Conference call minutes 23 April 2015

Health Concern Topic

Patient Care WG

April 23, 2015

Attendees:

• Michael Tan – Chair
• Jay Lyle
• Dave Pyke
• Laura Heermann Langford
• Stephen Chu (partial)

Participation Information Phone Number: +1 770-657-9270 Participant Passcode: 943377

Web Meeting Info www.webex.com Meeting number 230 634 425

Previous Meeting Notes

The meeting minutes from 16th April were discussed, adjusted and approved. Motion made by Dave, second by Jay. Votes 0 against, 0 abstain, 3 approve

Harmonization of Care Plan and Health Concern

We continued with the discussion on harmonization that was initiated in the Care Plan call of Wednesday 22 April. The request was to add the following elements:

• expressed by (for example family members)
• disagreed by ( for example the patient with a drinking habit).

Jay has sent an e-mail prior to the call. The text below is a quote from the e-mail:

We will keep "ConcernAuthor," but we may also need to identify those who express a concern and to clarify the distinction between expressers and authors. This relationship is called “expressedBy” in the CarePlan DAM; we need a term for the role. ConcernExpresser? ConcernedPerson?

In addition, we may want to represent a disagreeing role for any condition where a significant stakeholder (e.g., the patient) disagrees that there is a concern (e.g., anorexia nervosa). ConcernDissenter? Disagreer? For both of these roles, we still need to articulate how this information is used before adding roles, rather than relying on existing or exogenous health concern events or annotations. A patient disagreeing with a diagnosis may be an important fact for a person treating that diagnosis (as are many other facts), but does it affect the creation, sharing, reconciling, or viewing of that diagnosis as a concern? Some participants felt that the term “custodian” has specific medical records management connotations, so we propose changing the name of ConcernCustodian. The term ResponsiblePerson was suggested, but that’s a bit too abstract for me. I’m happy to change the name of this role, if enough people find the term “ConcernCustodian” confusing, but we’d need a more descriptive alternative. ConcernMaintainer? Steward? Manager? Owner? A use case to help define some boundaries, with some questions: A. A parent is concerned that a child is anorexic, and expresses that concern to the child’s doctor. The child disagrees. The doctor is unable to examine the child at that point, but, due to the seriousness of the concern, concurs and instructs the nurse to record the concern.

1. ConcernedPerson: parent
2. ConcernAuthor: doctor
3. ConcernDissenter: child
4. ConcernSteward: doctor

B. A parent is concerned that a child is anorexic, and expresses that concern to the child’s doctor. The child disagrees. The doctor examines the child, concurs, and instructs the nurse to record the concern.

1. ConcernedPerson: parent, doctor
2. ConcernAuthor: doctor
3. ConcernDissenter: child
4. ConcernSteward: doctor.

C. A parent is concerned that a child is anorexic, and expresses that concern to the child’s doctor. The child disagrees. The doctor examines the child, concurs, and records the concern.

1. ConcernedPerson: parent, doctor
2. ConcernAuthor: doctor
3. ConcernDissenter: child
4. ConcernSteward: doctor.

D. A parent is concerned that a child is anorexic, and expresses that concern to the child’s doctor. The child disagrees. The doctor examines the child, also disagrees, but records the concern.

1. ConcernedPerson: parent
2. ConcernAuthor: doctor
3. ConcernDissenter: child
4. ConcernSteward: doctor.

Existing definitions: ConcernAuthor A patient, clinician, caregiver, family member, or other person who identifies a Health Concern Note that different persons may identify different focal components for a concern at the same time. This should eventuate in those who disagree recognizing that there is disagreement and taking steps to ensure both parties are in full command of the facts.

ConcernCustodian

The person or organization responsible for maintenance of the concern, whether by direct or delegated action. Custodianship confers authorization to modify a concern. It may be assumed by the author or assigned by delegation, rule, or any other mechanism. These mechanisms are a matter of institutional policy.

The feeling was that expressed by or disagreed by were not the same type of role as the other defined roles. The author, custodian and monitor are playing functional roles towards the health concern which is managerial with certain tasks towards the health concern. The "expressed by" and "disagreed by" are not. They are more attributes to the health concern. There are 3 ways to model this requirement:

1. Add these data as Concerned persons (roles) just like Concern author.
2. Add the info as properties to Health Concern just like status.
3. Add this data as an observation or event,.

This discussion was not resolved during the call. We agreed to continue this issue through e-mail and otherwise discuss it in the next conference call of Health Concerns.

There was also no agreement on the naming of the these elements. Stephen preferred to stick to the name given by Care Plan so that Health Concern is in line. I.e. "expressed by, disagreed by and responsible person. While Health Concern prefers to call these persons "concerned Person" , "Concern dissenter" and "Concern steward".

The next call will be on Thursday 30 April 4 pm.