Care Plan (CP) Team Meeting Notes(As updated during meeting)

André Boudreau (a.boudreau@boroan.ca)

Laura Heermann Langford (Laura.Heermann@imail.org)

2011-04-27 (No. 11)Care Plan wiki: http://wiki.hl7.org/index.php?title=Care_Plan_Initiative_project_2011

HL7 Patient Care Work Group

See agenda for May 4th on page 3Documents mentioned in these minutes are on the wiki

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Agenda for April 27

• Summary of care plan situations (Susan)• Feedback and discussion on first storyboard: Chronic

Care (Danny to circulate in advance)• Highlights from IHE Patient Centered Coordination

Plan (PCCP) (Ian M.)• MU material (Susan)• Next meeting agenda

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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)• New storyboard for acute care (Danny)• Business requirements: summary of key aspects since

February (André)• Coaching on Eclipse: what to install for our needs, quick start

(Kevin)• Next meeting agenda

• Later Overarching term to use (Ian M.) Care Plan Glossary

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Participants- Meetg of 2011-04-27 p1Name email Country Yes Notes

André Boudreau a.boudreau@boroan.ca CA Yes 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 Laura.Heermann@imail.org US Yes 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

Peter MacIsaac peter.macisaac@hp.com AU HP Enterprise Services. MD; Clinical Informatics Consultant; IHE Australia; Medical Practitioner - General Practice

Adel Ghlamallah aghlamallah@infoway-inforoute.ca CA Yes Canada Health Infoway. SME at Infoway (shared health record); past architect on EMR projects

William Goossen wgoossen@results4care.nl 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 agoossen@results4care.nl 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 ian.townend@nhs.net UK NHS Connecting for Health. Health Informatics; Senior Interoperability Developer, Data Standards and Products; HL7 Patient Care Co-Chair

Rosemary Kennedy Rosemary.kennedy@jefferson.edu US Yes 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 jaylyle@gmail.com US Yes JP Systems. Informatics Consultant; Business Consultant & Sr. Project Manager

Margaret Dittloff mkd@cbord.com 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 adickerson@himss.org 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 Ian.McNicoll@oceaninformatics.com UK Yes Ocean Informatics . Health informatics specialist; Formal general medical practitioner; OpenEHR; Slovakia Pediatrics EMR; Sweden distributed care approach

Danny Probst Daniel.Probst@imail.org US Intermountain Healthcare. Data Manager

Kevin Coonan Kevin.coonan@gmail.com US MD. Emergency medicine. HL7 Emergency care WG.

Gordon Raup graup@datuit.com US CTO, Datuit LLC (software industry).

Susan Campbell bostoncampbell@mindspring.com US Yes PhD microbiologist. Specialist Master Consultant at Deloitte. HL7 Dynamic Care Plan Co-developer

Elayne Ayres EAyres@cc.nih.gov 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

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Participants- Meetg of 2011-04-27 p2Name email Country Yes No Notes

David Rowed david.rowed@gmail.com AUCharlie Bishop charlie.bishop@isofthealth.com UKWalter Suarez walter.g.suarez@kp.org USPeter Hendler Peter.Hendler@kp.org USRay Simkus ray@wmt.ca CALloyd Mackenzie lloyd@lmckenzie.com CA LM&A Consulting Ltd.Serafina Versaggi serafina.versaggi@gmail.com US Yes

Sasha Bojicic SBojicic@infoway-inforoute.ca CA Lead architect, Blueprint 2015, Canada Health Infoway

Agnes Wong awong@infoway-inforoute.ca CA

RN, BScN, MN, CHE. Clinical Adoption - Director, Professional Practice & Clinical Informatics, Canada Health Infoway

Cindy Hollister chollister@infoway-inforoute.ca CARN, BHSc(N), Clinical Adoption -Clinical Leader, Canada Health Infoway

Valerie Leung vleung@infoway-inforoute.ca CA Pharmacist. Clinical Leader, Canada Health Infoway

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CARE PLAN SITUATIONS

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Care Plan Situations

• See document prepared by Susan Campbell: Care Management Concept Matrix-v2-20110427a.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

Add explanations and brief descriptions for the various types and characteristics (second worksheet added)

Add if possible another worksheet with vendors and roles

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Care Management Resources

• See document prepared by Susan Campbell: Care Management Professional Organizations Matrix-20110427b.xls Formerly named CM Society & Certification2.xls

• Identifies societies that provide certification in care or case management in health care and /or social services

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Discussion

• To what extent are we connected to the S&I Transition of Care initiative in the US? Contacts have been established We have looked at their methodology and integrated some

elements into our structure of deliverables• Our goal is to produce the Domain Analysis Model (DAM)

for Care Plan. We are at the business need level and at the conceptual level of what must happen with information exchange. The how (e.g. the use of CDA or IHE or both) will come later

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STORYBOARDS

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Care Plan Storyboards- Chronic Care Plan

• See document prepared by Danny Probst: Care Plan Storyboards-HL7 Patient Care WG- v0.2 20110427a post CP meetg.docx

• Is format/structure of document ok? Yes• Introduction: explains what storyboards are and how they

should be structured• List of storyboards: will these cover the range of situations for

which we want care planning to apply Chronic Care: a first version is proposed. Add Asthma? Acute Care: should be the next one and should cover a broken hip

situation from ER to rehab (see amended doc above) Home Care: for elderly Perinatology Pediatric: include Allergy/Intolerance? Stay healthy?

• Chronic Care Plan: some adjustment made Feedback is wanted to ensure a robust storyboard

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IHE PATIENT CENTERED COORDINATION PLAN (PCCP)• By Ian McNicoll

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IHE Patient Centered Coordination Plan (PCCP): Highlights and Discussion• Highlights: see document prepared by Ian McNicoll : HL7 Care

PlanComparison.zip This zipped file is available on the wiki. It uses the xmind mind mapping SW

available free.• Compares the structure and types of contents for the care plan of IHE,

Sweden, and NEHTA IHE and Sweden have many similarities NEHTA model is more detailed. It is a draft proposal prepared by Stephen

(see meeting of 2011-03-09)• The full IHE PCCP specification is available on the IHE web site, at:

http://www.ihe.net/Technical_Framework/index.cfm#pcc• It is key that we focus on structure and not reinvent contents that

already exists in HL7 for contents supportive to the care plans• Care plans typically are based on predefined guidelines for specific

problems or care objectives/ goals• What is the scope of care planning that we want to address? Medical,

behavioural, social, financial, etc?

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CONCLUSION

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Action Items as of 2011-04-27

No. Action Items By 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/Laura Outstanding

7 Update new wiki page with previous meeting material. Adjust structure of wiki. André Wiki restructured

8 Draft list of deliverables for this phase André Draft prepared

9 Draft a new PSS and review with project group André Deferred

10 Initiate draft of requirements André Started

11 Prepare draft storyboard for one situation using HDF 1.5 Danny Done

12

13

14

NB: Completed action items have been removed.

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APPENDIX

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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 Chu12 April 2011

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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

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MODELING TOOL- ECLIPSE

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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 thereo 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

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REQUIREMENTS