So many points here to tease out and discuss although I expect that we may be more aligned than it seems at first glance.
Another point is that we need to prioritise the display of a care plan that is relevant to the clinical role of the viewer, and the patient. In fact, we need to be able to provide a variety of views, hence my idea of the sub-plans - so that the endocrine physician can see the Diabetes plan relevant to them, and the Diabetes nurse can see the relevant items for them. The GP can see both and the tasks related to their practice.d
In the community space in AU there is an increasing role for a care coordinator who actively manages the care plans and assigns tasks to members of the appropriate care team. So there are times when all care plan items need to be viewed as a whole, but others where only a specific subset should be viewed and actioned, based on their role in the community or hospital care team. So, for this model to be successful, there needs to be a coordinator - if not the patient, then someone appointed. It still won’t be perfect but aiming to avoid duplication and ensure tasks are ticked off using the patient time and provider resources as efficiently as possible.
So I’m prioritising some different things, assuming slightly different work processes etc, and I’m pushing back gently again, even if only to play devil’s advocate a little - you still need to decide what works within your environment .
If a sub-plan for UTI is completed, then the ACTION should be recorded as complete and the completed items removed from the active care plan - both doc and nurse need to be informed of this, and there needs to be a protocol about who records it as complete and in what timeframe to ensure the plan is up-to-date.
In an ideal, fully integrated world I think it is desirable to be able to make a single care plan available for viewing, where every item is potentially viewable. In lieu of that nirvana, we should strive to achieve as much transparency for all the tasks required for this patient as we can in the environment we have control over. Whether the underlying structure is a single COMPOSITION or a view comprised of multiple data sources, is up to the implementer. However, that master (monster?) care plan also needs to be filtered, sliced & dices in many ways so that it can be a useful tool within clinical practice. The design should be as flexible as possible, that’s why I’d rather speak in terms of filtered views (subsets) presented to the end user rather than fixed folders etc - then it can grow and evolve via querys or filters as clinical practice changes, new roles are added, etc etc rather than changing/evolving the storage mechanism with new queries etc.
I don’t really think in terms of a sub-plan as obsolete. It is completed, suspended or aborted etc in ACTION pathway terms. I’m not sure that this should be a COMPOSITION attribute.
If you want to query care plans, then you definitely need to first define if it is active or not, and ensure that this is prominently displayed. Again, a master/monster list will need clever querying on currency/clinician role/ tasks due within the next x wks etc to display the relevant items for the clinician role/location etc.
It is the most complex of complex EHR tasks that we’re discussing here!
It is almost certainly impossible to come to conclusions about care plans on a thread like this - needs more like a week-long F2F workshop