The HL7 FHIR® standard provides a unique opportunity to improve our capability for creating and exchanging patient care plans that enhance the coordination between stakeholders involved in patient care. Examples of care planning stakeholders include:

  • the patient
  • the patient’s caregivers, including family members
  • the patient’s primary care provider
  • specialist providers
  • home health care team
  • case managers from both providers and payers

I organized and led a Care Plan track at the HL7 FHIR Connectathon, held in San Antonio, Texas in January 2017. This track was intended to advance the maturity of FHIR resources for care planning (CarePlan, CareTeam, Goal, Condition, and others) and to document industry best practices for improving care coordination using shared care plans. HL7 FHIR Connectathons are very popular events held prior to each HL7 working group meeting, three times per year. Connectathon participants (about 200 at recent events) include large healthcare vendors (e.g. Allscripts, Cerner, and Epic) and many developers interested in learning to use the FHIR standard or to test servers and applications developed by their organizations.

I worked with several members of the HL7 Patient Care working group to write a storyboard scenario for a patient diagnosed with Type II Diabetes Mellitus that would be used by connectathon participants to test and discuss use of the FHIR CarePlan standard. This scenario is used to illustrate treatment of a chronic health condition and required communication flow and documentation of care plans between a patient, his or her primary care provider, specialist providers, and home health care teams involved in the diagnosis and treatment. This simplified storyboard consists of four encounters, although in reality there could be many more:

  • Primary Care Physician, initial visit and diagnosis
  • Dietitian referral
  • Podiatrist referral
  • Primary Care follow-up visits

The storyboard document and associated FHIR test data are available on GitHub:

  • A storyboard for the Type II Diabetes Mellitus scenario was prepared to guide Connectathon participants.
  • Test data JSON files for this storyboard are available in a GitHub repository based on FHIR v1.8.0, the Jan 2017 build prepared for this Connectathon. [Update: these sample data were modified for conformance with FHIR Release 3 in April 2017.]
  • Additional guidance and a presentation of connectathon results are available on the HL7 Care Plan track wiki page.