Stream: implementers
Topic: CarePlan Modelling
ravi.kuchi (Nov 10 2016 at 12:48):
Hi , I have a question on CarePlan resource, we are planning to build a care plan management product in our EHR, the following is how we are trying to model this:
a) We first build a library of careplans that contain the condition that each of them addresses along with the set of activities that are prescribed to bring the condition under control and also meet the goals that are defined to address the condition.
b) Each of the care plans defined at the library level are carefully devised so that each meet a specific purpose and one does not eclipse or mimic another careplan.
c) Now, when a patient is diagnosed with a specific condition/conditions, a care plan for each of the condition is derived from the library we have built in above steps. So a patient may endup with one or more careplans derived from the library. Each of the derived careplan has a reference to the library careplan and this will enable us to support analytics.
d) An individual care plan is a mirror image of the library careplan with the activities curtailed to the individual/patient specific condition. The goals may also be modified to suit the patient's condition.
e) Now if we have a situation where we need to have an activity for a patient which is not defined in library, we first add the activity to the library and then derive the individual plan.
f) We also have a use case wherein as part of the careplan the condition is monitored via the Labs/procedures (actionResulting) and that keep the goal in check
Please let us know if you see any flaw/issues with this model and also any suggestions comments are welcome.
Bryn Rhodes (Nov 10 2016 at 15:47):
The CarePlan resource supports modeling a specific care plan for a particular patient or group, and it sounds like what you're trying to define here is a definition of a CarePlan. The PlanDefinition resource is intended to support that use case, so the library of careplans you are referring to would be a set of PlanDefinition resources, and applying one of those to a particular patient would then produce a CarePlan.
Abbie Watson (Nov 14 2016 at 19:08):
Yup, that's basically how we implemented it.
ravi.kuchi (Nov 16 2016 at 02:23):
Hi,
Ok, so Plandefinition for the definition and CarePlan for the individual looks
apt. We have one more usecase where we want to group the set of clinics that
provide/participate in the careplan.We looked at the group resource but it does
not have location as one of its member. Should we go with an extension for
group to accomodate the location or should we use healthcare service to make
this association but looks like it complicates more than it solves the problem?
Or should the association be made from the Practitioner (Part of CareTeam) via the role in a location(clinic)?
Please advice...
Bryn Rhodes (Nov 16 2016 at 10:44):
It seems like that would always just be inferred based on the practitioners involved. Would it ever be the case that a location could be involved with the CarePlan but no practitioner from that location would be?
Lloyd McKenzie (Nov 16 2016 at 11:15):
You could have a preferred pharmacy or something referenced in a CarePlan but the pharmacy isn't involved in the maintenance of the CarePlan and you wouldn't identify any particular practitioner
ravi.kuchi (Nov 16 2016 at 14:14):
@Bryn Rhodes ,Yes, in a realistic scenario a clinic may have been enrolled in providing a careplan and a user/practitioner is still not assigned. It could also be a case where an existing practitioner may have resigned or left and the clinic is yet to appoint one in his place.
Bryn Rhodes (Nov 16 2016 at 17:06):
I see, in that case I'd suggest an extension for now, maybe accompanied by a tracker request to the CarePlan to support that use case?
Grahame Grieve (Nov 16 2016 at 17:07):
still, it's organization. What happens if the team at the location moves down the road?
ravi.kuchi (Nov 16 2016 at 17:42):
@Grahame Grieve , Hi, so are you suggesting that the grouping of clinics offering a CarePlan can be supported by Organization? In our case, a clinic can support multiple CarePlans which would mean that a location need to refer more than one Organization.
Grahame Grieve (Nov 16 2016 at 18:53):
organizations refer to locations, not vice versa?
ravi.kuchi (Nov 16 2016 at 21:50):
@Grahame Grieve , I do not see any reference to location in Organization Resource, am I missing something here?
Bryn Rhodes (Nov 16 2016 at 21:57):
A Location has a managingOrganization element.
ravi.kuchi (Nov 16 2016 at 22:07):
@Bryn Rhodes , as I mentioned earlier how can a location refer to multiple organizations..
Stefan Lang (Nov 16 2016 at 22:21):
@ravi.kuchi What exactly do you want to express when using a location in that context?
Like, the place where the care plan is applied to the patient? Or rather the responsible organization (might be CareTeam.managingOrganization then)?
ravi.kuchi (Nov 17 2016 at 13:38):
We actually want to show a list of clinics(location) that can support the careplan so when a user is to be assigned a careplan he can select one among the location.
Stefan Lang (Nov 17 2016 at 14:09):
In FHIR terms, the clinics aka locations are Organization resources while Location is rather about the physical place.
As Grahame pointed out, the clinic may move down the road but is still capable of supplying the care plan.
Your use case sounds like an extension to me that would extend PlanDefinition, containing references to Organization resources and having a cardinality of 0..* (maybe 1..*, if you can ensure there is always at least one clinic that is able to provide any PlanDefinition).
From that list, the application will let the user choose, eventually resulting in the chosen organization becoming managingOrganization of the CarePlan's CareTeam.
ravi.kuchi (Nov 17 2016 at 18:00):
The extension sounds good and it would make our design simple, thanks for all your suggestions @Stefan Lang , @Bryn Rhodes & @Grahame Grieve
ravi.kuchi (Nov 18 2016 at 21:57):
Hi, We are trying to use Plandefinition as a library of CarePlans and dervie CarePlan that could be associated to each individual patient. A CarePlan has Goal, Condition and activity , I am trying to map these to PlanDefinition so when a Patient is enrolled we can scope a Careplan from the PlanDefinition. I assume that the activity in CarePlan could be mapped to ActivityDefinition in PlanDefinition. The Condition could be mapped to condition in actiondefinition. I am struggling to map Goals... I looked at requiredBehavior but it is just a code , any ideas or corrections about these thoughts is appreciated. Thanks!
ravi.kuchi (Nov 21 2016 at 17:26):
After going through the PlanDefinition Resource in Comparison with CarePlan, I feel that Goal is something that should have been part of the action definition but is missing, I am planning to log in a request in GForge for that, please let me know if any of alternate opinions?
Bryn Rhodes (Nov 23 2016 at 00:33):
The documentation for the Goal resource indicates it's intended to support description of a Goal with respect to a specific patient, so it might not be the best fit for describing goals on the PlanDefinition. That being said, I think you're right there isn't a good place to express that sort of thing on the PlanDefinition right now. So yes, submit a request to GForge I think, and if you can include a specific example of a Goal you are trying to represent, that would be very helpful. Thank you!
ravi.kuchi (Dec 02 2016 at 16:25):
Hi, The CarePlan has a relatedPlan reference to CarePlan, would it also make sense to include PlanDefinition in the realtedPlan so we can keep track of the PlanDefinitions from which we have derived this CarePlan. I know that there is a reference to PlanDefinition in the activity detail but that seems to be at a lower level in the hierarchy... The usecase here is when we create a CarePlan from a PlanDefinition, the CarePlan would be in the initial phase of plan definition where only few activities may be asscociated with the CarePlan based on the triggerdefinition and condition. As the CarePlan gets updated with it's current activities it will be ready to move on to the next phase where the CarePlan needs to be associated with other set of activities defined in the plandefinition again based on the trigger and condition. So we require a reference to PlanDefinition so whenever an update/event happens we can go back to the plandefinition and perform the next sequence of actions...
Michelle (Moseman) Miller (Dec 02 2016 at 16:30):
CarePlan supports both of the following:
CarePlan.definition -- reference to the PlanDefinition at the CarePlan level
CarePlan.activity.detail.definition -- reference to the PlanDefinition at the activity level
ravi.kuchi (Dec 02 2016 at 16:39):
I am looking at DSTU3 http://hl7.org/fhir/2016Sep/careplan.html, not able to find CarePlan.definition , @Michelle (Moseman) Miller , could you please point me where to find that?
Michelle (Moseman) Miller (Dec 02 2016 at 16:46):
@ravi.kuchi Your link is to the Sept 2016 ballot version. The current build is what I was looking at (which will feed into STU3 publication in March 2017): http://build.fhir.org/
ravi.kuchi (Dec 02 2016 at 17:17):
Thanks @Michelle (Moseman) Miller
Last updated: Apr 12 2022 at 19:14 UTC
