Care Management & Planning track HL7 FHIR Connectathon Saturday, January 27 & Sunday, January 28 Care Management & Planning track (starting on slide 10)

Connectathon Overview FHIR Connectathon Objectives Track Selection Timeline of Activities Participant Opportunities Location of Support Materials How to get your questions answered

What’s to be gained by attending a FHIR Connectathon? Join a community of FHIR users Develop and test your system and use of the standard Demonstrate what’s possible Refine the FHIR Specification

Track Selection Review track details to find your focus Select your track in the Pre-Connectathon Survey Connect with your track lead in advance We recommend participating fully in only one track

Timeline of Activities One Month Prior: Registration 1-3 weeks prior: Track Orientation Meeting On-Site Friday Breakout: Saturday Q1-Q4: Working Sessions Breakouts: Orientations on FHIR and Test Tools Sunday Q1-Q2 Working, Q3 Testing, Q4 Wrap Up

Participant Opportunities Join in the community Bring Questions and share your challenges Help others by sharing your knowledge Bring your development system ready to go Have your application installed Have you environment configured Raise questions that identify hot topics Record your Results What happens at Connectathon stays at Connectathon. It’s OK to fail.

Location of Support Materials FHIR version 3.0.1 will be used by this track http://hl7.org/fhir/ Connectathon wiki http://wiki.hl7.org/index.php?title=FHIR_Connectathon_17 Care Management & Planning Track Definition http://wiki.hl7.org/index.php?title=201801_Care_Plan Tracking Spreadsheet – Coming Soon! Gforge FHIR Chat https://chat.fhir.org/

How to Get your Questions Answered Review track descriptions Sign up for the FHIR Chat Enter issues into Gforge Administrative Questions On Site Issues

Who’s Who at the FHIR Connectathon? FHIR Product Director: Grahame Grieve FHIR Management Group (FMG): Connectathon Administrator: Sandy Vance

Intro to Care Management Track Introduction to Track Lead Dave Carlson, VHA Standards & Interoperability (contractor) Track Definition http://wiki.hl7.org/index.php?title=201801_Care_Plan List of participating systems in the track References to the servers & clients for the track Goals for this track

Participant Roles Care Plan Server Care Plan Requestor Supports: CarePlan, Condition, Goal, CareTeam, and other resources included via CarePlan.activity.reference Care Plan Requestor Using debug tools, such as Postman, to query servers SMART on FHIR applications for use by patients and clinicians Care Plan Protocol Creator Define care protocols using PlanDefinition and ActivityDefinition PlanDefinition $apply operation creates CarePlan for a patient CDS Service Requestor Invoke a CDS Hooks service to evaluate or suggest modifications to a care plan

Use Case: Chronic Care Management Recommend following clinical use case based on the NIH Chronic Kidney Disease (CKD) Care Plan project. Patient personas; this track's sample data are based on Betsy Johnson's persona Provider personas for six members of a CKD patient's care team Includes a draft set of data elements and terminology codes for CKD care management Sample FHIR resources were created from the CKD use case personas and data elements

Scenarios Retrieve a patient’s care plan(s) Care Plan Server & Care Plan Requestor Create new Care Plan from protocol definition PlanDefinition $apply operation creates CarePlan for a patient Save resulting CarePlan resource for retrieval by requestor role Request CDS Hooks care plan evaluation Invoke 'patient-view' hook on one or more CDS Hook service providers Display returned cards, information and/or suggestions

Servers and Clients Participating Sample FHIR resources for chronic care management https://github.com/clinical-cloud/sample-data HSPC Sandbox (FHIR v3.0.1) open endpoint https://api-stu3.hspconsortium.org/careplantest/open Loaded with all sample FHIR data Allscripts server PlanDefinition protocols for chronic conditions Use protocols to create new CarePlan resources SMART on FHIR care management client apps Clinical Cloud Solutions – iOS app for viewing care plan resources and invoking CDS Hook services Other Clients & Servers TBD by participants

Track Goals Advance the maturity of FHIR resources for Care management and planning (CarePlan, CareTeam, Goal, Condition, and others) Definition of computable clinical protocols (PlanDefinition, ActivityDefinition) Document industry best practices for improving care coordination using shared care plans