Care Plan (CP) Meeting 90 minutes André Boudreau Laura Heermann Langford Stephen Chu André to lead *C are Plan wiki: HL7 Patient Care Work Group To join the meeting: Phone Number: Participant Passcode: # WebEx link (thanks to Canada Health Infoway): With meeting notes

Page 2 Agenda- March 14th (Lead: André) Review changes to Pediatric immunization SB (Susan) Review Coordination of care concepts (Susan) Review Care Plan BPMN first results (Luigi) Review Care Plan Class Model first results (Luigi)  William’s Guidelines for DAM Information Modeling Next meeting agenda If time permits: Postponed Review and augment draft of requirements (André)  Coordination of care  Care management matrix  Do a few past meetings Update work plan

Page 3 Participants- Meetg of p1 Name Country YesNotes André Boudreau 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 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 AU Yes 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 USYes PhD microbiologist. Principal at Care Management Professionals. HL7 Dynamic Care Plan Co-developer 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 Luigi Sison 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. Peter MacIsaac AU HP Enterprise Services. MD; Clinical Informatics Consultant; IHE Australia; Medical Practitioner - General Practice 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 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 US JP Systems. Informatics Consultant; Business Consultant & Sr. Project Manager Ian McNicoll UK Ocean Informatics. Health informatics specialist; Formal general medical practitioner; OpenEHR; Slovakia Pediatrics EMR; Sweden distributed care approach Maggie Gilligan US Dietician; Owner, Senior Member, Nutra Tech Technology, LLC Kevin Coonan US MD. Emergency medicine. HL7 Emergency care WG. Gordon Raup US CTO, Datuit LLC (software industry). Elaine 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 Rob Savage US CDC Immunization

Page 4 Participants- Meetg of p2 Name Country Yes Notes David Rowed AU MD. Family GP.; Was chair, 2005, Electronic Communications Working Group of the AU General Practice Computing Group Charlie Bishop UK Steve HufnagelUSYes Peter Hendler US Ray Simkus CA Practicing Family GP, Vancouver, BC. User of EMR. Intense interest and involvement in EHR and EMR standards, functionality and terminology Serafina Versaggi USClinical Systems Consultant Brett Esler AUPen Computer Sys Catherine Hoang USVA Hugh Leslie AU a General Practitioner ; Chief Medical Officer, Ocean Informatics Seam Heard Thomson Kuhn US Sr. Systems Architect at American College of Physicians Russell Leftwich US Md, Allergist, internal medicine; Chief Medical Informatics Officer, Office of eHealth Initiatives, State of Tennessee Michael Tan NL Publishing Facilitator, Care Provision, PC WG; Senior Project manager, Nictiz, NL Corinne Gower NZ Senior Business Analyst at NZHIS; Senior Advisor at Ministry of Health New Zealand Susan US Medical Informaticist at 3M Health Care; Chair Elect of the SNOMED CT Nursing Special Interest Group at IHTSDO; Vocab Facilitator for Patient Care TC at HL7 Standards 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. Gaby Jewell US Senior strategist at Cerner Corp, Ken Rubin US Co-Chair, HL7 Service Oriented Architecture Work Group; Chief Architect, Federal Healthcare Portfolio, HP Enterprise Services Mark Shafarman US Member of HL7 since Co-Chair, HL7 Template WG; Shafarman Consulting Inc.

Page 5 REVIEW OF STORYBOARDS Reference file from the wiki: Chronic-Conditions_Care-Plan-Storyboard_V0-5_Revised_ docx

Page 6 Changes to Pediatric Immunization SB (Susan) See  Pediatric_Immunization_Care_Plan_Storyboard_v0_4_ doc (available on wiki) The SB was simplified We have to look at immunization beyond pediatrics Influenza immunization Part of preventive care See the various notes and general comments in the updated version (on the wiki)  Pediatric_Immunization_Care_Plan_Storyboard_v0_5_ a.doc

Page 7 Coordination of Care (Susan) See document by Susan:  Coordination of Care using a Care Plan- refinements-SEC docx  Available on the wiki (Ref Material section) Focus should be on supporting the process of care planning, not on the static plan There are many different roles in care management  Nurse case manager  Social case manager  Disease case manager  Care coordinator  Care navigator Care coordination may be viewed as just logistical in some contexts but it is more than just logistical. It is about the proper execution of the workflow, combining people and machine actions In our Requirements statement, we need to document this range of complexity Our Glossary needs to clarify the meaning that we want to give to these various terms. Semantics vary by culture and language

Page 8 CARE PLAN DAM MODELING Luigi

Page 9 BPMN Model (Luigi) Enterprise Architect SW (EA) is used Review of a first draft of the BPMN for the encounters A and B of the Chronic care SB We use roles, not individuals or systems in the model The other 2 encounters will be added in the next round

Page 10 Class Model (Luigi) Discussion We need good definitions (Glossary of terms) The class model is being built in parallel to the BPMN model in Enterprise Architect SW (EA)

Page 11 FORWARD PLAN

Page 12 Status of 7 SBs – OwnerSB NameStatusDate for Complete Draft PCCP Final review Kevin CoonanAcute ConditionDraft 1 completed Second draft pending ???Pending André Boudreau Home CareUnder external review DoneFeb 15th Stephen ChuChronic ConditionsReviewed. Third draft completed DoneFeb 29th Susan Campbell -Pediatric Allergy -Immunization Reviewed. Second draft of both Immunization done Allergy done March 14 Feb 29 th Laura Heermann Langford PerinatologyReviewed. Second draft Final: pending DoneFeb 29 th Carolyn SilzleStay healthy/ health promotion Draft 1 completed Final draft distributed DoneFeb 29th

Page 13 Ongoing and Future Work, and Outstanding Items- as of Acute Care SB to be completed - (Kevin) Care Plan DAM Requirements (André and Care Plan Group) BPMN models including information exchange (Luigi and CP Group) Information model and glossary (Luigi and CP Group) Business rules and triggers (TBD) Action plan for balloting (CP Group and Co-Chairs)  Target:

Page 14 William’s Guidelines for DAM Information Modeling ( ) See example from CIC/PC on Diabetes  Use expression of data elements instead of a glossary with a list of words  Diabetes: data element name, definition, permissible values, permissible values definitions, reference, and optional items For the DAM, develop a class diagram with just names.  For example, if we encounter a scale: give the scale a class name and stop. Next create a DCM for the scale that can hold all knowledge, data elements, coding, data types, meta information and so on  DCM: variable, value set, description, example, data type, vocabulary, code for variable, code for value, comments CP Group discussion ( )  We will still build a Glossary to clarify the meaning of our terms/ concepts  We will give example of value sets to illustrate meanings

Page 15 HDF- Domain Analysis Overview Source: HDF_1.5.doc, page 37 Last updated:

Page 16 FUTURE MEETINGS Conference calls between now and May 2012 – see wiki 90 min., Wednesday 5-6:30pm US Eastern, fortnightly (every 2 weeks) Starting Feb. 1 st Webex supplied by Canada Health Infoway

Page 17 Next meeting Agenda- March 28 th (Lead: André) EHRS FIM on Immunization profile (Steve) Review Care Plan BPMN (Luigi) Review Care Plan Class Model (Luigi) Next meeting agenda If time permits Review and augment draft of requirements (André)  Coordination of care  Care management matrix  Analyze a few past meetings Update work plan

Page 18 APPENDIX

Page 19 Proposed Modeling Approach Two streams of parallel modeling From Storyboards to Business Process Modeling (BPM)  One single model, using the chronic care SB  Modeling focused on Patient movement and interchange of care plan data  No details on care activities at a given site (e.g. hospital, physician office, etc.) From Storyboards to UML Class Model / Entity-Relationship Diagram)  Focused on care plan information  Identification of other relevant information without detailed modeling (e.g. patient demographics, local organization policies and rules)  Include good definitions of concepts  Tie to the PC data element specifications  Take advantage to existing definitions o e.g. ISO CONTSYS model o HL7 Vocabulary: patient, care plan,  Build definitions as we move forward Laura: How will we capture different coordination of care processes: care manager, primary care physician; simple vs complex care Updated

Page 20 CARE PLAN REQUIREMENTS

Page 21 Discussion- Requirements Structure/Approach See new structure  EHR-S FM R2 contents integrated o For EHR-S FM R2 December 2011 ballot package, see EHR WG wiki  Agree that it will become a collector of all our thoughts regarding the care plan  We will take a bit if time at each meeting to review notes from the past and enrich the requirements Updated

Page 22 Forward Plan Discussion Notes WGM Suggestion from William – WRT HDF processes: good to follow  But do not use glossary  Capture data definitions/metadata as data element specification  William to send standard examples of data element specification to the group- André to follow-up Work plan discussed as per work plan excel file contents:  Itemised deliverable components, need to work on and agree on deliverable dates  Target DAM ballot date: possible September 2012  To be discussed and confirmed in next conf calls Feb 1 Good storyboards will make the mapping and modelling of process flows a lot easier