FHIR PlanDefinition for Care Planning Presented by Emma Jones, Jeff Danford, George Dixon - Allscripts

The Problem Patients are suffering from an increasing number of complex or chronic health conditions which require frequent episodes of care involving multiple providers. With this complexity, it is difficult to plan care for patients There need to be a means of defining how care planning interventions can be derived from clinically relevant order sets, protocols, clinical practice guidelines, etc as part of the clinical workflow. FHIR may provide a solution to the problem. However, there is not enough guidance provided by HL7 FHIR resources on the use of FHIR planDefinition resource to create carePlan activities.

Use Case Transitions in care Example: Discharge from Acute Care to Post Acute Care Acute care hospital discharge planning and transfer of care information Managing ongoing care Example: Home health services, Referrals, Consultations, etc Treatment Plans, Plan of care orders, etc

Use Case (Cont) Clinicians usually have the following workflow Questions: How do I use order sets when planning care? How does care plans identify what protocol it’s adhering to? How can I use best practices or clinical practice guidelines while planning care? How do I close-the-loop? How do I know a request or an order has been satisfied? How does an event or a result point to the order that authorized it? How do I know who the patient care team members are so I am able to follow-up or direct care?

Standards & Systems Standards Systems EHR PHR Patient Portal HIE CPOE FHIR Constructs/FHIR workflows Mobile Device – mobile friendly xdw (r/t ITI proposal) Mobile apps can access xdw CDA Documents XDR (for Direct exports and inbound documents) Audit Logging Error Handling Secure Transport Systems EHR PHR Patient Portal HIE CPOE

Discussion Why IHE PCC would be a good venue to solve the problem Involves developing a profile across several existing standards. Necessary expertise in PCC to address content issues as well as functional workflows. This profile differs from XDW in that it is not limited to sharing of documents although sharing of documents will be supported. This profile is a workflow profile that streamlines the ability to create and share information that will enhance clinical workflow by focusing on the data that is created and shared and how it’s shared and updated.

Questions? ITI engagement needed? Want to ensure we are not solving the same problem. Need to take a look at ITI XDWm proposal to see if the use case is intending to solve the same problem. Or how we can compliment each profile? PCC profile will provide guidance on the use of FHIR planDefinition resource to create carePlan activities ITI XDWm does the “orchestration” of the activity definition using xdw tasks Guidance on Writing Profiles of FHIR - http://wiki.ihe.net/index.php/Guidance_on_writing_Profil es_of_FHIR