Care Plan (CP) Team Meeting - WGM

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13 Νοε 2013 (πριν από 3 χρόνια και 11 μήνες)

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Care Plan (CP) Team Meeting
-

WGM

90 minutes

André Boudreau
(a.boudreau@boroan.ca)

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

Stephen Chu
(stephen.chu@nehta.gov.au)


2011
-
09
-
15
, Thursday Q2
(San Diego)

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
-
9270

Participant
Passcode
: 943377

WebEx

link

for WGM
-

Sept. 15th:

https://infoway
-
inforoute.webex.com/infoway
-
inforoute/j.php?ED=168011242&UID=494535562&RT=NCMxMQ%3D%3D




With meeting notes.

See also updated Perinatology Storyboard.

Agenda for Sept 28
th

meeting added.


Please advise André of any errors/omissions.

Page
2

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
3

Participants
-

WGM
Meetg

of 2011
-
09
-
15 p1

Name

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

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

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

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

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

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

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. Principal at Care Management Professionals. 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

Gaby Jewell

gjewell@cerner.com

US

Yes

Senior
strategist

at

Cerner
Corp
,

Page
4

Participants
-

WGM
Meetg

of 2011
-
09
-
15 p2

Name

email

Country

Yes

Notes

David Rowed

drowed@bigpond.net.au

AU

Yes

MD. Family GP.; Was chair, 2005, Electronic Communications
Working Group of the AU General Practice Computing Group

Charlie Bishop

charlie.bishop@isofthealth.com

UK

Walter Suarez

walter.g.suarez@kp.org

US

Peter
Hendler

Peter.Hendler@kp.org

US

Ray Simkus

ray@wmt.ca

CA

Serafina

Versaggi

serafina.versaggi@gmail.com

US

Clinical Systems Consultant

Luigi Sison

lsison@yahoo.com

US

Yes

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.

Brett

Esler

brett.esler@pencs.com.au

AU

Pen Computer Sys

Catherine Hoang

catherine.hoang2@va.gov

US

VA

Hugh

Leslie

hugh.leslie@oceaninformatics.com

AU

Yes

a General Practitioner ; Chief Medical Officer, Ocean Informatics

Seam

Heard

sam.heard@oceaninformatics.com

Thomson Kuhn

TKUHN@acponline.org

US

Yes

Sr. Systems Architect at American College of Physicians

Carolyn
Silzle

Carolyn.silzle@choa.org

US

?

American Dietetic Association

Denise

Yes

?

Russell Leftwich

Russell.Leftwich@tn.gov

US

Yes

Md
,
Allergist, internal medicine;

Chief Medical Informatics Officer, Office
of eHealth Initiatives, State of Tennessee

Jane
Brokel

US

Yes

PhD, RN, NANDA International; University of Iowa, Iowa City, IA &
Trinity Health

Corinne Gower

Corrine@paradise.net.nz

NZ

Yes

Senior Business Analyst at NZHIS;

Senior Advisor at Ministry of Health
New Zealand

Yu
-
Ting
Yeh

yutingyeh@mail2000.com.tw

TW

Yes

HL7 Taiwan

Page
5

APPROACH TO STRUCTURING
STORYBOARDS


André

Page
6

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
care’)


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
management)


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
7

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
8

PERINATOLOGY STORYBOARD


Laura

Page
9

Perinatology


See document by Laura with discussion notes and tracked
changes.


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
meeting


Stephen: we need to make explicit the care coordination steps
and data: agreed

Page
10

PLAN FOR STORYBOARD VALIDATION


André

Page
11

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
12

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
information


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
exchange


Who are the HL7 SB SMEs?
MnM
, Lloyd, Graham

Page
13

CONCLUSION


Next Care Plan meeting on Sept. 28, 17h00 ET


See wiki

Stephen

Page
14

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
15

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
16

APPENDIX 1


ISO CONCEPT MODEL
AND TERMS


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
Health

Page
17

Health issues and their management

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

NB: These models and definitions are currently being reviewed and updated through the ISO CONTSYS project

Page
18

Time
-
related concepts in Continuity of
Care

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

NB: These models and definitions are currently being reviewed and updated through the ISO CONTSYS project

Page
19

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

o
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.

o
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

o
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

o
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

o
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
presence

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
20

APPENDIX 2
-

HL7 KEY TERMS


This needs to be augmented for our Care Plan needs


See ISO

Page
21

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
recuperation.


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
22

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
23

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


http://www.reference.md/files/D017/mD017050.html


Sources:
NLM Medical Subject Headings
,
NIH UMLS
,
Drugs@FDA
,
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
encounter.


J
Fam

Pract
.

1996 Feb;42(2):161
-
9.
Episode of care: a core concept in family
practice.


http://www.ncbi.nlm.nih.gov/pubmed/8606306

Page
24

Term: Episode of Care
-

2


A defined period of illness that has a definite start and end date.


www.mibcn.com/glossary/glossaryE.shtml


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. ...


www.uhc.com/united_for_reform_resource_center/health_refor…


the range of treatments provided over time for treating a condition or
illness


www.stonybrookmedicalcenter.org/patientcare/healtheducation/


Treatment rendered in a defined time frame for a specific disease.
Episodes provide a useful basis for analyzing quality, cost and
utilization patterns.


www.mtinformedpatient.org/glossary.html




Page
25

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

Added on 2011
-
08
-
17