FHIR Chat · CarePlan · implementers

Stream: implementers

Topic: CarePlan

Pascal Pfiffner (Apr 14 2016 at 13:59):

If I have a treatment plan, e.g. what to do when a seizure happens, I might describe this as a CarePlan, right? The seizure hasn't happened yet, so I'm not sure I'd assign a Condition to addresses. What I'm missing is something like a trigger, any ideas? Or should I not be using CarePlan for this?

Aaron Seib (Apr 14 2016 at 14:28):

I think a treatment plan and a Care plan are distinct in that a treatment plan may be one element of a comprehensive care plan. A care plan might have only one treatment plan but that is not suficient to be a careplan as a careplan would have other elements for typical patients. IMHO, a careplan would include the client's other supports including the social\family care giver associated with the client.

Pascal Pfiffner (Apr 14 2016 at 15:37):

I do have a rather extensive care plan. One part of is is how to act when a seizure occurs. I was planning to add the seizure plan as a relatedPlan with an includes code, and now I'm stuck in not knowing whether this is the right way.

Lloyd McKenzie (Apr 14 2016 at 15:54):

CarePlan is specific to a particular patient. If you're wanting to define a generic set of actions to follow regardless of patient or timeframe, that's a Protocol or OrderSet (we may end up merging those two resources). Protocols will definitely support notions like triggers, pre-conditions, relative timing, etc. You can do that with CarePlan as well, but, based on the 80%, it's either handled as text or extensions.

Pascal Pfiffner (Apr 14 2016 at 15:55):

It's a plan to treat a seizure customized to the patient, including medications to give and phone numbers to call.

Lloyd McKenzie (Apr 14 2016 at 16:29):

Then CarePlan is the correct resource and the expectation is that the text of the plan would provide a description of when to invoke the various activities described within the plan. If you want something more computable than that, you'll need to use extensions (or make the case that most existing systems that support care plans can support capturing computable trigger information).

Andrew Ross (May 23 2016 at 18:23):

I have a question that's half about CarePlans and maybe half about Goals. How would you mark that a particular care plan, specifically for oncology, is curative vs. palliative?

Andrew Ross (May 23 2016 at 18:24):

I was thinking of having it reference a "curative" goal, but the Goal documentation doesn't seem to allow for that type of abstract goal

Andrew Ross (May 23 2016 at 18:25):

the allowed values for Goal category are much more general, and the outcomes are much more specific

Andrew Ross (May 23 2016 at 18:29):

perhaps in this case, if that CarePlan were generated from a template resource, it could be part of that template resource's ModuleMetadata

David Hay (May 23 2016 at 18:29):

category (for either) does seem the best fit - and it is a 'example' binding (meaning that the one in the spec is intended to be set by the implementer)

Andrew Ross (May 23 2016 at 18:30):

ah, ok

DLBrown (May 23 2016 at 18:31):

I was going to add the same as David: http://hl7.org/fhir/2016May/careplan-definitions.html#CarePlan.category This allows you to hand off the complexity of what you mean to a vocabulary/ontology.

Andrew Ross (May 23 2016 at 18:33):

Oh, nice. So a "curative" category could be placed on the CarePlan itself. That seems good to me.

Andrew Ross (May 23 2016 at 18:36):

So maybe something like this?

{
  "category": [
    {
      "system": "http://hl7.org/fhir/ValueSet/care-plan-category",
      "code": "395082007",
      "display": "Cancer care plan"
    },
    {
      "system": "http://hl7.org/fhir/ValueSet/v3-ActRelationshipType",
      "code": "CURE",
      "display": "curative indication"
    }
  ]
}

Andrew Ross (May 23 2016 at 18:36):

not sure if "curative indication" is the right code

Andrew Ross (May 23 2016 at 18:37):

what i really want is intent

Erich Schulz (May 24 2016 at 00:41):

@Andrew Ross Care plans have 0..n goals.

Erich Schulz (May 24 2016 at 00:43):

~~and goals have 0..n outcomes~~

Erich Schulz (May 24 2016 at 00:48):

I can see how there could be careplan.categories for "paliative care" and "oncology care plan" if these are developed routinely by different teams

Erich Schulz (May 24 2016 at 00:53):

but if oncology are making chemo/radiation plans that are either 'palliative' or 'curative' (or often a bit of both) then putting that into goal.descriptionseem to be the most accurate place

Erich Schulz (May 24 2016 at 00:53):

"relief of symptoms", "disease free survival" , "cure"

Erich Schulz (May 24 2016 at 00:54):

looking at goal.outcome its actually unsuitable because it is "actual outcome" not "desired outcome"

Erich Schulz (May 24 2016 at 00:54):

its a shame that goal.description isn't a codeableConcept

Lloyd McKenzie (May 24 2016 at 06:32):

Goal.description will be changing to CodeableConcept shortly. The change is approved. Someone just needs to find time to make it so :)

Andrew Ross (May 24 2016 at 13:00):

Ah, awesome! That's perfect.

Andrew Ross (May 24 2016 at 13:02):

@Erich Schulz i think the careplan will always be either curative or palliative, because they're for specific patients, but the template resources which generate the careplan definitely could be both

Andrew Ross (May 24 2016 at 13:03):

but using the goal resource definitely feels more correct / useful

Andrew Ross (May 24 2016 at 14:33):

Is there any plan to make it possible to reference an EpisodeOfCare from a CarePlan? the two resources seem highly related to me.

Viet Nguyen (May 25 2016 at 17:35):

@Andrew Ross - CarePlan does allow for the reference you're wanting:

Viet Nguyen (May 25 2016 at 17:35):

CarePlan.context
Definition - Identifies the context in which this particular CarePlan is defined.

Control 0..1
Type Reference(Encounter | EpisodeOfCare)
Summary true
Comments
Activities conducted as a result of the care plan may well occur as part of other encounters/episodes.

Andrew Ross (May 25 2016 at 17:42):

Ah, good. That will be useful.

Andrew Ross (Jun 02 2016 at 17:32):

are there any plans for MedicationOrder / MedicationAdministration to be able to reference back to the CarePlan they might be part of?

Andrew Ross (Jun 02 2016 at 17:33):

it's not strictly necessary i think, because you could always fetch all of the patient's CarePlans and see if any of them reference the Order/Administration, but the question came up in development and I thought I'd just echo it here

Lloyd McKenzie (Jun 03 2016 at 01:49):

There's a general pattern proposed by the Workflow project for all "request" resources to be able to point back to other requests (higher level requests of the same resource type - e.g. proposals, plans) as well as other resources like ReferralRequest, CarePlan, etc. The list of recommended changes should be coming out next week. The work groups will have a chance to decide whether they want to implement each proposal as core or as an extension or argue that it's not required/appropriate for their resource. (Objective with the latter is to see if there are further issues that the Workflow task force needs to work through.)

Andrew Ross (Jun 03 2016 at 13:21):

Sounds good, thanks.

Andrew Ross (Jun 03 2016 at 13:28):

One other question -- in our system, we have a notion of a CarePlan being "suspended" -- which is a temporary but indefinite delay in administration, and might lead to cancellation but not always. I think we need to be able to access that information in our integrating app. Any suggestions for how to represent this?

Andrew Ross (Jun 03 2016 at 13:28):

CarePlan.status seems like the right place, but it's not one of the allowed codes

Andrew Ross (Jun 03 2016 at 13:29):

we could send an extension I guess

Andrew Ross (Jun 03 2016 at 13:29):

but it's coupled to status; "suspended" should only ever be true if the status is "active"

Lloyd McKenzie (Jun 03 2016 at 13:40):

Certainly submit a change proposal. We've talked about individual activities being suspended, but not the plan as a whole. It seems reasonable now that you mention it low. (And in the mean-time, yes an extension will work.)

Mat Coolidge (Mar 30 2017 at 18:23):

Would it be appropriate to have activities in a careplan for questionnaires a patient should be asked?

Lloyd McKenzie (Mar 30 2017 at 18:58):

Sure. CarePlan.activity.detail.definition lets you reference the Questionnaire

Jayashree Surnar (Jul 31 2017 at 07:09):

hi,
here (http://build.fhir.org/careplan.html)given
CarePlans represent a specific plan instance for a particular patient or group. It is not intended to be used to define generic plans or protocols that are independent of a specific individual or group. CarePlan represents a specific intent, not a general definition. Protocols and order sets are supported through PlanDefinition.
i have gone through the ActivityDefinition,Plandefination,Careplan resources but did't get clear idea how to impl.

any suggesions how to implement careplan( specific plan instance and templates)?

Thank you.

Lloyd McKenzie (Jul 31 2017 at 14:21):

You're going to need to be a bit more specific about your question. What parts of implementation are you struggling with? Have you looked at the examples?

Jayashree Surnar (Aug 02 2017 at 03:53):

lets pick Pneumonia .. we will write orders : Antibiotics, Blood cultures, Oxygen needed to be given.
Then we write in a Document. a patient came to hospital with pneumonia and I will be ordering all these things.
We are more focused on Documentation, not actual orders.
how to do it ?

Lloyd McKenzie (Aug 02 2017 at 04:54):

Can you be a bit more specific about what sort of answer you're looking for?

Stoyan Halkaliev (Sep 05 2017 at 20:01):

Hi,
assuming I want to create a CarePlan with repetitive activity and I want to document the execution of it, what is the right way to do it?

For example, the activity can be "feed the patient 3 times a day", and I want to document when and by whom actually every single of these meals ware given. I see, that the integrated CarePlan activity can reference a Task, but just one. This was my first though - an activity that consist of many single Tasks, but as it is right now, it is not supported (maybe there was a reason for this?)

A possible solution is to have two CarePlans - one with the planned activities (like "feed the patient 3 times a day") and one where those repetitive activities are actually separated (in three activities like activity breakfast, activity for lunch and activity for dinner).

Thank you for your input.

Lloyd McKenzie (Sep 05 2017 at 20:23):

Generally "request" resources don't point to "event" resources. The references are the other way around. An event points to the orders/plans/recommendations it is fulfilling. So you can query for the Procedures that are "basedOn" your CarePlan or, if you want to track at the level of the specific step, your CarePlan would need to point to a ProcedureRequest and you could look for Procedures "basedOn" that.

Michelle (Moseman) Miller (Sep 05 2017 at 22:28):

Note: CarePlan deviates from that pattern currently.
CarePlan.activity.reference (0..1) ProcedureRequest -- often a single "request" that has a timing
CarePlan.activity.outcomeReference (0..*) Procedure -- each "event" occurrence

Lloyd McKenzie (Sep 05 2017 at 22:35):

Ah, yes. Forgot about that. So outcomeReference could work for you

Stoyan Halkaliev (Sep 06 2017 at 10:29):

Great info. Thank you very much Michelle and Lloyd.

Nate Walker (Sep 14 2017 at 23:44):

Hi all, has anyone implemented these fully? Is it possible to add a Questionnaire as one of the activity resources, or would this be best done as a Task? We intend to use it as a plan for patient self-care around a surgery encounter so want patients to fill in pre- and post- operation surveys as part of this plan

Lloyd McKenzie (Sep 15 2017 at 03:08):

The activity would be a ProcedureRequest (soon to be ServiceRequest) that solicits a Questionnaire to be filled out.

Dave Carlson (Sep 19 2017 at 16:54):

Hi @Nate Walker, great question! We had some discussion related to this during the Care Plan track at the connectathon last week. We should work out a complete example of including a ProcedureRequest or a Task as a patient assigned activity within a plan, the result of which should be (in most cases) one or more Observations that can be evaluated by a CDS and used for possible updates to the care plan. The example we discussed at connectathon was an Anxiety Assessment scale presented as a questionnaire that records an Observation with the resulting anxiety score.

Nate Walker (Sep 21 2017 at 22:07):

Thanks @Dave Carlson and @Lloyd McKenzie . I think the plan for us will be to integrate this as part of the PlanDefinition as a Questionnaire, then in the CarePlan it will be an empty QuestionnaireResponse contained within a Task, as it appears that this is more relevantly linked than a ProcedureRequest

Brian Postlethwaite (Sep 25 2017 at 03:03):

I'm reviewing my search parameter implementation and noted that the Scheduled property can be either a timing, period or string.
http://hl7.org/fhir/careplan-definitions.html#CarePlan.activity.detail.scheduled_x_
My implementation covers period fine, (and now covers Timing only on event dates) but a little confused as to the string form. What does that mean? and should it really be DateTime? (as that's what the examples have in them using the FhirString type)

Lloyd McKenzie (Oct 08 2017 at 14:23):

It's intended as a fall-back for when the timing is just captured as a string blob

Brian Postlethwaite (Oct 16 2017 at 03:36):

Maybe a note in the search would be useful to note that when using the string blob, it won't be included in the searching.
(or specifically exclude it from the search expression)

Lloyd McKenzie (Oct 16 2017 at 13:58):

Feel free to submit a change request :)

Last updated: Apr 12 2022 at 19:14 UTC