Care Plan Topic project

Introduction

Care Plan has been balloted some years ago as DSTU. However, it was felt at that time that more work needed to be done in defining care plan, the components of the care plan, identifying use cases and use. The plan for 2010 is to complete the contents of Care Plan.

HL7 PC will work together with: HL7 Structured Documents WG IMIA-NI IHE For the content of this DSTU material.

Project Need

Items about Care Planning to be discussed towards a future round of DSTU include:

• Existing RMIM: does it cover all kinds of care plans and pathways.
• Definition of care plan
• The overall structure that has been agreed: Care Plan -> Order set -> Clinical Statement. Discussion about this hierarchy is done in PC, O&O and CDS WG.

Project Scope

The Care Plan Topic is one of the roll outs of the Care Provision Domain Message Information Model (D-MIM). The Care Plan is a specification of the Care Statement with a focus on defined Acts in a guideline, and their transformation towards an individualized plan of care in which the selected Acts are added. The purpose of the care plan as defined upon acceptance of the DSTU materials in 2007 is: - To define the management action plans for the various conditions (for example problems, diagnosis, health concerns)identified for the target of care - To organize a plan for care and check for completion by all individual professions and/or (responsible parties (including the patient, caregiver or family) for decision making, communication, and continuity and coordination) - To communicate explicitly by documenting and planning actions and goals - To permit the monitoring, and flagging, evaluating and feedback of the status of goals, actions, and outcomes such as completed, or unperformed activities and unmet goals and/or unmet outcomes for later follow up. - Managing the risk related to effectuating the care plan, Generally a care plan greatly aids the team (responsible parties – it could be the patient caregiver/family) in understanding and coordinating the actions that need to be performed for the person. The Care Plan structure is used to define the management action plans for the various conditions identified for the target of care. It is the structure in which the care planning for all individual professions or for groups of professionals can be organized, planned and checked for completion. Communicating explicitly documented and planned actions and goals greatly aids the team in understanding and coordinating the actions that need to be performed for the person. Care plans also permit the monitoring and flagging of unperformed activities and unmet goals for later follow up.

Project Team

Primary Sponsor/Work Group is Patient Care WG

Co-sponsor Work Group(s) is Structured Documents WG

Role	Name	Email	Notes
Project facilitator	Rosemary Kennedy	rkennedy@qualityforum.org
Other interested parties	IMIA-NI and IHE
Publishing facilitator	Jean Duteau	jean.duteau@gpinfornatics.com
Vocabulary facilitator	Susan Matney	susan.matney@utah.edu
Modeling facilitator	Jean Duteau	jean.duteau@gpinfornatics.com
Domain expert representative 1	Rosemary Kennedy	rkennedy@qualityforum.org
Domain expert representative 2	Anneke Goossen	agoossen@results4care.nl
Data Analyst facilitator	Gay Gianone	gay@alschulerassociates.com
Business requirement analyst	Rosemary Kennedy	rkennedy@qualityforum.org
Requirements process facilitator
Business requirement analyst
Requirements process facilitator	Frank Oemig	hl7@oemig.de
Implementor	Ewout Kramer	e.kramer@furore.com

Action items

Action	Description	Timeline	Status
Analyse and model Glasgow Coma Scale for DSTU	An DCM for the Glascow Coma Scale is in enterprise archtect available for ballot.Also available is an export document so clinicians can give comment on the clinical content.	Informative ballot september 2010	In progress.
Revise Barthel index in PC DSTU and ISO 13606-3	An DCM for the Barthel index is in enterprise architect available for ballot. Also available is an export document so clinicians can give comment on the clinical content.	Informative ballot september 2010	In progress
Translate Dutch example scales into English	Examples are available. Different scales with different modeling issues should be choosen for balloting. the different examples must be modeled in EA. An export document must be made and available.	Informative ballot september 2010	To be discussed during the HL7 WGM in Rio de Janeiro
Identify use cases for larger scales and make new R-MIM for nested scales based on PC DSTU and Oemig’s set of scores and model and Coonans clinical examples	Last revisions underway before filing DSTU status.	Informative ballot september 2010	Status to be discussed in HL7 WGM in May 2010.
Proof of concept with Top 10 of items	Together with CIC (clinical), Terminfo (apply Snomed CT and or LOINC), Templates (authorization and registry) for 10 items (now 9).Simultaneous work. Send out the material now and ask for review feedback.	Informative ballot september 2010	In Progress. Material is available on the HL7 wiki. General feedback has been given. Yes must go on.
Specification how to link to the work in clinical groups	To be specified in the ballot. Before that a discussion in the clinical groups	May 2010	In Progress
Analyse the feedback on the actions above	Feedback given on the content of the DCM. Feedback given on the methodology of DCM.	After the ballot of september 2010	Waiting.
Outline a methodology for making DCM, checking for vocabulary requirements, template requirements	Based on the analysis of the feedback.	Informative ballot January 2011	Waiting.
Transform DCM to R-MIM, archetypes and EHR profiles	See DAM vs DCM vs SAEAF	Informative ballot 2011	Some progress made.
Develop a guideline for creating a DCM	Simultaneous work with work for the ISO standard and NIctiz. Include quality criteria for DCM.	Informative ballot september 2010	In progress
Publishing DCM in the HL7 repository	Contribution to the work done by Jane Curry, Mark Shafarman and Keith Boone	To be determined	Waiting.
Publishing the top 10 of DCM on the wiki HL7 Patient Care	Includes the Glasgow Coma Scale and the Barthel index. Open for feedback	Is published already	In Progress.
Publishing the examples DCM of some scales on the wiki HL7 Patient Care		May 2010	Waiting.
Publishing the guideline for creation of a DCM on the wiki HL7 Patient Care		May 2010	Waiting.
Develop and use metrics for quality criteria	This will be based on the work of Sunju Ahn from South Korea.This is put into ISO work as soon as this is allowed due to PhD obligations	After May 2010	Waiting.
Make a summary of different existing models, approaches and their implementation
Identify where work is done and future work should be done, in relationship with ISO and JIC
Do comparison of DCM work as in first motion	This is a follow up on the Cologne DCM meeting where some work started from
Create tooling to do DCM and exchange with other tools	A tool has been created in Enterprise Architect. This is ungoing work. Exchange with other tools is work to be done	Before 2011	In Progress
Identify a method for inclusion of DCM into the larger SAEAF picture of HL7 methodology	This included how to engage clinicians in particular in the HL7 space, and methods for how to go from DCM to HL7 templates and message artefacts. It will include also the position of DCM in the overall picture which is about decoupling semantics from constraining and from implementing. It should account why this reduces complexity in HL7 as a whole in keeping the clinical data element expression and use consistent. Patient care will accept the request to become an ARB SAEAF alpha project		In Progress
Set up joint meeting with ARB and MnN and publishing	This to ascertain that DCM fits in the overall SAEAF approach as part of methodology in HL7 and can be published for balloting	May 2010	In Progress
Identify dependencies for success and how these can be met	In particular to identify dependencies such as on a templates registry and specification, tooling, publishing and linkage to SAEAF	May 2010	In Progress
Submitting DCM to JIC	A particular approach was agreed roughly a year ago with the JIC chair. That is in particular to bring it to JIC once it is established as a project in both HL7 (May 2008) and ISO (July 2009). The plan has always been to bring the JWG requested projects to JIC	As soon as possible by William	In Progress

Remark: The actions came from the project scope statement, but must be reviewd by William Goossen as a co-chair of Patient Care.

Project Process

• Teleconferences on Wednesday at 4 pm Eastern time.

• Using Tooling's telecon. Will be announced via the Patient Care mailing list.

• Standing Agenda Items
  • Review of project plan and action items
  • Opportunity to ask questions and answers

Project Objectives and Deliverables

1. Domain analysis Model with the following deliverables (together with SD WG):

• • Definitions of Care Plan and others.
  • Work on storyboards and use cases (multiple). Emergency, Clinical hospital (discharge), Nursing home, chronic disease, primary care. Multidisciplinary. Example use cases can be: 1 chronic condition, obstetric case with transfer. After that CDA can use the work that is be done. CDS is an addition to the messages which already exist. They must be updated.
  • Dynamic model for the Care Plan Topic
  • Structural model. -> DAM (HDF within HL7)

2. R-MIM update, meeting all care plan and pathway requirements (PC WG only)

3. CDA for discharge of a nursing care plan (joint PC, SD and IHE), including a robust set of examples.

4. Work on relationship of care plan with ordering, verifying and reporting of orders

Success Criteria

Clear definitions of Care Plan and components, harmonized with CEN Contsys standard, the risk management standards, IHE profiling and IMIA NI project work. Use cases and storyboards updated Proper description how the care plan and pathways can be mapped to the Care Plan R-MIM Update of the R-MIM, if necessary to accommodate the use cases

Project Timeline

Work will be done during 2010 en 2011. Accepted as DSTU end of 2011

Project Resources

Most will be done in normal committee work time, and online via meetings, where all contributors have their normal responsibilities to develop DCM for their day job / clients / projects.

Project Budget

There will be a budget necessary for the HL7 repository

=Ballot strategy - general||

Revision of existing DSTU materials, inclusion of new scales into ballot and ongoing maintenance and new materials. Future normative will probably only possible if HL7 at large has established a repository of templates / R-MIMs.

Links to relevant documents

Templates Registry Pilot

Participants

DCM Contributors

Collaborating with	Agreement status	Comments
CEN	Existing
ISO	Existing
OpenEHR	Unknown	Informal agreement on this work