Product CP

Product Brief - V3 Domain: Care Provision

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Product Name

HL7 V3 Standard: Care Provision Domain

Topics

• Care Structures
• Care Plan
• Care Record
• Care Record Query
• Care Transfer
• Care Transfer Query
• Allergies & Intolerance
• Adverse Reaction
• Professional Service
• Care Composition
• Health Concern
• Clinical Document
• Assessment Scales

Standard Category

• Health Information Exchange Standards

Integration Paradigm

• Messaging

Type

DSTU

Releases

• HL7 CP, R1 - HL7 Version 3 Standard: Care Provision, Release 1;
• HL7 CP CP, R1 (Topic Level Ballots) July 2007

  Care Transfer

  Care Record Query

  Care Record

  Care Structures

  Care Plan

  Care Transfer Query

  Allergies & Intolerance

  Adverse Reaction

  Professional Service

  Care Composition

  Health Concern

  Assessment Scales

• HL7 CP ASCALE, R2 - HL7 Version 3 Standard: Care Provision; Assessment Scale, Release 2; DSTU Ballot 2 - September 2009
• HL7 CP CC, R1 - HL7 Version 3 Standard: Care Provision; Care Composition, Release 1; DSTU Ballot 3 - September 2009
• HL7 CP HC, R1 - HL7 Version 3 Standard: Care Provision; Health Concern, Release 1; DSTU Ballot 2 - September 2009

Summary

The Care Provision Domain addresses the information that is needed for the ongoing care of individuals, populations, and other targets of care. The 'Act of Care Provision' is the recording of a process that defines the responsibility for supplying support to the target of care. It is a statement of SUPERVISION, MANAGEMENT, and CUSTODY. Professional services deals with the capturing of information about specific activities done 'to' a patient such as training, assessments, counseling, physiotherapy and surgery. Care Provision in particular addresses continuity of care. One way to handle this is transfer of care, accepting of transfer, querying records for data and record exchange. The Care Record can be used for discharge or reporting about care for an individual. It excludes activities meant to evaluate a characteristic of a patient (i.e. all observations), though interventions such as colonoscopies which include removal of samples that may be classified as professional services. It also excludes the administration of drugs or vaccines, as these are handled by more specialized transactions.

Description

The people or other entities associated with 'Responsibility for Care', are divided into the providers and targets of care, where a patient may be considered both a provider and a target of care and where any person may carry multiple roles. The scope of the 'Responsibility for Care' is defined in three layers.

1. The Act of Care Provision represents a kind of responsibility defined by CareProvision.code, which usually represents the scope of responsibility described by a governmental license, a certification agency, or other legally recognized entity such as the patients themselves.
2. The reasons for the Care Provision further constrains the scope of responsibility to one or more 'Concerns'.
3. The third layer expresses the Care Plans or management plans. These plans further identify the expectations for specific actions to be performed via the component relationship.

The first layer is required in a statement of responsibility; the second two layers, which constrain the first layer, are optional.

This domain also includes the transfer of responsibility for care and the updating of pertinent information about respective responsibilities between collaborating care providers, such as the communications that occur when a patient is discharged from the hospital to a home health agency. This domain recognizes the fact that care coordination often includes many types of providers that care for people, devices, facilities, and the general environment, not just clinicians delivering direct care to a patient. The pertinent information regarding care provision may include general summary information or granular primary information, but may not carry all the information known about a specific instance in the generating system. However, in general, the scope of the domain includes all the information needed for decision support by a care provider. At a minimum, the domain includes the identifiers and other data needed to query a source system for the additional information needed for care. The scope is formalized in the following scope statement.

The Care Provision Domain describes information structures and vocabulary used to communicate information pertinent to the care of living subjects, devices, geographic sites, and other physical entities by a responsible care provider. This domain supports multiple specifications appropriate to referrals and record communications supporting collaboration and the continuity of care between care providers.

Among other more generalized care activities that can be defined by analogy and interpretation of the scope above, the Care Provision Domain specifically supports:

Sharing of health record extracts and event summaries of the health record between collaborating providers (including the patient) in order to support the clinical decision support activities of the receiving persons or systems.
Request for the transfer of patient care responsibility of a specific type of care by a healthcare provider by a requesting healthcare provider, a responsible party, such as a care coordinator, advocate or family member or the patient themselves.
Acceptance or rejection of a request for care transfer as well as the ability to provide information about the intent to provide care to the requesting party.
Communication of a summary of relevant findings and outcomes of the care provided in response to a request for further information.

Limits of Scope: The scope of the Care Provision Domain is also limited by its focus on HL7's Care Provision Act, that describes 'the responsibility for supplying support to the target of care.'

The Care Provision Domain is not intended to represent all the information communicated by systems that originate detailed pertinent information such as observation data or person registration data. The domains that support communication from these data generating systems tend to supply much more detail regarding the complex data context within which the data was generated. In that spirit, the intention of the Care Provision Domain is to communicate the instance identifiers and meta data for these granular instances of data such that the receiving system has enough information to query sending systems for more detail on specific items of pertinent information (assuming the sending systems support queries and instance identifiers).

Care Provision Domain uses the clinical statement pattern. This patterns is used as the care statement to fit the overall Care Provision model. Patient Care committee developed and develops several smaller R-MIM structures that are specifications of the care statement. Examples include the Concern tracker, the vital signs R-MIM, the Statement Collector, Allergy and Intolerance R-MIM and Assessment Scale R-MIM among others. The purpose of these are to use generic and consistent structures in the HL7 messages. Although developed by Patient Care for use in Care Statement, other messages and also CDA can deploy these structures.

Learn more at http://www.hl7.org/implement/standards/v3messages.cfm

Business Case (Intended Use, Customers)

Provider: Healthcare Institutions and Healthcare Professionals (hospitals, general practice, long term care, home care, mental health)

Implementations/ Case Studies (Actual Users)

The Care Provision Messages are used in Ontario, Canada, In IHE query profile, and in the Netherlands by two Nictiz projects for perinatology and diabetes care.

Resources

Work Groups

• Patient Care
• Patient Care wiki

Education

• See more at http://hl7new.amg-hq.net/implement/training.cfm

Links to current projects in development

• Project Insight ID # 284, Care Provision Domain
• Project Insight ID # 174/107,Care Provision DSTU - Topic Allergy & Intolerances
• Project Insight ID # 106, Care Provision DSTU - Topic Care Composition
• Project Insight ID # 105, Care Provision DSTU - Topic Care Plan
• Project Insight ID # 103, Care Provision DSTU - Topic Professional Services