With meeting notes See also updated Perinatology Storyboard

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With meeting notes. See also updated Perinatology Storyboard. Agenda for Sept 28 th meeting

With meeting notes. See also updated Perinatology Storyboard. Agenda for Sept 28 th meeting added. To join the meeting: Please advise André of any errors/omissions. Phone Number: +1 770 -657 -9270 Participant Passcode: 943377 Web. Ex link for WGM- Sept. 15 th: https: //infoway-inforoute. webex. com/infoway-inforoute/j. php? ED=168011242&UID=494535562&RT=NCMx. MQ%3 D%3 D Care Plan (CP) Team Meeting - WGM 90 minutes André Boudreau (a. [email protected] ca) Laura Heermann Langford (Laura. [email protected] org) Stephen Chu (stephen. [email protected] gov. au) 2011 -09 -15, Thursday Q 2 (San Diego) Care Plan wiki: http: //wiki. hl 7. org/index. php? title=Care_Plan_Initiative_project_2011 HL 7 Patient Care Work Group

WGM Care Plan Objectives and Agenda • Objectives § Review our approach to storyboards

WGM Care Plan Objectives and Agenda • Objectives § Review our approach to storyboards § Review one SB: Perinatology § Review our approach to validation of SBs by clinicians • Agenda § § § Roll call and session objectives (Stephen) (5 min. ) Review of approach to structuring SBs (André) (20 min. ) Perinatology SB (Laura) (40 min. ) Plan for clinical validation of all SBs (André) (20 min) Wrap-up (Stephen) (5 min. ) Page 2

Participants- WGM Meetg of 2011 -09 -15 p 1 Name email Country Yes Notes

Participants- WGM Meetg of 2011 -09 -15 p 1 Name email Country Yes Notes André Boudreau a. [email protected] ca CA Yes Co-Lead- Care Plan initiative/HL 7 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. HL 7 EHR WG. Laura Heermann Langford Laura. [email protected] org US Yes Co-Lead- Care Plan initiative/HL 7 Patient Care WG. Intermountain Healthcare. RN Ph. D, : Nursing Informatics; Emergency Informatics Association, American Medical Informatics Association; IHE Stephen Chu stephen. [email protected] gov. au AU Yes NEHTA-National e. Health Transition Authority. RN, MD, Clinical Informatics; Clinical lead and Lead Clinical Information Architecture; co-chair HL 7 Patient care WG; vice-chair HL 7 NZ Peter Mac. Isaac peter. [email protected] com AU HP Enterprise Services. MD; Clinical Informatics Consultant; IHE Australia; Medical Practitioner - General Practice Adel Ghlamallah [email protected] ca CA Canada Health Infoway. SME at Infoway (shared health record); past architect on EMR projects William Goossen [email protected] 4 care. nl NL Results 4 Care B. V. RN, Ph. D; -chair HL 7 Patient Care WG at HL 7; Detailed Clinical Models ISO TC 215 WG 1 and HL 7 ; nursing practicioner Anneke Goossen [email protected] 4 care. nl NL Results 4 Care B. V. RN; Consultant; Co-Chair Technical Committee EHR at HL 7 Netherlands; Member at IMIA NI; Member of the Patient Care Working Group at HL 7 International Ian Townsend ian. [email protected] net UK NHS Connecting for Health Informatics; Senior Interoperability Developer, Data Standards and Products; HL 7 Patient Care Co-Chair Rosemary Kennedy Rosemary. [email protected] edu US Thomas Jefferson University School of Nursing. RN; Informatics; Associate Professor; HL 7 EHR WG; HL 7 Patient care WG; terminology engine for Plan of care; Jay Lyle [email protected] com US JP Systems. Informatics Consultant; Business Consultant & Sr. Project Manager Margaret Dittloff [email protected] com US The CBORD Group, Inc. . RD (Registered Dietitian); Product Manager, Nutrition Service Suite; HL 7 DAM project for diet/nutrition orders; American Dietetic Association Audrey Dickerson [email protected] org 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 Mc. Nicoll Ian. Mc. [email protected] com UK Ocean Informatics. Health informatics specialist; Formal general medical practitioner; Open. EHR; Slovakia Pediatrics EMR; Sweden distributed care approach Danny Probst Daniel. [email protected] org US Intermountain Healthcare. Data Manager Kevin Coonan Kevin. [email protected] com US MD. Emergency medicine. HL 7 Emergency care WG. Gordon Raup [email protected] com US CTO, Datuit LLC (software industry). Susan Campbell [email protected] com US Elayne Ayres [email protected] nih. gov US Gaby Jewell [email protected] com US Yes Ph. D microbiologist. Principal at Care Management Professionals. HL 7 Dynamic Care Plan Co-developer 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 Yes Senior strategist at Cerner Corp, Page 3

Participants- WGM Meetg of 2011 -09 -15 p 2 Name email Country Notes Yes

Participants- WGM Meetg of 2011 -09 -15 p 2 Name email Country Notes Yes MD. Family GP. ; Was chair, 2005, Electronic Communications Working Group of the AU General Practice Computing Group David Rowed [email protected] net. au AU Charlie Bishop charlie. [email protected] com UK Walter Suarez walter. g. [email protected] org US Peter Hendler Peter. [email protected] org US Ray Simkus [email protected] ca CA Serafina Versaggi serafina. [email protected] com US Luigi Sison [email protected] com US Brett Esler brett. [email protected] com. au AU Pen Computer Sys Catherine Hoang catherine. hoang [email protected] gov US VA Hugh Leslie hugh. [email protected] com AU Yes a General Practitioner ; Chief Medical Officer, Ocean Informatics Seam Heard sam. [email protected] com Thomson Kuhn [email protected] org US Yes Sr. Systems Architect at American College of Physicians Carolyn Silzle Carolyn. [email protected] org US ? American Dietetic Association Yes ? US Yes Md, Allergist, internal medicine; Chief Medical Informatics Officer, Office of e. Health Initiatives, State of Tennessee US Yes Ph. D, RN, NANDA International; University of Iowa, Iowa City, IA & Trinity Health Denise Russell Leftwich Russell. [email protected] gov Jane Brokel Clinical Systems Consultant Yes Information Architect at LOINC and at HL 7. Enterprise Data Architect at VA. Developing standard for Detailed Clinical Models (DCM), information models for Electronic Health Record (EHR) Diabetes Project, etc. Corinne Gower [email protected] net. nz NZ Yes Senior Business Analyst at NZHIS; Senior Advisor at Ministry of Health New Zealand Yu-Ting Yeh [email protected] 2000. com. tw TW Yes HL 7 Taiwan Page 4

André APPROACH TO STRUCTURING STORYBOARDS Page 5

André APPROACH TO STRUCTURING STORYBOARDS Page 5

Structure of Care Plan Storyboards • Care plans consist for the most part in

Structure of Care Plan Storyboards • Care plans consist for the most part in an evolving group of information for a given health issue thread (wrongly called ‘episode of care’) • One storyboard describes in ‘business’ terms the flow of care and the associated flow of care plan data through multiple patient encounters among a multidisciplinary team of clinicians for that one health issue thread (see ISO definition, in Appendix 1) (or one stream of condition management) § § Note: an episode of care is provider specific (see HL 7 and ISO definitions in Appendix 1 and 2) Once we agree on terms, we will need to adjust the vocabulary used in our SBs, likely replacing ‘episode of care’ with ‘health issue thread’ Page 6

Portfolio of Storyboards Required • To understand the range of situations where exchange of

Portfolio of Storyboards Required • To understand the range of situations where exchange of care plan information will take place and interoperability will be necessary, the following situations (i. e. episode of care) will be documented: § § § Perinatology (ready for WG review at WGM) Home Care (drafted and ready for another review by WG) Chronic Care (drafted) Pediatric and Allergy/Intolerance (drafted) Stay healthy (drafted) Acute Care • Should we have a distinctive primary care SB? (David) § § Primary care is included in many of the above, if not all AU needs that explicitly To be reassessed Name it ‘Adult primary care’? Page 7

Laura PERINATOLOGY STORYBOARD Page 8

Laura PERINATOLOGY STORYBOARD Page 8

Perinatology • See document by Laura with discussion notes and tracked changes. § Terminology

Perinatology • See document by Laura with discussion notes and tracked changes. § Terminology to be adjusted based on decision as to terms for structure of SBs: done • Luigi: we need more details in the SB to facilitate modeling of the info and the care plan: agreed § 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

André PLAN FOR STORYBOARD VALIDATION Page 10

André PLAN FOR STORYBOARD VALIDATION Page 10

Storyboard (SB) Validation & Approval • Clarify the guidelines and quality criteria for the

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 11

Care Plan Storyboard Guidelines and Quality Criteria • Focused on one typical story, not

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 HL 7 SB SMEs? Mn. M, Lloyd, Graham Page 12

Stephen CONCLUSION • Next Care Plan meeting on Sept. 28, 17 h 00 ET

Stephen CONCLUSION • Next Care Plan meeting on Sept. 28, 17 h 00 ET • See wiki Page 13

Concluding notes • Terms to use § See ISO and HL 7 in Appendix

Concluding notes • Terms to use § See ISO and HL 7 in Appendix § Health Issue Thread (similar to HL 7 Health Concern) o Multiple encounters and multiple providers for one health issue § Encounter o One patient contact with one provider § We will not use Episode of care o Applies to multiple encounters with the same provider for one health issue • Target for next WGM in January § Complete and validate 4 SB § First set of use cases and information model • Validation of SB § We will request through our meetings volunteers from multiple countries § We will place requests on the meeting invitations posted to the Patient Care list Page 14

Agenda for Sept. 28 th • Minutes of August 31 st • Feedback from

Agenda for Sept. 28 th • Minutes of August 31 st • 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 15

APPENDIX 1 – ISO CONCEPT MODEL AND TERMS • NB: These models are currently

APPENDIX 1 – ISO CONCEPT MODEL AND TERMS • NB: These models are currently being reviewed and updated through the ISO CONTSYS project (N 821 - NWIP 13940, a 2 -year project started in 2011) • Project manager: Nicholas Oughtibridge, Acting Director - Data Standards and Products, Department of Health Informatics Directorate, UK NHS Connecting for Health Page 16

Health issues and their management NB: These models and definitions are currently being reviewed

Health issues and their management NB: These models and definitions are currently being reviewed and updated through the ISO CONTSYS project Source: ISO 13940 -1: Health informatics - System of concepts to support continuity of care - Part 1: Basic concepts , pr. EN 13940 -1: 2007, CEN/TC 251 Page 17

Time-related concepts in Continuity of Care NB: These models and definitions are currently being

Time-related concepts in Continuity of Care NB: These models and definitions are currently being reviewed and updated through the ISO CONTSYS project Source: ISO 13940 -1: Health informatics - System of concepts to support continuity of care - Part 1: Basic concepts , pr. EN 13940 -1: 2007, CEN/TC 251 Page 18

Key Definitions from ISO • Health Issue § Issue related to the health of

Key Definitions from ISO • Health Issue § Issue related to the health of a subject of care, as identified or stated by a specific health care party o o NOTE 1 According to this definition, a health issue can correspond to a health problem, a disease, an illness. But it may not, such as when it is simply a request for a procedure (therapeutic or preventive) by the subject of care or another health care party etc. Therefore, health issue is a superordinate concept to "health problem", "disease", "illness" etc. NOTE 2 A health issue is given a label, which may be a diagnosis, a problem or another topic. • Health issue thread § Defined association between health issues, as decided by one or several health care parties o NOTE 1 A health issue thread reconciles a range of health issues reflecting the variety of scopes of health care parties, particularly of health care providers. A health issue thread inherently associates the contact elements referring to those health issues. • Episode of care § Time interval during which health care activities are performed by one health care provider to address one professionally defined health issue o Note: An episode of care starts with the very first contact with a health care provider for a health issue, and it ends after the completion of all health care activities related to the latest contact with that health care provider for the same health issue. • Cumulative episode of care § Collection of episodes of care delineated by one health issue thread o Note: A cumulative episode of care starts with the very first contact with a health care provider for a health issue considered in a health issue thread, and ends after the completion of all health care activities related to the latest contact with any health care provider for a health issue encompassed in the same health issue thread. • Encounter (patient contact) § Contact in the course of which health care activities are delivered to a subject of care in her or his presence Source: ISO 13940 -1: Health informatics - System of concepts to support continuity of care - Part 1: Basic concepts , pr. EN 13940 -1: 2007, CEN/TC 251 Page 19

APPENDIX 2 - HL 7 KEY TERMS • This needs to be augmented for

APPENDIX 2 - HL 7 KEY TERMS • This needs to be augmented for our Care Plan needs • See ISO Page 20

Term: Patient encounter • Patient encounter is defined as an interaction between a patient

Term: Patient encounter • Patient encounter is defined as an interaction between a patient and one or more healthcare practitioners for the purpose of providing patient services or assessing the health status of the patient. A patient encounter is further characterized by the setting in which it takes place; currently HL 7 recognizes seven unique patient encounter types: § § § § Ambulatory Encounter - A comprehensive term for health care provided in a facility or setting that provides diagnostic, therapeutic and health maintenance services for persons not requiring stays that exceed 24 hours (e. g. a practitioner's office, clinic setting, or hospital) on a nonresident and non-emergency basis. The term ambulatory implies that the patient has come to the location and is not assigned to a bed. Sometimes referred to as an outpatient encounter. Emergency Encounter - A patient encounter that takes place at a dedicated healthcare service delivery location where the patient receives immediate evaluation and treatment, provided until the patient can be discharged or responsibility for the patient's care is transferred elsewhere (for example, the patient could be admitted as an inpatient or transferred to another facility. ) Field Encounter - A patient encounter that takes place both outside a dedicated service delivery location and outside a patient's residence. Example locations might include an accident site or at a supermarket. Home Health Encounter - A patient encounter where services are provided or supervised by a practitioner at the patient's residence. Services may include recurring visits for chronic or terminal conditions or visits facilitating recuperation. Inpatient Encounter - A patient encounter where a patient is admitted by a hospital or equivalent facility, assigned to a location where patients generally stay at least overnight and provided with room, board, and continuous nursing service. Short Stay Encounter - A patient encounter where the patient is admitted to a health care facility for a predetermined length of time, usually less than 24 hours. Virtual Encounter - A patient encounter where the patient and the practitioner are not in the same physical location. Examples include telephone conference, email exchange, robotic surgery, and televideo conference. Source: HL 7 Version 3 Standard: Patient Administration Release 2; Patient Encounter, Release 1 DSTU Ballot 1 - May 2011 Page 21

Term: Encounter • Encounter § § § An Encounter (ENC) choice is an interaction

Term: Encounter • Encounter § § § An Encounter (ENC) choice is an interaction between a patient and care provider(s) for the purpose of providing healthcare-related service(s). Healthcare-related services include health assessment. Note this type of statement covers admissions, discharges and transfers of care, as well as the more usual understanding of a single discrete office visit. It further deals with a plan for regular visits, such as preventive care during pregnancy, or monitoring of chronic ill patients. Includes requesting, proposing, promising, prohibiting or refusing an encounter as well as an actual encounter event. The encounter is a derivative of the RIM Patient. Encounter class, used to represent related encounters, such as follow-up visits or referenced past encounters. § Source: HL 7 Draft Standard for Trial Use - HL 7 Version 3 Standard: Clinical Statement Pattern, Release 1 - Last Published: 12/06/2007 10: 24 AM Page 22

Term: Episode of Care - 1 • An interval of care by a health

Term: Episode of Care - 1 • An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e. g. , emergency, inpatient, outpatient), thus serving as one measure of health care provided. Note: may be one instance of care, a series of episodes or a sequence of care: read Me. SH definition § § http: //www. reference. md/files/D 017/m. D 017050. html Sources: NLM Medical Subject Headings, NIH UMLS, [email protected], FDA AERS • The new Institute of Medicine definition of primary care requires that primary care clinicians address the large majority of personal health care needs of their patients. The unit of assessment for this is the episode of care, defined as a health problem from its first encounter with a health care provider through the completion of the last encounter. § § J Fam Pract. 1996 Feb; 42(2): 161 -9. Episode of care: a core concept in family practice. http: //www. ncbi. nlm. nih. gov/pubmed/8606306 Page 23

Term: Episode of Care - 2 • A defined period of illness that has

Term: Episode of Care - 2 • A defined period of illness that has a definite start and end date. § www. mibcn. com/glossary. E. shtml • Refers to all the health services related to the treatment of a condition. For acute conditions (such as a concussion or a broken bone), the episode includes all treatment and services from the onset of the condition to its resolution. . § www. uhc. com/united_for_reform_resource_center/health_refor… • the range of treatments provided over time for treating a condition or illness § www. stonybrookmedicalcenter. org/patientcare/healtheducation/ • Treatment rendered in a defined time frame for a specific disease. Episodes provide a useful basis for analyzing quality, cost and utilization patterns. § www. mtinformedpatient. org/glossary. html • Page 24

Added on 2011 -08 -17 Term: Episode of Care – Difficulties with the concept

Added on 2011 -08 -17 Term: Episode of Care – Difficulties with the concept • The concept is easy to apply in acute care settings where there is a clear beginning and a clear end to the health issue/problem • However, in chronic care situations, there is no clear end… • The concept of condition management is more applicable to chronic care management • For our chronic care plan, we will document a sample of encounters illustrative of a representative set of interactions among clinicians and the interchange of care plan information between them Page 25