Care Plan (CP) Team Meeting Notes (As updated during meeting) André Boudreau Laura Heermann Langford (No. 16) Care Plan wiki: HL7 Patient Care Work Group To join the meeting: Phone Number: Participant Passcode: WebEx link is on the wiki (link below) See post meeting notes from Kevin about Storyboards.

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

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

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

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

Page 6 Participants- WGM 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 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 CA 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 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 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 UK 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 Yes MD. Emergency medicine. HL7 Emergency care WG. Gordon Raup US CTO, Datuit LLC (software industry). Susan Campbell USYes PhD microbiologist. Principal at Care Management Professionals. HL7 Dynamic Care Plan Co-developer Elayne Ayres 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

Page 7 Participants- WGM Meetg of p2 Name Country Yes Notes David Rowed AU Charlie Bishop UK Walter Suarez US Peter Hendler US Ray Simkus CA Lloyd Mackenzie CALM&A Consulting Ltd. Serafina Versaggi US Clinical Systems Consultant Sasha Bojicic CALead 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 CAPharmacist. Clinical Leader, Canada Health Infoway 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. Brett Esler AUPen Computer Sys Catherine Hoang US VA Hugh Leslie Seam Heard Tom KuhnSr. Systems Architect at American College of Physicians Mona ??? ??

Page 8 STORYBOARDS

Page 9 Storyboards Ref file: Care Plan Storyboards-HL7 Patient Care WG- v0.2c b.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

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.

Page 11 CHRONIC CARE SEQUENCE DIAGRAM Luigi

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

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Page 14 CARE MANAGEMENT CONCEPT MATRIX: UPDATE Susan

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.)

Page 16 CONCLUSION

Page 17 Action Items as of 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.

Page 18 APPENDIX