I’m curious to understand more about the extent of care planning implementation experience in the wild. If anyone is willing to provide some insights into their approach to developing and managing care plans it would be appreciated.
Ping @heath.frankel/@Seref from Ocean, @joostholslag from NEDAP.
Others?.. there must be many other implementations - ranging from simple to very complex; stand-alone to integrated/shared.
In particular, I’d like to get some insight if the current archetypes are supporting this work appropriately. There have been no requests that I’m aware of, from vendors seeking archetypes to support care planning.
The earliest iteration of the COMPOSITION.care_plan contains a proposed structure which gives insight into how I envisaged that a care plan might be constructed - as a single persistent list containing goals/targets and a collection of INSTRUCTION/ACTION pairs. The latest iteration has had that content removed as result of an Editorial decision to remove any constraints in templates as design guidance, but the intended build of a SECTION representing this content has not quite eventuated as planned.
This recent thread with @joostholslag proposes a slightly different approach.
If you look at CKM, the INSTRUCTION/ACTION duo is one of the least mature areas of our modelling - only a handful of each.
The INSTRUCTION.service_request can be very flexible for many situations by using a value set within the ‘Service name’ data element.
There are very few ACTIONs developed to date, mainly because there has been no request for them. However, a single, matching generic ACTION is unlikely to adequately record the data elements or the pathway required for most of the values within that ‘Service name’ value set. We have a generic ACTION.service but in truth, I’m not sure it has ever been used in an implementation, presumably because it is too generic - the attempt for ‘one size fits all’ results in ‘one size fits none’!
I’ve always anticipated that we would eventually have to develop a rather large number of ACTIONs, potentially one for each possible Service that can be requested, ensuring that the data elements and pathway steps are accurate and appropriate for the service. Despite their apparent elegant simplicity and clever approach to recording the progress/activities related to each INSTRUCTION, they are by far the hardest to design & model. Frankly, we have little experience in building them and care planning is the perfect environment in which to sharpen our modelling skillset and support smart care planning implementations.
Personally, I’d also like to see more cross-pollination between the openEHR programs, and the different types of members. Consider things like:
- Developing a library of case studies about how care plans have been implemented
- Developing guidance for ‘best practice’, or even a range of options, for care plan implementation.
- Developing issues and pitfalls to avoid
- Developing a collaborative effort to develop and fund the archetypes required to support this work
- Publishing a governed package or release set of archetypes, shareable templates, other supporting technical artefacts and implementation guidance for newbies