Care Plan (CP) Meeting - Minutes December 12, EDT Laura Heermann Langford Stephen Chu *C are Plan wiki: HL7 Patient Care Work Group To join the meeting: Phone Number: Participant Passcode: # With meeting discussion notes

Page 2 Participants- Name Country YesNotes Laura Heermann Langford US x 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 AU x 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 Carolyn Silzle US American Dietetic Association Susan Campbell USx PhD microbiologist. Principal at Care Management Professionals. HL7 Dynamic Care Plan Co-developer Kevin Coonan US MD. Emergency medicine. HL7 Emergency care WG. Nancy Wilson RomanUS Enrique Meneses US x Serafina Versaggi USClinical Systems Consultant John Farmer US Chris White US LuigiSison US 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. Iona Threan USx

Page 3 Tentative: December 12, 2012 (subject to change) Discussion on the care plan relationships, what is included and not, definitions and terminology Reviewing modeling work as it is ready and needing discussion.

Page 4 MODELING Enrique Meneses

Page 5 Discussion Notes  Specific discussion on the model was deferred to next meeting.

Page 6 CARE PLAN RELATIONSHIPS (LINKED OR NESTED…MASTER VS COORDINATED) Laura

Page 7 Discussion Notes

Page 8 Previous Meeting Discussion Notes  Have come to agreement there is an all over coordinating care plan… the Master Patient Care Plan.  Agreements o The master care plan is the specialty care plans interleaved. The service could be created to accommodate the reconciliation o The concept of the patient or someone else being able to “hide” or “conceal” data from one care giver or provider or another exists – but will be addressed later. o Examples of content that would need reconciliation--Meds, problems, history, allergies, advanced directives,  Discussions…. o Care plan might inform the plan of care, o Plan of care = episodic plan o Master care plan and specialty care plan – both could inform the plan of care… o This is all very difficult to follow would be helpful to have a diagram. Perhaps – use a problem specific….such as hypertension, or use one of the use cases we have developed – use the chronic care storyboard ….Laura to present next time… o Terminology – to refer to Master Plan and the Specialty Plan that are really detailed but likewise relatively long term. o History of the plan and reports of activities from the plan are part of the medical record. In the case of some observations – you may have the meta data on the care plan (blood pressure stead) instead of the last 14 readings… o Active goals stay on the care plan, resolved/completed goals become part of the medical record o Some goals, or medical issues may stay on the care plan even if they are complete or resolved…because they are relevant to the overall care. Such as “smoked 4ppd for 30 years until last month…..”  Questions- o How much detail should be in the master care plan

Page 9 Discussion Notes Significant discussion on the relationship of Care Plan, Plans of Care and somewhat Treatment Plans. Recent work by ONC S&I Team referenced. Identified some relationship between this work and the ISO consys work. Stephen found link and sent to group for review. ( The System of Concepts for Continuity of Care information is hosted by the UK NHS: Determined ideas and thoughts needed to be captured in writing and agreed drafting of the DAM text was needed. Laura agreed to bring straw man of text for DAM structure to next meeting. Care Plan Plans of Care Treatm ent Plans Instructi ons

Page 10 FUTURE MEETINGS Conference calls between now and January 2013 – see wiki 90 min., Wednesday 5-6:30pm US Eastern, fortnightly (every 2 weeks) Starting September 19 Next Agenda

Page 11 Next meeting Agenda- January 2, 2013 Next regular meeting date would be 12/26/2012. Consensus to not meet on 12/26 but to meet on 1/2/2013 to continue discussion. Agenda: Modeling Discussion Care Plan/Plan of Care etc Relationship (as needed) DAM draft structure Phoenix F2F Meeting 1/17 Q1 Agenda

Page 12 APPENDIX