Care Plan (CP) Team Meeting Notes (As updated during meeting) André Boudreau Laura Heermann Langford (No. 12) Care Plan wiki: HL7 Patient Care Work Group

Page 2 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) Storyboards  Feedback on Chronic care Plan storyboard  New storyboard for acute care (Danny) Modeling resource: Luigi: agrees to be our modeler: use case, data, process, UML  EA Vs Eclipse: EA is preferred by many Next meeting agenda For a future meeting:  Business requirements: summary of key aspects since February (André)  EA or Eclipse  Overarching term to use (Ian M.)  Care Plan Glossary

Page 3 Agenda for May 11th Storyboards (Laura, Danny, Susan, André) Requirements (André)  Include processes (Stephen’s work)  Include key functionalities (diabetes case) Comparison of care plan contents (Ian)  To inform the information model  Start of spreadsheet Finalization of Orlando WGM agenda (All) Next meeting date and agenda Later  EA or Eclipse  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 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 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 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 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 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 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 USYes 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.

Page 6 ORLANDO WGM

Page 7 Orlando WGM Topics Thursday May 19 th, Q1, 9h00 to 10h30 Duration 1.5 hour Who to lead: Laura Potential Topics, to be finalized next week  Status of Care Plan DAM project  Identifying key material from other Patient Care work (Pressure Ulcer, DCM) and other WG (Emergency Care, Care Provision, Care Statement, Structured Document, CDA consolidation, etc.)  Requirements, include inventory of existing material and standards  Storyboard review  Identifying clinical resources that would review future storyboards  Modeling work required

Page 8 CARE PLAN SITUATIONS

Page 9 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: postponed (Susan)  Add explanations and brief descriptions for the various types and characteristics (second worksheet added)  Add if possible another worksheet with vendors and roles

Page 10 MEANINGFUL USE MATERIAL

Page 11 MU Material (Susan) MU aspects  Demonstrate that providers and institutions have EHR that have been certified o Have all patient records electronic o Interoperability can be verified o EHR can be used meaningfully to report  Health conditions that are most common are the ones targeted for the first phase o Use evidence based care to lower costs and improve patient outcome 3 phases  Ph1: population health o By attestation that they can send the measures, one test to CDC; Use certified SW and have e-record  Ph2: similar but data reporting of the measures (80% of population)  Ph3: individual health: longitudinal measures for outcomes Issue: finding common measures for all the segments Document: HIT POLICY COMMITTEE MEASURE CONCEPTS Document: Notes from Oct 20, Policy Committee meeting on Meaningful Use Phase 2

Page 12 MU Material See SHIPPS DAM ballot material (Serafina, CBCC WG)  NQF E-Measures  Relation to Care Plan?  Identify specific items relevant to CP (Serafina, with Susan) Care Plan has not entered yet the quality measures  A very key area of communication for quality care  Needs to be able to surveying ‘care plans’ Important in the development of the Care Plan reference model S&I Transition of Care initiative can influence our work and vice-versa

Page 13 CARE PLAN MATERIAL FROM VARIOUS ORGANIZATIONS

Page 14 Care Plan Material from Various Organizations Laura: will contact KP Info to ask for:  Care plan processes, guidelines (disease treatment models)  Criteria that a patient must exhibit in order to trigger the CP process  Key care plan contents /data elements  Data exchange between providers PPOC summary in the CP comparison diagram is incomplete  Ask Ian to enrich it

Page 15 Care Plan Scope Question The whole care perspective? VS care plan communications among providers Bottom up approach vs top down Top down: EHR FM Field approach: storyboards Need to complete the storyboards Restructure? Test our set of storyboards at the end with the following:  3 age groups: newborns, adults, seniors  Types of care: chronic, acute, palliative, mental, behavioural, stay healthy, others?

Page 16 STORYBOARDS

Page 17 Feedback on Chronic Care Plan Storyboard Want to ensure  Readability  Clinical accuracy, validity  Coverage (focus on the 80%, not the exceptions)  Remember: storyboards get improved over time, as the project advances By clinicians As we progress in the progress Ask the PC list/members

Page 18 Storyboards- Next week if possible Acute Care Plan Storyboard: Danny  In progress Home Care: André Perinatology: Laura Pediatric and Allergy/Intolerance: Susan Stay healthy: Laura

Page 19 MODELING TOOL- EA OR 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 CONCLUSION

Page 22 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 9Draft a new PSS and review with project groupAndréDeferred 10Complete a first draft of requirementsAndréStarted 12Complete storyboardsMulti 13Prepare Orlando WGM 14 NB: Completed action items have been removed.

Page 23 APPENDIX

Page 24 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 25 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 26 REQUIREMENTS