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

1. Care Plan (CP) Team Meeting Notes(As updated during meeting) André Boudreau (a.boudreau@boroan.ca) Laura Heermann Langford (Laura.Heermann@imail.org) 2011-05-04 (No. 12) Care Plan wiki:http://wiki.hl7.org/index.php?title=Care_Plan_Initiative_project_2011 HL7 Patient Care Work Group

2. 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) • Storyboards • Feedback on Chronic care Plan storyboard • New storyboard for acute care (Danny) • Modeling resource: Luigi: agrees to be our modeler: use case, data, process, UML • EA Vs Eclipse: EA is preferred by many • Next meeting agenda • For a future meeting: • Business requirements: summary of key aspects since February (André) • EA or Eclipse • Overarching term to use (Ian M.) • Care Plan Glossary

3. Agenda for May 11th • Storyboards (Laura, Danny, Susan, André) • Requirements (André) • Include processes (Stephen’s work) • Include key functionalities (diabetes case) • Comparison of care plan contents (Ian) • To inform the information model • Start of spreadsheet • Finalization of Orlando WGM agenda (All) • Next meeting date and agenda • Later • EA or Eclipse • Overarching term to use (Ian M.) • Care Plan Glossary

4. Participants- Meetg of 2011-05-04 p1

5. Participants- Meetg of 2011-05-04 p2

6. Orlando WGM

7. Orlando WGM Topics • Thursday May 19th, Q1, 9h00 to 10h30 • Duration 1.5 hour • Who to lead: Laura • Potential Topics, to be finalized next week • Status of Care Plan DAM project • Identifying key material from other Patient Care work (Pressure Ulcer, DCM) and other WG (Emergency Care, Care Provision, Care Statement, Structured Document, CDA consolidation, etc.) • Requirements, include inventory of existing material and standards • Storyboard review • Identifying clinical resources that would review future storyboards • Modeling work required

8. Care Plan Situations

9. 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: postponed (Susan) • Add explanations and brief descriptions for the various types and characteristics (second worksheet added) • Add if possible another worksheet with vendors and roles

10. Meaningful Use material

11. MU Material (Susan) • MU aspects • Demonstrate that providers and institutions have EHR that have been certified • Have all patient records electronic • Interoperability can be verified • EHR can be used meaningfully to report • Health conditions that are most common are the ones targeted for the first phase • Use evidence based care to lower costs and improve patient outcome • 3 phases • Ph1: population health • By attestation that they can send the measures, one test to CDC; Use certified SW and have e-record • Ph2: similar but data reporting of the measures (80% of population) • Ph3: individual health: longitudinal measures for outcomes • Issue: finding common measures for all the segments • Document: HIT POLICY COMMITTEE MEASURE CONCEPTS • Document: Notes from Oct 20, 2010- Policy Committee meeting on Meaningful Use Phase 2

12. MU Material • See SHIPPS DAM ballot material (Serafina, CBCC WG) • NQF E-Measures • Relation to Care Plan? • Identify specific items relevant to CP (Serafina, with Susan) • Care Plan has not entered yet the quality measures • A very key area of communication for quality care • Needs to be able to surveying ‘care plans’ • Important in the development of the Care Plan reference model • S&I Transition of Care initiative can influence our work and vice-versa

13. Care Plan material from Various organizations

14. Care Plan Material from Various Organizations • Laura: will contact KP • Info to ask for: • Care plan processes, guidelines (disease treatment models) • Criteria that a patient must exhibit in order to trigger the CP process • Key care plan contents /data elements • Data exchange between providers • PPOC summary in the CP comparison diagram is incomplete • Ask Ian to enrich it

15. Care Plan Scope Question • The whole care perspective? • VS care plan communications among providers • Bottom up approach vs top down • Top down: EHR FM • Field approach: storyboards • Need to complete the storyboards • Restructure? Test our set of storyboards at the end with the following: • 3 age groups: newborns, adults, seniors • Types of care: chronic, acute, palliative, mental, behavioural, stay healthy, others?

16. Storyboards

17. Feedback on Chronic Care Plan Storyboard • Want to ensure • Readability • Clinical accuracy, validity • Coverage (focus on the 80%, not the exceptions) • Remember: storyboards get improved over time, as the project advances • By clinicians • As we progress in the progress • Ask the PC list/members

18. Storyboards- Next week if possible • Acute Care Plan Storyboard: Danny • In progress • Home Care: André • Perinatology: Laura • Pediatric and Allergy/Intolerance: Susan • Stay healthy: Laura

19. Modeling Tool- EA or Eclipse

20. Includes post-meeting notes 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 • Adel agreed to help us there • André will find a resource • The tool will be used to do: • Use cases • Activity and workflow diagrams • Interaction diagrams • Class models

21. Conclusion

22. Action Items as of 2011-05-04 NB: Completed action items have been removed.

23. Appendix

24. 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 Chu 12 April 2011

25. 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

26. Requirements