Care Plan

With meeting notes.
See also updated Perinatology Storyboard.
Agenda for Sept 28th meeting added.
Please advise André of any errors/omissions.
To join the meeting:
Phone Number: +1 770-657-9270
Participant Passcode: 943377
WebEx link for WGM- Sept. 15th:
Care Plan (CP) Team Meeting - WGM
90 minutes
André Boudreau ([email protected])
Laura Heermann Langford ([email protected])
Stephen Chu ([email protected])
2011-09-15, Thursday Q2 (San Diego)
Care Plan wiki:
HL7 Patient Care Work Group
WGM Care Plan Objectives and Agenda
• Objectives
 Review our approach to storyboards
 Review one SB: Perinatology
 Review our approach to validation of SBs by clinicians
• Agenda
Roll call and session objectives (Stephen) (5 min.)
Review of approach to structuring SBs (André) (20 min.)
Perinatology SB (Laura) (40 min.)
Plan for clinical validation of all SBs (André) (20 min)
Wrap-up (Stephen) (5 min.)
Page 2
Participants- WGM Meetg of 2011-09-15 p1
André Boudreau
[email protected]
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
[email protected]
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]
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]
HP Enterprise Services. MD; Clinical Informatics Consultant; IHE Australia; Medical Practitioner General Practice
Adel Ghlamallah
[email protected]
Canada Health Infoway. SME at Infoway (shared health record); past architect on EMR projects
William Goossen
[email protected]
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]
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]
NHS Connecting for Health. Health Informatics; Senior Interoperability Developer, Data Standards and
Products; HL7 Patient Care Co-Chair
Rosemary Kennedy
[email protected]
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]
JP Systems. Informatics Consultant; Business Consultant & Sr. Project Manager
Margaret Dittloff
[email protected]
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]
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]
Ocean Informatics . Health informatics specialist; Formal general medical practitioner; OpenEHR;
Slovakia Pediatrics EMR; Sweden distributed care approach
Danny Probst
[email protected]
Intermountain Healthcare. Data Manager
Kevin Coonan
[email protected]
MD. Emergency medicine. HL7 Emergency care WG.
Gordon Raup
[email protected]
CTO, Datuit LLC (software industry).
Susan Campbell
[email protected]
Elayne Ayres
[email protected]
Gaby Jewell
[email protected]
PhD microbiologist. Principal at Care Management Professionals. HL7 Dynamic Care Plan Co-developer
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
Senior strategist at Cerner Corp,
Page 3
Participants- WGM Meetg of 2011-09-15 p2
MD. Family GP.; Was chair, 2005, Electronic Communications
Working Group of the AU General Practice Computing Group
David Rowed
[email protected]
Charlie Bishop
[email protected]
Walter Suarez
[email protected]
Peter Hendler
[email protected]
Ray Simkus
[email protected]
Serafina Versaggi
[email protected]
Luigi Sison
[email protected]
Brett Esler
[email protected]
Pen Computer Sys
Catherine Hoang
[email protected]
Hugh Leslie
[email protected]
a General Practitioner ; Chief Medical Officer, Ocean Informatics
Seam Heard
[email protected]
Thomson Kuhn
[email protected]
Sr. Systems Architect at American College of Physicians
Carolyn Silzle
[email protected]
American Dietetic Association
Md, Allergist, internal medicine; Chief Medical Informatics Officer, Office
of eHealth Initiatives, State of Tennessee
PhD, RN, NANDA International; University of Iowa, Iowa City, IA &
Trinity Health
Russell Leftwich
[email protected]
Jane Brokel
Clinical Systems Consultant
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.
Corinne Gower
[email protected]
Senior Business Analyst at NZHIS; Senior Advisor at Ministry of Health
New Zealand
Yu-Ting Yeh
[email protected]
HL7 Taiwan
Page 4
Page 5
Structure of Care Plan Storyboards
• Care plans consist for the most part in an evolving group of
information for a given health issue thread (wrongly called ‘episode of
• One storyboard describes in ‘business’ terms the flow of care and the
associated flow of care plan data through multiple patient encounters
among a multidisciplinary team of clinicians for that one health issue
thread (see ISO definition, in Appendix 1) (or one stream of condition
Note: an episode of care is provider specific (see HL7 and ISO definitions in Appendix
1 and 2)
Once we agree on terms, we will need to adjust the vocabulary used in our SBs, likely
replacing ‘episode of care’ with ‘health issue thread’
Page 6
Portfolio of Storyboards Required
• To understand the range of situations where exchange of care plan
information will take place and interoperability will be necessary, the
following situations (i.e. episode of care) will be documented:
Perinatology (ready for WG review at WGM)
Home Care (drafted and ready for another review by WG)
Chronic Care (drafted)
Pediatric and Allergy/Intolerance (drafted)
Stay healthy (drafted)
Acute Care
• Should we have a distinctive primary care SB? (David)
Primary care is included in many of the above, if not all
AU needs that explicitly
To be reassessed
Name it ‘Adult primary care’?
Page 7
Page 8
• See document by Laura with discussion notes and tracked
 Terminology to be adjusted based on decision as to terms for
structure of SBs: done
• Luigi: we need more details in the SB to facilitate modeling of
the info and the care plan: agreed
 Luigi will show the work done at the diabetes project at our next
• Stephen: we need to make explicit the care coordination steps
and data: agreed
Page 9
Page 10
Storyboard (SB) Validation & Approval
• Clarify the guidelines and quality criteria for the Care Plan Storyboard
– see next slide
• Assign a Care Plan ‘owner’ for each SB
• For each SB, identify a validation group (3 to 5) of SMEs that include
 At least one physician, one nurse, and one other type of clinician that is
described in the SB
 Representation from at least 2 countries
 Where possible and relevant, include a care coordinator/manager
• Recruit SMEs and obtain agreement to participate
• Communicate the criteria and the specific SB to the appropriate
group of SMEs
• Obtain individual feedback from the SMEs
• Consolidate feedback from individual SMEs and update the SB
• Review the updated SB with the SMEs at a regular meeting
• Finalize and ‘publish’ the SB
Page 11
Care Plan Storyboard Guidelines and
Quality Criteria
• Focused on one typical story, not on exceptions
• Is written in common clinical term, not in technical or IT terms
• Focused on the exchange of information about care plan
 Distinguish clearly Care Plan information from medical record / EHR data
and other non care plan specific data (e.g. patient profile, referral request)
• Identifies what should be a best practice in the exchange of clinical
• Is at the conceptual level
 Is architecture, implementation and platform independent
• Notes:
 Do we need to make explicit the state transitions at this stage?
 We will need to clarify the criteria for what is being sent in the information
exchange, especially for patients with a long history
 We will exclude application services related to care plan information
• Who are the HL7 SB SMEs? MnM, Lloyd, Graham
Page 12
• Next Care Plan meeting on Sept. 28, 17h00 ET
• See wiki
Page 13
Concluding notes
• Terms to use
 See ISO and HL7 in Appendix
 Health Issue Thread (similar to HL7 Health Concern)
o Multiple encounters and multiple providers for one health issue
 Encounter
o One patient contact with one provider
 We will not use Episode of care
o Applies to multiple encounters with the same provider for one health issue
• Target for next WGM in January
 Complete and validate 4 SB
 First set of use cases and information model
• Validation of SB
 We will request through our meetings volunteers from multiple countries
 We will place requests on the meeting invitations posted to the Patient
Care list
Page 14
Agenda for Sept. 28th
• Minutes of August 31st
• Feedback from San Diego WGM (Stephen, Laura, others)
 Care plan
 Other meetings
• Final review of Perinatology SB (Laura)
• Review of Home Care SB (André/Danny)
• Clinical validation of storyboards in October (André)
 Perinatology
 Home Care (3 home care nurses in Canada recruited)
• Other storyboards
 Chronic care (Stephen)
• Roadmap for Oct to Dec. (André)
• Decide on future meetings and roles
 Every 2 weeks as in the summer
• If time permits: Storyboard document introduction (Andre)
 Purpose, scope, guidelines, structure, quality criteria
Page 15
• NB: These models are currently being reviewed and updated through the ISO
CONTSYS project (N821- NWIP 13940, a 2-year project started in 2011)
• Project manager: Nicholas Oughtibridge, Acting Director - Data Standards and
Products, Department of Health Informatics Directorate, UK NHS Connecting for
Page 16
Health issues and their management
NB: These models and definitions are currently being reviewed and updated through the ISO CONTSYS project
Source: ISO 13940-1: Health informatics - System of concepts to support continuity of care - Part 1: Basic concepts , prEN 13940-1:2007, CEN/TC 251
Page 17
Time-related concepts in Continuity of
NB: These models and definitions are currently being reviewed and updated through the ISO CONTSYS project
Source: ISO 13940-1: Health informatics - System of concepts to support continuity of care - Part 1: Basic concepts , prEN 13940-1:2007, CEN/TC 251
Page 18
Key Definitions from ISO
• Health Issue
Issue related to the health of a subject of care, as identified or stated by a specific health care party
NOTE 1 According to this definition, a health issue can correspond to a health problem, a disease, an illness. But it
may not, such as when it is simply a request for a procedure (therapeutic or preventive) by the subject of care or
another health care party etc. Therefore, health issue is a superordinate concept to "health problem", "disease",
"illness" etc.
NOTE 2 A health issue is given a label, which may be a diagnosis, a problem or another topic.
• Health issue thread
Defined association between health issues, as decided by one or several health care parties
NOTE 1 A health issue thread reconciles a range of health issues reflecting the variety of scopes of health care
parties, particularly of health care providers. A health issue thread inherently associates the contact elements
referring to those health issues.
• Episode of care
Time interval during which health care activities are performed by one health care provider to
address one professionally defined health issue
Note: An episode of care starts with the very first contact with a health care provider for a health issue, and it
ends after the completion of all health care activities related to the latest contact with that health care provider
for the same health issue.
• Cumulative episode of care
Collection of episodes of care delineated by one health issue thread
Note: A cumulative episode of care starts with the very first contact with a health care provider for a health issue
considered in a health issue thread, and ends after the completion of all health care activities related to the latest
contact with any health care provider for a health issue encompassed in the same health issue thread.
• Encounter (patient contact)
Contact in the course of which health care activities are delivered to a subject of care in her or his
Source: ISO 13940-1: Health informatics - System of concepts to support continuity of care - Part 1: Basic concepts , prEN 13940-1:2007, CEN/TC 251
Page 19
• This needs to be augmented for our Care Plan needs
• See ISO
Page 20
Term: Patient encounter
Patient encounter is defined as an interaction between a patient and one or more healthcare
practitioners for the purpose of providing patient services or assessing the health status of the patient. A
patient encounter is further characterized by the setting in which it takes place; currently HL7
recognizes seven unique patient encounter types:
Ambulatory Encounter - A comprehensive term for health care provided in a facility or setting that provides
diagnostic, therapeutic and health maintenance services for persons not requiring stays that exceed 24 hours
(e.g. a practitioner's office, clinic setting, or hospital) on a nonresident and non-emergency basis. The term
ambulatory implies that the patient has come to the location and is not assigned to a bed. Sometimes referred to
as an outpatient encounter.
Emergency Encounter - A patient encounter that takes place at a dedicated healthcare service delivery location
where the patient receives immediate evaluation and treatment, provided until the patient can be discharged or
responsibility for the patient's care is transferred elsewhere (for example, the patient could be admitted as an
inpatient or transferred to another facility.)
Field Encounter - A patient encounter that takes place both outside a dedicated service delivery location and
outside a patient's residence. Example locations might include an accident site or at a supermarket.
Home Health Encounter - A patient encounter where services are provided or supervised by a practitioner at
the patient's residence. Services may include recurring visits for chronic or terminal conditions or visits facilitating
Inpatient Encounter - A patient encounter where a patient is admitted by a hospital or equivalent facility,
assigned to a location where patients generally stay at least overnight and provided with room, board, and
continuous nursing service.
Short Stay Encounter - A patient encounter where the patient is admitted to a health care facility for a
predetermined length of time, usually less than 24 hours.
Virtual Encounter - A patient encounter where the patient and the practitioner are not in the same physical
location. Examples include telephone conference, email exchange, robotic surgery, and televideo conference.
Source: HL7 Version 3 Standard: Patient Administration Release 2; Patient Encounter, Release 1
DSTU Ballot 1 - May 2011
Page 21
Term: Encounter
• Encounter
An Encounter (ENC) choice is an interaction between a patient and care provider(s)
for the purpose of providing healthcare-related service(s). Healthcare-related services
include health assessment.
Note this type of statement covers admissions, discharges and transfers of care, as
well as the more usual understanding of a single discrete office visit.
It further deals with a plan for regular visits, such as preventive care during
pregnancy, or monitoring of chronic ill patients.
Includes requesting, proposing, promising, prohibiting or refusing an encounter as
well as an actual encounter event.
The encounter is a derivative of the RIM PatientEncounter class, used to represent
related encounters, such as follow-up visits or referenced past encounters.
Source: HL7 Draft Standard for Trial Use - HL7 Version 3 Standard: Clinical Statement Pattern, Release 1 - Last
Published: 12/06/2007 10:24 AM
Page 22
Term: Episode of Care - 1
• An interval of care by a health care facility or provider for a specific
medical problem or condition. It may be continuous or it may consist
of a series of intervals marked by one or more brief separations from
care, and can also identify the sequence of care (e.g., emergency,
inpatient, outpatient), thus serving as one measure of health care
provided. Note: may be one instance of care, a series of episodes or
a sequence of care: read MeSH definition
Sources: NLM Medical Subject Headings, NIH UMLS, [email protected], FDA AERS
• The new Institute of Medicine definition of primary care requires that
primary care clinicians address the large majority of personal health
care needs of their patients. The unit of assessment for this is the
episode of care, defined as a health problem from its first encounter
with a health care provider through the completion of the last
J Fam Pract. 1996 Feb;42(2):161-9. Episode of care: a core concept in family
Page 23
Term: Episode of Care - 2
• A defined period of illness that has a definite start and end date.
• Refers to all the health services related to the treatment of a
condition. For acute conditions (such as a concussion or a broken
bone), the episode includes all treatment and services from the onset
of the condition to its resolution. ...
• the range of treatments provided over time for treating a condition or
• Treatment rendered in a defined time frame for a specific disease.
Episodes provide a useful basis for analyzing quality, cost and
utilization patterns.
Page 24
Added on 2011-08-17
Term: Episode of Care – Difficulties with the concept
• The concept is easy to apply in acute care settings
where there is a clear beginning and a clear end to
the health issue/problem
• However, in chronic care situations, there is no
clear end…
• The concept of condition management is more
applicable to chronic care management
• For our chronic care plan, we will document a
sample of encounters illustrative of a representative
set of interactions among clinicians and the
interchange of care plan information between them
Page 25

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