1. With discussion notes and updates from the meeting To join the meeting: Phone Number: +1 770-657-9270Participant Passcode: 943377 WebExlinkis on the wiki (linkbelow) Care Plan (CP) Team Meeting(As updated during meeting) André Boudreau (a.boudreau@boroan.ca) Laura Heermann Langford (Laura.Heermann@imail.org) 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

2. 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

3. 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

4. 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 • Review of Care plan functionalities in EHR-S FM R2 work by the HL7 EHR WG?

5. 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

6. Participants- WGM Meetg of 2011-07-06 p1

7. Participants- WGM Meetg of 2011-07-06 p2

8. Storyboard Vetting Process

9. 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)

10. 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

11. 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:

12. Storyboards

13. 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.

14. Discussion Notes • Care Plan is a grouper with different pieces of information • Each piece of info has a life cycle, e.g. • 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

15. State: RIM ActStatus

16. 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: • Resolve /reconcile 2 versions • Acute Care Plan Storyboard: Danny • In progress • Perinatology: Laura

17. Models • Luigi

18. 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

19. Requirements • Stakeholders and their Expectations

20. 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

21. Stakeholder Expectations

22. Discussion Notes- Stakeholders and their Expectations • These look like functional requirements • Let’s reassess whether we need this or not…

23. Conclusion

24. Action Items as of 2011-07-06 NB: Completed action items have been removed.

25. Appendix