We are planning on holding the Friday event at the Fall Meetings in Baltimore. We will be using new functionality available through David Hay in his "Conman" tool.
The video provides more information regarding the tool. Please review it prior to attending the event. We will be running the tracks as listed below.
Clinician on FHIR Tracks
Link to tool for Friday Baltimore meeting
Lead: Emma Jones
Use case: Chronic Kidney Disease Use Case,
FHIR Resources: Care Plan and Care Team Workflow
Use Case workflow: Care Plan Create, Review, Update
Care Plan as a whole and individual care plan components need to be reviewed periodically (scheduled and adhoc) to ensure that health concerns, goals, interventions defined for managing patient's conditions are appropriate over time, and that the goals are met and identified health concerns are addressed/resolved adequately.
The current CarePlan resource lacks structure(s) required to support reviews as required.
It is proposed:
FHIR Resources involved: Required = CarePlan, CareTeam, clinicalImpression; for consideration/evaluation = VerificationResult resource
Optional = PlanDefinition, ActivityDefinition
Betsy Johnson has Type 2 DM diagnosed 20 years ago and started to develop chronic kidney disease (CKD) about 10 years ago. Her CKD is managed by a multi-disciplinary nephrology care team which is led by Dr Vince Jones, the Chief Nephrologist. the care team instantiated a CKD care plan to manage Betsy's chronic renal condition.
Betsy's diabetes condition is managed by her Primary Care Physician. Her chronic renal condition is well managed and considered as relatively stable. She is seen by the nephrology care team every 2 monthly. Her CKD care plan is reviewed and intervention activities adjusted in accordance to her clinical assessment results (clinicalImpression)
**Full Use Case - See NDDK Development of an Electronic CKD Care Plan
Supplemental Care Plan Discussion: SDOH (Social Determinates of Health)
Scenario description addendum for SDOH
Assessing Betsy Johnson’s potential barriers to treatment compliance and healthy outcome reveals Betsy’s understanding of nutrition is oriented to diabetes management and not specifically accounting for CKD restrictions and recommendations. Betsy no longer drives and reports that she recently moved, her new location has less public transportation options than her previous location. She is concerned about making it to her medical appointments.
Leads: Laura Heermann and Jim McClay
Use Case: Screenings done during ED visit
FHIR Resources: Questionnaire, Questionnaire Response.
Scope: Entering the data for the answers to the questions contained on the screening tools such as PHQ9, Seatbelt use, Tobacco use, Alcohol use, ....
2017 San Antonio HL7 ECWG Clinon FHIR.docx
Use Case: Peter Test is a 50 yo male office encounter re HTN, CHOL, DM2 for refills metoprolol succ 25mg qd, lisinopril hct 10/12.5 mg qd, metformin 500 mg bid, asa 81 mg qd. 1M/2
Office encounter w PCP. Ideally need insurance formulary interaction at point of care integrated (CDShooks). Ultimately will also need PDMP for narcotics/sedatives/stimulants eg https://apprisshealth.com/solutions/narxcare/
Lead: Stephen Chu, Rob Hausam
Use Case: (Stephen working on the use case/storyboard)
Betsy Johnson Storyboard
History: Betsy Johnson, a 60 yo female patients with medical history of Type 2 diabetes, hypertension, hyperlipidema
On September 28, 2018 she attended a routine follow-up medical appointment at her Primary Care Provider's (Dr John Carlson) clinic
Betsy complained that recently she felt a bit more tired than usual, otherwise, things seemed to be nothing remarkable
Dr Carlson reviewed Betsy's last blood work, which indicated that her eGFR was elevated beyond the normal reference range. A spot urine dipstick test revealed urine protein = 1+. Dr Carlson requested a repeat of eGFR and spot urine albumin-to-creatinine (ACR) ratio test, and told Betsy to return next week for a detailed clinical assessment on Betsy and documented the process and outcome
Betsy recently experiences some mood swings, insomnia, feels anxious that her CKD is getting worse, and becomes lethargic, lacks motivation, starts to gain weight.
Her PCP performs a clinical assessment and determines that she has another episode of mild clinical depression. Dr Carlson discussed the management options with Betsy. Given that she has Type 2 DM, pharmacological management will risk aggravating her DM. Betsy agrees that psychotherapy should be tried first. Dr Carlson refers Betsy to see Ms Jane Mind, a clinical psychologist within the primary health network
National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Guideline
CKD Risk Progression assessment (Source: Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1-150)
FHIR Resources: Clinical Impression, Condition, Observation, diagnostic request, diagnostic reports, RiskAssessment; other related resources: Patient, Practitioner, Encounter
To test clinical fitness-for-purpose of the ClinicalImpression resource. The usecase and scenario are defined so that the instance/contents can be reused in the CarePlan usecase of the Card Coordination track
Several attendees expressed satisfaction with the new tool, ConMan. New attendees were able to begin using the tool (once it was explained that it is not a poorly designed EHR).
There was discussion of the role clinicians play in this exercise, with varying levels of enthusiasm and skepticism. John suggested the tool might make a good “veneer” on FHIR.
Pharmacy noted that the tool helped them identify a terminology issue: SNOMED CT changed the medication model, and the medication form value set broke.
Care Coordination leveraged work done at the connectathon as a baseline and used use cases about security, behavioral health, clinical impression, and social determinants of health to identify gaps.
Emergency care examined modifiable emergency intake questionnaires, to support the case where a health department might need to distribute a new question to hospitals in its geography.