My Care Guide ios app Dave Carlson, Ph.D. dcarlson@clinicalcloud.solutions Clinical Cloud Solutions, LLC Dec 6, 2017 http://clinicalcloud.solutions/my-care-guide/ FHIR & flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
My Care Guide app components My Health Overview of your current medications, allergies, and assessments (FHIR) My Guide Suggestions and actionable recommendations from one or more Clinical Decision Support (CDS) services via CDS Hooks Care Plans Detailed content from your FHIR care plan(s) including health concerns addressed, goals, and planned activities. Today From your care plan(s), current scheduled activities for you to perform. The care activities are integrated with Apple CareKit and HealthKit frameworks. Care Team List of your care team members and how to contact them. Care teams are represented using the HL7 FHIR standard, and presented via the Apple CareKit app views. 2
User Centered Design VHA Human Factors Engineering (HFE) has developed a suite of personas intended to aid in the development of usable and useful HIT that supports seamless care for Veterans. https://veteransaffairsuxguide.com Meghan s persona (post 9/11 female Veteran) Health Issues Depression, anxiety & PTSD TBI with seizures Headaches Lower back/extremities pain Weight management Pregnancy Meghan s HIT Needs Make it easy for me to send my provider information. Help me with my appointments and don t waste my time. (time management) Coordination with neurology and OB/GYN 12/6/17 Copyright 2017 Clinical Cloud Solutions, LLC. All rights reserved. 3
12/6/17 VHA Human Factors Engineering (HFE) Veteran Personas 4
HL7 FHIR for Care Planning FHIR v3.0, SMART on FHIR app Built on the excellent open source Swift-SMART framework for ios OAuth2 & SMART launch framework Complete FHIR v3.0 model support Developing additional ios Swift frameworks for open source release CDS Hooks client in Swift for ios FHIR care plan view controllers Mapping between FHIR & Apple CareKit All patient and care plan data are read from a FHIR v3 server 5
Person Centered Care Planning Care Plans app tab Display one or more care plans from FHIR server(s) Consolidated within app for combined view of activities Summary All Conditions & Goals Care Plan Detail Health issues addressed by selected plan Goals for this plan Plan activities (interventions) References to FHIR requests In-line activities Includes tasks assigned to Patient (Meghan) 6
clinfhir Resource Graph for Meghan 12/6/17 Copyright 2017 Clinical Cloud Solutions, LLC. All rights reserved. 7
HL7 FHIR + Apple CareKit Today app tab FHIR care plan activities are mapped to CareKit activities, displayed using CareKit views Values entered into CareKit are also shared with Apple HealthKit, and possibly with other apps Assessments entered into CareKit are written back to EHR as new FHIR Observations Using appropriate LOINC codes Observations are then available for evaluation via CDS Hook services, advice shown in app My Guide app tab 8
CDS Hooks client in ios Swift Invoke a CDS Hooks Service that guides the app user toward fulfillment of a Care Plan's goals, or suggests additional activities based on clinical practice guidelines. Evaluate progress toward care plan goals Invoke 'patient-view' hook on all configured CDS services Query and analyze relevant Observations related to a Goal target measure (e.g. blood glucose, weight, etc.) Notify care team members when insufficient progress Recommend additions to care plan activities CDS service uses FHIR PlanDefinition protocols for preventive care or chronic condition management Returns CDS Hook suggestion cards 12/6/17 Copyright 2017 Clinical Cloud Solutions, LLC. All rights reserved. 9
CDS Hooks client in ios Swift My Guide app tab CDS patient-view hook returns cards to app, displayed in My Guide view Information card (shown here) Suggestion card App link card Person/patient centered CDS guidance is work-in-progress Using FHIR PlanDefinition and CQL logic Suggestion cards for care plan activity updates Using https://github.com/dbcg/cqf-ruler Preventive care practice guidelines Australian guidelines for preventive activities in general practice (Red Book), 9 th edition https://oridashiquickhooksstu3.azurewebsites.net/ cds/cds-services 10
Meghan s Care Team Care Team app tab FHIR CareTeam resource(s) Query FHIR server references from CarePlan resources Consolidated within app for combined view of members from several care plans/teams FHIR resources mapped to Apple CareKit care teams Displayed using CareKit UI views 11
My Care Guide app video demo Updated videos available here: http://clinicalcloud.solutions/my-care-guide/ 12
Team Care Guide app for Care Providers Care Provider users Share care plans among all participants in a Care Team Review care plans for all patients they support Apple CareKit/HealthKit is applicable only to Patient users Eliminate Today tab, used by patients for plan activities All other app capabilities are designed using FHIR resources and services 13
Join the HL7 Connectathon! HL7 FHIR Care Plan connectathon track, Jan 2018 in New Orleans http://wiki.hl7.org/index.php?title=201801_care_plan Meghan s care plan FHIR resources are available for testing https://github.com/clinical-cloud/sample-data FHIR PlanDefinition, ActivityDefinition & CQL Care protocols defined using PlanDefinition, create CarePlan for a Patient PlanDefinition + CQL = CDS Hook services Integrate CDS for care planning via cds-hooks service Evaluate progress toward care plan goals Query and analyze Observations related to Goal target measure E.g. blood glucose, weight, etc. Suggest new or modified care plan activities 12/6/17 Copyright 2017 Clinical Cloud Solutions, LLC. All rights reserved. 14