My Care GuideiOS app for person-centered care planning
My Care Guide is a unique mobile app for iPhone and iPad that puts you at the center of coordinating your health care planning. Within our current healthcare environment these care plans are usually created by doctors and other health practitioners when we are their “patients”. However, we are not always patients. And when we are patients being treated for acute or chronic health conditions, care plans created for our treatment should be an integral part of our personal health journey. A person-centered care plan adopts this broader, long-term view for wellness that is guided by your personal team of doctors, therapists, family caregivers, and supportive friends.
A care plan addresses specific health problems or concerns, defines measurable goals, and includes interventions, medications or other activities that you should perform or are performed by members of your care team. You may contribute activity data (weight, blood pressure, blood glucose, pain score, etc.) that helps your care team evaluate progress, or lack of progress, toward your goals. All aspects of shared care plans are available on your iPhone or iPad, and changes to the care plans are updated in real-time from your care team’s health record system. My Care Guide is based on three complementary technologies that are uniquely suited for putting the person at the center of wellness and care planning: HL7 FHIR®© standard for EHR interoperability, CDS Hooks for providing real-time guidance on your progress, and the Apple CareKit™ and HealthKit™ frameworks for tracking and completing your care plan tasks.
Benefits for you and your care team
My Care Guide enables you to create and share personalized goals and activity plans, and receive guidance for wellness and health care that put you at the center supported by your care team. My Care Guide also enables your health care team members to share their care plans with you, all in the palm of your hand on your iPhone!
My Care Guide improves care and care planning with the following capabilities:
- Share care plans and progress assessments using the HL7 FHIR®© standard
- Collect and share Patient Reported Outcomes (PRO), including:
- Health-related quality of life (including functional status)
- Symptoms and symptom burden (e.g. pain, fatigue)
- Health behaviors (e.g., smoking, diet, exercise)
- Collect and share health data from your wearable and connected devices that are focused on your goals and care plans
- e.g. your care activities include measuring blood pressure if you have hypertension, or blood glucose if you are diabetic
- Receive guidance that helps you achieve your goals
- Progress assessments on your goals (e.g. weight loss, blood pressure, blood glucose, etc.)
- Care plan activity tips, suggestions, warnings, reminders, etc.
- We will build an an ecosystem of partner organizations that provide condition-specific guidance, integrated into My Care Guide using the CDS Hooks standard.
My Care Guide app components
Five primary functions of My Care Guide are organized into the five toolbar tabs in the iOS app interface. These features are interrelated and their integrated capability enables you to more effectively coordinate care planning with your extended care team, and receive personalized guidance that helps you to achieve your goals.
- My Health – Overview of your current medications, allergies, and assessments.
- My Guide – Suggestions and actionable recommendations from one or more Clinical Decision Support (CDS) services.
- Care Plans – Detailed content from your care plan(s) including health concerns addressed, goals created by you and your care team to address those concerns, and planned activities for reaching the goals.
- Today – From your care plan(s), current scheduled activities for you to perform including medications, procedures, appointments, and outcome assessments. The care activities are integrated with, and presented using, the Apple CareKit™ and HealthKit frameworks.
- Care Teams – List of your care team members and how to contact them, including doctors, therapists, family members – whomever you choose to include or are included as part of your healthcare provider team(s). Care teams are represented using the HL7 FHIR standard, and presented via the Apple CareKit™ app views.
Meghan is a fictitious person, but with a story that is intended to describe a realistic journey for a person using My Care Guide app to manage multiple chronic health conditions. Meghan’s persona and her journey with complications during her pregnancy were developed by the Veterans Health Administration (VHA) Human Factors Engineering (HFE) team and published on their User Experience Guide web site. See their web site for additional guidance on User Centered Design, plus a detailed description of Meghan’s persona and journey (and 3 additional personas representing other Veteran stereotypes).
Meghan is 35 years old and a post-9/11 Veteran who served in Afghanistan and is recovering from a Traumatic Brain Injury (TBI) and PTSD. Meghan recently became pregnant with her third child and is coordinating care plans between her primary care provider at VA and a community provider outside of VA for her maternity care. Meghan has concerns about possible negative effects of her PTSD anti-anxiety medication on her new baby.
You will learn more about Meghan’s journey with person-centered care and the challenges that she must manage after suffering a TBI-relarted seizure during her pregnancy. For now, we’ll use Meghan’s story to introduce the features of My Care Guide. Our app is still under development and not yet available on the Apple App Store, but we are actively seeking collaboration with healthcare providers or other organizations that share our vision for a mobile app that empowers Meghan and others like her to realize the benefits of improved person-centered care. Contact Dave Carlson for more information about how to join Meghan’s journey with My Care Guide.
My Care Guide for managing chronic conditions
Care plans for chronic conditions are usually created and managed by a person’s primary care provider, often in collaboration with other members of the care team that depend on which condition(s) are present. There are many examples where person-centered care would be beneficial, especially when multiple conditions are present, such as hypertension, diabetes, obesity, arthritis, Chronic Obstructive Pulmonary Disease (COPD), etc.
Meghan’s primary care plan addresses her depression, anxiety, PTSD, TBI with seizures, headaches, lower back pain, weight management, and her recent pregnancy.
My Care Guide for Veterans
We have a particular commitment for supporting and improving person-centered care for Veterans. Providing seamless care for a Veteran is especially challenging because it often requires several healthcare providers to coordinate care for multiple chronic health conditions, and includes care team members from both within and outside of the VA healthcare system. See My Care Guide for Veterans for a more detailed description and Veteran-specific care plan scenarios, including Meghan’s Journey.
All of Meghan’s care planning data are represented using the HL7 FHIR standard and stored on a cloud server that is protected using OAuth2 security. Where applicable, the FHIR data are mapped to Apple CareKit for display. Click on the app screen image to open a slideshow viewer with more screens, or play a short video with narrative describing how Meghan would use this app. Both will be updated periodically as Meghan’s care plans are expanded to demonstrate person-centered care coordination.