Care Plan (CP) Meeting 90 minutes André Boudreau ([email protected]) Laura Heermann Langford ([email protected]) Stephen Chu ([email protected])

Care Plan (CP) Meeting 90 minutes

André Boudreau ([email protected])

Laura Heermann Langford ([email protected])

Stephen Chu ([email protected])

2012-02-29 André to lead*Care Plan wiki: http://wiki.hl7.org/index.php?title=Care_Plan_Initiative_project_2011

HL7 Patient Care Work Group

To join the meeting:

Phone Number: +1 770-657-9270Participant Passcode: 943377# WebEx link (thanks to Canada Health Infoway): https://infoway-inforoute.webex.com/infoway-inforoute/j.php?ED=168011982&UID=494535562&RT=NCMxMQ%3D%3D

With meeting notes

Page 2

Agenda- Feb 29th (Lead: André)

• Agree on approach for modeling (Luigi)• Pediatric Allergy SB (20120201-RS on wiki) (Susan)

Review coordination of  care section- Postponed• Stay Healthy SB - (final version 20120214 plus Appendix B on wiki)

(Carolyn)• Pediatric immunization (Susan)- next meeting• Perinatology SB - (complete version to be provided by Laura) (Laura) • Home Care SB - (2011-02-28 final version on wiki) (André) • Acute Care SB - (complete version to be provided by Kevin) (Kevin)

Postponed

• Action plan to finalize SBs• Decide on consolidated format for SBs- Postponed• Review and augment draft of requirements (André)• Update work plan• Next meeting agenda

Page 3

Participants- Meetg of 2012-02-29 p1Name email Country Yes Notes

André Boudreau [email protected] CA YesCo-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

[email protected] 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 [email protected] AU Yes 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

Carolyn Silzle [email protected] US Yes American Dietetic Association

Susan Campbell [email protected] US Yes PhD microbiologist. Principal at Care Management Professionals. HL7 Dynamic Care Plan Co-developer

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

Luigi Sison [email protected] US YesInformation 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.

Peter MacIsaac [email protected] AU HP Enterprise Services. MD; Clinical Informatics Consultant; IHE Australia; Medical Practitioner - General Practice

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

Ian McNicoll [email protected] UK Ocean Informatics . Health informatics specialist; Formal general medical practitioner; OpenEHR; Slovakia Pediatrics EMR; Sweden distributed care approach

Maggie Gilligan [email protected] US Dietician; Owner, Senior Member , Nutra Tech Technology, LLC

Kevin Coonan [email protected] US MD. Emergency medicine. HL7 Emergency care WG.

Gordon Raup [email protected] US CTO, Datuit LLC (software industry).

Elaine Ayres [email protected] USNIH 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

Rob Savage [email protected] US CDC Immunization

Page 4

Participants- Meetg of 2012-02-29 p2Name email Country Yes Notes

David Rowed [email protected] AU MD. Family GP.; Was chair, 2005, Electronic Communications Working Group of the AU General Practice Computing Group

Charlie Bishop [email protected] UK

Walter Suarez [email protected] US

Peter Hendler [email protected] US

Ray Simkus [email protected] CA Practicing Family GP, Vancouver, BC. User of EMR. Intense interest and involvement in EHR and EMR standards , functionality and terminology

Serafina Versaggi [email protected] US Clinical Systems Consultant

Brett Esler [email protected] AU Pen Computer Sys

Catherine Hoang [email protected] US VA

Hugh Leslie [email protected] AU a General Practitioner ; Chief Medical Officer, Ocean Informatics

Seam Heard [email protected]

Thomson Kuhn [email protected] US Sr. Systems Architect at American College of Physicians

Russell Leftwich [email protected] US Md, Allergist, internal medicine; Chief Medical Informatics Officer, Office of eHealth Initiatives, State of Tennessee

Michael Tan [email protected] NL Publishing Facilitator , Care Provision, PC WG; Senior Project manager, Nictiz, NL

Corinne Gower [email protected] NZ Senior Business Analyst at NZHIS; Senior Advisor at Ministry of Health New Zealand

Susan Matney [email protected] US Medical Informaticist at 3M Health Care; Chair Elect of the SNOMED CT Nursing Special Interest Group at IHTSDO; Vocab Facilitator for Patient Care TC at HL7 Standards

Audrey Dickerson [email protected] USHIMSS. 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.

Gaby Jewell [email protected] US Senior strategist at Cerner Corp,

Ken Rubin US Co-Chair, HL7 Service Oriented Architecture Work Group; Chief Architect, Federal Healthcare Portfolio, HP Enterprise Services

Mark Shafarman [email protected] US Member of HL7 since 1992. Co-Chair, HL7 Template WG; Shafarman Consulting Inc.

Page 5

CARE PLAN DAM MODELING APPROACH

Page 6

Proposed Modeling Approach

• Two streams of parallel modeling• From Storyboards to Business Process Modeling (BPM)

One single model, using the chronic care SB Modeling focused on Patient movement and interchange of care plan data No details on care activities at a given site (e.g. hospital, physician office,

etc.)• From Storyboards to UML Class Model / Entity-Relationship Diagram)

Focused on care plan information Identification of other relevant information without detailed modeling (e.g.

patient demographics, local organization policies and rules) Include good definitions of concepts Tie to the PC data element specifications Take advantage to existing definitions

o e.g. ISO CONTSYS modelo HL7 Vocabulary: patient, care plan,

Build definitions as we move forward• Laura: How will we capture different coordination of care processes:

care manager, primary care physician; simple vs complex care

Updated

Page 7

BPM Example (from EA)

Page 8

Class Model Example (from EA)

Without the green part and without data types

Key: have good definitions

Page 9

• The Class diagram captures the logical structure of the system - the Classes - and things that make up the model. It is a static model, describing what exists and what attributes and behavior it has, rather than how something is done.

Class Diagram Example (from EA)

Page 10

REVIEW OF STORYBOARDS • Reference file from the wiki:

Chronic-Conditions_Care-Plan-Storyboard_V0-5_Revised_2012-01-06.docx

Page 11

Pediatric Allergy SB- Coordination of care (Susan)

• See Pediatric Allergy Care Plan Storyboard 20120229-RS_SEC.doc Pediatric Allergy Care Plan Storyboard 20120228- References

SEC.docx

• See new doc by Susan• Postpone the discussion to next meeting• Also send the list of sources.

Updated

Page 12

Stay Healthy SB (Carolyn)

• See Stay_Healthy_Health_Promotion-_Care_Plan_SB-_final

20120214.docx Stay Healthy Health Promotion Appendix B info exchanged-

20120214.docx• Updated version• Need clear links inside the SB to Appendix B

Updated

Page 13

Perinatology CP SB (Laura)

• Complete version provided by Laura• See new version.• Consider complete!!

Updated

Page 14

Home Care SB (André)

• See Home Care Care Plan Storyboard V0_4a- Final- 2012-02-

28a.docx• Review add-ons• Ask permission to load NYeHC doc to wiki (André)

Updated

Page 15

New York eHealth Collaborative

• Extract from Developing Interoperability Standards for Homecare Plan of Care: Use Case

• Version F1 - December 21, 2011

Plan Of Care (POC) Approval Process: Future Flowchart

Homecare EMRUser Physician EMRTransport

(direct EMR-EMR or via HIE/RHIO)

User

2 (11, 13)User

documents assessments

and/or updates to

POC

3 (12, 14)Generates POC(Initial, Update,

Recert)

No

No

7.1 Signs as is?

7.3Not My

Order/No Longer My

Patient

7User reviews

and processes

POC

*7.2

Signs with Changes?

7.2.1Files signed POC in

patient's recordwith changes

identified

8Returns POC

(Signed with or without changes,

or unsigned)

7.1.1Files signed POC in

patient's record

7.3.1Does not sign,

captures reason why

15Medical Provider

Initiates POC Update

15.1User opens most

recent POC

See * aboveand

follow process for Signed with

changes

- Requires ability to view most

current POC as a whole

15.2User updates

POC

Yes

No

No

Yes

Yes

10.2.1Files POC in

patient's record with changes

identified

10.3.2User identifies

correct provider and process

repeats

10.1Signedas is?

10.3Not My

Order/No Longer My

Patient

10.2Signed with Changes?

- User Action

Ongoing and Recertification

Yes

Yes

Yes

1Receives

Referral/Verbal order to provide

homecare

5Transport

5.1 -Via Direct protocols or HIE/RHIO

5.2 – Will address:- Delivery

timeframes- ACK/NACK

- Patient matching

4Sends POC

4.1 - Assembles export file to POC standard for exchange

4.2 - Transmits POC to receiving entity

66.1 - Receives POC based

on new POC standard6.2 - Directs POC to patient's

provider's Inbox

10Receives POC based

on new POC standard

9Transport

-Via Direct protocols or HIE/RHIO

– Will address:- Delivery

timeframes- ACK/NACK

- Patient matching

10.1.1Files POC in

patient's record

10.2.2Notify Clinician

of changes

10.3.1Display reason why not signed

Page 16

Acute Care SB (Kevin)

• Previous notes 2 encounters to document at the end: ICU, psychiatry Also key thoughts on coordination of care in this case

should be added• Complete version to be provided by Kevin

• Postpone?• We have enough to start modeling

Not done

Page 17

STATUS AND PLAN FOR ALL STORYBOARDS

Page 18

Status of 7 SBs – 2012-02-29

Owner SB Name Status Date for Complete Draft

PCCP Final review

Kevin Coonan Acute Condition Draft 1 completedSecond draft pending

??? Pending

André Boudreau

Home Care Under external review

Done Feb 15th

Stephen Chu Chronic Conditions Reviewed.Third draft completed

Done Feb 29th

Susan Campbell

-Pediatric Allergy-Immunization

Reviewed.Second draft of both

Immunization

Allergy done

March 14

Feb 29th

Laura Heermann Langford

Perinatology Reviewed.Second draftFinal: pending

Done Feb 29th

Carolyn Silzle Stay healthy/ health promotion

Draft 1 completedFinal draft distributed

Done Feb 29th

Updated

Page 19

CARE PLAN REQUIREMENTS

Page 20

Discussion- Requirements Structure/Approach

• See new structure EHR-S FM R2 contents integrated

o For EHR-S FM R2 December 2011 ballot package, see EHR WG wiki http://wiki.hl7.org/index.php?title=EHR

Agree that it will become a collector of all our thoughts regarding the care plan

We will take a bit if time at each meeting to review notes from the past and enrich the requirements

Updated

Page 21

FORWARD PLAN• See Spreadsheet

Page 22

HDF- Domain Analysis Overview

act 3: Domain Analysis Ov erv iew

Analyze Business Context

(from 3.4.1 Business Context Analysis)

Analyze Use Cases

(from 3.4.2 Use Case Analysis)

Analyze Process Flow

(from 3.4.3 Process Analysis)

Analyze Information Exchanged

(from 3.4.4 Information Analysis)

Analyze Business Rules

(from 3.4.5 Business Rules Analysis)

Story board

(from 3.7 Artifacts)

Use Case Analysis

(from 3.7 Artifacts)

Process Flow

(from 3.7 Artifacts)

Information Model (Analysis)

(from 3.7 Artifacts)

Glossary

(from 3.7 Artifacts)

«optional»Business Rules Description

(from 3.7 Artifacts)

Business Trigger Analysis

(from 3.7 Artifacts)

DAM Approv al

Publish DAM

ProjectApproved

Business Requirements

«outcome»«outcome»

Source: HDF_1.5.doc, page 37

Last updated: 2011-02-09

Page 23

Forward Plan Discussion Notes 2012-01-19 WGM

• Suggestion from William – WRT HDF processes: good to follow But do not use glossary Capture data definitions/metadata as data element specification William to send standard examples of data element specification

to the group- André to follow-up• Work plan discussed as per work plan excel file contents:

Itemised deliverable components, need to work on and agree on deliverable dates

Target DAM ballot date: possible September 2012 To be discussed and confirmed in next conf calls Feb 1

• Good storyboards will make the mapping and modelling of process flows a lot easier

Page 24

FUTURE MEETINGS• Conference calls between now and May 2012 – see wiki

• 90 min., Wednesday 5-6:30pm US Eastern, fortnightly (every 2 weeks)• Starting Feb. 1st

• Webex supplied by Canada Health Infoway

Page 25

Next meeting Agenda- March 14th (Lead: André)

• Pediatric immunization SB (Susan)- was forgotten on Feb. 29th• Review Coordination of care concepts (Susan)• Review Care Plan BPMN first results (Luigi)• Review Care Plan Class Model first results (Luigi)• Review and augment draft of requirements (André)

Coordination of care Care management matrix Do a few past meetings

• Update work plan• Next meeting agenda

Page 26

APPENDIX