Care Plan (CP) Team Meeting (As updated during meeting) André Boudreau Laura Heermann Langford (No. 17) Care Plan wiki: HL7 Patient Care Work Group To join the meeting: Phone Number: Participant Passcode: WebEx link is on the wiki (link below) With discussion notes and updates from the meeting

Page 2 Agenda for July 6 Minutes of June 22 nd Storyboard vetting process (André) Storyboards  Note by Kevin on ‘Care Plan States’ (Kevin)  Reviews: postponed to next meeting Models (Luigi) Requirements (André)  Stakeholders expectations Next meeting agenda

Page 3 Agenda for July 20 th Minutes of July 6 th Storyboards- first draft  Stay healthy: Laura  Home care SB resolution: André, Danny  Perinatology: Laura  Acute care: Kevin (Danny) Storyboard validation: identification of SME teams Models (Luigi)  Resolve BPMN vs Activity diagram: feedback from SMEs  Chronic care  Home care Tentative Plan (André)  Validation Next meeting(s) 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 20  August 3  August 17 o Review of Care plan functionalities in 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) Care Management Concept Matrix update (Susan) 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 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 US PhD microbiologist. Principal at Care Management Professionals. 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 Gaby Jewell US Yes Cerner Corp,

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 STORYBOARD VETTING PROCESS

Page 9 Storyboard (SB) Validation & Approval Clarify the guidelines and quality criteria for the Care Plan Storyboard (Care Plan Work Team CPWT) Assign a PCWT ‘owner’ for each SB (CPWT) For each SB, identify a validation group (3 to 5) of SMEs that include (CPWT)  At least one physician, one nurse, and one other type of clinician that is described in the SB  Representation from at least 2 countries Obtain agreement to participate from SMEs (SB Owner) Communicate the criteria and the specific SB to the appropriate group of SMEs (SB Owner) Obtain individual feedback from the SMEs (SB Owner) Consolidate feedback and update the SB (SB Owner) Review the updated SB with the SMEs and the CPWT at a regular meeting (CPWT) Finalize the SB (SB Owner)

Page 10 Care Plan Storyboard Guidelines and Quality Criteria Focused on one typical story, not on exceptions Focused on the exchange of information about care plan Identifies what should be a best practice in the exchange of clinical information Is at the conceptual level, Is architecture, implementation and platform independent Is written in common clinical term, not in technical or IT terms Notes:  Make explicit the state transitions?  We will need to clarify the criteria for what is being sent in the information exchange, especially for patients with a long history  Exclude patient profile, referral request  Do not exclude application services related to care plan information exchange SB SME? MnM, Lloyd, Graham

Page 11 Storyboard Owners Owners are coordinators for the preparation, review and approval of SB, not experts in the domain Home Care: André  SMEs: Acute Care Plan Storyboard: Danny/Kevin  SMEs: Perinatology: Laura  SMEs: Pediatric and Allergy/Intolerance: Susan  SMEs: Stay healthy: Laura  SMEs:

Page 12 STORYBOARDS

Page 13 Care Plan States: Note 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 update 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 of 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 an 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 care 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 14 Discussion Notes Care Plan is a grouper with different pieces of information  Each piece of info has a life cycle, e.g. o Change in medication o Activities completed o Partial progress o Outcomes results (observation)  There will be data from various parts of the EHR Check with Transition of care initiative for jargon and specifications for Care Plan  Caution: we had a previous discussion on this about the level of quality of the deliverables from that initiative, how much validation was made, how robust was the information model

Page 15 State: RIM ActStatus

Page 16 Storyboards: deferred 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  Stay healthy: Laura  Home Care: o Resolve /reconcile 2 versions  Acute Care Plan Storyboard: Danny o In progress  Perinatology: Laura

Page 17 MODELS Luigi

Page 18 Chronic Care Plan Models Sequence Diagram  See new version of Sequence Diagram for Chronic Care SB (Luigi) Activity Diagram  See Activity Diagram for Chronic Care SB (Luigi) Note: use only one: the activity diagram Explore whether we should use BPMN instead of Activity diagram

Page 19 REQUIREMENTS Stakeholders and their Expectations

Page 20 Stakeholders Patient Patient family Care Coordinator  This is a role that can be assumed by a number of people, depending on the context and the specifics of the case  Patient  Family physician  Nurse Practitioner  Patient guardian  Etc… Pharmacist Allied health Professional  Includes dietician, physiotherapist, inhalotherapist, podiatrist, optician, etc. Other professionals

Page 21 Stakeholder Expectations StakeholderExpectationsNotes Patient Clear understanding of goals, outcomes, care activities, roles, and timeline Reminders for activities Access to clarifying information Info on progress achieved Updates on the plan Information in an easy to understand language Patient family Clear understanding of goals, outcomes, care activities, roles, and timeline Access to clarifying information Info on progress achieved Updates on the plan Information in an easy to understand language Care Coordinator Easy to use tools to document goals, outcomes, care activities, roles, and timeline, plus links to relevant health record info Tool that will trigger reminders and follow-up Pharmacist Prescription info Relevant patient profile Allergies and intolerance, other medications, Information in an easy to understand language Allied Health Professional Clear understanding of specific objectives, role and activities for them Relevant patient info and context Easy mean to send progress update Information in an easy to understand language

Page 22 Discussion Notes- Stakeholders and their Expectations These look like functional requirements Let’s reassess whether we need this or not…

Page 23 CONCLUSION

Page 24 Action Items as of No.Action Items By Whom For When Status 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 25 APPENDIX