San Antonio WGM and 5 February Conference Call Discussions/Resolutions

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San Antonio WGM Discussions and Resolutions

Issues regarding different types of "Care Plan"

• The Care Plan project team accepts that the concepts: "Care Plan", "Plan of Care" and "Treatment Plan" are likely to be understood and used in different ways depending on the preference, culture, experiences, context of use, and funding models under which they operate.

• Patient Care Workgroup (PCWG) acknowledges that:

- Care Plan, Plan of Care are often used interchangeably to mean the same thing

- Consolidate Plan, Care Plan are also used interchangeably to mean the same thing

Resolutions

• Given that after more than 6 months of intensive debates, the situation is still no closer to resolution and will likely remain so in foreseeable future, PCWG passed the following resolutions at the San Antonio meeting (January 2014):

- Agree that Care Plan DAM document will remove references to the three types of plan. The different types of plan classes will also be removed from the logical and conceptual models.

- Remove planClass (attribute): Plan Class Type and the three types of plans from the detailed model.

- Preserve displayName (attribute) to allow naming of different types of care plan according to stakeholder practice/usage needs

- Review of storyboards to ensure that the contents adequately illustrate the use of the care plan model in the different contexts and different level of complexity that is congruent with the concepts: consolidate care plan, care plan, plan of care and treatment plan

- Noted that there is a need to support nesting of [care] plan(s) within [care] plan. The next version of the DAM (May 2014 Ballot package) and the logical and implementable models to be developed will need to adequately and correctly illustrate how the nesting relationships should be represented If removing the three types of plans how will relationship be represented

- Likewise, consideration should also be given to the structure of the care plan model on how to support linking different plans instead of nesting them

- i.e., the compositional issues of linking vs. association in the model will need to be analysed and supported

ACTION:

• - Five recommendations were passed:

1. Removing reference to the three types of plan (Care Plan, Plan of Care, Treatment Plan) from the Care Plan DAM

2. Remove the three type of plan from the Care Plan Conceptual and Logical Models

3. Remove the "PlanClass" attribute from the Care Plan Logical Model

4. The issue of supporting "composition" and/or "association" between different types of plans in the model will need to be addressed

5. The storyboards will need to be adjusted to reflect the recommended changes

• The glossary of revised Care Plan DAM will contain a list of terms for the different types of plan, they synonymous terms/names and the associated differentiating characteristics/attributes

- It is anticipated that the added information will help stakeholders determine how they prefer to name and use the different types of plan

February 5 Conference Call Discussions

• Adding PlanCode attribute to "Care Plan":

- During the San Antonio WGM, there were a number of discussions with stakeholders on PCWG decision to remove reference to the different types of plan in the next version (May 2014 ballot)

- Many stakeholders expressed strong support for this decision

- Stakeholders also expressed strong view on inclusion of a PlanCode attribute in the "Care Plan" to complement the "displayName" attribute, thus allowing machine processing

- NOTE:

- The concept of "Care Plan" is used here and will be used in future version of Care Plan DAM and models as a generic concept (i.e. "Plan")

• Linking "DisciplineCode", "PlanCode" and "DisplayName" (or "planName")

- The "DisciplineCode" supports the expression of the clinical domain/discipline that has overall responsibility for the "Care Plan" (whether it is the care plan, plan of care, or treatment plan)

(Note - the "disciplineCode" may need to be changed to "teamCode" to support a more comprehensive approach to care plan responsibility)

- Examples: Neurosurgery, Orthopedic, Cardiology, Nephrology, Endocrinology, etc

(Note - need examples of team)

- The "PlanCode" supports the inclusion of standard terminology/codes from authorized codesets, such as LOINC document codeset

- The code may be used to represent a combination of discipline and types of plan

- The "displayName" (or "planName") supports the expression of human readable concept names for the different care plans used by different stakeholders

- Question has been raised regarding the appropriate use of the concept "displayName", which is linked/tied to the code value

- Consider change the concept name to: "planName"

- Example: neurology spinal injury care plan; orthopedic spinal injury care plan; GP diabetic care plan, cardiology heart failure treatment plan, etc

(Note - these are examples only and it is not intended to be definitive or exhaustive list)

• Meeting requirements of Quality Measure and Payor/Insurer:

- Quality Measure requires care plans to demonstrate a number of components/elements that support the measurement of quality of care

- code/name of care plan that allows identification of discipline and health problem(s)/diagnoses addressed by the care plan

- health concern(s) relevant to the health problem(s)/diagnoses affecting the patient

- health goals to address each health concern

- activities/interventions to achieve health goals

- outcome measures

- Payor/Insurer requires the code/name of care plan which captures the clinical discipline, health problems/health concerns for funding determination

- The comprehensive nature of the care plan structure with the addition of "PlanCode" attribute are considered adequate to meet the requirements of these two important stakeholders

- Example: patient suffering from spinal injury (e.g. fractured L1 and L2 with complete spinal cord injury) under the care of orthopedic spinal injury team

- DisciplineCode = orthopedic (or orthopedic spinal injury)

- PlanCode/DisplayName (or "planName") = LOINC document code and human readable name: orthopedic spinal injury care plan

- Spinal injury health concerns:

- Loss of functions below the level of injury. Examples include:

- loss of muscle/motor function

- loss of sensory function

- loss of control of the bowels

- loss of control of bladder

- loss of sexual function

- aggression, depression

- a set of health goals will be associated with each health concern

- a set of care activities/interventions will be identified to realize/achieve the health goals

- effect(s) of the interventions will be assessed, compared to health goals to determine whether the goals are met (outcomes)