Revision as of 23:39, 27 February 2013

1 Business Capabilities
2 Care Collaboration - Build "Social" Network Capability Set
3 Care Collaboration - Team Conversation Capability Set
4 Care Collaboration - Participant Availability Capability Set
- 4.1 Indicate Personal Availability for Collaboration
- 4.2 Find Participant Availability for Collaboration
5 Care Collaboration - Semantic Tagging Capability
- 5.1 Tag Collaborative Content
6 Care Observations and Assessment Capability Set
7 Care Planning - Plan Life Cycle Capability Set
8 Clinical Evaluation of Plan Items
- 8.1 Check Clinical Appropriateness Capability
9 Recommend Plan Template Capability
10 Care Plan Implementation Capability Set
11 Care Review Capability Set
12 Documentation Template for Capability Details

Business Capabilities

What are capabilities

Capabilities express "abilit[ies] that an organization, person or system possesses" [1]. Capabilities are independent of business process and business rules; capabilities express the "what" rather than the "how".

Business capabilities may outlive specific technical specifications or implementations that realize business processes. They may be represented in HL7 V2, V3 or V10 but they will endure and continue to represent what the business does and describe what services in technology X will need to perform.

The Care Coordination capabilities comprise the core of the normative content specified by theCCS HSSP Service Functional Model (SFM).

Capabilities may naturally fall into logical groupings which we'll also represent as UML interfaces in the informative part of the SOA SFM.

As a general rule the capabilities are independent from organizational policies and business rules. This decoupling will allow capabilities to be combined to support various business processes and organizational policies. This is key for realizing care coordination services through the continuum of care.

HL7 Care Coordination Service Scope Overview

Complementary Efforts

Care Collaboration - Build "Social" Network Capability Set

Invite to Collaborate Capability

Capability Status	2-26-2012	Proposed	Reviewers Here

An invitation is a request from one individual to another to participate as collaborators in care coordination activities. Participants join the the Care Team via an invitation based process which helps to organically grow the patient's care network just as it does in the "real world".

A patient can directly invite providers and care givers to join his or her care team (as the patient is the first member of the care team).
An invitations may be sent from an any existing care team participant to new care team member.

The patient's delegated steward of their care plan, licensed independent practitioner (LIP) (e.g. PCP or other professional care plan facilitators such as a nurse case manager) will typically serve as the "seed" of the collaboration tree as they invite other providers to collaborate in care coordination.

Policies and rules regarding who is entitled to receive invitations and receive access to collaborate on patient care will continue to be dictated by existing processes (e.g. policies that allow a provider to fax clinical information to a specialist or have a phone conversation about my health conditions).

Precondition	The invitation placer must be an existing member of the patient's care team. This may include the following roles as defined in the HL7 Care Plan model: Patient Provider Care Giver Support Member
Inputs	Initiating collaborator (Role and Person/Entity details) Patient New Collaborator (Role and Person/Entity details) Collaboration Reason (e.g referral, care transition)
Outputs	none
Postconditions	New collaborator receives a secure message with request for collaboration
Exception Conditions	New collaborator not vetted by external policy checks
Included in Profiles	edit here
Outstanding Issues	edit here

Respond to Collaboration Invitation

Capability Status	2-26-2012	Proposed	Reviewers Here

Recipients of collaboration invitations have the options to respond as follows:

Accept request for collaboration
Delegate request for collaboration to another participant
Reject request for collaboration

Preconditions	Collaboration invitation has been initiated by an activated member of the care team and received in the form of a secure message containing a unique invitation token.
Inputs	Invitation Token Response Type Invitation recipient Role and Person/Entity Details [if response type is delegation] New Collaborator Role and Person/Entity Details
Outputs	none
Postconditions	Invited participant becomes a new member of the care team with access to patient care context.
Exception Conditions	Invitation has been recalled by placer Invitation has expired due to inaction Invitation can not be delegated
Included in Profiles	edit here
Outstanding Issues	edit here

Find All Collaboration Participant Relationships

Capability Status	2-26-2012	Proposed	Reviewers Here

The care team grows organically based on invitation from the care team. For example, an invitation from a licensed independent probationer (LIP) to a cardiologist results in relationship links from the new provider to the patient and between the two providers. These relationships represent a mini-community of individuals working towards the patient's health goals. The relationships are a network or social graph used to support collaboration in care coordination activities.

Preconditions	none
Inputs	Patient role and Person/Entity information
Outputs	Role and entities linked based on the role relationships
Postconditions	none
Exception Conditions	none
Included in Profiles	edit here
Outstanding Issues	edit here

Care Collaboration - Team Conversation Capability Set

Care Team Chat Communications

Capability Status	2-26-2012	Proposed	Reviewers Here

TODO: Care team chat communications with optional multimedia support.

Preconditions	edit here
Inputs	Free form text with linked semantic content Communication Semantic context (e.g. Plan, HealthGoal, HealthConcern, Outcomes, Team Member)
Outputs	edit here
Postconditions	edit here
Exception Conditions	edit here
Included in Profiles	edit here
Outstanding Issues	edit here