Computer Sys Catherine Hoang catherine.hoang2@va.gov US VA Hugh Leslie hugh.leslie@oceaninformatics.com Seam Heard sam.heard@oceaninformatics.com Tom KuhnSr. Systems Architect at American College of Physicians Mona ??? ??

8. Page 8 STORYBOARDS

9. Page 9 Storyboards Ref file: Care Plan Storyboards-HL7 Patient Care WG- v0.2c 20110621b.docx Pediatric and Allergy/Intolerance: first draft  See updated Storyboard document Deferred to next meeting  Home Care: o Resolve /reconcile 2 versions  Acute Care Plan Storyboard: Danny o In progress  Perinatology: Laura  Stay healthy: Laura

10. Page 10 Post Meeting Notes by Kevin Coonan The Care Plan and the Health Concern share a similar issue about state management, and how it gets updated between providers involved with care of a mutual patient. Both an instance of a Health Concern and a Care Plan need well prescribed use of the Act state machine (along with the associated specific transitions, which need to be part of the picture) to do this. We need to be very explicit in our use cases and stories about when the status of a plan/problem is updated, and how that updated is communicated to others. The static semantics isn't the issue here (thankfully), but the interactions are. This is going to be different in enterprises (which can assume a single broker of Health Concern and Care Plan status, and manage updates to it, as well as record the history of updates) v. a loose federation (which may have some mechanism to pass messages/updates) v. a bunch if separate EHRS which need to exchange content (esp. if in the form of CDA r2, as there is no mechanism to handle status updates other than generating a new document instance). An order (ActRequest) is something that also has state, and needs to be managed by a order entry system. The details of how the order entry system makes its own sausage is out of scope for the Care Plan topic. The order state is not going to always agree with the pare plan state. Care Plan/Health Concern state is pretty easy.state We have to call this out, as well as how interactions between systems/providers are managed to be sure the assumptions are explicit, so that we can be sure that we have a representative set when it comes time to define messages, documents, and services. As long as we are careful to make this explicit in use cases, things will be OK. It is just when we make assumptions about updating EHRSs we will get into trouble.

11. Page 11 CHRONIC CARE SEQUENCE DIAGRAM Luigi

12. Page 12 Chronic Care Plan Sequence Diagram See updated Sequence Diagram for Chronic Care SB, next page

13. Page 13

14. Page 14 CARE MANAGEMENT CONCEPT MATRIX: UPDATE Susan

15. Page 15 Care Management Concept Matrix: update Descriptions and acronyms have been added The document will be reviewed with the Case Management Society of America This matrix provides a high level view of the range of care management situations that can be encountered We will use the matrix to validate our portfolio of storyboards once we have completed their descriptions and their corresponding models (sequence diagrams, etc.)

16. Page 16 CONCLUSION

17. Page 17 Action Items as of 2011-06-22 No.Action Items By Whom For When Status 2.Do an inventory of use cases and storyboard on hand Laura (Danny) Done 3.Ask William for an update (add in a diff colour to the appropriate pages)AndréCancel 5Obtain OK from ISO to use their CONTSYS work on Care Plan for our work Stephen/ William Cancel 9Draft a new PSS and review with project groupAndréDeferred 10Complete a first draft of requirementsAndréStarted 12Complete storyboardsMultiStarted 15Organise and schedule a review of the Care Plan components of the EHR-S FM R2André In process. EHR WG agreement received. 16Organise and schedule a review of the Care Plan components of ISO ContSysAndré NB: Completed action items have been removed.

18. Page 18 APPENDIX