1. Care Management & Planning track
HL7 FHIR Connectathon
Saturday, January 27 & Sunday, January 28
Care Management & Planning track
(starting on slide 10)

2. Connectathon Overview
FHIR Connectathon Objectives
Track Selection
Timeline of Activities
Participant Opportunities
Location of Support Materials
How to get your questions answered

3. What’s to be gained by attending a FHIR Connectathon?
Join a community of FHIR users
Develop and test your system and use of the standard
Demonstrate what’s possible
Refine the FHIR Specification

4. Track Selection Review track details to find your focus
Select your track in the Pre-Connectathon Survey
Connect with your track lead in advance
We recommend participating fully in only one track

5. Timeline of Activities
One Month Prior: Registration
1-3 weeks prior: Track Orientation Meeting
On-Site
Friday
Breakout:
Saturday
Q1-Q4: Working Sessions
Breakouts: Orientations on FHIR and Test Tools
Sunday
Q1-Q2 Working, Q3 Testing, Q4 Wrap Up

6. Participant Opportunities
Join in the community
Bring Questions and share your challenges
Help others by sharing your knowledge
Bring your development system ready to go
Have your application installed
Have you environment configured
Raise questions that identify hot topics
Record your Results
What happens at Connectathon stays at Connectathon.
It’s OK to fail.

7. Location of Support Materials
FHIR version will be used by this track
Connectathon wiki
Care Management & Planning Track Definition
Tracking Spreadsheet – Coming Soon!
Gforge
FHIR Chat

8. How to Get your Questions Answered
Review track descriptions
Sign up for the FHIR Chat
Enter issues into Gforge
Administrative Questions
On Site Issues

9. Who’s Who at the FHIR Connectathon?
FHIR Product Director: Grahame Grieve
FHIR Management Group (FMG):
Connectathon Administrator: Sandy Vance

10. Intro to Care Management Track
Introduction to Track Lead
Dave Carlson, VHA Standards & Interoperability (contractor)
Track Definition
List of participating systems in the track
References to the servers & clients for the track
Goals for this track

11. Participant Roles Care Plan Server Care Plan Requestor
Supports: CarePlan, Condition, Goal, CareTeam, and other resources included via CarePlan.activity.reference
Care Plan Requestor
Using debug tools, such as Postman, to query servers
SMART on FHIR applications for use by patients and clinicians
Care Plan Protocol Creator
Define care protocols using PlanDefinition and ActivityDefinition
PlanDefinition $apply operation creates CarePlan for a patient
CDS Service Requestor
Invoke a CDS Hooks service to evaluate or suggest modifications to a care plan

12. Use Case: Chronic Care Management
Recommend following clinical use case based on the NIH Chronic Kidney Disease (CKD) Care Plan project.
Patient personas; this track's sample data are based on Betsy Johnson's persona
Provider personas for six members of a CKD patient's care team
Includes a draft set of data elements and terminology codes for CKD care management
Sample FHIR resources were created from the CKD use case personas and data elements

13. Scenarios Retrieve a patient’s care plan(s)
Care Plan Server & Care Plan Requestor
Create new Care Plan from protocol definition
PlanDefinition $apply operation creates CarePlan for a patient
Save resulting CarePlan resource for retrieval by requestor role
Request CDS Hooks care plan evaluation
Invoke 'patient-view' hook on one or more CDS Hook service providers
Display returned cards, information and/or suggestions

14. Servers and Clients Participating
Sample FHIR resources for chronic care management
HSPC Sandbox (FHIR v3.0.1) open endpoint
Loaded with all sample FHIR data
Allscripts server
PlanDefinition protocols for chronic conditions
Use protocols to create new CarePlan resources
SMART on FHIR care management client apps
Clinical Cloud Solutions – iOS app for viewing care plan resources and invoking CDS Hook services
Other Clients & Servers TBD by participants

15. Track Goals Advance the maturity of FHIR resources for
Care management and planning (CarePlan, CareTeam, Goal, Condition, and others)
Definition of computable clinical protocols (PlanDefinition, ActivityDefinition)
Document industry best practices for improving care coordination using shared care plans