1. Care Plan (CP) Team Meeting Notes (As updated during meeting) André Boudreau (a.boudreau@boroan.ca) Laura Heermann Langford (Laura.Heermann@imail.org) 2011-03-16 (No. 6) HL7 Patient Care Work group

2. Page 2 Agenda for March 16th Presentation by Canada (Ron Parker and Sasha Bojicic) on the COPD use case they developed:  Done, see separate PP deck with discussion notes. See also the COPD use case document Next meeting (March 23 rd ):  Review IHE approach to care coordination and planning, including the nursing perspective o Peter and co-chair of IHE AU o Laura Heermann Langford, co-chair of PCCC  Start defining the in-scope and out-of-scope contents and aspects of care plan  Update from Danny Then, decide on the deliverables and how we will produce the DAM

3. Page 3 Updated Agenda for March 9th Review inventory and examples of Care Plan (CP) use cases (Laura)  Still in progress  Model developed for dynamic CP: see slide 6 and 7 o Laura will update to a more complete cycle for CDM (Chronic Disease Management), with different sites of care within one system, and different sites with different systems o We need to include sites that need to be informed of CP without delivering care per say Review material received on care plan types (dynamic, interchanged) (Stephen)- done. See slide 8-9 Review material received on care plan structure (Stephen)- done -see slide 10 Review IHE approach to care plans (André)- see attached PCCP doc- postponed

4. Page 4 Participants- Meetg of 2011-03-16 p1 Nameemail Country YesNoNotes André Boudreau a.boudreau@boroan.ca CAYes Laura Heermann Langford Laura.Heermann@imail.org USYes Stephen Chu stephen.chu@nehta.gov.au AU Yes Peter MacIsaac peter.macisaac@hp.com AU Yes Adel Ghlamallah aghlamallah@infoway-inforoute.ca CA William Goossen wgoossen@results4care.nl NL Anneke Goossen agoossen@results4care.nl NL Ian Townsend ian.townend@nhs.net UK Rosemary Kennedy Rosemary.kennedy@jefferson.edu US Yes Jay Lyle jaylyle@gmail.com US Margaret Dittloff mkd@cbord.com US Audrey Dickerson adickerson@himss.org US Ian McNicoll Ian.McNicoll@oceaninformatics.com UKYes Danny Probst Danny.Probst@imail.org USYes Kevin Coonan Kevin.coonan@gmail.com USYes

5. Page 5 Participants- Meetg of 2011-03-16 p2 Nameemail Country YesNoNotes David Rowed david.rowed@gmail.com AU Charlie Bishop charlie.bishop@isofthealth.com UK Walter Suarez walter.g.suarez@kp.org US Peter Hendler Peter.Hendler@kp.org US Ray Simkus ray@wmt.ca CA Elayne Ayres EAyres@cc.nih.gov US Lloyd Mackenzie lloyd@lmckenzie.com CALM&A Consulting Ltd. Serafina Versaggi serafina.versaggi@gmail.com US Sasha Bojicic SBojicic@infoway-inforoute.ca CAYes Lead architect, Blueprint 2015, Canada Health Infoway Agnes Wong awong@infoway-inforoute.ca CAYes RN, BScN, MN, CHE. Clinical Adoption - Director, Professional Practice & Clinical Informatics, Canada Health Infoway Cindy Hollister chollister@infoway-inforoute.ca CAYes RN, BHSc(N), Clinical Adoption -Clinical Leader, Canada Health Infoway Valerie Leung vleung@infoway-inforoute.ca CAYes Pharmacist. Clinical Leader, Canada Health Infoway Gordon Raup graup@comcast.net USYes Was CEO, CareFacts Information Systems, Inc.

6. Page 6 Other participants on 2011-03-16 Ron Parker Sasha Bojicic

7. Page 7 Meeting Notes 2011-03-16- p1 See PP deck on COPD Use Case Danny  Been looking at Structured Docs standards  Looking also at some use cases  Tried to develop a spreadsheet on components of Care Plan We have committed of the DAM  Identify the deliverables  Decide on the methods and techniques BPMN: needs to be socialized more as a method Functional perspective in addition to dynamic and exchanged components  Also links to referral process  Also links to EHR/EMR contents  Contents may vary based on context and particular care involved  Include links to evaluation components (may be outcome related, e.g. blood sugar level), include target dates

8. Page 8 Meeting Notes 2011-03-16- p2 Wiki (see appendix for structure of current wiki page)  Wait until we have clarified  PRIORITY: Ensure to have the place for meeting notes and working docs o Also, post meeting call-in info

9. Page 9 Scope of 2011 Care Plan Initiative In scopeOut of scope

10. Page 10 Action Items as of 2011-02-16/23 No.Action ItemsBy Whom For When Status 1.Clarify procedure and obtain rights for André/Laura to update CP wikiWilliam?Active: Procedure obtained 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 4Prepare summary of the steps from HDF to produce the DAMAndréDone. See Appendix 1 5 Obtain and share the published version of the CEN Continuity of care P1 and P2; obtain ok from ISO Audrey/LauraOutstanding 6 Provide copy of the DAM presentation in Sydney and the name of a free mind mapping tool StephenDone. Sent to list.

11. Page 11 APPENDIX

12. Page 12 Definition of Care Plan on Wiki The Care Plan Topic is one of the roll outs of the Care Provision Domain Message Information Model (D-MIM). The Care Plan is a specification of the Care Statement with a focus on defined Acts in a guideline, and their transformation towards an individualized plan of care in which the selected Acts are added. The purpose of the care plan as defined upon acceptance of the DSTU materials in 2007 is:  To define the management action plans for the various conditions (for example problems, diagnosis, health concerns)identified for the target of care  To organize a plan for care and check for completion by all individual professions and/or (responsible parties (including the patient, caregiver or family) for decision making, communication, and continuity and coordination)  To communicate explicitly by documenting and planning actions and goals  To permit the monitoring, and flagging, evaluating and feedback of the status of goals, actions, and outcomes such as completed, or unperformed activities and unmet goals and/or unmet outcomes for later follow up  Managing the risk related to effectuating the care plan, Source: http://wiki.hl7.org/index.php?title=Care_Plan_Topic_project

13. Page 13 Actual Care Plan Topic project HL7 Wiki further to: Care Plan Topic & OrdersetsCare Plan Topic & Ordersets further to: Care Plan GlossaryCare Plan Glossary further to: Care Plan StoryboardsCare Plan Storyboards further to: Care Plan Use casesCare Plan Use cases Contents  1 Introduction 1 Introduction  2 Project Need 2 Project Need  3 Project Scope 3 Project Scope  4 Project Team 4 Project Team  5 Action items 5 Action items  6 Project Process 6 Project Process  7 Project Objectives and Deliverables 7 Project Objectives and Deliverables  8 Success Criteria 8 Success Criteria  9 Project Timeline 9 Project Timeline  10 Project Resources 10 Project Resources  11 Project Budget 11 Project Budget  12 Links to relevant documents 12 Links to relevant documents  13 Participants 13 Participants o 13.1 Users of the Care Plan Topic 13.1 Users of the Care Plan Topic o 13.2 Annonators of the Care Plan Topic 13.2 Annonators of the Care Plan Topic o 13.3 Liasons of the Care Plan Topic 13.3 Liasons of the Care Plan Topic o 13.4 Developers of the Care Plan Topic 13.4 Developers of the Care Plan Topic o 13.5 Contributors of the Care Plan Topic 13.5 Contributors of the Care Plan Topic  14 Sub Projects 14 Sub Projects