Care Plan (CP) Team Meeting Notes (As updated during meeting) André Boudreau Laura Heermann Langford (No. 11) Care Plan wiki: HL7 Patient Care Work Group See agenda for May 4 th on page 3 Documents mentioned in these minutes are on the wiki

Page 2 Agenda for April 27 Summary of care plan situations (Susan) Feedback and discussion on first storyboard: Chronic Care (Danny to circulate in advance) Highlights from IHE Patient Centered Coordination Plan (PCCP) (Ian M.) MU material (Susan) Next meeting agenda

Page 3 Agenda for May 4th Preparation for WGM in Orlando Care plan situations update (Susan) MU material (Susan) Care Plan elements from KP, Intermountain, VA, etc. (Laura) New storyboard for acute care (Danny) Business requirements: summary of key aspects since February (André) Coaching on Eclipse: what to install for our needs, quick start (Kevin) Next meeting agenda Later  Overarching term to use (Ian M.)  Care Plan Glossary

Page 4 Participants- Meetg of p1 Name Country YesNotes André Boudreau CAYes 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 USYes 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 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 AU HP Enterprise Services. MD; Clinical Informatics Consultant; IHE Australia; Medical Practitioner - General Practice Adel Ghlamallah CAYes Canada Health Infoway. SME at Infoway (shared health record); past architect on EMR projects William Goossen 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 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 UK NHS Connecting for Health. Health Informatics; Senior Interoperability Developer, Data Standards and Products; HL7 Patient Care Co-Chair Rosemary Kennedy USYes 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 USYes JP Systems. Informatics Consultant; Business Consultant & Sr. Project Manager Margaret Dittloff 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 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 UKYes Ocean Informatics. Health informatics specialist; Formal general medical practitioner; OpenEHR; Slovakia Pediatrics EMR; Sweden distributed care approach Danny Probst US Intermountain Healthcare. Data Manager Kevin Coonan US MD. Emergency medicine. HL7 Emergency care WG. Gordon Raup US CTO, Datuit LLC (software industry). Susan Campbell USYes PhD microbiologist. Specialist Master Consultant at Deloitte. HL7 Dynamic Care Plan Co-developer Elayne Ayres US 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

Page 5 Participants- Meetg of p2 Name Country YesNoNotes David Rowed AU Charlie Bishop UK Walter Suarez US Peter Hendler US Ray Simkus CA Lloyd Mackenzie CALM&A Consulting Ltd. Serafina Versaggi USYes Sasha Bojicic CA Lead architect, Blueprint 2015, Canada Health Infoway Agnes Wong CA RN, BScN, MN, CHE. Clinical Adoption - Director, Professional Practice & Clinical Informatics, Canada Health Infoway Cindy Hollister CA RN, BHSc(N), Clinical Adoption -Clinical Leader, Canada Health Infoway Valerie Leung CA Pharmacist. Clinical Leader, Canada Health Infoway

Page 6 CARE PLAN SITUATIONS

Page 7 Care Plan Situations See document prepared by Susan Campbell: Care Management Concept Matrix-v a.xls Identifies different types of care management and for each, presents characteristics from a provider and payer perspective as well as from a patient perspective Matrix has some elements that are US specific.  Some columns could be added so that other country specific terms/types could be added Next steps  Add explanations and brief descriptions for the various types and characteristics (second worksheet added)  Add if possible another worksheet with vendors and roles

Page 8 Care Management Resources See document prepared by Susan Campbell: Care Management Professional Organizations Matrix b.xls  Formerly named CM Society & Certification2.xls Identifies societies that provide certification in care or case management in health care and /or social services

Page 9 Discussion To what extent are we connected to the S&I Transition of Care initiative in the US?  Contacts have been established  We have looked at their methodology and integrated some elements into our structure of deliverables Our goal is to produce the Domain Analysis Model (DAM) for Care Plan. We are at the business need level and at the conceptual level of what must happen with information exchange. The how (e.g. the use of CDA or IHE or both) will come later

Page 10 STORYBOARDS

Page 11 Care Plan Storyboards- Chronic Care Plan See document prepared by Danny Probst: Care Plan Storyboards-HL7 Patient Care WG- v a post CP meetg.docx Is format/structure of document ok? Yes Introduction: explains what storyboards are and how they should be structured List of storyboards: will these cover the range of situations for which we want care planning to apply  Chronic Care: a first version is proposed. Add Asthma?  Acute Care: should be the next one and should cover a broken hip situation from ER to rehab (see amended doc above)  Home Care: for elderly  Perinatology  Pediatric: include Allergy/Intolerance?  Stay healthy? Chronic Care Plan: some adjustment made  Feedback is wanted to ensure a robust storyboard

Page 12 IHE PATIENT CENTERED COORDINATION PLAN (PCCP) By Ian McNicoll

Page 13 IHE Patient Centered Coordination Plan (PCCP): Highlights and Discussion Highlights: see document prepared by Ian McNicoll : HL7 Care PlanComparison.zip  This zipped file is available on the wiki. It uses the xmind mind mapping SW available free. Compares the structure and types of contents for the care plan of IHE, Sweden, and NEHTA  IHE and Sweden have many similarities  NEHTA model is more detailed. It is a draft proposal prepared by Stephen (see meeting of ) The full IHE PCCP specification is available on the IHE web site, at: It is key that we focus on structure and not reinvent contents that already exists in HL7 for contents supportive to the care plans Care plans typically are based on predefined guidelines for specific problems or care objectives/ goals What is the scope of care planning that we want to address? Medical, behavioural, social, financial, etc?

Page 14 CONCLUSION

Page 15 Action Items as of No.Action ItemsBy Whom For When Status 2.Do an inventory of use cases and storyboard on hand Laura (Danny) Active: Underway 3.Ask William for an update (add in a diff colour to the appropriate pages)André Outstanding - Request made 5 Obtain and share the published version of the CEN Continuity of care P1 and P2; obtain ok from ISO Audrey/LauraOutstanding 7Update new wiki page with previous meeting material. Adjust structure of wiki.AndréWiki restructured 8Draft list of deliverables for this phaseAndréDraft prepared 9Draft a new PSS and review with project groupAndréDeferred 10Initiate draft of requirementsAndréStarted 11Prepare draft storyboard for one situation using HDF 1.5DannyDone NB: Completed action items have been removed.

Page 16 APPENDIX

Page 17 Storyboard: what is it? Narrative of business (clinical; administrative) processes on domain/area of interest Non technical (conceptual in nature) Describes: Activities, interactions, workflows Participants High level data contents feeding into or resulting from processes Provides inputs for: Activity diagrams Interaction diagrams State transition diagrams High level class diagrams Stephen Chu 12 April 2011

Page 18 Storyboards 5 to 10 max  See list on wiki Identify actors and understand their roles Understanding the care planning processes will help understand the needs for info exchange  E.g. query for resource availability vs the care plan needs for patient X 3 types of requirements  Functions to be carried out, workflow, processes  Static semantics: info model, glossary, vocabulary  Functions to be carried out by the system: EHR FM, PHR FM, etc  Interactions between systems: interoperability Include meaningful use items that are universal in perspective

Page 19 MODELING TOOL- ECLIPSE

Page 20 Modeling Tool to Use Responses from Lloyd Mackenzie and Jean Duteau  Both use Enterprise Architect (EA) Response from Andy Stechishin, HL7 Tooling and V3 Publishing co-chair  First, there is an active Tooling project (called MAX) to export information from EA using MIF, the HL7 official interchange format.  Second, at the WGM in Sydney, Sparx gave each attendee a license for EA.  Third, during my tenure as a co-chair of Publishing, most DAMs that have been submitted for ballot have been developed (or at least published) using EA.  It seems to me that a convergence is occurring and EA seems to at least be the tool of choice for many. Eclipse is a platform for doing many different things using specific plug-ins  Recommended by HL7  Open Source but not as intuitive as Enterprise Architect (which costs some 100$ for a desktop version)  However, choosing which tool and plug-in (for UML) to install is difficult for non technical folks (vs the easy-to-use EA)  We would need some coaching to allow a quick start o Adel agreed to help us there o André will find a resource The tool will be used to do:  Use cases  Activity and workflow diagrams  Interaction diagrams  Class models Includes post-meeting notes

Page 21 REQUIREMENTS