201701 Care Plan

Return to January 2017 Proposals

Care Plan and Care Team

Submitting WG/Project/Implementer Group

Patient Care Workgroup

Healthcare Services Platform Consortium (HSPC)

Justification

This track is intended to advance the maturity of FHIR resources for care planning (CarePlan, CareTeam, Goal, Condition, and others) and to document industry best practices for improving care coordination using shared care plans. This work will inform the development of a more comprehensive US Realm implementation guide and profiles for care planning based on FHIR release 3.

Participants using both FHIR DSTU-2 and STU-3 are welcome!

The U.S. Department of Health and Human Services (HHS) recently published an article that describes a vision for a Comprehensive Shared Care Plan (CSCP). HHS identifies these goals for a CSCP:

• It should allow a clinician to electronically view information that is directly relevant to his or her role in the care of the person; to easily identify which clinician is doing what; and to update other members of an interdisciplinary team on new developments.
• It should put the person’s goals (captured in his or her own words) at the center of decision-making and give that individual direct access to his or her information in the CSCP.
• It should be holistic and describe both clinical and nonclinical (including home- and community-based) needs and services.
• It should follow the person through high-need episodes (e.g., acute illness), as well as periods of health improvement and maintenance.

TODO: describe use of APIs vs document-based care coordination. APIs enable development of vendor-independent applications for clinicians/providers and for patients/caregivers, e.g. mobile app for patients.

Relationship with other Connectathon tracks

• DAF-Core / US-Core IG and Argonaut
• Coordination of Care Service (CCS) – TBD?

Proposed Track Lead

Dave Carlson – VA

E-mail: Dave.Carlson@BookZurman.com

Zulip: Dave Carlson

Expected participants

The following organizations have indicated an interest in participating in this track:

• VA – Dave Carlson
• HSPC – Dave Carlson
• 'Your organization here!'

Roles

Please include information here regarding how much advance preparation will be required if creating a client and/or server.

Care Plan Requestor

• TODO link to HSPC sandbox with test data.

Care Plan Creator

• e.g. from ProcessDefinition for protocols or care pathways

Scenarios

Scenario Step 1 Name

Action:

Precondition:

Success Criteria:

Bonus point: