Dynamic Care Planning Meetings

This Profile team meets on Mondays 10-11:00 EST Please navigate to https://himss.webex.com for call in information.

Profile Supporting documents are here [1]

Monday November 30, 2015

Attendees:

• Anne Diamond
• Lisa Nelson
• Emma Jones
• Keith Boone
• Amit Popat
• George cole
• Denise Downing
• Elena Vio
• Gunther Meyer
• Did I miss someone?

Goal for Today's call 1. Need to determine the Use cases we will need 2. Discuss concerns with scope and infrastructure and what we were thinking about profiling in terms of CCS Capabilities

• Use Cases
  • Decided we should do two - transition of care and chronic disease management (Chronic disease management - can be useful in Canada)
  • To assist with marketing suggestion made to ensure we include support of MU CCDS
  • Recommendation made to not be specific with use of 'Post-acute' - need to keep it high level and more generalized. Post-acute means different things to different folks
  • Suggestion to flush out the use case before we work on the transactions and actors

• Scope and infrastructure
  • Reviewed the CCS capabilities we may need to support
  • Discussion about the scope of what we will profile - the CCS capabilities- this will be the actors and transactions.
  • Suggestion made to focus on care Plan management capabilities primarily
  • Discussion about combination of subscribing and publishing - can be logically and virtual
  • Discussion about not needing to do anything special to have a transaction that is to 'create the plan'. Let that be a pre-condition, one or more care plan exists and this is the process to get those plans aligned and centralized

• George presented the 'Back of the napkin' idea
  • Actor A provides content, actor B pulls data out of the care plan
  • Certain set of FHIR operations - can get multiple FHIR servers to synchronize their activities. There is a subscription resource in FHIR that can set up queries to query- resource describing a query
  • Discussion about resolving patient identity. Community EMPI, PDQ - use of PQm
  • First approach is to do a handshake about what patient we're talking about - we would have to profile this -
    • First we have to know the identity - an agreed upon identity Or Use chaining - care plan associated with patient.
  • Lisa presented her 'Star' idea
    • Federated - Use a network of some sort. Community exchange will handle the staring. Lisa's Star.

Call ended. Next meeting Monday Dec 7th

Monday Dec 7, 2015

Attendees

• Lisa Nelson
• George Cole
• Emma Jones

8 Keith Boone

Lisa suggests adding this use case [2]as one of the purple boxes to the diagram Keith emailed http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29+References#eLTSS

Discussion about Actor transaction with updator as an actor.

Various actions:

• Contribute
• Read
• Read various pieces and put in the reconcile view - the updator

• • Content updater is a combination of content creator and content consumer.

• • Content updator actor came into existence with ITI - XWD profile.

Discussion around the relationship to CP 211 Keith Question: For dynamic care planning, what are the systems trying to accomplish for their users?

CRUD - Create Read Update Delete

What are the different systems doing?

Discovery services is needed.

Main question - how do I find content for a patient?

• • Talk to the patient - this is just one way
  • Another case is when patients show up in care settings where the patients have never been seen before

Need a way to figure out who the care team is and how to get information from them.

Flesh out the Use Cases - here's a patient who doesn't have all the information and how to get the information Then from there, what do you ?

1. Connecting with a patient dynamic care plan 2. Content of the care plan - what meds they are on, problems, social history, etc.

Need to clarify the use case because this does not seem much different from QED Need to understand how this is different from other work that have been done?

• • How to fix the new thing.
  • Need a scenario and talk thru what's actually happening and how this dynamic care planning will help. How is this different from xds and QED

Action Item: Summarize existing story boards.