Care Plan (CP) Team Meeting 60 minutes André Boudreau Laura Heermann Langford Stephen Chu Care Plan wiki: HL7 Patient Care Work Group To join the meeting: Phone Number: Participant Passcode: WebEx link for Sept to december:

Page 2 Agenda for Sept. 28th Minutes of August 31st Feedback from San Diego WGM (Stephen, Laura, others)  Care plan  Other meetings Final review of Perinatology SB (Laura) Review of Home Care SB (André/Danny) Clinical validation of storyboards in October (André)  Perinatology  Home Care (3 home care nurses in Canada recruited) Other storyboards  Chronic care (Stephen) Roadmap for Oct to Dec. (André) Decide on future meetings and roles  Every 2 weeks as in the summer If time permits: Storyboard document introduction (Andre)  Purpose, scope, guidelines, structure, quality criteria

Page 3 Agenda for Oct. 12 Final review of Perinatology SB (Laura) Review of Home Care SB (André/Danny) Clinical validation of storyboards in October (André)  Perinatology  Home Care (3 home care nurses in Canada recruited) Other storyboards  Chronic care (Stephen) Roadmap for Oct to Dec. (André) Decide on future meetings and roles  Every 2 weeks as in the summer If time permits: Storyboard document introduction (Andre)  Purpose, scope, guidelines, structure, quality criteria

Page 4 Participants- Meetg of p1 Name Country YesNotes André Boudreau CA Yes Co-Lead- Care Plan initiative/HL7 Patient Care WG. B.Sc.(Physics), MBA. Owner Boroan Inc. Management Consultin. Chair, Individual Care pan Canadian Standards Collaborative Working Group (SCWG). Sr project manager. HL7 EHR WG. Laura Heermann Langford US Yes Co-Lead- Care Plan initiative/HL7 Patient Care WG. Intermountain Healthcare. RN PhD,: Nursing Informatics; Emergency Informatics Association, American Medical Informatics Association; IHE Stephen Chu AU Yes NEHTA-National eHealth Transition Authority. RN, MD, Clinical Informatics; Clinical lead and Lead Clinical Information Architecture; co-chair HL7 Patient care WG; vice-chair HL7 NZ Peter MacIsaac AU HP Enterprise Services. MD; Clinical Informatics Consultant; IHE Australia; Medical Practitioner - General Practice Adel Ghlamallah CA Canada Health Infoway. SME at Infoway (shared health record); past architect on EMR projects William Goossen NL Results 4 Care B.V. RN, PhD; -chair HL7 Patient Care WG at HL7; Detailed Clinical Models ISO TC 215 WG1 and HL7 ; nursing practicioner Anneke Goossen NL Results 4 Care B.V. RN; Consultant; Co-Chair Technical Committee EHR at HL7 Netherlands; Member at IMIA NI; Member of the Patient Care Working Group at HL7 International Ian Townsend UK NHS Connecting for Health. Health Informatics; Senior Interoperability Developer, Data Standards and Products; HL7 Patient Care Co-Chair Rosemary Kennedy US Thomas Jefferson University School of Nursing. RN; Informatics; Associate Professor; HL7 EHR WG; HL7 Patient care WG; terminology engine for Plan of care; Jay Lyle US JP Systems. Informatics Consultant; Business Consultant & Sr. Project Manager Margaret Dittloff US The CBORD Group, Inc.. RD (Registered Dietitian); Product Manager, Nutrition Service Suite; HL7 DAM project for diet/nutrition orders; American Dietetic Association Audrey Dickerson US HIMSS. RN, MS; Standards Initiatives at HIMSS; ISO/TC 215 Health Informatics, Secretary; US TAG for ISO/TC 215 Health Informatics, Administrator; Co-Chair of Nursing Sub-committee to IHE-Patient Care Coordination Domain. Ian McNicoll UK Ocean Informatics. Health informatics specialist; Formal general medical practitioner; OpenEHR; Slovakia Pediatrics EMR; Sweden distributed care approach Danny Probst US Intermountain Healthcare. Data Manager Kevin Coonan US MD. Emergency medicine. HL7 Emergency care WG. Gordon Raup US CTO, Datuit LLC (software industry). Susan Campbell US PhD microbiologist. Principal at Care Management Professionals. HL7 Dynamic Care Plan Co-developer Elayne Ayres US NIH National Institutes of Health. MS, RD; Deputy Chief, Laboratory for Informatics Development, NIH Clinical Center ; Project manager for BTRIS (Biomedical Translational Research Information System), a Clinical Research Data Repository Gaby Jewell US Senior strategist at Cerner Corp,

Page 5 Participants- Meetg of p2 Name Country Yes Notes David Rowed AU MD. Family GP.; Was chair, 2005, Electronic Communications Working Group of the AU General Practice Computing Group Charlie Bishop UK Walter Suarez US Peter Hendler US Ray Simkus CA Serafina Versaggi USClinical Systems Consultant Luigi Sison US Information Architect at LOINC and at HL7. Enterprise Data Architect at VA. Developing standard for Detailed Clinical Models (DCM), information models for Electronic Health Record (EHR) Diabetes Project, etc. Brett Esler AUPen Computer Sys Catherine Hoang USVA Hugh Leslie AU a General Practitioner ; Chief Medical Officer, Ocean Informatics Seam Heard Thomson Kuhn US Sr. Systems Architect at American College of Physicians Carolyn Silzle USYes American Dietetic Association Denise ? Russell Leftwich US Md, Allergist, internal medicine; Chief Medical Informatics Officer, Office of eHealth Initiatives, State of Tennessee Jane BrokelUS PhD, RN, NANDA International; University of Iowa, Iowa City, IA & Trinity Health Corinne Gower NZ Senior Business Analyst at NZHIS; Senior Advisor at Ministry of Health New Zealand Yu-Ting Taiwan

Page 6 Feedback from WGM 15 participants in Care Plan session Key points on Care Plan  Good feedback on perinatology  Key points: add more meat on info exchanged and care coordination  Target for next WGM in January o Complete and validate 4 SB o First set of use cases and information model  Validation of SB o We will request through our meetings volunteers from multiple countries o We will place requests on the meeting invitations posted to the Patient Care list  Should we have a distinctive primary care SB? (David) o Primary care is included in many of the above, if not all o AU needs that explicitly o To be reassessed o Name it ‘Adult primary care’? Laura  Based on what she was able to see, DAMs are very loosely defined across HL7  Our approach is ok

Page 7 HOME CARE CARE PLAN STORYBOARD

Page 8 Home Care CP SB See new format  Simplify  OK for adding IDs and brief description of the information exchanged  Add a rehab encounter in parallel to home care encounter  Add instructions at the beginning on what we expect from the reviewer From WGM  Luigi: we need more details in the SB to facilitate modeling of the info and the care plan: agreed o Luigi will show the work done at the diabetes project at our next meeting  Stephen: we need to make explicit the care coordination steps and data: agreed

Page 9 PERINATOLOGY STORYBOARD

Page 10 Perinatology Deferred to the next meeting Content will be adjusted based on today’s discussion on the Home Care SB.

Page 11 PLAN FOR STORYBOARD VALIDATION These slides are from the WGM meeting

Page 12 Storyboard (SB) Validation & Approval Clarify the guidelines and quality criteria for the Care Plan Storyboard – see next slide Assign a Care Plan ‘owner’ for each SB For each SB, identify a validation group (3 to 5) of SMEs that include  At least one physician, one nurse, and one other type of clinician that is described in the SB  Representation from at least 2 countries  Where possible and relevant, include a care coordinator/manager Recruit SMEs and obtain agreement to participate Communicate the criteria and the specific SB to the appropriate group of SMEs Obtain individual feedback from the SMEs Consolidate feedback from individual SMEs and update the SB Review the updated SB with the SMEs at a regular meeting Finalize and ‘publish’ the SB

Page 13 Care Plan Storyboard Guidelines and Quality Criteria Focused on one typical story, not on exceptions Is written in common clinical term, not in technical or IT terms Focused on the exchange of information about care plan  Distinguish clearly Care Plan information from medical record / EHR data and other non care plan specific data (e.g. patient profile, referral request) Identifies what should be a best practice in the exchange of clinical information Is at the conceptual level  Is architecture, implementation and platform independent Notes:  Do we need to make explicit the state transitions at this stage?  We will need to clarify the criteria for what is being sent in the information exchange, especially for patients with a long history  We will exclude application services related to care plan information exchange Who are the HL7 SB SMEs? MnM, Lloyd, Graham

Page 14 CONCLUSION

Page 15 Concluding notes Issue of Patient Care coordination (lack of)