Transcript Slide 1

With discussion notes and updates from the meeting
To join the meeting:
Phone Number: +1 770-657-9270
Participant Passcode: 943377
WebEx link is on the wiki (link below)
Care Plan (CP) Team Meeting
(As updated during meeting)
André Boudreau ([email protected])
Laura Heermann Langford ([email protected])
2011-07-06 (No. 17)
Care Plan wiki: http://wiki.hl7.org/index.php?title=Care_Plan_Initiative_project_2011
HL7 Patient Care Work Group
Agenda for July 6
• Minutes of June 22nd
• 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 2
Agenda for July 20th
• Minutes of July 6th
• 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
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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?
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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
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Participants- WGM Meetg of 2011-07-06 p1
Name
email
Country
Yes
Notes
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.
André Boudreau
[email protected]
CA
Laura Heermann
Langford
[email protected]
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
[email protected]
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
[email protected]
AU
HP Enterprise Services. MD; Clinical Informatics Consultant; IHE Australia; Medical Practitioner General Practice
Adel Ghlamallah
[email protected]
CA
Canada Health Infoway. SME at Infoway (shared health record); past architect on EMR projects
William Goossen
[email protected]
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
[email protected]
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
[email protected]
UK
NHS Connecting for Health. Health Informatics; Senior Interoperability Developer, Data Standards and
Products; HL7 Patient Care Co-Chair
Rosemary Kennedy
[email protected]
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
[email protected]
US
JP Systems. Informatics Consultant; Business Consultant & Sr. Project Manager
Margaret Dittloff
[email protected]
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
[email protected]
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
[email protected]
UK
Ocean Informatics . Health informatics specialist; Formal general medical practitioner; OpenEHR;
Slovakia Pediatrics EMR; Sweden distributed care approach
Danny Probst
[email protected]
US
Intermountain Healthcare. Data Manager
Kevin Coonan
[email protected]
US
Gordon Raup
[email protected]
US
CTO, Datuit LLC (software industry).
Susan Campbell
[email protected]
US
PhD microbiologist. Principal at Care Management Professionals. HL7 Dynamic Care Plan Co-developer
Elayne Ayres
[email protected]
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
[email protected]
US
Yes
Yes
Yes
MD. Emergency medicine. HL7 Emergency care WG.
Cerner Corp,
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Participants- WGM Meetg of 2011-07-06 p2
Name
email
Country
Notes
Yes
David Rowed
[email protected]
AU
Charlie Bishop
[email protected]
UK
Walter Suarez
[email protected]
US
Peter Hendler
[email protected]
US
Ray Simkus
[email protected]
CA
Lloyd Mackenzie
[email protected]
CA
LM&A Consulting Ltd.
Serafina Versaggi
[email protected]
US
Clinical Systems Consultant
Sasha Bojicic
[email protected]
CA
Lead architect, Blueprint 2015, Canada Health Infoway
Agnes Wong
[email protected]
CA
RN, BScN, MN, CHE.
Clinical Adoption - Director, Professional Practice & Clinical
Informatics, Canada Health Infoway
Cindy Hollister
[email protected]
CA
RN, BHSc(N), Clinical Adoption -Clinical Leader, Canada Health
Infoway
Valerie Leung
[email protected]
CA
Pharmacist. Clinical Leader, Canada Health Infoway
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.
Luigi Sison
[email protected]
US
Brett Esler
[email protected]
AU
Catherine Hoang
[email protected]
Hugh Leslie
[email protected]
Seam Heard
[email protected]
US
Tom Kuhn
Mona
Yes
Pen Computer Sys
VA
Sr. Systems Architect at American College of Physicians
???
??
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STORYBOARD VETTING PROCESS
Page 8
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)
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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
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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:
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STORYBOARDS
Page 12
2011-06-22
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.
• 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.
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Discussion Notes
• Care Plan is a grouper with different pieces of information
 Each piece of info has a life cycle, e.g.
o
o
o
o
Change in medication
Activities completed
Partial progress
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
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State: RIM ActStatus
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Storyboards: deferred
• Ref file:
Care Plan Storyboards-HL7 Patient Care WG- v0.2c 20110621b.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
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MODELS
• Luigi
Page 17
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
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REQUIREMENTS
• Stakeholders and their Expectations
Page 19
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 20
Stakeholder Expectations
Stakeholder
Expectations
Notes
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
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Discussion Notes- Stakeholders and their
Expectations
• These look like functional requirements
• Let’s reassess whether we need this or not…
Page 22
CONCLUSION
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Action Items as of 2011-07-06
No.
Action Items
By
Whom
For
When
Status
9
Draft a new PSS and review with project group
André
Deferred
10
Complete a first draft of requirements
André
Started
12
Complete storyboards
Multi
Started
15
Organise and schedule a review of the Care Plan components of the EHR-S FM R2
André
In process. EHR WG
agreement received.
16
Organise and schedule a review of the Care Plan components of ISO ContSys
André
NB: Completed action items have been removed.
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APPENDIX
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