1. Care Plan (CP) Meeting - Agenda November 28, 2012 1700-1830 EDT Laura Heermann Langford (Laura.Heermann@imail.org) Stephen Chu (stephen.chu@nehta.gov.au) *C are Plan wiki: http://wiki.hl7.org/index.php?title=Care_Plan_Initiative_project_2011 http://wiki.hl7.org/index.php?title=Care_Plan_Initiative_project_2011 HL7 Patient Care Work Group To join the meeting: Phone Number: +1 770-657-9270 Participant Passcode: 943377# With meeting discussion notes

2. Page 2 Participants- Nameemail Country YesNotes Laura Heermann Langford Laura.Heermann@imail.org 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 stephen.chu@nehta.gov.au 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 Carolyn Silzle Carolyn.silzle@choa.org US American Dietetic Association Susan Campbell bostoncampbell@mindspring.com US PhD microbiologist. Principal at Care Management Professionals. HL7 Dynamic Care Plan Co-developer Kevin Coonan Kevin.coonan@gmail.com US MD. Emergency medicine. HL7 Emergency care WG. Nancy Wilson RomanUS Enrique Meneses enrique@careflow.com US Serafina Versaggi serafina.versaggi@gmail.com USClinical Systems Consultant John Farmer Jon.farmer@thrasis.com US Chris White Chris.white@thrasis.com US Luigi Sison lsison@yahoo.com US 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.

3. Page 3 Tentative: November 14, 2012 (subject to change) Modelling update - continued Continue Discussion on Care Plan relationships and definitions – Deferred from last meeting  Review Diagram from Laura o Clarifying “master care plan”/”care coordination plan” – definitions Master care plan – domain specific detail care plan relationship (Plan-plan compositions, that is, peer-peer or hierarchical connections between CPs and/or between CP and POC) o Inter-detail care plan relationship – inbound and outbound risk o Care plan concepts – terminology and definitions

4. Page 4 MODELING Enrique Meneses

5. Page 5 Discussion Notes Notes from Previous Discussion  Have worked on classes in EA extracted from the Storyboards  Needs more work before reviews.  Enrique and Jon will continue working in pairs offline. Jon could work on it and propose reviewing in this larger group in 2 weeks (next meeting)  Jon has also begun modeling a class diagram in EA describing relations and how they would integrate into the model currently in progress.  Enrique will work to set up a shared model repository for Jon to have easier access to the model.  Underlying files for the repository would be password protected.  Need the corporate version EA to access.

6. Page 6 CARE PLAN RELATIONSHIPS (LINKED OR NESTED…MASTER VS COORDINATED) Jon/Laura/Stephen…

7. Page 7 Discussion Notes

8. Page 8 Previous Meeting Discussion Notes  Have come to agreement there is an all over coordinating care plan… the Master Patient Care Plan.  Agreements o The master care plan is the specialty care plans interleaved. The service could be created to accommodate the reconciliation o The concept of the patient or someone else being able to “hide” or “conceal” data from one care giver or provider or another exists – but will be addressed later. o Examples of content that would need reconciliation--Meds, problems, history, allergies, advanced directives,  Discussions…. o Care plan might inform the plan of care, o Plan of care = episodic plan o Master care plan and specialty care plan – both could inform the plan of care… o This is all very difficult to follow would be helpful to have a diagram. Perhaps – use a problem specific….such as hypertension, or use one of the use cases we have developed – use the chronic care storyboard ….Laura to present next time… o Terminology – to refer to Master Plan and the Specialty Plan that are really detailed but likewise relatively long term. o History of the plan and reports of activities from the plan are part of the medical record. In the case of some observations – you may have the meta data on the care plan (blood pressure stead) instead of the last 14 readings… o Active goals stay on the care plan, resolved/completed goals become part of the medical record o Some goals, or medical issues may stay on the care plan even if they are complete or resolved…because they are relevant to the overall care. Such as “smoked 4ppd for 30 years until last month…..”  Questions- o How much detail should be in the master care plan

9. Page 9 Next steps from Previous Meeting Jon has taken extensive notes Laura to send her notes to him for consolidation. Next meeting  Continue discussion on the care plan relationships, what is included and not, definitions and terminology o Laura to have diagram ready to generate and refine further discussion Drill down to goals at some point in the diagram to demonstrate how goals are added, updated, moved to medical record etc. -Laura to bring goal work to next meeting Review modeling work as it is ready and needing discussion.

10. Page 10 Additional Discussion Notes

11. Page 11 FUTURE MEETINGS Conference calls between now and January 2013 – see wiki 90 min., Wednesday 5-6:30pm US Eastern, fortnightly (every 2 weeks) Starting September 19 Next Agenda

12. Page 12 Next meeting Agenda- November 28 (Lead: Laura) Upcoming Topics . Future topic

13. Page 13 APPENDIX